Voice Therapy Exercises PDF for Adult Speech Therapy

In this post, you’ll find treatment ideas for voice therapy for speech-language pathologists.

These include techniques and exercises, word lists, massage, breathing, and voice therapy exercises PDFs!

Visit our shop for evidence-based voice therapy handouts, treatment guides, and much more.

Read More Voice Articles:

• Voice Therapy Goal Bank
• Vocal Function Exercises
• How To Assess Voice

Voice Disorders Treatment Approaches

Below are the broad treatment approaches to address vocal tension and weakness.

Treating Vocal Tension

• Flow phonation treats dysphonia and aphonia. This approach teaches patients to focus on the outflow of air during phonation, without throat tightness (Gartner-Schmidt, 2020).
  
  
• Resonant Voice Therapy is used to treat muscle tension dysphonia. The goal of this therapy is to produce a strong, clear voice with the least amount of vocal effort. Read a step-by-step guide to resonant voice therapy.
  
  
• Smith Accent Technique uses controlled breathing and rhythmic exercises to help coordinate vocal fold vibration, air pressure, and airflow.

Treating Weakness

• Expiratory Muscle Strength Training (EMST) is for patients with a weak cough or those at risk for aspiration (including patients with Parkinson’s disease, weaning from mechanical ventilation, and some who are post-stroke).
  
  It uses a handheld device to strengthen the swallowing and breathing muscles. Learn more about EMST.
  
  
• Lee Silverman Voice Treatment (LSVT LOUD®) was created for people with Parkinson’s disease. Its goal is to increase loudness and intelligibility by maximizing phonatory and respiratory function. You can train to become a certified LSVT provider.
  
  
• SPEAK OUT®! The goal of SPEAK OUT! is for people with Parkinson’s disease to produce a stronger, clearer voice. Here’s where to train in this approach.
  
  
• Vocal Function Exercises is an exercise regiment that focuses on the use of easy onsets and forward focus to increase strength and voice production (Angadi, 2019).
  
  It’s been shown to improve maximum phonation time in adults with dysphonia or voice disorders (Barsties V Latoszek, 2023).

Read Vocal Function Exercises for a step-by-step guide.

Referring Out

Treat the underlying issue whenever possible. This may mean referring the patient to an otolaryngologist (ENT doctor), gastroenterologist, and/or voice specialist, among others.

Voice Therapy Treatment Ideas

Here are 13 voice therapy treatment ideas to use in your practice.

1. Voice Therapy Techniques for Vocal Tension

Teach your patients with tense or tight voices the following exercises. Scroll down to find word lists and drills to practice these exercises.

• Chant Speak. Read or speak using a monotone, slightly high-pitched voice.
  
  
• Yawn/Sigh Technique. This is meant to lower the lower back of the tongue and raise the velum (the soft part of the roof of your mouth) for a more relaxed and natural-sounding voice.
  1. Pretend that you’re going to yawn. Let out a relaxed sigh.
  2. While you’re sighing, say the following sounds:
     • a, e, i, o, u
     • Maa, paa, baa, faa, vaa, thaw, naw, taw, daw, saw, raw, law
  3. Use this technique while speaking throughout the day
     
     
• Confidential Voice. Use an easy, breathy, low-airflow voice so that your vocal folds don’t completely touch.
  
  
• Relaxation. Do progressive muscle relaxation and circumlaryngeal massage (see below).
  
  
• Practice. Practice vocal tension techniques (see below).

Read about how to treat hypernasality.

2. Voice Therapy Techniques for Vocal Weakness

Teach your patients with soft or weak voices the following exercises. Scroll down to find word lists and drills that they can use to practice these exercises.

Again, consider LSVT LOUD, SPEAK OUT!, vocal function exercises, and/or respiratory muscle strength training to further help these patients.

• Twang. Speak using a “twangy” vocal quality, similar to that of a country-western singer (or a witch cackling or a duck quacking!) Adding power to the vocal track (where the twang is created) will also add power to the voice.
  
  
• Amplication. Amplifiers increase the loudness of your voice in noisy settings, such as at a restaurant or shopping mall. They’re available at major retailers, including Amazon.com.
  
  
• Biofeedback. You can learn to hear and feel vocal weakness. This helps remind you to use a stronger voice.
  • Place your hands on your chest and stomach to make sure that you’re taking deep enough breaths (see ‘Diaphragmatic Breathing’ below).
  • Record your voice and rate your loudness. Many smartphones come preloaded with a voice recording app, or you can easily download one from an App store.
  • Use a sound level meter to measure your loudness.

Learn speech therapy exercises for dysarthria.

3. Voice Therapy Exercises: Biofeedback Treatment

Biofeedback is the use of sensory feedback (tactile, auditory, visual, etc.) to help patients become more aware of the physical sensations they feel with respiration, resonance, and phonation.

The goal of biofeedback treatment is to improve pitch, loudness, quality, and/or effort.

• Tactile
  • The patient places their hands on their chest and stomach to feel diaphragmatic breathing.
    
    
• Auditory
  • Record the patient’s voice and play it back to them.
    
    
• Visual
  • Use a sound level meter to measure intensity or loudness.
  • Use surface electromyography (sEMG) to measure intensity or loudness.

4. Voice Therapy Exercises: Easy Onsets

Prompt your patient:

“These words contain sounds that require a wide, open space in your voice box. As you read each word aloud, gently move your lips and tongue for easy onsets.

1. Ha
2. How
3. Hoe
4. Ham
5. Have
6. Half
7. Hill
8. Hear
9. High
10. His

For more easy onsets, check out the Voice & Resonance Pack on our shop!

5. Voice Therapy Exercises: Tense Vowels

Prompt your patient:

“These words contain tense vowels—they require more muscle tension to say. Use your voice techniques as you read each word.”

1. Nay
2. Cake
3. Seat
4. Neat
5. Late
6. Bees
7. Fame
8. Hall
9. Eat
10. Wage
11. Please
12. Keep

6. Voice Therapy Exercises: Voiced vs. Voiceless

Prompt your patient:

“The words in each word pair differ only by ‘voicing.’ Voicing is whether or not your vocal folds vibrate. One word starts with a voiced sound, and the other starts with a voiceless sound. Say these words using light contacts: Your lips and tongue should move gently.”

1. Gall/Call
2. Pass/Bass
3. Pig/Big
4. Peas/Bees
5. Zone/Shone
6. Zing/Sing
7. Vaughn/Fawn
8. Gut/Cut
9. Zoo/Sue
10. Gap/Cap
11. Veal/Feel
12. Ten/Den
13. Cheese/Jeez
14. Tea/Dee
15. Came/Game
16. To/Do
17. Zip/Sip
18. Pooh/Boo
19. Zeal/Seal
20. Gab/Cab

For more voiced vs. voiceless word lists, visit our shop!

7. Voice Therapy Exercises: Continuous Voicing

Prompt your patient:

“Use your voice techniques while saying the following words. Your vocal folds will vibrate and remain closed while you say each word.”

1. Buzz
2. Dog
3. Road
4. Brain
5. Gobble
6. Lemon
7. Ringing
8. Goodbye
9. Video
10. Lovingly

8. Voice Therapy Exercises: Open Vowels

Prompt your patient:

“Use your voice techniques while saying the following words. The vowels are ‘open’ which means you need to create a large space in the back of your mouth to say them.”

1. Bomb
2. Soft
3. Moss
4. Hat
5. Hot
6. Bath
7. vocalLoft
8. Job
9. Lull
10. Knot

Find more open vowel word lists in our shop.

9. Diaphragmatic Breathing for Voice Therapy

Prompt your patient:

1. Put one hand on your stomach and your other hand on your chest. Feel your stomach rise and fall with each breath. Continue for one minute.
   
   
   • When you breathe in: Your stomach pushes out. The hand on your chest should remain still.
   • When you breathe out: Tighten your stomach muscles and feel them pull in. The hand on your chest should remain still.
     
     
2. Breathe in, feeling your stomach push out. As you breathe out, say the following sounds and words, remaining aware of your stomach slowly pulling in.
   
   
   • Start with simple sounds like “sss” and “shh”
   • Gradually work up to vowel sounds like “ahh” and “ooh”
   • Work up to single words like “hello” and your first name
   • Gradually work up towards longer words, phrases, and sentences

10. Vocal Hygiene for Voice Therapy: Free PDF!

Vocal hygiene may help improve vocal quality and treat vocal fold nodules (Mansuri, 2018).

The following are some of the dos and don’ts of vocal hygiene. Educate your patients on these guidelines to avoid vocal fold damage or to heal after damage.

What To Do

• Vocal rest
• Hydrate
• Talk at moderate volumes
• Eat a healthy diet

What to Avoid

• Avoid yelling and whispering
• Avoid smoking
• Avoid alcohol & caffeine
• Avoid coughing & throat-clearing

For an in-depth guide, download The Vocal Hygiene Checklist or read the article for an in-depth guide.

11. Reflux Tips for Voice Therapy

The following are tips for those of your patients who experience reflux. If appropriate, refer out to their primary care physician, gastroenterologist, etc. to help manage reflux symptoms.

• Drink plenty of water
• Sit upright during and after you eat or drink
• Wear loose-fitting clothes around your waist (avoid tight belts and waistbands)
• Eat smaller meals more frequently
• Sleep with the head of your bed raised at least 30-45 degrees
• Maintain a healthy weight
• Ask your doctor about medication to manage reflux symptoms
• Avoid caffeinated beverages (coffee, tea, soda, etc.)
• Avoid trigger foods (tomatoes, citrus fruits, etc.)
• Avoid fried foods
• Avoid alcohol
• Quit smoking

12. Conversation Training Therapy

Conversation Training Therapy was designed to solve some of the issues that both patients and therapists had with traditional voice therapy techniques.

Namely, patients struggled to generalize the gains from voice therapy into their everyday lives.

How does Conversation Training Therapy do this? By keeping treatment short and functional and by following the principles of motor learning.

It’s not a step-by-step treatment approach, but it does have a few guidelines:

• Use conversation
• Teach Clear Speech right away. From there, it’s up to the therapist which of the 6 tenants (below) to work on next
• Mirror the target voice during conversation to add to their sensory experience of their “new” versus “old” voice

The 6 tenets of Conversation Training Therapy:

1. Clear speech. Speaking in a very precise and intelligible way
2. Auditory and kinesthetic awareness. Have patients feel and hear the difference between their unhealthy and healthy voices
3. Negative practice/labeling. Having the patient regularly switch to their ‘old’ voice and come up with personalized labels for both their new and old voices
4. Rapport-building
5. Embedding basic training gestures. Sustain certain consonants with the goal of feeling the voice at the front of the mouth.
6. Prosody. Teach patients to improve pitch, timing, and loudness. As always, practice using conversation.

Learn more about Conversation Training Therapy.

(Gillespie, 2019)

13. Voice Therapy Exercises PDF: Circumlaryngeal Massage

Manual circumlaryngeal massage is a voice therapy treatment for muscle tension dysphonia. It aims to lower the larynx into a more neutral position.

If the tension continues despite massage, consider a mental health referral to address unmanaged stress.

1. Find the thyroid notch with your index finger.
   
   
2. Gently run your index finger and thumb laterally until you find the thyroid laminae.
   
   
3. Work your fingers superiorly until you locate the hyoid bone.
   
   
4. Massage the hyoid using your index finger and thumb, working anterior to posterior until you reach the major cornu. Have the patient hum while you massage. Note any changes in voice.
   • The carotid artery is located close to this area—make sure that you are massaging the hyoid bone and not the artery!
     
     
5. Run your fingers inferiorly and medially to the thyroid cartilage and massage the thyroid cartilage using your index finger and thumb.
   
   
6. Massage anterior to posterior until you reach the posterior borders of the thyroid cartilage. Have the patient hum while you massage to detect any voice changes, including reduced tension.

More Voice Therapy Materials

References

• 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
• American Speech-Language-Hearing Association. (n.d.). Voice Disorders. (Practice Portal). Retrieved month, day, year, from www.asha.org/Practice-Portal/Clinical-Topics/Voice-Disorders/.
• Gartner-Schmidt, G. (2020). Optimize the Flow of Your Voice Therapy Patients: Flow Phonation https://www.medbridge.com/blog/2020/10/optimize-the-flow-of-your-voice-therapy-patients-flow-phonation/. Retrieved Nov 2023.
• Barsties V Latoszek, B., Watts, C. R., Schwan, K., & Hetjens, S. (2023). The maximum phonation time as marker for voice treatment efficacy: A network meta-analysis. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery, 48(2), 130–138. https://doi.org/10.1111/coa.14019
• Gillespie, A. I., Yabes, J., Rosen, C. A., & Gartner-Schmidt, J. L. (2019). Efficacy of Conversation Training Therapy for Patients With Benign Vocal Fold Lesions and Muscle Tension Dysphonia Compared to Historical Matched Control Patients. Journal of speech, language, and hearing research : JSLHR, 62(11), 4062–4079. https://doi.org/10.1044/2019_JSLHR-S-19-0136
• Mansuri, B., Tohidast, S. A., Soltaninejad, N., Kamali, M., Ghelichi, L., & Azimi, H. (2018). Nonmedical Treatments of Vocal Fold Nodules: A Systematic Review. Journal of voice : official journal of the Voice Foundation, 32(5), 609–620. https://doi.org/10.1016/j.jvoice.2017.08.023