They all are names for the same disorder. In clinical experience, I have found that many factors can contribute to functional aphonia, not all clients are "malingerers" and it takes skill, patience and experience to separate these malingerers from those truly in need of voice therapy. With this diagnosis, many insurance companies deny at the hint of anything functional. It usually occurs following an illness such as an upper respiratory infection or following a traumatic or emotional occurrence. It may even develop as a result of fear. Before speech therapy was seen as an appropriate intervention technique, psychogenic aphonia was treated in very odd ways.
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They all are names for the same disorder. In clinical experience, I have found that many factors can contribute to functional aphonia, not all clients are "malingerers" and it takes skill, patience and experience to separate these malingerers from those truly in need of voice therapy.
With this diagnosis, many insurance companies deny at the hint of anything functional. It usually occurs following an illness such as an upper respiratory infection or following a traumatic or emotional occurrence.
It may even develop as a result of fear. Before speech therapy was seen as an appropriate intervention technique, psychogenic aphonia was treated in very odd ways. One way was essentially "suffocating" the patient to evoke a vocal cry of alarm. Other treatments included using electricity, grabbing the tongue, water torture or cocaine applied to the laryngeal mucosa. None of my therapy techniques include any of these thankfully. The first functional aphonic patient I ever saw was by observation only.
She was a young woman who had a child at home. Being a single mom, she worked at a very demanding job where she had to use her voice all day. She was receiving voice therapy fully paid for by her insurance company, and her job was giving her time off for short term disability.
Each time she would come for a session, we made progress and she was able to find a wonderful and resonant target voice. The next time she would come in, the voice would be whispery and diminished again. It made me wonder if she was just using the time off for whatever personal reason, but the struggle in each session to achieve a normal sounding voice was all too real.
A memorable functional aphonia patient I saw was in a hospital where I worked. He had not been intubated, and I spend most of the evaluation trying to figure out if he was faking or not.
Malingerers are out there The more I found out about his family and the emotional trauma of what brought him to the hospital, the more I realized that the trauma itself had changed how this man functioned in every way, including how he spoke. It took 3 sessions before he even made a noise, but through semi-occluded vocal tract exercises with a straw in a cup of water, we were able to bring him into a complete and normal speaking voice in no time. This population can be difficult to treat because, like most voice cases, no "one" treatment will work all the time.
I have compiled a list of tricks and tips to help any SLP treating a functional aphonic achieve that "light bulb" moment. Bubbles in a cup. Have the patient place the straw in the water and blow air until bubbles are seen. This gives the patient visual feedback that air is indeed flowing. Next, have the patient begin to hum this way. Sometimes the distraction of the cup, the vibration of the bubbles and the noise made is all that is necessary to get phonation to occur again.
If the patient is appropriate and not an aspiration risk i. Raspberries or tongue trills. These semi-occluded vocal tract exercises are based on the same scientific idea as straw phonation , but these easy productions may be the key for some patients.
Get out your joke book here. Sometimes all that is needed is good old-fashioned joking around. Some YouTube videos can be used as well.
I like this old superbowl commercial about herding cats. Being silly. Act out some lines from a play in ridiculous accents or at different tempos.
If you have headphones with some white noise you want to use, great! If you are interested in a more budget friendly and quick trick, crinkle paper towels or plastic next to both ears while having the patient attempt to phonate. Use your phone or a small recording device to record the patient making these noises. Sometimes patients will not even believe it is really them in the recording, so videos are the next step here.
Laryngeal Reposturing ideas from Nelson Roy can also be helpful in these cases. The book, Exercises for Voice Rehabilitation , shows this nicely in detail, but it is best learned from a practicing clinician. Make sure you are utilizing negative practice in your sessions because the quicker the patient regains the ability to reorganize his or her own kinesthetic framework for phonation, the quicker the patient can get back to a normal life.
Psychogenic aphonia: No fixation even after a lengthy period of aphonia. Swiss Med Weekly, ,; Plural Publishing, She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on vocal health to area choirs and students.
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Have you ever experienced a crisis or convulsion? Do the symptoms manifest when you start feeling anxious? Do you suffer from a neurological disease or any other type of illness? Are these symptoms affecting your life to some degree? He believed that unconscious problems manifested as physical symptoms.
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