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ACQ

Volume 12, Number 1 2010

ACQ

uiring knowledge in speech, language and hearing

practice at a higher skill level than those receiving a single

prepractice demonstration (Weeks & Anderson, 2000).

Additionally, provision of visual and verbal cues in

combination with a visual model was found to increase

accuracy and consistency of a discrete, complex motor

movement (soccer kicking) at a faster rate than verbal

instructions and demonstrations alone (Janelle et al, 2003).

Observation of other people as they learn or acquire a

new motor skill is equally or more beneficial for effective

learning than observation of experts demonstrating “correct”

performance (Hebert & Landin, 1994; Hodges & Franks,

2002). This research suggests that clients are not merely

copying movements but are engaged in a problem-solving

process through vicarious learning. It follows that voice

clinicians, who are by definition voice experts, cannot simply

model a clear voice as a therapeutic device and expect a

client to imitate it readily. Instead, clinicians may need to

explicitly engage in activities that assist the client to problem-

solve. This may be achieved by use of a step-wise approach

whereby the clinician models successive, incremental

changes to voice production and explain making these

changes to their voice, for example, from hyperfunctional to

easy and efficient voicing. One application to voice therapy

of this research on learning-modelling is the adoption of

group voice intervention, where clients can see each other

learning (Simberg, Sala, Tuomainen, Selleman, & Ronnemaa,

2006).

Perceptual training

Perceptual training involves raising the client’s awareness of

sensations to develop understanding of the target

movement. This may include auditory, kinaesthetic, visual,

proprioceptive, or other sensory inputs alone or in

combination. Perceptual training is most effective if it requires

attention and some sort of response (Abernethy, Wood, &

Parks, 1999; Schmidt & Lee, 2005). Such perceptual training

may involve the clinician directing the client’s attention to

what they see, feel, hear, or otherwise sense during or after

they attempt a new movement. In calling attention, the

clinician may ask the client to attend to the sensation,

remember the sensation, or contrast one sensation with

another. An example of this from general speech pathology

techniques might be the “Old way, New way” approach

where the client is asked to compare the sensory outcome

of two motor behaviours (Hanin, Korjus, Jouste, & Baxter,

2002).

Auditory perception abilities play a vital role in developing

an internal reference-of-correctness for both speech and

voice therapy where the movement goal may be defined in

an auditory way. Additionally, there is evidence that auditory

therapy, it may be appropriate to focus on the desired

long-term change which results from learning a more

effective vocal technique, that is, improved vocal stamina,

power, and clarity. In planning such change, the client and

clinician may together identify a functional goal that allows

them to determine when therapy has been successful

(Verdolini Abbott, 2008).

Instruction

The client must possess an understanding of the target

movement in order to accurately produce the movement

pattern (Hodges & Franks, 2002), suggesting that

instructions and explanations about the movement goal may

be necessary in the prepractice phase (Schmidt & Lee,

2005). However, the use of extensive instructions may

reduce learning due to high cognitive demands interfering

with effectively processing feedback or breaking from stable,

undesirable behaviours (Hodges & Franks, 2001; Hodges &

Lee, 1999; Wulf & Weigelt, 1997). Additionally, motor

learning can occur without the client’s explicit awareness of

task rules and mechanical properties (Masters, 1992;

Verdolini-Marston & Balota, 1994). Thus, simple holistic

instructions focusing on the essential aspects of the actions

are recommended to ensure that clients can achieve the

movement goal in prepractice (Hodges & Franks, 2001;

Schmidt & Lee, 2005). For more complex tasks, breaking the

task into logical subunits may be appropriate where

instructions initially focus on one or two essential aspects of

the movement. Once they are achieved the client is

instructed on the next most important aspects to attend to,

and so on (Schmidt & Lee, 2005). Finally, instructions that

direct attention to the effects of movements rather than the

movement patterns themselves are most beneficial to

learning the new movement (see Wulf & Prinz, 2001, for a

review). By way of example, in tennis coaching one would

focus on where the ball is intended to go rather than how to

swing the racket. Consideration of these ideas suggests that

instructions given during the prepractice phase of voice

therapy should be short, simple, and focus on the sound of

the voice (i.e., voice clarity) or on the sensations associated

with successful production rather than contractions of

laryngeal, respiratory, pharyngeal, or oral musculature.

Modelling

Modelling allows the client to observe aspects of the skill that

cannot be verbally explained, and to observe and implement

strategies that facilitate the learning of the target movement

(Magill, 2007; McNeil, 2009; Ram, Riggs, Skaling, Landers,

& McCullagh, 2007; Schmidt & Lee, 2005). Learners

receiving multiple prepractice demonstrations start their own

Table 1. Principles of motor learning and voice therapy: the prepractice phase of therapy

Example from the general motor learning literature Hypothesised example

Motivation

Establishing importance of the task (Maas et al., 2008).

Education that vocal technique can improve vocal stamina,

power and clarity.

Instruction

External attentional focus instructions

Clinician provides instructions focused on effects of movement

(Wulf & Prinz, 2001).

(voice clarity and sense of ease).

Modelling

Observation of learning-model more effective than

Group voice therapy which allows clients to see others learning

expert model (Hodges & Franks, 2002).

from a beginner phase.

Perceptual Training Auditory training leads to motor learning in the absence

Auditory discrimination training of clear versus hoarse voice

of motor training (Meegan et al., 2000).

quality.

Feedback

Augmented knowledge of performance feedback

Clinician provides information about pattern of voicing (e.g., hard

(Swinnen, 1996).

glottal attack onset produced).