Researchers have shown that when voice patients were required to speak on a specific subject and at the same time self-monitor some aspect of voice that they were trying to change, modify, or improve, the degree of cognitive effort could easily distract the patient from maintaining dual focus of attention on both content and some aspect of voice production. [i]

Studies have shown that people who stutter are also more vulnerable to increased cognitive load because cognitive load has a disrupting effect on speech language planning. [ii]

For years, I have witnessed the communication breakdown many individuals with Parkinson’s disease experience when attempting to self-monitor speech or internalize a cue outside of the structure of therapy. Researchers who study motor speech disorders are also beginning to focus not only on the patient’s dysarthria, but also the language and cognitive changes that are often prevalent non-motor aspects of the disease that can be quite disabling for some patients.

[1] Cognitive Load in Voice Therapy, Jenny Iwarsson,  David Jackson Morris, and Laura Winther Balling, JSLHR 2017 [11] The effect of concurrent cognitive load on phonological processing in adults who stutter .Jones, R. M., Fox, R. A., & Jacewicz, E. JSLHR 2012


Def: taking notice of someone or something; the regarding of someone or something as interesting or important; the act or power of carefully thinking about, listening to, or watching someone or something. To pay attention, we need to block out distractions.

What did you pay attention to this morning?

The way you felt (emotionally or physically)? The news (good or bad)? Something your spouse said to you?The weather? The traffic? A new flower or plant blooming?

There are potentially hundreds of things we can pay attention to or give our attention to in any given day and moment. How many things did you give your attention to today that were interesting, important, or worthwhile of your attention?

       Photo by Stefan Cosma on Unsplash


Def: a thing intended; an aim or plan we give our attention to before we execute it.

How would you focus your attention in order to execute the tasks below?

I intend to clean out the garage today. I intend to go golfing today. I intend to take my wife out to dinner today.      I intend to call my grandchildren today. I intend to exercise for 30 minutes. I intend to speak LOUD, SLOW, and CLEAR so others understand me

ATTENTION and INTENTION both require Cognitive energy and FOCUS

If attention was like money and you started each day with $500 in your cognitive wallet, what would you spend your ATTENTION on? Would you spend your attention on the positive things in life or negative?

Would you spend your attention on your own thoughts, or instead, turn on the TV and spend it on someone else’s thoughts? Would you spend your attention on worrying about Parkinson’s or doing something to improve your symptoms today?

When you speak with Intent, you are like a broadcasting tower. You must execute speech with ATTENTION, FOCUS, and a PLAN to speak LOUDLY, SLOWLY, and CLEARLY so that listeners, whether familiar or unfamiliar, understand your message.

Intentiona course of action that one intends to follow. What will you do today?


NEW!! Voice Aerobics® Travel Pack

Voice Aerobics®, a whole-body voice strengthening program, was created over 20 years ago, because I knew that patients needed tools for speech practice that extended beyond 30 days of therapy. The newest addition to the Voice Aerobics family of products is the Travel Pack. I have packaged three of our most popular programs on a flash drive you can plug into your computer or tablet USB port and take voice practice with you wherever you go. Affordably priced at only $29.99.

Learn more or buy now:

Speech Therapy Telepractice/Telehealth

Could you benefit from speech therapy but don’t want to travel to a clinic? Consider enrolling in telepractice. All you need is a computer or tablet with a webcam, and an internet connection. Medicare has expanded coverage during the COVID-19 pandemic to include speech therapy. You are enrolled in an electronic health record, video-recording is available, and most patients report that it is just like being with me in the office. I am licensed in Florida, North Carolina, and Ohio. Visit:



My MissionTo enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate  and empower. Mary Spremulli, MA, CCC-SLP *  FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice

Voice Aerobics the heART and Science of Voice Practice