I decided to digress a little from my next entry to go into more detail about what my therapy sessions were like per some questions I’ve been receiving. (More on the re-pitching of my voice in the next post...)
The very first session was an intake session, where the therapist took some objective and subjective measures of my voice. She would continue to do this throughout our sessions to track my progress, but at the first session, we spent a little more time and went into more detailed measurements so she could see where my main problems were.
Objective measures are quantitative, i.e. all about the numbers and how they add up. They offer evidence on the health of the voice (especially post-diagnosis) by taking measurements of habitual pitch, mean pitch (or the most common pitch where you speak when saying a phrase), jitter and shimmer levels (where jitter is the measure of fluctuation in frequency and shimmer is the fluctuation of amplitude which relate to asymmetrical vocal fold motion), vocal range, and sometimes loudness in terms of decibel level. At school, we have been using the PRAAT software to take these measurements at our voice screenings. At my therapist’s office, she used individual instrumentation that I’m not currently familiar with to take these measurements. (Another SLP in the area I observed for school actually had a very cool, and very expensive, computer program that allowed her to not only take these measurements, but also to measure the amount of muscular effort being used during phonation, i.e. sustained voice, using some complex algorithms...thanks engineers! She was able to have that software because she worked through a hospital that would pay for it. I suspect the cost of that program makes it not as widely used for SLPs in private practice.) The PRAAT software is free for anyone to download and use to your liking.
The purpose of taking these objective measurements is to compare a person’s voice to the normal levels found in healthy voices and to track their progress in comparison to those norms. However, SLPs who work with professional voices understand that a professional voice user should probably have measurements that exceed the norm, since they need a voice in pristine condition to perform at the high levels they do. My SLP understood that, so whatever measurements fell below norms for me, she assured me she would try to get those measurements well above the norm before ending my sessions. And bless her for that!
Subjective measures are perceptual rankings an SLP makes on the quality of the voice: perceived loudness (rather than actual dB level), hoarseness, breathiness, harshness, resonance, nasality, etc. These measures are intended to help track progress through the use of the SLP’s ear rather than computer programs or equipment. They take these measurements during normal conversation and during the reading of the rainbow passage, because many people converse using their voice a little differently than when they read. (The rainbow passage is a passage of text that contains every sound in the English language, so you can assess their voice and speaking with every sound.) This is also where a voice specialist is very useful, as their ears have more experience assessing voice and are sharper, and every singer knows you want some sharp ears doing the assessment here, just like with your voice teacher.
A typical therapy session for me, after the initial assessment, went something like this: I would be seated near my therapist while she would begin recording the session. (She kept me in a seated position so I wouldn’t go into “singer mode” while doing the therapy exercises.) We would then go through a series of massages for the extrinsic neck musculature, the jaw, the larynx itself, tongue root, etc., ending with some tongue stretches. Then, we would do some belly breathing where I would just let my belly relax out, allow the air to go in without thinking about it or forcing it to do so, and then blow out. We’d do three to five regular belly breaths, and then do the same thing while exhaling on ‘s’ and ‘sh.’ Then, using those belly breaths, we would do some vocal exercises that stayed mostly in my speaking voice range on /a/, /i/, and /u/. These would include onset exercises (much like staccati on one note), glides of a third to a fifth to an octave, and some sustaining exercises going from soft to loud on one note as I progressed further. Each session had a new set of exercises for me to take home and do for the week. Throughout the exercise portion, we would frequently pause to do more massages and belly breaths with the ‘s’ and ‘sh’ exhales before moving on to other exercises. The exercises started out very simple at first and increased with range and difficulty as the sessions progressed.
The therapy session would end with the objective measurements, and I would be sent home with a CD of us doing the exercises to practice with and a copy of my measurements for that week along with notes of what to practice and for how long and how often. (I have not observed many SLPs as of yet who do all of this in their practice. I really aspire to follow her model of being so organized and “with it” when I get to be a practicing SLP.)
One thing my therapist did not do was any fry register work. I did ask her about that and she said that she had not done any training on how to use that technique effectively, so she didn’t use it. She got great results with what she did do, so she did not feel it would add anything to her practice right now, and, as she said, “You get what you practice." So basically, her stance is: Since you don’t want an abundance of vocal fry during daily voice use, why practice it? I have read some intriguing articles regarding the use of fry register in therapy, so I think it is a viable technique when used in the right situation, but I really respect my therapist for not using a technique she was not well trained for nor comfortable with. That is a mark of a good SLP: someone who doesn’t use techniques if they don’t know exactly how to use them and/or if they at all question the validity of those techniques. That goes along with something called evidence-based practice in the field, and it's what separates the true clinicians from the rest.
Thanks for taking this little detour with me. Now on to: Rediscovering What I Had Lost!
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