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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).