Yes, I was that SLP who took their iPad up to the register at McDonalds, typed in my message and pressed the voice output button “Can I have a large double quarter pounder meal please?”. I could tell that the cashier was quite surprised, both at the size of my order for quite a little SLP (I love a burger, what can I say?) and that I was using AAC to communicate. But you see, I had lost my voice and I knew the importance of vocal rest.
Now, I don’t remember too much else about voice, I must admit. A lot of us probably wouldn’t. So to save me from using my iPad the next time I’m at Macca’s, I decided to ask the AMAZINGLY brilliant Kristie Knickerbocker the questions I probably once knew.
I can always tell when I’m going to lose my voice. What are the different reasons SLP’s lose their voices and can we actually prevent it?
Aphonia can becaused from a variety of things, but a common cause is laryngitis. Laryngitis is an inflammation of the larynx. Many professional voice users can have chronic laryngitis from vocal overuse, but other factors may exacerbate (or make worse) the symptoms. Allergies and Reflux are often thought to make laryngitis worse. I am a professional voice user in my job as an SLP, so I keep my aphonia to a minimum by staying hydrated so vocal fold secretions stay thin and lubricating, I rest my voice when I can, and I make sure I am utilizing resonant supported voice when talking to my patients. If and when I get allergies or an illness where my vocal folds are swollen, I keep in mind that there is really nothing to do except consume fluids and rest my voice, as I know I could cause damage if I “push through” my work day with talking.
I know that liquids make or break your voice when you have lost or are in the process of losing it. Is there something I should be drinking more than other things?
There was a recent study about hydrating beverages and what stays in your body the longest. Interestingly enough, they looked at rehydration after a person was dehydrated. Fat-free milk, pedialyte and whole milk had rehydration index scores around 1.5, and orange juice was not far behind at 1.1, and all were more hydrating than water at 1.0. The study was actually funded by the European Hydration Institute which is supported by funds from Coca-Cola. Read another article about this.
I’m a huge fan of complete vocal rest, but what if I know that I need to talk? Should I do any vocal exercises or warm-ups to prepare for talking?
A recent blog I wrote talks about vocal rest versus resonant voice. The study discussed in the blog shows that there is a benefit to producing resonant voice sounds, which are forward focused with easy feeling to promote low impact vocal fold vibrations (this means the vocal fold barely touch) The benefit was found to be present after a vocally loading task (like yelling for a while) when compared with strict voice rest or continued talking with no modification. It should also be noted that the resonant voice group also rested their voice as well.
Have you got a little routine for how an SLP can structure their work day and protect their voice if they think that they might lose it?
What I do in my practice as an SLP, is I do Joseph Stemple’s Vocal Function Exercises twice per day. I recently had the pleasure of listening to a lecture given by him in October at Fall Voice Conference, where he was talking about statistically significant differences/improvements when using these VFE’s, and what was found was that doing them once per day didn’t produce a difference. 2 times per day, did, and 4 times per day made a huge positive impact. I also make sure I am charting while being completely silent, and I try to chart right after the patient leaves so I have 10 minutes in the 60 minutes of time to rest. I weigh around 120lbs, and don’t take any dehydrating medication. I try for 64oz of water daily throughout the day.
What are we doing or using in our everyday lives that we might forget has a negative impact on our voice and recovery time?
Multiple things can have a negative impact on the voice. This includes phonotrauma, which is throat clearing, coughing, pressed talking, and talking at an increased volume for long periods of time. These behaviors increase the collision forces of the vocal fold tissue, possibly leading to swelling and/or lesions. I also make sure that if i’m taking pain killers for a headache I’m not taking any ibuprofen as it thins my blood and puts me at risk for vocal fold bleeding for about 24 hours. I take acetaminophen if I know I’ll be using my voice. I make sure I’m not taking aspirin if I know I’ll have heavy vocal load, as it can stay in my system for 7-10 days and increase my bleeding risk, especially if i’m already sick with laryngitis or a cold. Read more on this topic at Kristie’s blog.
What message or tip do you find yourself saying over and over again that we’re just not doing?
Haha. Don’t yell at your kids! This is a struggle for me as a parent, and as an SLP. I tell my patients to use lights, clap hands and ring bells. I remind them to come to the communication partner instead of yelling up the stairs, but as my littles are yelling for me from the other part of the house and I’m bent over in the washing machine moving clothes to the dryer, I find myself doing exactly what I tell them not to do! Hey, we do our best.
Disclaimer: This blog/interview is for informational purposes only and is not meant to substitute for recommendations from a licensed physician, laryngologist, ENT or SLP. If you have voice issues, please see a qualified professional for an instrumental exam so a care plan can be tailored to your specific needs.
Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on vocal health to area choirs and students. She also owns and runs a mobile videostroboscopy and FEES company, Voice Diagnostix. She is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders, and a member of the National Association of Teachers of Singing, Voice Foundation and the Pan-American Vocology Association. Knickerbocker blogs on her website at www.atempovoicecenter.com. She has developed a line of kid and adult-friendly therapy materials specifically for voice on TPT or her website. Follow her on Pinterest, on Twitter and Instagram or like her on Facebook.