Voice Disorders and the Role of Stress

Most health professionals are well aware that stress can be hazardous and effect functional activity.
The impact of stress can range from the excessive secretion of gastric acid in the stomach, to stress related back, neck and headache. General stress decreases life enjoyment, functional activity and certainly productivity in the workplace.

Clinically, when assessing and treating voice disorders, the Speech Pathologist should not only take a thorough case history but should always `get to know` their client. Professional boundaries are always maintained without question, however, through conversation and the early stages of therapeutic interaction, much can be learned about the individual`s personality and the role that stress may play in their life. The clinician should be aware of the various forms and aetiology of stress. Whether the stress is exogenous, that is from external sources or endogenous, that is from internal personality drives, traits, tolerances and expectations of self and others.

Muscular tension can not only cause a voice disorder, it can be responsible for the negation of therapeutic technique employed and can undermine potential positive outcomes.

Voice quality relies upon relaxed musculature, particularly, the muscle groups within the larynx, pharynx and neck. Unfortunately, these muscle groups, due to their inner structure and nerve innervations are more susceptible to stress and anxiety. Muscles that are under stress tend to tighten, causing mechanical limitations and inhibiting natural movement.
Stress, together with moderate to high vocal usage, can result in Dysphonia; a breathy or sometimes croaky voice and a reduction in quality, loudness- intensity, resonance and pitch range.

An individual will detect this change in muscular tension and immediately attempt to clear their throat back to normal. In doing so, they unwittingly tighten the muscle groups further with increased tension, experiencing further loss of voice quality. Increased levels of muscular tension and a pattern of pushing the voice out is the result. The client with a chronic voice disorder then arrives at our consulting rooms
for treatment.

Clinically, patient education is crucial at this early stage. The mechanics and dynamics of voice production are detailed to the client. Certainly a period of voice conservation is recommended and a set of specific Vocal Do`s and Don’ts is supplied. General and then specific relaxation exercises are introduced, demonstrated and encouraged between sessions on a regular basis. Voice therapy can then be introduced and tends to be more effective in the attempt to restore the normal and natural mechanics of voice.
Due to the nature of Voice Therapy, client –clinician trust is an important factor.
Before therapy commences the rationale of the techniques should be explained carefully.
Voice therapy is both physical and perceptually based. If the clinician-client relationship has a firm foundation, then a positive clinical outcome is the result.

Mr Craig Gorman
Speech Pathologist
Melbourne Speech Clinics

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