Pitch Exercises

Pitch exercises are activities utilized in voice therapy to improve vocal pitch levels so that word productions can be articulated more accurately. An individual's perceptual attention is focused on the most important words and ideas of the speech using this method. Using this strategy allows the individual to express different emotions and attitudes through intonation ("Pitch Exercises", 2022). Pitch variations heavily rely on the pitch glide during speech production. A pitch glide occurs when there is a change in tone on a particular syllable within a word. Gliding up indicates a question being asked while gliding down indicates a conclusion to a statement ("Pitch Exercises", 2022).

Who benefits from pitch exercise therapy?

A common disorder manifested in neurodegenerative diseases such as Huntington's disease, Sydenham's chorea and tardive dyskinesia is the involuntary, irregular and unpredictable movements of the muscles (Duffy, 2013). Individuals with such diagnoses have imprecise consonants, delays in initiation of speech, monopitch, sudden change in rhythm and rate of speech with bursts of words alternating with pauses, excess loudness variation and prolonged phonemes (Duffy, 2013).

Motor Speech Impairment Target

Hyperkinetic Dysarthria is associated with the disorders of the basal ganglia control circuit (American Speeh-Language-Hearing Association [ASHA], 2022). Caused by myoclonic and choreiform disorders (rapid and jerky movements), hyperkinetic dysarthria is characterized by erratic rate and rhythm of speech, uncoordinated articulation and segments of sounds left out from an entire word ("Dysarthria", 2022).

Therapy Goal: In 6 months, given 20 short sentences, the client will repeat the sentences using the appropriate pitch (high or low) with minimal verbal prompts in 4 out of 5 opportunities with 80% accuracy across 3 sessions as measured by SLP data collection.

Sample Video Demos

Activity Breakdown (45-minute session, 2x a week)

Begin session with the client taking 10 deep and slow breaths.
Count the numbers 1 through 5 in a low pitch.
Count the numbers 1 through 5 in a high pitch.
Count the numbers 1 through 5 in an alternating pitch of low and high.
Repeat the cycle 3 times,
Client will take a break for 2 minutes
Client will transition to pitch gliding by producing the sound "eeeh" starting with a low pitch, increasing to a high pitch and finishing with a low pitch
Still producing the sound "eeeh", reverse the pitch glide by starting with a high pitch, decreasing to a low pitch and finishing with a high pitch.
This cycle will be repeated 6 times.
Client will take a break for 2 minutes.
Client will transition to producing the days of the week (Monday/Tuesday/Wednesday/Thursday/Friday/Saturday/Sunday) with a low pitch.
Repeat the days of the week in a high pitch
Alternate the pitch for each day (e.g Monday-low pitch, Tuesday-high pitch, Wednesday-low, Thursday-high, Friday-low, Saturday-high, Sunday-).
Client will repeat the cycle (low/high/alternate) 3 times
End of session.

Hierarchical Cueing

Modeling: Clinician will model how the numbers or words are to be said in both low and high pitches.
Direct verbal prompt: Clinician will provide direct feedback to client when error is produced.
Scaffolding with the use of non-verbal prompt: Use of hand gestures to indicate high or low pitch, and fast or slow rhythm.
Minimize verbal prompt: Client is able to repeat the production of sounds with the correct pitch given with minimal prompts.

Data Collection Tool

An Evidenced-based Approach

A recent study pertinent to the study of pitch exercises by Angadi, Croake, and Stemple (2017) "analyzed the evidence for the effectiveness of vocal function exercises (VSEs) in improving voice production." Their findings showed that in comparison to other types of exercises, namely symptomatic and vocal hygiene therapies, those that targeted "physiologic components in the vocalization subsystems of respiration, phonation, and resonance to restore their physiologic balance" ranked higher in use (Angadi et al., 2017). Further, after assessing 21 articles that used VFES as their intervention, their results revealed that all "studies demonstrated positive effects of VFEs as demonstrated by effect sizes across selected voice parameters." Therefore, the conventional approach to voice disorder management, such as pitch exercises, continues to focus on the underlying subsystems of speech rather than just the symptomatic and hygiene aspects which should still be addressed but with exceptions.

References:

Angadi, V., Croake, D., Stemple, J. (2019). Effects of vocal fold function exercises: a systematic review. Journal of Voice, (33)1. https://doi.org/10.1016/j.jvoice.2017.08.031.

American Speech-Language-Hearing Association. (2022). Dysarthria in adults. ASHA. Retrieved from https://www.asha.org/practice-portal/clinical-topics/dysarthria-in-adults/#collapse_6

County Durham and Darlington NHS Foundation Trust. (2016, December 21). Adult Speech and Language Therapy - Pitch [Video File]. YouTube. https://www.youtube.com/watch?v=2RhuqySHAi4

Duffy, J. R. (2013). Motor speech disorders: Substrates , differential diagnosis, and management. St. Louis, MO: Elsevier.

Dysarthria. (2022). Retrieved from https://www.slt.co.uk/conditions/speech-disorders/dysarthia/

Exercise chart - template free download | Speedy Template. (n.d.). Retrieved December 22, 2022, from https://www.speedytemplate.com/exercise-chart.asp

Pitch exercises: Improve your stress and intonation in American English with steps and glides. (2022). English with Kim. Retrieved December 18, 2022, from https://englishwithkim.com/pitch-exercises-steps-glides/

Speech Therapy Practice. (2021, June 24). Pitch Glides [Video File]. YouTube. https://www.youtube.com/watch?v=71OpgXZXeRw

Page updated

Report abuse