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iVoiceTherapy
Introductory Webinar 8.7.14
13:00-‐15:00 PST
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Meet the instructors
Liza Blumenfeld
Erin Walsh
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Webinar E<queBe • Technical ques<ons ?s rogerio.defaria@infone<nc.net • Submit ques<ons by typing them into the Ques<on tab in lieu of virtual raising hand. We will answer as many as we can in our final 30 minutes.
• AKer the webinar, all aBendees will receive an email with a link for post-‐tes<ng and cer<ficate of comple<on. US par<cipants – ASHA credit is also available during this process. We will also provide answers to all ques<ons submiBed that were not answered due to <me constraints.
• Please be pa<ent with us, this is our first webinar!
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Goals of iVT
• Enhance pa<ent awareness • Promote & monitor exercise compliance • Reduce # therapy sessions • Model exercises for novice voice clinician • Tasks applicable across wide range of pathologies
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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GeYng Started
• Self-‐ra<ngs – Hydra<on – Voice Handicap Index – Singing Voice Handicap Index
– Reflux Symptom Index – Cough Severity Index – Dyspnea Index – Pre/Post Progress
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Hydra<on
• Enter values throughout the day or es<mates at the end of the day – Calculates goal of 64oz net water / day: GREEN
– YELLOW: mod hydra<on – RED: dehydra<on – Alcohol and coffee/caffeine subtract from 64oz net water / day
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Vocal IQ
• Ear Training – Awareness – Auditory bombardment – Normal vs Abnormal – Links quality of voice to pathology
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Ear Training #1
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Ear Training #2
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Ear Training #3
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Ear Training #4
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Vocal IQ
• Pathology Lab – Videostroboscopy of variety of pathologies
– Plahorm to teach structure and func<on of larynx
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Path Lab
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Body Alignment
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Irritable Larynx
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Irritable Larynx
• Behaviors – Throat clearing – Cough – Laryngospasms – Paradoxical Vocal Fold Movement / Vocal Cord Dysfunc<on
– Muscle Tension Dysphonia
• Results – Forceful TVF collision – Habit forming – Perpetuates hypersensi<vity
– May lend to narrow airway due to constant vocal cord adduc<on
– Likely causes more coughing and muscle tension
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Irritable Larynx • Causes
– Vocal cord lesions – Reflux – Allergies – Post-‐nasal drip – Pulmonary – Neurological diseases
• Strategies – Must first have physician clearance to suppress
– Behavioral subs<tutes • Swallow saliva/ pH water • Humming • Paced pursed lip breathing • Rolled R • Exhale on /s/ • Gum, lozenges • Distrac<on
– Quan<fying triggers – An<cipa<on / paBern – Humidifier – *Neuromodulators*
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Vocal Hygiene / Hydra<on
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Vocal Hygiene
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Vocal Hygiene
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Post-‐Opera<ve
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Post-‐Opera<ve
• General guidelines clinicians will likely recommend
• Disclaimer – always discuss par<cular parameters with physician and team.
• Program exact prescrip<on in SeYngs
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Exercises
• Vocal Yoga – All diagnoses benefit – Balances airflow and vocal cord closure
– Promotes pliability for vibratory cycles, which can reduce speaking effort
– Expands pitch range
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Exercises
• Tone Flow – Resonance – Easy onsets – Muscle tension dysphonia
– Irritable larynx syndrome
– Vocal fa<gue
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Exercises
• Breathing – Irritable Larynx – Cough – Laryngospasm – Paradoxical Vocal Fold movement
– Pacing – Shallow breathing – Inhale stridor
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Exercises
• Inflec<on & Emphasis – Progressive neuromuscular disease: e.g., Parkinson’s, MS
– Presbylarynx – Vocal fold paralysis, especially if involving superior laryngeal nerve
– Adjunct to dysarthria therapy
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Exercises
• Vowel Onsets – Vocal Nodules – Cysts – Polyps – Scarring – Hyperfunc<on – Vocal fa<gue – Inflamma<on – Midfold free edge thickening
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Exercises
• Play and Run – Allows programming of a specific series of exercises to play in succession
– Ideal if pa<ent is wan<ng to perform exercises during commute or simply complete their Rx tasks all at once 2-‐3x/day
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Exercises
• Sing – User develops playlist in iTunes called “iVoice”
– Songs on playlist serve to keep voice in shape
– Works for presbylarynx, decondi<oning, paresis/paralysis
– Help pa<ent select songs based on challenging range and agility
Technical ques<ons ?s
rogerio.defaria@infone<nc.net
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Exercises • Cough & Throat Clearing – Behavior counter – Set dura<on of “Cough Timer” under MORE -‐> SETTINGS -‐> GENERAL -‐> COUGH TIMER
– Start with shorter dura<ons to encourage compliance
– Counter pauses if a phone call is received
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Cough Count
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Exercises
• Volume – Excellent for Parkinson’s disease, presbylarynx, any presenta<on of hypophonia
– Can be an aspect of LSVT home exercise program
– Hyperfunc<onal voices benefit as well to acquire awareness of their volume excess
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Volume
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Exercises • Voice Sample
– Audio biofeedback – All diagnoses benefit from awareness tasks
– Awareness precedes change to behaviors
– Tracks progress over <me – Able to assign specific aspects of voice to monitor each week during playback.
– Create your own audio exercises
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Exercises
• Conserva<on – Behaviors contribu<ng to phonotrauma
– Ideas how to quan<fy overuse
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Conserva<on
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Exercises
• Pitch – Modifying speaking pitch – Pitch range: LSVT, presbylarynx, SLN injury
– Puberphonia, MTD, excessively low or high habitual speaking pitch
– Awareness and cues real <me during structured or unstructured tasks
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Pitch
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Exercises
• Post-‐Opera<ve – Provides cues to complete specific exercises based on days post-‐op.
– All is pre-‐programmed in SETTINGS -‐> POST-‐OPERATIVE and can be modified at any <me.
– Post-‐opera<ve general pa<ent info under EDUCATION tab
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MORE Tab
• Journal – Free form text to track any variety of laryngeal dysfunc<on
– Helpful for individuals who tend to overuse their voice and develop lesions or vocal fa<gue
– May also be used for diet tracking in cough / PVFM pa<ents
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• History – Tracks log in <mes – Tracks tasks performed – Compliance data
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• SeYngs – General
• Volume Sensi<vity – do not recommend changing. Set for 1 foot from mouth or hanging ear bud.
• Cough Timer – change based on pa<ent needs
• Primary diagnosis -‐ add • Secondary diagnosis -‐ add
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• SeYngs – Play and Run
• Vocal Yoga • Tone Flow • Breathing • Inflec<on and Emphasis • Vowel Onsets
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• SeYngs – Daily Reminders
• Coordinate with your pa<ent’s schedule – Morning – Drive to work – Midday break – AKernoon – Evening – Special events – Recurring events
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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• SeYngs – Post-‐Opera<ve
• Program in advance • Able to modify • If unforeseen event occurs (e.g., new hemorrhage), delay more advanced task by x number of days/weeks
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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• SeYngs – Post-‐Opera<ve
• Complete Voice Rest – Specify dura<on – Able to change – These reminders make take up to a minute to interface with the reminders applica<on of the iPhone or iPad.
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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• SeYngs – Post-‐Opera<ve
• Start Exercises • This will run along side the talking parameters. – Example: A pa<ent may be on Light Talking and Exercises simultaneously
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• SeYngs – Post-‐Opera<ve
• Light / Moderate Talking – Define light talking based on your recommenda<ons.
– Example: no more than 5min each hour.
– Write in flexibility exercises you would like for them to perform while on light talking.
– Func<onal phrases (similar to LSVT) can be wriBen in Journal
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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• SeYngs – Post-‐Opera<ve
• Light / Moderate Singing – Can write exactly which vocalise you want them to perform.
– These can be recorded into voice memos if you want them to use your model.
– It is helpful to con<nue the speaking exercises.
– Set daily reminders of whichever exercises are applicable.
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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The future of iVT
• Interac<ve server • Teleprac<ce • Pa<ent / clinician communica<on • Track compliance remotely • Electronic medical record
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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iVT
Ques<on and Answer
Technical ques<ons ?s rogerio.defaria@infone<nc.net
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Thank you!
Technical ques<ons ?s rogerio.defaria@infone<nc.net