ACQ Vol 12 no 1 2010

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).

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

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

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ACQ Volume 12, Number 1 2010

ACQ uiring knowledge in speech, language and hearing