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Cures of Hopeless Spasmodic Voices (SD) by One Lone Doctor in the World vs. the Entire Medical Establishment Worldwide
 
SPASMODIC DYSPHONIA: CURES, RECOVERIES AND IMPROVEMENT BY DIRECT VOICE REHABILITATION

The goals and objectives of this presentation are:
1) that participants will acquire a new orientation to SD,
2) that participants will learn how Direct Voice Rehabilitation finds success, including cures, with SD, and
3) that participants will consider new skills and techniques for treating SD.

Spasmodic Dysphonia (SD) is considered to be a hopeless condition by the medical profession. The treatment of SD is to contain the symptoms, not to cure the problem. Since Traube first described SD in 1871 (one hundred thirty years ago), the medical profession has never reported a single cure of this condition and insists the condition is incurable. SD is neurological problem, a dystonia, with the center of the disorder in the basal ganglia, according to current reports in the medical and speech pathology literature. In addition, other medical paradigms attribute SD to a gene related problem, chemical imbalance in the brain, a central nervous system dysfunction due to a virus, etc. I disagree markedly with these theories, finding the cause is voice misuse and abuse, with psychological overtones.

Over the past 35 years, I have been reporting improvement, recoveries, and cures with Direct Voice Rehabilitation (DVR).  My approach to SD is the same I use with all types of voice disorders, as well as to improve the speaking voice from a normal to a professional sound.  In the treatment of voice disorders and voices in general, I emphasize the variables of pitch, tone focus, and breath support.  These are the three variables that affect and control quality of voice as well as volume. 

My essential approach to SD is to quickly locate the optimal or natural pitch level and range within seconds of the evaluation of the patient’s voice.  The techniques to do this are the instant voice press, humming “Happy Birthday” (first bar), and the “um-hum” technique. Securing an optimal pitch level and range is not the vital attribute to changing the spasticity of voice, even though I can tell the optimal or efficient voice, the essential item is to refocus the voice from the lower throat to the mask (balanced oral and nasal resonance).  Pitch is merely a variable and quite often the most responsive variable that allows the focus from the lower throat to the mask area.

 Step one is to have the patient sit before the Voice Mirror to use the simple sound, “um-hum.”  Nearly all patients with SD can say the sound with the lips closed.  The “um-hum” sound is basically within the optimal pitch level and range of where the voice should be.  This level and range is essentially at odds with and different from the pitch level and range of the SD voice.  The “um-hum” places the voice in the mask, around the lips and nose.  The “um-hum” has not been utilized as a pitch pipe or method although it serves the same function.  The “um-hum” allows the optimal pitch level and range and efficient tone focus as well as a correct tone, all within the context of the “um-hum” itself.  The “um-hum” approach replaces the piano as the basic means of finding the optimal pitch level and range, replacing it with the natural sound of the individual spontaneously and sincerely saying, “um-hum.”  The efficient focus of the voice in the mask can be felt as a tingle, buzz, or ring about the lips and nose.  The “um-hum” approach relies upon the sensory feel by the patient to reproduce the correct placement of voice.  The Voice Mirror allows the patient to get visual feedback by seeing the pitch level and range of the “um-hum” as compared to the so-called normal voice or the SD voice and where it is pitched in normal conversation.  The SD voice is essentially pitched too low but can be and is, at other times, pitched too high.  Regardless of the pitch being incorrect, either too high or too low, the pitch is placed within the lower throat and forced from the laryngopharynx.  The “um-hum” repitches the voice naturally and automatically and refocuses the voice from the lower throat to the mask at the same time.  The pitch of voice is correct for some SD patients, but the focus is always from the lower throat, the one place that nature will not allow the voice to be produced for normal conversation, per se.  

I I take a step-by-step approach, concentrating on the location of the optimal pitch level and range, at the same time gaining the focus in the mask with the individual repeating the “um-hum” over and over until the contrast between the wrong pitch and tone focus is seen and felt. 

The “um-hum” breaks the pattern, but the “um-hum” must be in the mask, not the lower throat.  Again, there is no substitute for the ear of the clinician.  I work off this sound hour after hour until the patient gets the feel of this sound in the mask. I then move to the “um-hum” and the word, matching the “um-hum” to the word with the same pitch level and focus.  I have the patient progress to “um-hum” and a word, then “hum” and a sentence, all at the same pitch level and tone focus.

Basically all SD patients misuse or reverse the breathing pattern in that rather than exhaling as they talk, they hold their breath or let the air out quickly on a word or two and continue talking or reverse the breathing pattern so that the stomach pouches out when they talk rather than moving in gradually and consistently.   (Exercises to achieve mid-section breath support will be demonstrated.)

 Almost invariably, the patient complains that the new pitch level and tone focus is a negative rather than a positive voice.  This is the over-whelming reaction of almost all patients undergoing DVR.  The voice image is a most vital psychological and emotional attribute that must be understood by the clinician and the patient and dealt with to the patient’s satisfaction. 

 For recovery and cure of SD or any dysphonia or voice improvement, a cooperative patient and a competent voice clinician is essential. 
 In this presentation, audio and videotapes of cured SD patients before and after DVR will be shown. In addition, step-by-step DVR techniques will be demonstrated.  Actual patients who have been cured from SD by DVR will be presented.

The audience can ask questions throughout the presentation.  Participants will be able to experience hands-on therapy provided to SD patients.  SD patients will be present to explain their experiences with SD and their cures and recoveries by Direct Voice Rehabilitation. The patients will also answer questions from the audience.