By: Jeni Leeps, Caitlin Montgomery, and Jennifer Rose Gonzalez
What are Vocal Function Exercises?
Vocal Function Exercises (VFE) are therapeutic tasks used to strengthen and increase coordination of the muscles of voice production. VFE was originally developed by Dr. Joseph Stemple. The treatment protocol for VFE is broken into three main exercises. In combination, these tasks can effectively “strengthen and balance the laryngeal musculature, increase or improve vocal fold adduction, and coordinate the subsystems of voice production” (Stemple, 2020).
There are three main steps to the VFE protocol.
1. The first step is a vocal warm-up in which the patient performs a maximum phonation task on the vowel /i/. This task engages the vocal mechanism and emphasizes the importance of respiration on the production of voice.
2. During the second step of VFE, the client performs pitch glides on open vowel words such as “whoop”. The client should feel a yawn-like posture of the oral cavity. Pitch glides are performed from the lowest to the highest possible pitch and vice versa. This
step induces stretching of the vocal folds increasing flexibility and muscle coordination. (Jasmine, 2019).
3. The third step of VFE, a prolonged phonation exercise, is useful in modifying the tone of voice and promoting respiratory drive to sustain pitch. The goal of the task is to sustain /o/ for as long as possible with a soft voice and focused tone with no breathiness. The phoneme /o/ is used to encourage a forward focus of airflow, thus relaxing any excessive strain on the larynx (Greenleaf, 2016).
Populations Who Benefit Most from VFE
● Hyperfunctional Voice Disorders
● Hypofunctional Voice Disorders
● Age-Related Voice Changes
● Elite Vocal Performers
● High-Intensity Voice Users
(Angadi, Croakes, & Stemple, 2019; Bane, Angadi, Dressler, Andreatta, & Stemple, 2017; Gorman, Weinrich, Lee, & Stemple, 2008)
Efficacy of VFE
VFE has been widely studied and found to be effective across many patient populations. Angadi, Croake, & Stemple found the effects of VFE to be mild-to-moderate across objective measures of vocal performance (auditory perceptual measures, acoustic measures, aerodynamic measures, and visual perceptual measures) and moderate-to-strong on voice self-report measures. This study also revealed a link between compliance and efficacy (Angadi et. al., 2019).
Another study examined the effects of varying doses of VFE home practice on the attainment of pre-established MPT. In this study, 28 females without voice disorders participated in this pre- and post- longitudinal group study. Participants completed a 6-week VFE protocol with practice twice a day with varying dosages. The results of VFE increased all participant’s MPT with significant results for the high dosage group (Bane et. al., 2017).
Age-related voice disorders are increasing as the United States population ages. According to the National Institute on Aging, by 2050, there will be more than 89 million people who are 65 years old or older. Gorman and colleagues examined the efficacy of VFE on older adults and found that after 12 weeks of training, VFEs increased MPT and improved glottal closure in older men (Gorman et. al., 2008).
Angadi, V., Croake, D., & Stemple, J. (2019). Effects of Vocal Function Exercises: A Systematic Review. Journal of Voice, 33(1), 124.e13–124.e34. https://doi.org/10.1016/j.jvoice.2017.08.031
Bane, M., Angadi, V., Dressler, E., Andreatta, R., & Stemple, J. (2017). Vocal function exercises for normal voice: The effects of varying dosage. International Journal of Speech-Language Pathology, 21(1), 37-45. doi:10.1080/17549507.2017.1373858
Gorman, S., Weinrich, B., Lee, L., & Stemple, J. C. (2008). Aerodynamic Changes as a Result of Vocal Function Exercises in Elderly Men. The Laryngoscope, 118(10), 1900-1903. doi:10.1097/mlg.0b013e31817f9822 Greenleaf, E. (2016). Vocal Function Exercises. Emily Greenleaf. http://emilygreenleaf.com/vocal-function-exercises/
Hapner, A., Ziegler, A., & Hapner, E. (2003, March 1). The Behavioral Voice-Lift. Retrieved November 08, 2020, from https://leader.pubs.asha.org/doi/full/10.1044/leader.FTR4.18032013.np Jasmine, L. (2019) Vocal Function Exercises. Naples Speech Therapy. http://naplesspeechtherapy.com/vocal-function-exercises/
Stemple, J. (2020). Vocal Function Exercises. MedBridge. https://www.medbridgeeducation.com/course-catalog/details/vocal-function-exercises-joseph-stemple-speech-langauge-pathology-vocal-therapy/