Accent method

Question 1

What is involved in the accent method?

Answer 1

Aims:

• Holistic approach - better balance between expiratory phonatory air flow and VF muscle power
• Improves co-ordination of voice, resonatory and articulatory activities - improves projection resonance and prosody

Fundamentals = dynamic integration of:
A. Abdomino-diaphragmatic breathing
B. Accentuated rhythmic vowel play
C. Body and arm movements.

Question 2

What is the rationale behind it?

Answer 2

Expiratory airflow and aerodynamic events at glottis (Bernoulli effect) - crucial role in voice production and maintenance of a symmetrical vibratory mucosal wave cycle.
Accent exercises use abdomino-diaphrgmatic accentuated rhythmic expiratory pulses - enhance Bernoulli effect.

Question 3

What is the mode of action?

Answer 3

Hypofunction = excessive glottal waste.
VF paralysis, loss of muscle tone –> glottic gap
Enhanced air flow due to accent exercises –> aerodynamic adductory (suction) effect that assists small glottal gap to close.

Hyperfunction = excessive glottal tightness
Excessive adductory force obscures VF mucosal wave.
Accent exercises increase and accelerate phonatory expiratory air flow in gradual crescendo –> optimal adductory forces (suction) –> approximate VF without muscle tension.
Improves timing - exhaled air and voice onset.
Optimal pitch and loudness - improved balance between air flow, subglottal pressure and laryngeal muscle contraction.

Question 4

What are the applications of Accent?

Answer 4

Organic voice disorders.
Functional voice disorders.
Minimal associated pathological lesions - small, soft VF nodules, contact granuloma, early Reinke’s oedema.
Vocal problems associated with professional voice users.
Supplemental to phonosurgery or drug therapy.
Dysphonia associated with dysarthria.

Question 5

What is Tempo 1 Largo?

Answer 5

Rhythm is slow - vowel, initial short, unstressed segment followed by long, accentuated segment - 3/4 beat.
Breath support - cyclic a-d breathing, comfortable inspiration –> accentuated expiration.
Phonatory exercises - vowel play, stressed long vowel ends in weak, soft unstressed tail - use breathy voice on unstressed vowel.
Associated arm movements - P moves bosy and limbs in forward/backward sway when phonating.

Question 6

What is Tempo 2 Andante?

Answer 6

Rhythm is faster, 4/4 beat
3 Accentuations, short successive vocalisations.
Breath support - Inspiratory phase quick and deep
Movements - 90 degree swinging motion.

Question 7

What is Tempo 3 Allegro?

Answer 7

Rhythm - faster 4/4 beat
5 accentuations, short successive vocalisations.
Breath support - Inspiratory phase quick and deep
Movements: short, rhythmic, bouncing movement - vertical motion of forearms (beating drum).

Question 8

What is involved in the stabilisation of new vocal behaviour?

Answer 8

Attention to phonatory aspects:

• Interplay of different rhythms with accentuated vowel play
• Varying amplitude
• Practise until P produces relaxed, well-resonated voice, variable accentuations and loudness, comfortable pitch.
• Practise nonsense syllables and consonants.

Attention to posture:
- Correct faulty postural habits

Attention to supralaryngeal vocal tract:

• Encourage active jaw and lip movements during vowel play.
• Encourage to use wide pharynx with false VF retracted.

Question 9

How does P transfer to connected speech?

Answer 9

Counting/serial speech tasks
Reading
Monologue and dialogue
Adaptations to tempos of accent method
Identify tempos and stresses in connected speech and reading

Question 10

What is the mode and duration of therapy?

Answer 10

Usually individual therapy, 2-3 sessions/week, 20 mins/session.
Functional voice disorders = 20-25 sessions
Organic voice disorders = longer than 25 sessions
Contact granuloma = 70 sessions

Question 11

Criteria for termination of therapy?

Answer 11

Patient satisfaction.
Improvement and stabilisation of auditory perceptual assessment.
Improvement of P’s phonatory function as observed via instrumentation (visipitch, PRAAT).
Videostroboscopy shows improvement.