Optimize the Flow of Your Voice Therapy Patients: Flow Phonation

 Do your patients “sigh” a lot? Are breath-holders a big part of your voice therapy schedule? They’re a big part of mine!

Voice therapy techniques and programs focused on airflow management are evidence-based ways to facilitate optimized speech breathing while reducing muscle tension, and all that is required is tissue or your finger to see and feel the flow of air, something we all have around us.

What is flow phonation?

Flow Phonation, in particular, is a hierarchical therapy concept that aims to facilitate increased airflow, ease of phonation, and direct oral resonance. It was modified from Ed Stone's Stretch and Flow Phonation by removing the "stretch" component, which slowed speech in the original program for those patients who were hoarse.

Flow Phonation can be used with both symphonic and aphonic patients. Ultimately, therapy aims for clear speech while focusing on airflow and the balance between airflow and voice production.

What Are the Hierarchical Levels of Flow Phonation?

During flow phonation, patients are asked to notice the frontal energy/airflow without feeling tightness in the throat. This is not a programmatic approach to voice therapy as it allows clinicians to use their clinical judgment to determine the best way to achieve each skill level.

Flow Phonation consists of four skill levels:

  • Airflow release

  • Respiratory phonation

  • Flow phonation

  • Clear speech/articulatory precision

The first three skill levels are taught with articulated and non-articulated objectives. The exhaled voice is used for unarticulated targets to direct the flow of air in a column from the lips to achieve a visual cue: an easy and steady flow of air that is felt in lips or looks for an uplift piece of tissue. Articulated goals involve changing the shape of the oropharynx to produce different consonant-vowel tasks and, ultimately, connected speech.

The patient goes through all four skill levels, but if problems recur, he/she can return to the previous level until functional performance is reached. Furthermore, if a patient can skip a level, they are also allowed to go through the hierarchical levels as quickly as required individually.

How Can You Determine if Flow Phonation Is Right for Your Patient?

Determining the most appropriate voice therapy technique is crucial to patient improvement and success. Flow Phonation seeks to restore vocal balance and provides a conceptual framework towards an efficient voice for patients. Fluent phonation is best for patients who have increased muscle tension and who frequently exhibit tendencies to hold their breath during phonation. For more information related to Flow Phonation, how to implement it in your practice, and troubleshooting techniques, see Deborah Weisberg.

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