1) Warm-ups
Produced at 85-90db
May-me-my-mow-moo – draw out the vowels – vowels go from high to low, one syllable runs into the next exaggerate the vowels, should feel awkward, not chanted, not monotone
5 reps during treatment, 5 reps during HEP
Purpose: engages voices and starts coordination of respiratory and laryngeal systems, facilitates increased vocal intensity without straining, promotes forward nasal resonance with bilabial nasal consonants
2) Ahs
Produced at 85-90db
Consistent volume and pitch
Mouth open wide
10 reps during tx, 10 reps during HEP
Boone states that sustaining ah for 10 seconds is adequate for speech production – longer than 10 seconds promotes hyperfunction
If strained, shape a short two second ah.
Purpose: Increase awareness of breath support for speech, activates and coordinates the respiratory and laryngeal systems
3) Glides
Produced at 85-90dB
Glide, not stair step – use ah, not /o/ or /u/
Start at comfortable pitch (“home base”), glide up, take breath, start high, glide to starting frequency (“home base”) – going too low creates tension
Produced with clear vocal quality and consistent intensity throughout – strong, confident voice
Mouth open wide
10 reps during tx, 10 reps HEP
May be most challenging exs
If pt dem glottal fry it’s because they’ve relaxed glottal fry “As you’re gliding down, keep projecting your voice forward”
If pt’s have a hard time changing pitch use a stair-step approach – produce 2 steps, then 3 steps (may need this for a few sessions – a few weeks)
Purpose: Moves cricothyroid to stretch vf, increases action of the adductor intrinsic muscle, may elevate tongue position and larynx, targets muscles responsible for intonation and speech
4) Counting 1-12
Produced at 80-85dB
Smooth and connected (one number runs into the other), not separated or monotone, vowels should be prolonged
Cue to make them connected – run hand in a straight line as you count or draw lines in the workbook connecting the numbers
Don’t tell them to take a deep breath
Purpose: Re-coordinates breathing pattern, increases breath support as syllables per breath increase
5) Reading
Produced at 75-85 dB
Project voice forward and speak with intent
Pt may benefit from a bookmark to focus on only one line
Some pts will need more simplified reading material – don’t want to increase their cognitive load
If pt’s demonstrate low literacy, pt’s could recite familiar poems, chants, nursery rhymes, school cheers, daily prayers, patriotic songs, days of the month (January one, January two, January three, etc.) – select familiar songs if using music
Keep volume 5-10 dB louder than normal conversation
Purpose: coordinates respiratory and laryngeal systems with articulation, minimized the thought process necessary for using INTENT in connected speech, begins the transfer of skills to conversational speech
If pt gets quiet at the end: “You’re not finished until you’re finished”
6) Conversation
Produced at 72-78dB
Start with structured tasks (picture naming, “That is a ____”, “Name the picture and tell me what the item is used for.”) and then move to conversation (move to asking questions after pt names the picture)
“Use your best voice”
“In terms of effort you’re going to be at 7-8 on a scale of 1-10”
*This content is from the SPEAK OUT!® Therapy for Parkinson's: SLP Licensing Course
Education
Be prepared to educate your client and their caregiver on:
Automatic (extrapyramidal system) vs. intentional (pyramidal system)
Dr Boone has videos discussing these topics on Parkinson Voice Project
What it means to speak loud in comparison to speak with intent
Swallowing strategies if your client reports symptoms of dysphagia