Free to Speak Voice and Speech Therapy

	About Spasmodic Dysphonia The following information is from the American Speech – Language and Hearing Association Website, 2011. www.asha.org What is spasmodic dysphonia? Spasmodic dysphonia is a chronic (long-term) voice disorder. With spasmodic dysphonia, movement of the vocal cords is forced and strained resulting in a jerky, quivery, hoarse, tight, or groaning voice. Vocal interruptions or spasms, periods of no sound (aphonia), and periods when there is near normal voice occur. What causes spasmodic dysphonia? Symptoms come from more than one source. Some people appear to have nervous system changes that produce an organic tremor of the vocal cords. Others may have dystonia, another kind of neurologic disorder that creates abnormal muscle tone. In rare cases, people can have spasmodic dysphonia symptoms because of acute or chronic life stress. When not used for talking, the vocal cords of people with spasmodic dysphonia are normal in appearance and function. However, when the vocal cords are brought together for talking, their movement is uncontrolled. What are the signs and symptoms of spasmodic dysphonia? At first, symptoms may be mild. They may occur only occasionally. Later on, they may worsen and become more frequent before they even out. Symptoms may be worse when a person is tired or stressed. They may be greatly reduced or even disappear, for example, during singing or laughing. Spasmodic dysphonia is a disorder characterized by involuntary movements of one or more muscles of the larynx or voice box. The first signs of spasmodic dysphonia are most often found in individuals between 30 and 50 years old. More women appear to be affected by spasmodic dysphonia than men. Voice spasms fluctuate in severity. They may lessen for hours or even days at a time. How effective are treatments for spasmodic dysphonia? Speech-language pathology services alone are most helpful when symptoms are mild. Techniques such as relaxation, breath control, maintaining a steady flow of air from the lungs during voice production, and pitch and loudness modifications can help improve the person's voice. Botulinum Toxin Injections Repeat injections of small doses of botulinum toxin (Botox) into one or both vocal cords are frequently recommended and performed by doctors. Botox weakens the laryngeal muscles and results in a smoother, less effortful voice because of less forceful closing of the vocal cords. Temporary breathiness or difficulty swallowing sometimes occurs for a short time after injection. Treatment by an SLP may also be recommended following injections to optimize voice production. Find out more information about Botox, including some recent warnings about its use. Surgery for Spasmodic Dysphonia Recent studies have shown that cutting of the recurrent laryngeal nerve to paralyze one vocal cord appeared to reduce the force of vocal cord closure. There was a return of voice symptoms within 6 months to 3 years of surgery in almost two thirds of these patients. Many patients were worse than before. Speech-language pathology treatment was often recommended after surgery. How effective is voice therapy? Here is what ASHA says: http://www.asha.org/uploadedFiles/public/speech/disorders/TESLaryngealBasedVoiceDisorders.pdf The following is what the link says: Treatment Efficacy Summary - Laryngeal-Based Voice Disorders A voice disorder is characterized by abnormal pitch, loudness, or vocal quality resulting from disordered laryngeal function and may cause pain or vocal fatigue. Voice disorders range from mild hoarseness to complete voice loss, and limit the effectiveness of oral communication. Voice disorders can be caused by an injury resulting in paralysis of a vocal fold, an improper breathing pattern, or misuse of the voice. Voice disorders can also be due to medical/physical conditions or neurological in nature. The individual with a voice disorder may experience stress, withdrawal, and depression because of an inability to produce normal voice. Voice disorders affect as much as 10% of the U.S. population, with higher frequency for those who depend on their voice for work, such as teachers. Studies find voice treatment to be a significant factor in improving voice function and in reducing the recurrence of laryngeal pathology. Voice treatment can resolve a voice disorder when medical intervention (e.g., surgery) is not warranted and may reduce the need for laryngeal surgery or other medical intervention, when indicated, if initiated before any medical interventions.i Murray and Woodson found that the results of treatment for vocal nodules with or without surgery were comparable and suggested that voice treatment should be the first recommendation for treatment of vocal nodules.ii A study of teachers with voice disorders found that a program of vocal hygiene and voice amplification reduced the severity of voice problems and improved voice quality. ASHA’s National Outcomes Measurement System (NOMS) reveals that the majority of patients with voice disorders showed multiple levels of improvement on the Voice Functional Communication Measure, a 7-point rating scale. More treatment time was associated with better outcomes. The speech-language pathologist and otolaryngologist evaluate a patient and recommend voice treatment. Voice treatment may eliminate the need for surgical or pharmacological treatment, and it is frequently recommended before and after laryngeal surgery to achieve optimal voice. 7216 ASHA • 2200 Research Boulevard, Rockville, MD 20850 • Phone: 301-296-5700 • Fax: 301-296-5777 *End of ASHA quote* Connie’s philosophy on Spasmodic Dysphonia Spasmodic Dysphonia is a term used to describe a family of voice dysfunctions that are not well understood. Recent brain imaging studies suggest nervous system changes in those with SD, and it is considered to be incurable. However, since there is no easy way to diagnose the condition, other similar voice dysfunctions amenable to voice therapy may be misdiagnosed as laryngeal dystonia, or SD. These include functional dysphonia, muscle tension dysphonia or milder cases of episodic SD. Breathing dysfunctions and excessive tensions in the body, emotional distress, and even poor posture can contribute and exacerbate voice dysfunction. The emotional ramifications of SD are profound. SD is the most highly handicapping voice condition one can experience. The anxiety and despair of being diagnosed with a hopeless, incurable disease can render one helpless and create more tension and anxiety. Since I experienced this firsthand in May 2004, I speak from a personal place. I was told there was nothing to do but begin botulinum toxin injections and learn to live with a broken voice. I felt devastated and afraid. It was a difficult task to recover my voice, and it did not come quickly. My experience as a Speech Pathologist and many years of training others to change aspects of their speech, voice, or dialect led me to believe that I, too, could find a way out of SD. I felt that to do this behaviorally would give me a more lasting change and so I set out with great determination. I do believe that neurological changes are responsible for SD. There is also ample evidence that our brains possess the ability to change (neuroplasticity) and that this ability is with us throughout our lifetimes. People recover from other dystonias through rehabilitation (writer’s cramp, musician’s dystonia, torticollis), so why not SD? I believe that neuroplasticity is the way out, and that it is the new frontier for SD sufferers. Alas, it is not within the current paradigm as of yet, and there is little hope for far too many people. My profession has been very quick to diagnose SD based on the sound of the voice or a visual picture of a spasming vocal fold. There is no reliable method to definitively diagnose it, yet every day, another person is told they are a hopeless case. They start a life-time of botulinum toxin injections without exploring the possibility that maybe they can find a new groove for their voices behaviorally. Many, like myself and 85% of my patients, can find a new voice, or perhaps their real, true voice by changing many aspects of their lives. These changes include relaxing and releasing bodily tensions; changing pitch, focus, loudness or resonance of the voice; replacing fear with hope; managing life-style, incorporating fun voice explorations like singing and exercising the voice in novel ways; improving breathing patterns and posture; and sharing emotions in a safe, non-judgmental environment. Overcoming SD is not about voice therapy, it is about life change on many levels. It is about brain changes through cognitive-behavioral therapeutic methods. This is yet to be proven by scientific studies, but I see it working in many people. The drastic changes in voice production could only be the result of neurological reorganization. What I practice and teach others is a way to manage a difficult condition and to live with it in grace and acceptance. Some are fortunate enough to overcome it completely and emerge with a normal voice, but on average, that takes a year or more. Others have sporadic recoveries and setbacks, but have a permanent set of management tools at the ready. A small percentage of people are unable to manage their symptoms with this approach. For them, perhaps botulinum toxin is a better choice, but that does not mean they can’t utilize all they learn about holistic voice rehabilitation between treatments. For more information: cpike200@gmail.com Books by Connie Pike Overcoming Spasmodic Dysphonia Long Term Management of Spasmodic Dysphonia
	Stuttering and Other Speech/Voice Problems Free to Speak Voice and Speech Therapy currently has a primary focus to educate and provide voice rehabilitation to persons suffering from Spasmodic Dsyphonia or Laryngeal Dystonia. Since I still am a work in process and have episodes of dystonia sporadically, I feel most passionate about this area. I am at my best when helping others who suffer from this disorder to recover and maintain the freedom to speak. I am also available to treat any adult voice disorders other than laryngeal cancer/laryngectomy patients who benefit from a medical setting. This can include nodules, polyps, and functional voice disorders. While I am not board-certified in treating Fluency disorders or Stuttering, I approach this disorder much as I do SD; holistically. Stuttering involves breathing, motor re-training and emotional aspects and I find stuttering to be very similar to SD in many ways. I am also equipped to treat adults with social phobias regarding speaking, or with Asperger’s syndrome as it relates to communication skills.
	Links to Other Resources

About Spasmodic Dysphonia

The following information is from the American Speech – Language and Hearing Association Website, 2011. www.asha.org

What is spasmodic dysphonia?

Spasmodic dysphonia is a chronic (long-term) voice disorder. With spasmodic dysphonia, movement of the vocal cords is forced and strained resulting in a jerky, quivery, hoarse, tight, or groaning voice. Vocal interruptions or spasms, periods of no sound (aphonia), and periods when there is near normal voice occur.

What causes spasmodic dysphonia?

Symptoms come from more than one source. Some people appear to have nervous system changes that produce an organic tremor of the vocal cords. Others may have dystonia, another kind of neurologic disorder that creates abnormal muscle tone. In rare cases, people can have spasmodic dysphonia symptoms because of acute or chronic life stress.

When not used for talking, the vocal cords of people with spasmodic dysphonia are normal in appearance and function. However, when the vocal cords are brought together for talking, their movement is uncontrolled.

What are the signs and symptoms of spasmodic dysphonia?

At first, symptoms may be mild. They may occur only occasionally. Later on, they may worsen and become more frequent before they even out. Symptoms may be worse when a person is tired or stressed. They may be greatly reduced or even disappear, for example, during singing or laughing.

Spasmodic dysphonia is a disorder characterized by involuntary movements of one or more muscles of the larynx or voice box. The first signs of spasmodic dysphonia are most often found in individuals between 30 and 50 years old. More women appear to be affected by spasmodic dysphonia than men. Voice spasms fluctuate in severity. They may lessen for hours or even days at a time.

How effective are treatments for spasmodic dysphonia?

Speech-language pathology services alone are most helpful when symptoms are mild. Techniques such as relaxation, breath control, maintaining a steady flow of air from the lungs during voice production, and pitch and loudness modifications can help improve the person's voice.

Botulinum Toxin Injections

Repeat injections of small doses of botulinum toxin (Botox) into one or both vocal cords are frequently recommended and performed by doctors. Botox weakens the laryngeal muscles and results in a smoother, less effortful voice because of less forceful closing of the vocal cords. Temporary breathiness or difficulty swallowing sometimes occurs for a short time after injection. Treatment by an SLP may also be recommended following injections to optimize voice production.

Find out more information about Botox, including some recent warnings about its use.

Surgery for Spasmodic Dysphonia

Recent studies have shown that cutting of the recurrent laryngeal nerve to paralyze one vocal cord appeared to reduce the force of vocal cord closure. There was a return of voice symptoms within 6 months to 3 years of surgery in almost two thirds of these patients. Many patients were worse than before. Speech-language pathology treatment was often recommended after surgery.

How effective is voice therapy?

Here is what ASHA says:

http://www.asha.org/uploadedFiles/public/speech/disorders/TESLaryngealBasedVoiceDisorders.pdf

The following is what the link says:

Treatment Efficacy Summary - Laryngeal-Based Voice Disorders

A voice disorder is characterized by abnormal pitch, loudness, or vocal quality resulting from disordered laryngeal function and may cause pain or vocal fatigue. Voice disorders range from mild hoarseness to complete voice loss, and limit the effectiveness of oral communication. Voice disorders can be caused by an injury resulting in paralysis of a vocal fold, an improper breathing pattern, or misuse of the voice. Voice disorders can also be due to medical/physical conditions or neurological in nature. The individual with a voice disorder may experience stress, withdrawal, and depression because of an inability to produce normal voice. Voice disorders affect as much as 10% of the U.S. population, with higher frequency for those who depend on their voice for work, such as teachers.

Studies find voice treatment to be a significant factor in improving voice function and in reducing the recurrence of laryngeal pathology. Voice treatment can resolve a voice disorder when medical intervention (e.g., surgery) is not warranted and may reduce the need for laryngeal surgery or other medical intervention, when indicated, if initiated before any medical interventions.i Murray and Woodson found that the results of treatment for vocal nodules with or without surgery were comparable and suggested that voice treatment should be the first recommendation for treatment of vocal nodules.ii A study of teachers with voice disorders found that a program of vocal hygiene and voice amplification reduced the severity of voice problems and improved voice quality.

ASHA’s National Outcomes Measurement System (NOMS) reveals that the majority of patients with voice disorders showed multiple levels of improvement on the Voice Functional Communication Measure, a 7-point rating scale. More treatment time was associated with better outcomes.

The speech-language pathologist and otolaryngologist evaluate a patient and recommend voice treatment. Voice treatment may eliminate the need for surgical or pharmacological treatment, and it is frequently recommended before and after laryngeal surgery to achieve optimal voice.

7216 ASHA • 2200 Research Boulevard, Rockville, MD 20850 • Phone: 301-296-5700 • Fax: 301-296-5777

***End of ASHA quote***

Connie’s philosophy on Spasmodic Dysphonia

Spasmodic Dysphonia is a term used to describe a family of voice dysfunctions that are not well understood. Recent brain imaging studies suggest nervous system changes in those with SD, and it is considered to be incurable. However, since there is no easy way to diagnose the condition, other similar voice dysfunctions amenable to voice therapy may be misdiagnosed as laryngeal dystonia, or SD. These include functional dysphonia, muscle tension dysphonia or milder cases of episodic SD. Breathing dysfunctions and excessive tensions in the body, emotional distress, and even poor posture can contribute and exacerbate voice dysfunction.

The emotional ramifications of SD are profound. SD is the most highly handicapping voice condition one can experience. The anxiety and despair of being diagnosed with a hopeless, incurable disease can render one helpless and create more tension and anxiety. Since I experienced this firsthand in May 2004, I speak from a personal place. I was told there was nothing to do but begin botulinum toxin injections and learn to live with a broken voice. I felt devastated and afraid.

It was a difficult task to recover my voice, and it did not come quickly. My experience as a Speech Pathologist and many years of training others to change aspects of their speech, voice, or dialect led me to believe that I, too, could find a way out of SD. I felt that to do this behaviorally would give me a more lasting change and so I set out with great determination.

I do believe that neurological changes are responsible for SD. There is also ample evidence that our brains possess the ability to change (neuroplasticity) and that this ability is with us throughout our lifetimes. People recover from other dystonias through rehabilitation (writer’s cramp, musician’s dystonia, torticollis), so why not SD? I believe that neuroplasticity is the way out, and that it is the new frontier for SD sufferers. Alas, it is not within the current paradigm as of yet, and there is little hope for far too many people.

My profession has been very quick to diagnose SD based on the sound of the voice or a visual picture of a spasming vocal fold. There is no reliable method to definitively diagnose it, yet every day, another person is told they are a hopeless case. They start a life-time of botulinum toxin injections without exploring the possibility that maybe they can find a new groove for their voices behaviorally. Many, like myself and 85% of my patients, can find a new voice, or perhaps their real, true voice by changing many aspects of their lives. These changes include relaxing and releasing bodily tensions; changing pitch, focus, loudness or resonance of the voice; replacing fear with hope; managing life-style, incorporating fun voice explorations like singing and exercising the voice in novel ways; improving breathing patterns and posture; and sharing emotions in a safe, non-judgmental environment.

Overcoming SD is not about voice therapy, it is about life change on many levels. It is about brain changes through cognitive-behavioral therapeutic methods. This is yet to be proven by scientific studies, but I see it working in many people. The drastic changes in voice production could only be the result of neurological reorganization.

What I practice and teach others is a way to manage a difficult condition and to live with it in grace and acceptance. Some are fortunate enough to overcome it completely and emerge with a normal voice, but on average, that takes a year or more. Others have sporadic recoveries and setbacks, but have a permanent set of management tools at the ready. A small percentage of people are unable to manage their symptoms with this approach.

For them, perhaps botulinum toxin is a better choice, but that does not mean they can’t utilize all they learn about holistic voice rehabilitation between treatments.

For more information: cpike200@gmail.com

Books by Connie Pike

Overcoming Spasmodic Dysphonia

Long Term Management of Spasmodic Dysphonia

Stuttering and Other Speech/Voice Problems

Free to Speak Voice and Speech Therapy currently has a primary focus to educate and provide voice rehabilitation to persons suffering from Spasmodic Dsyphonia or Laryngeal Dystonia. Since I still am a work in process and have episodes of dystonia sporadically, I feel most passionate about this area. I am at my best when helping others who suffer from this disorder to recover and maintain the freedom to speak.

I am also available to treat any adult voice disorders other than laryngeal cancer/laryngectomy patients who benefit from a medical setting. This can include nodules, polyps, and functional voice disorders.

While I am not board-certified in treating Fluency disorders or Stuttering, I approach this disorder much as I do SD; holistically. Stuttering involves breathing, motor re-training and emotional aspects and I find stuttering to be very similar to SD in many ways.

I am also equipped to treat adults with social phobias regarding speaking, or with Asperger’s syndrome as it relates to communication skills.