Voice therapy for spasmodic dysphonia should focus on decreasing the effort needed to speak.
Producing voice requires a very delicate balance between all the muscles involved in speaking and breathing.
People with SD tend to push and strain their voice out. Because of the vocal spasms, the voice doesn’t come out naturally.
The logical reaction when things don’t go the way you want them to go, is that you try harder.
The more you try, the worse your voice becomes. You start to push more with all the muscles in your body, even the ones in your face.
The right way to produce more voice is counter intuitive; you have to try less. You have to speak softer with less effort.
Voice (speech) therapy for spasmodic dysphonia should do just that.
Exercises to speak easier could be:
- Start with speaking as soft as possible and then gradually turn up the volume
- Speak with maximum resonance; feel your voice more
- Work on diaphragmatic breathing
- Speak at a lower pitch
- Place your voice as low in your body as possible (at the position of your belly-button)
- Sit or stand straight
- Speak more breathy (start a sigh just before you start to speak)
- Humm just before you start to speak
- Make the words flow more. Speak like your singing.
- Speak with a lowered larynx to open up your windpipe. You do this by letting your tongue lie flat and relaxed on the floor of your mouth.
To watch this video you must join this facebook group: https://www.facebook.com/groups/30321495178/
Unfortunately the members have voted and made it a closed group to ensure their privacy.
The device used in the video is a “hex bug” which you can get in the toy store.
If you want to learn more then contact (and thank) this person:
Beginning of 2009
I was in the stage of not seeing any improvement in my voice
and was completely demotivated and frustrated about any hope I might have in ever getting my voice back.
And then I received an email from Ron Cox with a sound recording of him speaking.
Ron Cox was the guy with whom I attended Connie Pike’s voice clinic in Florida in July 2007.
You might have seen his video on Youtube or my website.
This is the video of Ron Cox prior to the voice clinic I attended with him.
When I was with him in the voice clinic he was in bad shape.
He suffered from severe spasmodic torticollis and spasmodic dysphonia.
The audio recording he included in the email blew me away.
I was shocked!
He sounded completely normal again.
He said that his voice was even better then before he attracted the spasmodic dysphonia.
This was great news for him and for anybody else who suffered from a dystonia.
Again more proof that you can recover almost 100% from spasmodic dysphonia.
My hope was restored and even more important for me was that I became very jealous.
Jealousy is a big motivator.
The hope and desire to recover my voice had gone back up from a small flame
into a big fire.
In July 2007 I attended the voice clinic at Connie Pike’s house in Apollo beach, Florida, USA.
Before registering for her clinic, I searched the internet trying to find people who recovered from SD and who could help me.
Soon I found the website of Dr. Morton Cooper in Los Angeles, USA.
I called him on the phone to find out more. He asked me to humm, happy birthday. That was no problem for me.
He listened and said:”You have a good chance of fully recovering your voice. Can you come to L.A for 4 weeks?
How much will it cost I asked him?
“5.000 dollar per week”:he said. “And I want you to come for four weeks.”
20.000 dollar…? A lot of money!
But I really wanted to recover, badly. So I went to the bank to ask if they could lend me the money.
I explained them everything, and that I needed the money to be able to keep my job.
They agreed with the lending and I was looking forward to going to the states and getting my old life back.
I kept on browsing the internet and found Connie Pike’s clinic.
A lot cheaper and more complete was my opinion. Only 2000 Dollar!
So I decided to register for the clinic and go for the first available date.
Below in the video, you can hear my voice before I went to the voice clinic.
I arrived in her nice house on the 4th of July.
When I entered the room, another guy was sitting at the table and I thought that he was in a terrible condition.
He had great difficulty with getting some voice out and his neck and shoulders were twisted. I thought that he was an invalid.
Around his neck was a thick black collar. He suffered from spasmodic torticollis and spasmodic dysphonia.
His name is Ron Cox.
Below in the video, you can see and hear Ron Cox before the voice clinic,
which he attended with me.
He was worse of then I was. What I didn’t knew then was that he was going to recover from both disorders within a year, fully.
The other participants for the clinic arrived after me and we ended up with a group of 6 people. 3 guys and 3 ladies.
Voice Clinic Connie Pike
We exchanged stories and it was a revelation to meet other people who suffered in the same way as I did.
I was not alone.
I was in the right place.
The 5 day clinic consisted of different parts:
Private speech training sessions
Personal sessions with Connie Pike of about one hour, 3 times. The session was video taped to watch back later at home.
We learned how to speak in a different way. Ways to get the voice out by speaking from the “mask” which is the area between your nose and mouth.
Speaking at a lower (men) or a higher pitch (women). Using the full force of the voice by using the full resonance of the whole body.
Doing different exercises with words and sentences starting with certain letters and sounds.
Some are difficult when you suffer from abductor sd and others are difficult when you have adductor sd.
Connie knew what she was talking about because she herself recovered from spasmodic dysphonia a few years before.
She has helped dozens of people to recover their voice.
Below in the video, you can see a very small part of my private sessions with Connie.
Private breathing sessions with Mike White
Mike started off with breath assessment. We had this breath flow meter which he used to measure the long capacity and the quality of my breathing.
He learned me to speak with good breath support. Standing up straight with the head tilted down a little bit, to have maximum flow past the vocal chords.
Mike works very intuitively to get your voice out so we ended up in some strange body positions to connect to my voice.
But it worked.
By finding some way to get your good voice out makes you experience a breakthrough which sparks the fire of hope.
You go from there.
Singing with Roger Love’s cd.
This consisted of singing with the whole group together, led by Connie Pike. The singing is fun and good for your breathing.
You sing scales with different sounds.
Self practise on the computer with voiceprint
The computer program: “Voiceprint” displays the pitch and the volume graphically on your screen. You speak in the microphone while the program runs and you see a horizontal graph of your voice pitch. It is great to see with with your eyes what your voice is doing. I continued to use the program long after I got back. It was a great tool to record voice samples and keep them for later. It tells you if you are on the right pitch and whether you speak with resonance.
Massage to relax the whole body
When the electric massage bed was available, we could use it to relax the muscles.
It is the Ceragem massage bed.
It massages different parts of your body while applying infra-red heat.
It was nice.
Manual massage by Megan Pike.
Megan Pike (Connie’s daughter) massaged everybody two times during the 5 day clinic. It is better then automatic massage because a machine is just a machine.
Especially the throat, neck and face were taken care of.
Group talk to discuss progress and revelations
We did this a couple of times. Everybody in it’s turn shared where they were coming from. How long they suffered from sd,
what they tried before, what worked and what impact the sd had on their life.
Connie shared with us her struggle and the story of her recovery. She told us her ups and downs and the lessons she learned.
Group breathing exercises with Mike white.
Mike showed and thought us different techniques, tricks and body positions to get more air in.
The more air you get in, the more power you have to get the voice out.
Psychological evaluation with Robbie Goss
We had one session with Robbie Goss, who is a psychologist. He interprets the Taylor-Johnson Psychosocial test we performed online before we came to the clinic.
The Taylor-Johnson Temperament Analysis® (T-JTA®) is a quick and convenient method of measuring important personality traits that influence personal, interpersonal, scholastic, and vocational functioning and adjustment. It functions both a diagnostic device and counseling tool.
The T-JTA measures 9 personality traits and their opposites:
• Nervous ↔ Composed
• Depressive ↔ Light-Hearted
• Active-Social ↔ Quiet
• Expressive-Responsive ↔ Inhibited
• Sympathetic ↔ Indifferent
• Subjective ↔ Objective
• Dominant ↔ Submissive
• Hostile ↔ Tolerant
• Self-Disciplined ↔ Impulsive
The profile gives you insight in your character profile.
My result was that I strongly tend to:
That is so true.
I am also a quite shy and introvert person.
So Robby told me that with my character profile it would be hard to stick to the training schedule.
The clinic was great because:
- You met with fellow sd sufferers
- You could hear first hand from somebody who recovered her voice from sd (Connie Pike)
- We were a nice group
- It gave me hope and that I was not alone on this journey
- I had things to do to recover my voice
Please leave your comments and questions below.
Road trip through the south of the U.S.A
In Februari 2009 me and my family were planning a holiday to the U.S.A.
It was going to be a road-trip because I like to drive and see things.
We made our starting point Miami because I knew that Ron Cox lives there and it would be a great opportunity
to see him back after his complete recovery from the spasmodic dysphonia and the spasmodic torticollis.
He had something I wanted *BADLY*.
And it was an GREAT opportunity to hear straight from his mouth the things he did,
so I could maybe model him,
to recover myself.
We arrived late in the evening in Miami, went to our motel, and the next morning
at 6.00 a.m I would meet him at his house…
I went and shot the next video….
When you listen closely to what he is saying, I noticed a very important thing…
He says at 5 min 29 seconds that he stopped exercising, and then his voice
became a lot better.
Hmmm, that is interesting, let’s think about that some more…
The standard treatment is injections with botuline toxin, Botox. It is a simple procedure
when you have an experienced doctor. You lay down flat on a bed with 2 electrodes
glued to you throat. The doctors first treatment is injecting 2,5 units of Botox. One
injection in both sides of the vocal chords. The whole procedure is painless and should
not take up more then a couple of minutes.
How long before it works
The Botox will start to work after about three days and the effect will last up to three
months. After 1 week you can go back to the doctor to evaluate your voice and take
additional shots if the desired effect is too small.
How to find the correct dose
It takes around 1 to 5 treatments over time to establish the correct dose. After the right
dosage is found you can continue with that over time. You will have to continue the
treatments for the rest of your life because the effects wear out after 3 months.
Disadvantages of the use of Botox:
● Recent analysis of quality-of-life questionnaires in patients undergoing regular
injections of botulinum toxin demonstrate that a large proportion of patients have
limited relief for relatively short periods due to early breathiness and loss-of benefit
● the benefits from injections were significantly reduced in patients in their
seventies and attributed this to the reduction in motor units with aging perhaps
affecting the response to botulinum toxin in spasmodic dysphonia patients
● aphonia, breathiness and swallowing difficulties in the first to fourth week after
injection. This can really interfere with your job because you might be unable to
speak for four weeks.
● optimal voice that was achieved never fully matched normal voice quality or
● Only good effects with ADSD
● The costs for treatment range from 0 to $4000,-
● Every 3 months you have to travel to the hospital.
● You might become immune for the Botox so that it has no effect anymore.
Advantages of the use of Botox:
● Relief-when it works for you, you will have much of your normal life back and
during this time you might forget you have spasmodic dysphonia.
● Happiness– You will feel emotionally better because you can express yourself
● Security– You can continue a normal job
● Freedom– You don’t have to think about speaking anymore, it just flows out.
Below you find a video which shows you injection of Botox.
For the production of voice we need 4 things:
1. Air pressure produced by the lungs to vibrate the vocal chords
2. Vocal chords that open and close creating vibrations in the air-flow
3. Resonance of the air vibrations in the vocal tract
4. Openings in the body like the mouth and the nose to let the produced sound out
If there is a problem with one or more of these requirements the voice quality will suffer.
When the vocal chords close more, there is more surface to vibrate or to produce sound. So
when they are closer together, the sound becomes louder, with a lower pitch, with more vibration.
After each vibration, the vocal chords close very fast, for a short moment. Air under the vocal
chords builds up pressure and when they re-open the vibrating air comes out, producing the
Male and female voice
The frequency of the male voice is around 120 Hz and of the average woman lies around 210
Hz. This means that the vocal chords will close 120 times and 210 times a second for the male
and female voice. If you have a job where speaking is important, they will close 30.000 times an hour.
A number of operations that cut one of the nerves of the vocal folds (the recurrent laryngeal nerve) has improved the voice of many for several months to several years but the improvement may be temporary.
An operation called “selective laryngeal adductor denervation-rennervation (SLAD-R)” is effective specifically for adductor spasmodic dysphonia which has shown good outcomes in about 80% of people at 4 years. Post-surgery voices can be imperfect and about 15% of people have significant difficulties.If symptoms do recur this is typically in the first 12 months. Another operation called “recurrent laryngeal nerve avulsion” has positive outcomes of 80% at three years.