Trial Studies on Spasmodic Dysphonia
I came across an article that was written by one of my clients about a clinical study I did with SD patients. I thought it might help many of you to understand about SD, and also fix the problems if you suffer from it. Best, Roger
In July, 2005, famous Hollywood vocal coach Roger Love began trial studies to see if his methods help people with spasmodic dysphonia.
Four participants were chosen – three women and one man. All had been diagnosed with spasmodic dysphonia by reputable doctors. Some had undergone speech therapy.
Each participant was first examined by Dr. Kantor, Beveral Hills ENT who looks after many singers and film stars’ vocal cords. Dr. Kantor verified that each had spasmodic dysphonia. The cords were examined and videoed while the participant talked. General health of the vocal cords was verified.
Roger Love then began training the four for about one hour per day for eight days.
This is an overview of the study. I have asked each participant to write up their personal experiences.
Roger said that we would start from where we were, without being concerned about how the problem started or what caused it. Each person was recorded while reading, singing, and doing vocal diagnostic exercises. Roger then put each participant through a series of initial exercises so he could determine what needed to be done to fix their voices. He said we all had mechanical problems with speaking and that they could be fixed.
Even though all had been diagnosed with spasmodic dysphonia, each participant had different problems and required different fixes. The problems included not enough air, an uneven supply of air, too much air (note that these are all airflow problems), high larynx, tight neck muscles, tight tongue muscles, tight jaw muscles, nasality, tongue too high or too active, tight muscles in the solar plexus, tight stomach, inability to relax the stomach, inability to let the stomach come in smoothly while speaking, inability to control pitch, inability of the vocal cords to vibrate in any other than head voice, etc.
Roger worked with eath participant and assigned them practice each day. The one using too much air was told to speak while holding her breath for one day. One was told to speak only on the note of F for one day as that was the only place that a balance of air and vocal cord vibration could be achieved. One was assigned to speak more loudly with a deeper voice. All were assigned exercises to lower the larynx.
Roger worked with one person at a time. Each day’s work was taped, and a tape given to the participant for practice at home or in Roger’s studio. The group decided that they wanted to watch Roger work with each person, rather than have private lessons. Much was learned this way, as what Roger was showing one person often applied to the others too.
On the last day of training, Roger recorded each of us while speaking, reading and singing the same material as the first day. Each of us showed marked improvement.
Because of Dr. Kantor’s schedule, he only saw two participants at the end of the two weeks. The other two were scheduled to come back in two weeks to be examined and have their cords videoed again.
Roger sent us home with the tapes from the sessions and instructions on how to finish fixing our voices. We were told to practice at least an hour a day. He plans to keep in touch with each of us.
Roger said that his motive for doing this was simply to prove that his methods work. He said each of us could regain our normal voices. He said he wanted to debunk the mysterious shroud around SD. Each of us had different mechanical problems that can be fixed. He has no financial motives, and does not seek to be the “go-to” person for SD. He is happy and successful at coaching and training singers and professional speakers.
I have had adductor spasmodic dysphonia for three years. I had one Botox injection about two years ago and it was helpful for about three weeks. I then made a personal decision not to have anymore Botox injections and have been coping with SD the best I can. Working with Roger Love over the past two weeks was amazing. His knowledge, commitment and dedication to this study are incredible. During the two-week study, we had the opportunity to work with Roger every day in a group setting, as well as individually for a couple of hours. While his general techniques have been extremely helpful, his attention to my specific breathing habits and use of air flow while speaking helped me to identify specific areas of focus..
My initial problem was that I was using too much cord and not enough air flow. We observed that I always tensed my stomach muscles in anticipation of talking, which did not allow enough air to push up to the vocal cords, thus creating spasms. I also realized that I constantly tensed my stomach even when I was not talking. When I consciously made an effort not to tense my stomach muscles at all times and used his techniques to allow for better air flow, I noticed that my breathing was much better and easier, and I got to the point to where I did not have to think about it as much.
I started out each session by singing scales along with Roger playing them on the piano. Toward the end of each session, we practiced speaking. He had me working in my “chest voice” the majority of the time. I always talked with the sound in my nose and Roger pointed out that I needed to get the sound out of my nose. I also needed to learn to open my throat more by lowering my larynx, which would allow fewer spasms of the cords. I did this by pulling my tongue down lower, which actually pulled the larynx down. This was challenging, however, during my last session I had a breakthrough! Somehow, all the practicing I had been doing opened up my throat and allowed me to sing and talk using my “head voice,” which I had not done before. When I talked in my head voice, I had no sound in my nose, which allowed me to use the right amount of air with the right amount of cords and it was so much easier for me to sing and talk. The goal is to get very good at talking in my head voice and eventually bring my voice down to my “middle voice” in a few weeks.
I am very fortunate to have been a part of this study. Since I have returned home from the study, I have noticed that the ease in talking is much better. Practicing the techniques he has given us, every day, is the key to making this work, so I will continue to work on the exercises and techniques until my voice is 100% better.
The whole trip and study with Roger Love was a dream come true. I was diagnosed with adductor spasmodic dysphonia five years ago. I had one botox shot but my instincts told me that if I ever wanted to recover my voice, I would stay away from botox.
I concentrated on improving my health, and did, but my voice did not magically come back. I had traditional voice therapy for 11 weeks. I learned easy onset and practiced speaking in a breathy voice. I learned exercises to relax my neck, cheeks, jaws and tongue. This was helpful and I did learn that I could speak in a breathy voice. However, it did nothing to build my voice. In fact, I think it got weaker from all the breathy speaking.
I had long felt that my voice problems needed strong vocal intervention by a daring expert.
When Roger first put me through my vocal paces. I was woefully inadequate. Let me tell you it took a lot of courage for me to stand up before anyone and sing for them, much less a famous Hollywood vocal coach. Although he winced a few times, he was very kind, and I came to think he is one of the nicest human beings I have ever met. Roger told me right away I wasn’t using enough air to speak, and my air supply was also unsteady.
He said what I needed was a steady stream of plentiful air vibrating the vocal cords. We all needed to work on airflow, relaxing our jaws, tongues, and stomachs, and keeping our larynxes down.
Roger told me later that the first 15 minutes of testing me, he asked himself what he had gotten himself into. After 15 minutes he finally found a note that I could hit and maintain a stable voice for more than 3 seconds – the F note. He told me to sing and speak only in head voice on F for the next 24 hours. This was to get my vocal cords in the habit of vibrating with the right amount of air and cord. That was our first breakthrough – getting the vocal cords to vibrate properly.
We worked on getting the vocal cords to vibrate at different pitches. We worked on reading. I had the habit of speaking one word at a time, then stopping. I had the habit of letting my air stop off before finishing the word. I had a hard time connecting the words and speaking in a smooth flow. Roger said to finish each word with air enough to start the next word. He had us visualize the air coming out in a smooth steady stream of blue. One day I practiced saying single words perfectly. Then we went on to saying more words at a time.
I was so inadequate at singing the scales, and when I tried it seemed to undo my speaking, that we concentrated mostly on smooth airflow, singing the vowels on one note, and speaking. At the end of the two weeks Roger told me I would have to get to the point where I could do the singing exercises in order to strengthen my voice.
All this was not easy. Even though my mind understood what he was saying, it took a while for me to “get” it. And even more time to be able to do it!
At times he had us move our ribcage from side to side while singing, move our jaw from side to side while singing, rotate our neck, and various activities designed to make it impossible to clench certain parts of our bodies that were blocking free airflow.
After a week of him telling me to use more air, he finally told me to go home, put my hands around my neck and figure out how to speak without moving my neck muscles. I went home, laid on my son’s massage table, put my hands around my neck, and tried and tried to speak without moving my neck muscles. Finally I discovered that if I – yes, USED MORE AIR, that my neck muscles didn’t move. I had been pushing the sounds out with my neck muscles instead of letting them ride out on a stream of air That was my personal epiphany. I went back the next day and said “Hey, Roger, I figured out that I need to use more air!”
Each of us had several breakthroughs and times of near-perfect voices. There were also times when we slid back into our old ways of doing things.
Roger told us that we had mechanical problems with speaking, and they could be fixed. He said “Do you want to let tight stomach muscles, or tight neck muscles, ruin your life? Of course you can gain control over your muscles! I’m showing you how!”
Roger told us that he has no doubts but that we can completely recover our voices and we will sound just the way we used to.
The last day of the two weeks, I was again seen by Dr. Kantor. He had me talk, sing, and put the scope down my throat and videoed my cords while talking and singing. Dr. Kantor, Roger Love, and the technician all said I had greatly improved.
I was so privileged to be a part of this study. When each of us four fully recover our voices, it will change the way the medical community looks at spasmodic dysphonia and give hope to thousands of SD sufferers.
Successes 10 Days Later
Let me emphasize that I practice at least an hour a day, and it is having results.
I started answering the phone again at work. One day a big corporation called looking for someone to service a 12-computer network they are moving to our town. He wanted to grill me, the software person, on my knowledge, so I talked with him and did fine. My husband was on the line. He said my voice sounded a little tight but there was no problem understanding me, and the questioner didn’t seem to have any reaction at all to my voice.
Yesterday at a restaurant in a noisy environment I automatically leaned over close to my husband’s ear and gave him my order so he could repeat it to the waitress. The waitress actually heard the order and repeated it to me to confirm. After she left my husband said “Okay kid, you’re on your own. I’m not your voice crutch any more.”
I have learned that when my voice gets spasmy and low, it is first my breathing that gets short, sharp and irregular, and my stomach gets clenched. At that point I have no chance of getting proper airflow to the voicebox. I need to stop talking, go somewhere quiet and relax (small nap is good), get my breathing in order, then start singing the vowels on the F note in head voice to get the vocal cords vibrating again. After I get my vocal cords vibrating, the most important thing I have to do is push out the air from my stomach and keep the throat muscles disengaged. I have to use the stomach muscles to push the air out, not just let if flow out on the exhale, and sometimes I push my stomach in with my hand. (This is not to be confused with tightening the solar plexus area, which actually stops the airflow.)
Getting the airflow correct gets the voice out of the throat and the pitch adjusts itself automatically. I pretend I have fish hooks attached to the neck muscles, and if I move them it will hurt.
I have gotten to the place where I can do the singing exercises slowly, and am practicing.
So we march on triumphantly, or plod along, depending on the day. But WE DO OUR EXERCISES regardless of whether we are marching or plodding.
Micki Nellis, August 1, 2005 ***
My experience with voice therapy in the Roger Love study of Spasmodic Dysphonia by Ron Barrett
I entered the study on Wednesday, July 13th with a visit to the offices of Dr. Kantor for an examination of my larynx and a video of it while speaking and emitting certain sounds as directed by the doctor. I was also asked to sing the song “Take Me Out to the Ball Game.” I could sing better than I could talk. I was mildly surprised since I almost never attempt to sing since contracting SD. From Dr. Kantors office I drove to Roger Loves studio and met the other SD sufferers participating in the study. I had no idea what to expect since Roger had not supplied any details of what we would be doing. I learned that he believes that with a continuous and sustained flow of air through the vocal cords and a relaxed larynx, a non SD voice can be created. We did this by singing since it is more normal to connect all words together and have a sustained airflow when singing. I have read a lot about SD, and the general consensus among medical professionals treating SD is that voice therapy does little, if any, good since SD is a neurological disorder that the sufferer can have no control over.
Wednesday, July 13
My experience with Roger Love was that on the first day of the study and within 15 minutes he was able to show me how to sustain an airflow, raise the pitch of my voice, relax my larynx and speak easily and normally for about 5 minutes. This was recorded onto a cassette tape as were the sessions we had over the next 6 days. When I returned to my daughters home after the first day and she heard my voice on the tape she was very surprised since she had not heard me speak without SD for 12 years. I spent about 30 minutes listening to the tape and doing the exercises. I sounded fairly normal while following the tape, but I found that when I spoke to my family I could not maintain the voice Roger had helped me create on the tape and earlier in the day. This was quite disappointing to me. My belief going into the study was that I would progress a little each day until I was “cured”. When I found that I had not “progressed” I was very discouraged. I began to doubt that I could overcome SD and that I was wasting Roger´s time with me being in the study. I wanted to call Roger and drop out of the study, but by the next morning I was feeling better. I played my tape during the 2 hour commute to Roger´s studio and by the time I arrived I had a fairly decent voice, and was feeling positive about my progress.
Thursday, July 14
Today we started out doing sustained “Aey” scales. After a minute or so I was able to do the sustained sounds with very little noticeable SD. We then did the “gug” through “nay” scales with the piano. I was again surprised at how high I could sing and the relative clarity of my singing voice. When I sang the lower notes I had the most trouble. A great deal of this seems to come from the amount of phlegm on my vocal cords. On this 2 nd day of the study I learned that if I increase the volume of my voice as if I am speaking to someone 20 feet away, I can speak clearly with very little SD systems at all. I also noticed that this only worked for me when I was reading or repeating what Roger was telling me to say. Nevertheless, the sound of my voice was clear, strong and very little SD symptoms at all. I sounded great! I left Roger’s studio determined to keep my voice strong and loud the rest of the day. Three of us went to lunch after our session and I noticed that I went back to my usual way of speaking, even though I really tried to avoid it. As soon as I got to my daughters home I tightened up, tensed my stomach and sounded just like I always do. I was able to intermittently put out a strong, clear and loud voice, but not without a lot of pausing and preparing to do it. Pretty frustrating.
Friday, July 15
Today we started out talking about how most SD sufferers tend to talk in a staccato manner, stopping between words. Roger’s approach is to have us sing all of our speech so that we mentally begin connecting all of our words together. I noticed that the more I sounded like I was singing, the less stressful it was to “speak”. We focused on me learning to sustain a pitch, allowing my stomach to relax and come in rather than push it out (which is what I usually do), and connect all of my words together. We learned that the singing exercises we do are not to teach us to sing, but to “reprogram” our brains to a new belief of how we are supposed to sound when we are speaking. I learned that if I consciously lower my larynx I can create a lower and clearer voice. This seems to be related to creating a much freer air flow that is not restricted by my larynx. Today my focus became sustaining the vowels in each word, allowing my stomach to come in while I speak, connecting all my words and lowering my larynx while I speak. I also have to try to speak with a “Yogi Bear” sound like I am deliberately trying to sound funny. This seems to make for a lower and more clear voice. Keeping the volume up is also critical. As soon as I lapse back into a soft voice, the SD comes back immediately.
I practiced my exercises using the tapes we made over the past 3 days. I can do pretty good keeping my voice unstrained and clear while I am following the tapes. It works especially well if I lie on my back while doing them. I have trouble not tensing my stomach and holding my breath while speaking. Lying on my back greatly alleviates this. It seems that as soon as I have to speak spontaneously without a script or following the tape, I immediately relapse back into my SD mode of speaking. I believe that this is about 90% emotional and not neurological as is believed by nearly 99% of the medical and SD community. I can feel the tenseness coming into my body as soon as I start to speak. It comes BEFORE I make a sound. It is pretty frustrating to know that I have control over my speech, but can’t seem to find a way to exercise that control.
Monday, July 18
Most of the time today I spent in the Gug through Nay scales. As long as I was singing the tones, I sounded pretty good. We also talked about falsetto voice and how it is formed without the use of the vocal cords so is much less affected by SD. Today it was difficult to maintain a low larynx voice. Toward the end of the session I lost the ability to maintain an even air flow. I started pushing out my stomach and holding my breath. Roger used the torso swing to force me to relax my stomach while speaking. This gave me the ability to sound totally normal for a few sentences. BUT the more I concentrated on relaxing my stomach the more difficult it became to do so. The more we focused on my issue of holding my breath and tightening my stomach the more difficult it became to speak. We discussed that much of SD is caused by the mental preparation of speaking and that SD is not purely neurological. If SD were a purely neurological condition, I would have no control over it at all. I learned that I do have control over it, but my emotional state can have a powerful effect on my ability to do so. My assignment for tomorrow is to practice the torso swing until I can do it while speaking. This helps me to maintain an even airflow and avoid tension in my voice.
Tuesday, July 19
We started off reviewing what I had done last night. Roger got me to talking in a fairly normal voice and then we started reciting from the book, Logan and the Duck Patrol, that we have been using in the study. All during the time that Roger was reading and I was repeating what he said, I sounded perfectly normal. I also had no stress or tension in my throat as I usually do. As soon as we began discussing how good my voice was sounding, I began to tense up and all of the SD sounds came back. This is totally related to emotions and has nothing to do with brain function. We learned that mind set and physiology are linked and that by focusing on the positive progress we are making will cause a change in the physiology of the way we speak. This in turn will produce a change in the way we speak. The more focused we can become on the positive progress we are making the more progress we will make. I learned that I have the least issues of SD in the study group, but because of my mind set I seem to cause Roger the most trouble. By speaking like I am singing (connecting all the words and keeping an even airflow) and keeping my larynx low I can keep a good voice with very little effort.
Wednesday, July 20
Today is the last day of the study. I started with singing the scales and sounded great. After a few minutes a large amount of phlegm started bothering me. I found that by adding a slight amount of nasal buzz to my voice, it helped with the phlegm. Roger also suggested that I look into a product called Humabid LA which helps thin phlegm so it is not so thick. He also suggested that I get an ultrasonic humidifier to help keep my cords moist and the phlegm as thin as possible. He had me focus on the torso swing which makes it very difficult to tense my stomach. This produced the clearest voice I had had all week. We ended the day with me reciting from the book, Logan and the Duck Patrol and finally by singing Take Me Out to the Ball Game .
It was a great week of learning about how the voice works and how my emotions can have a dramatic effect on my ability to speak. I have the tools to use as I practice the techniques Roger has suggested. I know that it is up to me and that I can have a clear and relaxed speaking voice. I am also convinced that I will be able to sing again. “I can if I want.”
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