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voice aerobics

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My Mission
To enlist individuals in their treatment, and help them express their personality & spirit through voice.
To educate and empower.

Mary Spremulli, MA, CCC-SLP

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Voice Aerobics®
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Voice Aerobics DVD

What is Voice Aerobics®?
Voice Aerobics®, was started in 1999 as a 50 minute exercise class. It combines techniques from voice therapy and exercise physiology. It was designed originally as an “after therapy” program for individuals with Parkinson’s disease, however, the class attracted participants with a variety of backgrounds, including, individuals who were involved in choral work, but felt they were losing power in their voice.
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Who is Mary Spremulli?

Mary Spremulli, MA,CCC-SLP, has been a medical speech-language pathologist  for over 30 years and currently owns a private practice, Voice Aerobics,LLC, located in SW Florida...

Ms. Spremulli has lectured nationally and internationally on health related topics, published in the area of Clinical Ethics and Patients Education, and her blog has  been selected as one of the top 49 blogs about Parkinson's disease...

Relocated to SW Florida in 1989 from Cleveland, Ohio, Ms. Spremulli holds speech-language pathology licenses in Florida, Ohio and North Carolina. She also holds a Florida nursing license. READ THE FULL ARTICLE

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Who Should Do Voice Aerobics®?
Generally, anyone who feels they have lost some power or range in their voice, and would like to combine some vocal function exercises with a general work-out would benefit. Specifically, anyone with changes in voice, speech, or swallowing, resulting from conditions such as: Parkinson’s, stroke, vocal fold paralysis from surgery, and individuals with vocal impairment due to breathing problems, such as COPD, post polio, and others.
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How Can Voice Aerobics® Improve My Voice?
There are many reasons for voice problems and any changes in your voice should be reported to your doctor. For all of us, however, a healthy voice requires functioning vocal folds, healthy and well hydrated (moist) tissue, and good breath support, as this is the real power source for the voice. If breath support is inadequate or the breathing (respiratory) muscles, which include the abdomen and diaphragm, are just not used efficiently, the result may be straining to generate voice, and eventually, changes in vocal quality, which may include: too soft, raspy, hoarse, and a variety of others. Exercising the vocal mechanism, including the respiratory muscles will yield the same benefit as any exercise, particularly if done at least three times a week.
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Is there research about Voice Aerobics®?

A 2013 study conducted at a community-based program for persons with Parkinson's, found that the Voice Aerobics® program, when offered over several weeks in a group setting, yielded a statistical difference in how persons with Parkinson's self-rated voice loudness.

A poster abstract was presented at the 3rd World Parkinson Congress in Montreal, Canada, 2013, entitled:

Benefits of a Community Based Whole Body Voice Strengthening Program for Persons With Parkinson's

Pre and post class surveys were completed by participants in a weekly Voice Aerobics® class held at a community based center for persons with Parkinson's disease in Sarasota, Florida. Results indicated that the Voice Aerobics® program when offered in a group setting yield a statistical difference in how persons with Parkinson's self-rated voice loudness. Additional research looking at the benefits of the Voice Aerobics® program is being conducted.

To view the poster please click ON THIS LINK.

When Voice Aerobics® was was created in 1999, it was designed to be an after therapy program for persons with PD. I had been certified in LSVT since 1997, and found that patients often had difficulty retaining home instructions, and so would create audio-tapes of the daily variables, along with variations of my own home practice. I also found that I had a subgroup of patients who resisted the cue to "be loud," stating: "I have never been loud, I have always been a quiet person." These statements went beyond the perceptual deficits we feel PD patients may have, but rather, were self-described personality traits. Those "soft spoken" persons appeared to be less resistant to the loud cue when I brought them into the aerobics room and coupled voice with exercise. So, that was the genesis of the program, and the DVD is a recording of the class created in 2008 in response to requests from many of the people who took the class.

The vocal function exercises are those types of things I had been doing for years, and are rooted in the voice literature. The "loud" voicing was derived from the work of Ramig et al. What makes the program unique, I believe, is coupling voice practice with movement. The movements incorporate principles from physical therapy treatment of persons with PD, and include: focus on extensor muscle activation, motor learning principles of repetition and simple cues, and sensory awareness training . Movements are also designed to address rigidity of muscles in cervical, axial, appendicular, and facial muscles. Since the fall of 2012 I have been conducting a weekly class at a Community Center for persons with PD in Sarasota, Fl, and I conducted a pre/post class survey, results which will be shared as a poster at the World Parkinson Congress in 2013. This is my first attempt to elicit feedback from patients as to what perceived benefit they receive from performing the program. Statistically, there was an effect of increased loudness reported. There were also anecdotal reports of improved flexibility and other movements, and I hypothesize that upregulating the system for voice may also have an effect on limbs. But, that is really the true stuff of a future research study, that hopefully will peak the interest of a colleague in a university setting, who has the knowledge and support to conduct this type of research.

How Can Voice Exercises Improve Swallowing?
Normally, swallowing is a well timed and orchestrated event. During the swallow, as food is propelled towards the opening to the esophagus, various valves are closing, including the vocal folds(cords) to provide protection to the airway. At the moment we swallow, breathing stops, to further protect our airway, and resumes after a brief pause. When the strength and timing of the swallow is impaired, when valves, such as the vocal folds, are not working correctly, or when breathing problems limit the ability to hold the breath, the result may be a swallowing problem, including aspiration of foods or liquid.

(Aspiration is when saliva, food, or liquid becomes misdirected and enters the airway by passing through the vocal folds. Chronic aspiration can result in pneumonia or other serious respiratory problems.)

Being hospitalized or immobile for any period of time can further create generalized muscle weakness and reduce your ability to generate a good cough or protect your airway when swallowing, increasing your risk for aspiration pneumonia

Exercises which improve breath support and strengthen the vocal folds may help improve airway protection during the swallow. General exercise may also help maintain mobility, flexibility, and endurance.

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Why Does Parkinson’s Disease Cause Changes In Voice?
Everyone with Parkinson’s Disease may have different symptoms, but, most will include stiffness and tremor. Voice and swallowing problems are frequently another symptom of this disease, sometimes occurring early, and sometimes later as the disease progresses.

Speech and voice symptoms occurring with Parkinson’s Disease are usually classified as a hypo kinetic dysarthria (hypo-slow, kinetic-referring to muscle movement, and dys-difficult, arthria-having to do with speech). The actual speech and voice of the person, is characterized as: low in volume, rate of speech which is too rushed or fast, low pitched, and monotone (boooooring!) Many people with Parkinson’s Disease complain that other people are always asking them to repeat, even though they think they’re talking just fine. Loss of facial expression is also associated with PD. The changes in voice and swallowing can be insidious (sneaky), and occur gradually over time. Consequently, the person who has the problem may not even realize how poor their voice has become, until their doctor is referring them for speech therapy.

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My Doctor Wants Me To Have Speech Therapy-How Is That Different From Voice Aerobics® ?
Voice and speech therapy from a licensed speech pathologist can be very beneficial. A speech pathologist will complete an evaluation and tailor a program specifically to meet your needs. For patients with voice changes from Parkinson’s, I typically recommend the: Lee Silverman Voice Treatment (LSVT) The LSVT is grounded in evidenced-based research, and can be a very effective program for addressing speech, voice, and swallowing problems in individuals with neurogenic diseases. Following completion of the LSVT or any program, however, you must still continue to do the exercises on your own to retain the benefit. And, here’s where Voice Aerobics® may help. Using the Voice Aerobics® DVD three times a week, may help you to retain the gains you have made following formal speech therapy treatment.

Remember: Voice Aerobics® is not meant to take the place of formal therapy, but, rather, may be beneficial following treatment, or prior to treatment for those who don’t think that they need or are ready to commit to formal speech therapy.

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My Husband Is In A Wheelchair Following A Head Injury , Can He Still Do Voice Aerobics® ?
Absolutely. Several of the individuals in the DVD use a wheelchair most of the time outside of their home. Many of the exercises are done seated, and others can be adapted to be done seated or standing. Emphasis throughout the video is to work at your own pace, and to the extent your body will allow.
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My Father Has PSP With Dementia. Can He Benefit From Voice Aerobics® ?
Progressive supra nuclear palsy (PSP) is sometimes confused with Parkinson’s in the early stage of diagnosis. Like Parkinson’s, it can also contribute to decline in speech, voice, and swallowing. Dementia can be another symptom or feature of this disease. Dementia is not a deterrent to exercise, and in fact, a program which does not require remembering instructions, and can be easily followed , may be the best kind of program for someone with dementia to participate in.

Exercise for any of us will always be beneficial, as long as it is done correctly, and as long as it’s done at least three times a week. Emerging research in exercise physiology suggests that high intensity exercise done regularly may actually be neuroprotective (protect the brain from further degeneration) or actually help the brain recover from neurological events such as a stroke , referred to as: neuroplasticity.

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I Was Just Diagnosed With Parkinson’s. My Doctor Thinks I Should Have Therapy, But, I Don’t Have Any Voice Problems. Why Should I Waste The Time Or Money?
Your voice may still sound fine to you, although, with Parkinson’s in the background, that is likely to eventually change. Waiting until you have problems to commit to an exercise program, is sort of like waiting for your car to start smoking to bring it to a mechanic.

(Medications, and even some surgical management for motor symptoms such as: Deep Brain Stimulation (DBS), may not cause improvement in speech and swallowing, and in some instances, patients report a worsening of those functions. If you notice a decline in speech and/or swallowing function following a change in medication or following DBS placement or adjustment, be sure to notify your physician, who may request an evaluation with a speech pathologist)

Make a commitment now to do this program or any exercise program which may maintain or improve muscles of voice, speech, and swallowing!
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How Can My Organization Schedule A Class Or Seminar?
Just email or phone for more information. Individual consultations are also available for anyone living in southwest Florida or visiting the area.
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Do You Have Other DVD'S I Can Order?

Other products you might consider:

Voice Aerobics® Grand Slam is a deck of 54 playing cards with illustrated voice exercises. It was designed to stand alone, or be used as a companion product to Voice Aerobics® DVD. My mom, an avid bridge player, inspired the name, and my patients inspired the product. You can carry them in your pocket or your purse, and practice when your away from home, or have fun when playing cards, and invite others to join you in some of the exercises.

Voice Aerobics® Songbirds is an audio CD, which contains speech and voice exercises set in music. Titles such as: Happy Vowel Trails, and Speech Sounds in Waltz Time, are likely to get you voice and body moving.

I used the exercises with patients for about a year before recording the CD, and most really enjoyed being able to blend speech practice with music.

Hi-VOLT® 4 PD is a 27 minute audio CD of guided voice practice, helping you feel the effort required to speak loud enough for everyday conversation.

The Hi-VOLT® voice-on-light provides external cuing or feedback, helping you during daily voice practice. Use is along with LSVT® Loud and Big or other speech therapy home practice.

To order any of the Voice Aerobics products visit our shopping page: http://www.voiceaerobicsdvd.com/shop.html

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Want to Read More On These Topics? Click here.

Medical Disclaimer: The information contained herein should not be construed as medical advice and is not intended to replace the medical advice of your physician or other licensed healthcare provider in your state. You should continue to consult your physician for matters regarding your health and prior to beginning any new exercise program.

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