Vocal Function Exercises

Vocal function exercises are a set of four exercises designed to help people regain healthy vocal function.

The program was developed by Joseph Stemple in the ’90s and has since been shown to enhance vocal function in people with normal and disordered voices, presbylaryngis, and even professional voice users (Angadi, 2019).

So what are the exercises? What’s the home program and maintenance schedule? And how do you teach them to your patients?

In this post, you’ll find a step-by-step, easy-to-follow guide to vocal function exercises.

For more step-by-step guidance, check out The Adult Speech Therapy Roadmap, an online course that teaches you how to assess, treat, and document all major areas of adult speech therapy!

More Popular Posts

• Voice Therapy Treatment Ideas
• Goal Bank for Adult Speech Therapy
• Complete Guide to Assessments

Before Starting Vocal Function Exercises

Before teaching the exercises, coach patients on how to elicit the target sounds successfully:

1. Posture: Upright yet comfortable
2. Breath: Abdominal breathing without tension. Either nose or mouth breathing are fine
3. Placement: Place the sound forward towards the lips (or, towards the mouth and bones of the front face)
   • Practice the following sounds first to ensure proper placement: sounds should be soft yet with full vibration
     • /i/, make a very nasally sound (“nasty nasal”) to keep the sound forward and off of the vocal folds
     • “knoll”, imagine speaking like a “reversed megaphone”: wide open throat with the lips rounded and almost closed Lips should buzz
4. Onset: Light but not breathy, and definitely not a glottal attack!

Determine Max Phonation Time

You can estimate your patient’s goal phonation time by asking them to sustain a /s/, prompting them to make it “soft and skinny.” Complete 3 times. Their longest trial will be their goal phonation time.

Vocal Function Exercises

1. Warm Up

“Sustain the vowel /i/ for as long as possible on the musical note F.”

The therapist plays the musical note F.

“First, take a deep breath. Place the sound. Go.”

Repeat two times.

• For the musical note
  • Use a pitch pipe app, pitch pipe, keyboard, etc.
  • Use F above middle C for female patients and F below middle C for male patients
  • They don’t have to perfectly match the note. It’s okay if they’re slightly off-key
• To place the sound: remind your patient to use a “nasty nasal /i/ sound” to keep the sound forward and off of the vocal folds
• Encourage using the abdominals to squeeze the sound out as long as possible
• Time and record how long the patient can sustain each
• Take note of any voice breaks, wavering, or breathiness. These should improve as the voice improves

2. Stretch

“Go from your lowest to highest sound on the sound knoll.”

“First, take a deep breath. Place the sound. Go.”

Repeat two times.

• To place the sound: remind your patient to make a reversed megaphone, making a wide open throat with the lips rounded and almost closed. Lips should buzz
• Start from the lowest sound (without a glottal fry) up to the highest sound
• Encourage a slow, controlled exhalation contraction
• Take note of any voice breaks, wavering, or breathiness

3. Contract

“Go from a comfortably high sound to your lowest sound on the sound knoll.”

“First, take a deep breath. Place the sound. Go.”

Repeat two times.

• To place the sound: remind your patient to make a reversed megaphone
• Start from a comfortable high note then glide down to the lowest sound (without a glottal fry)
• Encourage a slow, controlled contraction
• Take note of any voice breaks, wavering, or breathiness

4. Power

“You will sustain 5 different musical notes for as long as you can on the sound knoll without the kn.”

“Start with the note C (therapist plays the note).”

“First, take a deep breath. Place the sound. Go.”

Repeat two times.

• The should make the sound “oll”
• Repeat on the notes D, E, F, then G
  • Start at middle C for female voices and an octave below middle C for male voices
  • If the sounds are too high or too low for a patient, adjust the starting note by 1-2 notes, as needed
  • Use a pitch pipe app, pitch pipe, keyboard, etc.
• To place the sound: remind your patient to make a reversed megaphone
• Time and record how long the patient can sustain each
• Take note of any voice breaks, wavering, or breathiness.

Vocal Function Exercises Home Program

Home Program

The Goal: Reach and maintain the goal max phonation time (for exercises 1 and 4).

How Often: Complete all exercises 2 times each, 2 times per day.

What To Record: The patient should time and write down how long they can sustain each sound (for exercises 1 and 4).

For How Long? Do all exercises 2x each, 2x per day for 8-10 weeks.

This is, on average, how long it takes to reach the max phonation time and then to sustain it for around 2 weeks

7-Week Maintenence Schedule

A follow-up visit is recommended after completing the 8-10 week full home program above.

After patients can maintain their max phonation time for about 2 weeks, they will transition to the following 7-week maintenance schedule.

The Goal During the Maintenance Period: Maintain 80% of max phonation time. If the patient can’t, move back up in the maintenance schedule until they can.

Maintenance Schedule

• Week 1: 2x each, 2x per day
• Week 2: 2x each, 1x per day
• Week 3: 1x each, 1x per day
• Week 4: Exercise 4 only, 2x each, 1 time per day
• Week 5: Exercise 4 only, 1x each, 1 time per day
• Week 6: Exercise 4 only, 1x each, 3x per week (every other day)
• Week 7: Exercise 4 only, 1x each, 1x per week

Learn More

Joseph Stemple has a Medbridge Course and DVD teaching the vocal function exercises.

There are also speech-language pathologists and speech-language therapists on YouTube who model how to complete the exercises.

The Adult Speech Therapy Roadmap

References

• _{American Speech-Language-Hearing Association. (n.d.). Voice Disorders [Practice portal]. https://www.asha.org/practice-portal/clinical-topics/voice-disorders. Retrieved May 24, 2023.}
• _{Angadi, V., Croake, D., & Stemple, J. (2019). Effects of Vocal Function Exercises: A Systematic Review. Journal of voice : official journal of the Voice Foundation, 33(1), 124.e13–124.e34. https://doi.org/10.1016/j.jvoice.2017.08.031}
• _{Stemple, J. (n.d.) Vocal Function Exercises [Online course] Medbridge. https://www.medbridgeeducation.com/courses/details/vocal-function-exercises-joseph-stemple-speech-langauge-pathology-vocal-therapy}