What do VFE s consist of?
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1 The Use of Vocal Function Exercises as a Treatment Modality in VF Paralysis UCSF VOICE CONFERENCE October 16-18, 2008 Wendy DeLeo LeBorgne, Ph.D. CCC-SLP Voice Pathologist & Singing Voice Specialist wleborgne@dhns.net or Overview of Vocal Function Exercises (VFE s) Briess (1957, 1959); Barnes (1977); Stemple (1980 s) Vocal Function Exercises: a series of systematic voice manipulations, similar in theory to physical therapy for the vocal folds, designed to strengthen and balance the laryngeal musculature, and to improve the efficiency of the relationship among airflow, vocal fold vibration, and resonance RESONANCE PHONATION RESPIRATION What do VFE s consist of? Warm-up Stretch Contraction Isometric Power Exercise (i.e. Static Strength Training) Technique of exercise execution is essential for optimal results 1
2 Benefits of VFE s Provides quantitative change over time Easy to do Enables patient independence Very little time (<10 min 2x/day) Positive task Voice Related Symptoms Hoarseness (dysphonia) Breathiness or weakness (often sounds high pitched) Vocal fatigue (physical fatigue) Limited vocal range Breaking or cracking voice Shortness of breath/stridor (bilateral VF paralysis Treatment Planning Unilateral & Bilateral RLN Paresis & Paralysis Consider positioning Consider stimulability Consider voice demands Consider dysphagia complaints Consider time/nature of injury Consider airway Treatment Options Do nothing Voice Tx Temporary or permanent medialization Improve airway-compromise voice Criteria for VFE Therapy Trial < 1yr onset of VF paralysis No compromising factors Patient motivation Poor surgical candidate 2
3 Case Studies Case Study #1: Pre-Tx 72 y/o Male One month post-op for right carotid Complaint: woke up from surgery with hoarseness; dysphagia on thin liquids Medications: Plavix, Glucophage, Lipitor Max. Airflow: 2170 ml/sec VFE Goal: 2410/80=30.1sec Case Study #2: Pre-Tx AVG. VFE Visit 1: Baseline Case Study #2: VFE s Visit 2: One Week Visit 3: Three weeks* Visit 4: Five Weeks** Visit 5: Seven Weeks*** Warm up 2, 3, 3 4,6,7 5,6,6 13,18 27,23 Stretch F4 A4 A4 A#4 A#4 Contract F#2 F#2 F2 D2 C2 E 2,3,4 6,6 6,6 18, 20 23,26 F 2,4,2 7,8 7,8 24,21 38 G 5,4,3 7,6 6,6 17,21 39 A 4,4,3 9,9 7,6 14,21 32 B 4,4,3 9,9 7,10 18,
4 Case Study #2: Post VFE s Case Study #3 42 y/o male; Electrical Engineer Sudden onset of hoarseness 5 weeks prior to examination associated with a flu-like virus Never had voice problems before Meds: Prilosec for LPR Case Study #3: Sound & Video Pre-Tx Case Study #3: VFE s Visit 1: Baseline AVG. VFE 14.2 Visit 2: One Week* 10.7 Visit 3: Three weeks 17.3 Warm up 14,19 9,8 16,18 20,20 Stretch C3 A3 G#3 D#4 Contract C2 Ab2 G2 Eb2 C 11,12 7,10 18,16 34,32 D 12,12 12,11 14,16 36,37 E 15,14 11,12 18,17 33,31 F 10,12 11,9 16,17 30,27 G 10,12 10,10 17,17 24,22 Visit 4: Five Weeks
5 Case Study #3: Post- VFE s Video & Sound Conclusions Provide non-invasive option for trial period Patient is actively involved in the process Often see positive results Efficacy Studies Roy N, Gray S, Ebert M, Dove H, Corbin-Lewis K, Stemple J (2001) An evaluation of the effects of two treatments for voice disordered teachers: A randomized clinical trial. J Speech, Lang, Hear Res, 44, Sabol J, Lee L, Stemple J (1995) The value of vocal function exercises in the practice regimen of singers. J Voice, 9: Stemple J, Lee L, D Amico B (1994) Efficacy of vocal function exercise as a method of improving voice production. J Voice, 8:
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