1. Resonant Voice Therapy Protocol
(Joseph Stemple; Kitty Verdolini Marston)

2. in the context of easy phonation
PRINCIPLES OF RESONANCE THERAPY (RT)
voice production involving oral vibratory sensations, usually on the anterior alveolar ridge or higher in the face
 in the context of easy phonation
 where resonant voice is a continuum of oral sensations and easy phonation builds from basic speech gestures through conversational speech

3. PRINCIPLES OF RESONANCE THERAPY (RT) cont.
Training methodologies are experiential, focusing on the processing of sensory information
 The training model assumes similar approaches for voice restoration and enhancing the normal voice (excellence training)

4. Fundamental Characteristics of Resonance Therapy (RT)
The fundamental perceptual target is focused, oral vibratory sensations in the context of easy phonation.
 The singular training focus (resonance) is expected to affect multiple levels of physiology (breathing and laryngeal).
 Large numbers of repetitions are used, in varying speech contexts.
 Training is strongly goal (results) driven,
Insistence upon the greatest possible precision in the achievement of the perceptual tasks.

5. Targeted Populations
Any populations in which intra-vocal fold impact stress should be increased or decreased
- Decreased
edema, nodules, polyps, cysts, granulomas
- Increased
paresis, paralysis, atrophy, bowing, sulcus
Pt must be able and willing to process auditory and kinesthetic information related to voice and speech

6. Basic RVT Training : Stretches & Breathing
Stretches and Breathing Warm-Ups
(3-10 seconds per stretch)
- Shoulders
1. touch elbows in back
2. stretch arms in front
-Neck
1. drop head down slowly in fractions
2. rotate head up until right on top of the neck, feel neck muscles “turn off” when the crown and ball of head are balanced

7. Stretching continued 3. lift head away from the neck
4. cross fiber stretch toward shoulders with fingers
5. tilt ear to shoulder and stretch out opposite arm
- Jaws
1. massage the masseters, pull down and forward
2. push thumbs into masseters with slightly open mouth

8. Stretching cont. 1. press thumb into floor of mouth
2. first make no sound, then produce a vowel with no tongue stiffness
- Lips
1. lip trill
- no voice
- continuous voice
- alternating off/on

9. Stretching cont.
- Tongue 1. tongue trill - no voice - continuous voice - alternating off/on 2. protrude tongue out and down, hands behind back - voiceless breathing - voiced

10. Stretching cont. - Pharynx 1. yawn 2. yawn-sigh with voice
- stretch the pharynx with these maneuvers
- Breathing
1. breathe out all air on /f/; do not breathe in until you must; when you must, simply release the abdomen, it will breathe for you
2. breathe-release-breathe-release-breathe- release with and without voice

11. Basic Training Gesture for RT (This is Step 1 for all stages of RT)
Hmmm-molm-molm-molm-molm…..As a sigh but do not go into fry
Extreme forward focus is required with appropriate breath support
Make the connection from the abdominal muscles to the lips
Patient should feel very relaxed at the end of this gesture

12. RT Hierarchy: Stage 1 “All Voiced”
Chant ‘molm-molm-molm…..’ (sustained pitch) ____ pitch
 - vary the rate only
- discover the vibrations; experiment with broad and narrow vibrations;
- eventually focus on the narrow vibration; “like a narrow beam of light”
- increase the ease of production by reducing the effort by 1/2 and 1/2 again
- increase “lift” (as if pitch were increasing)

13. RT Hierarchy: Stage 1 “All Voiced” cont.
2. molm-molm-molm…..
slow-fast-slow
soft-loud-soft on ____ pitch
  3.  molm-molm-molm….. as speech
- use non-linguistic phrases; vary the rate, pitch, and loudness; make the connection from the abdominal muscles to the lips

14. RT Hierarchy: Stage 1 “All Voiced” cont.
4. Chant the following voiced phrases on the musical note ___ - Mary made me mad. - My mother made marmalade. - My merry mom made marmalade. - My mom may marry Marv. - My merry mom may marry Marv. - Marv made my mother merry. 5. Over-inflect these phrases as speech

15. RT Hierarchy: STAGE 2 “Voice-Voiceless Contrasts”
Basic Training Gesture
1. mamapapa…..vary the rate on ___ note
2. mamapapa…..
slow-fast-slow
soft-loud-soft on ___ note
3. mamapapa….. As speech
  -  use non-linguistic phrases; vary the rate, pitch, and loudness; make the connection from the
abdominal muscles to the lips

16. RT Hierarchy: STAGE 2 “Voice-Voiceless Contrasts” cont.
4. Chant the following voiced/voiceless phrases on the musical note ___ 
Mom may put Paul on the moon.
Mom told Tom to copy my manner.
My manner made Pete and Paul mad.
Mom may move Polly’s movie to ten.
My movie made Tim and Tom sad.
 5. Over-inflect these phrases as speech

17. RT Hierarchy: STAGE 3 “ANY PHRASE”
Basic Training Gesture
Produce the following phrases in sequence as follows:
First, chant the phrase on the note___,
then over-inflect it with extreme forward focus, and
then finally repeat it as natural speech with a forward focus.
Each individual phrase should be produced
following this 3-step sequence before moving on
to the next phrase.

18. RT Hierarchy: STAGE 3 “ANY PHRASE” cont.
- All the girls were laughing. - Get there before they close. - Did you hear what she said? - Come in and close the door. - Are you going tonight? - Put everything away. - Come whenever you can. - We heard that yesterday. - The player broke his leg. - The children went swimming.

19. RT Hierarchy Stage 4 “Paragraph Reading”
read a paragraph with phrase markers
separate each phrase only by the natural inhalation of air
exaggerate focus and then repeat with a more normal speech/voice production
repeat the above without phrase markers

20. RT Hierarchy Stage 5 “Controlled Conversation”
practice forward speech placement in conversation
do not permit glottal attacks, glottal fry, etc.

21. RT Hierarchy Stage 6 “Environmental Manipulations”
simulate actual speaking environments
use tapes of background noise
go to noisy cafeteria

22. RT Hierarchy Stage 7 “Emotional Manipulations”
use materials and topics that increasingly engage and challenge the patient

23. RT Home Exercises
The critical portion of each exercise for each week is tape recorded as a home exercise example. The home program involves minute sessions, two times per day with “minis” during the day as needed
1. Stretches
2. Basic RV gesture
3. Selected level of hierarchy