Optimize the Flow of Your Voice Therapy Patients: Flow Phonation

Flow Phonation

Do your patients “sigh” a lot? Are breath-holders a big part of your voice therapy schedule? They’re a big part of mine!

Voice therapy techniques and programs focused on airflow management are evidence-based ways to facilitate optimized speech breathing while reducing muscle tension—and all it requires is a tissue or your finger to see and feel the airflow, something we all have around.

What Is Flow Phonation?

Flow Phonation, in particular, is a hierarchal therapy concept that aims to facilitate increased airflow, ease of phonation, and forward oral resonance. It was modified from Ed Stone’s Stretch and Flow Phonation by dropping the “stretch” component, which reduced the rate of speech in the original program for those patients who were aphonic.

Flow Phonation can be used with both dysphonic and aphonic patients. Therapy ultimately aims for clear speech while focusing on airflow and the balance between airflow and voice production.

What Are the Hierarchical Levels of Flow Phonation?

During Flow Phonation, patients are asked to become aware of frontal energy/airflow while feeling no throat tightness. This is not a programmatic approach to voice therapy, as it allows clinicians to use their clinical judgment as to how to best achieve each skill level.

Flow Phonation consists of four skill levels:

  1. Airflow release
  2. Breathy phonation
  3. Flow phonation
  4. Clear speech/articulatory precision

The first three skill levels are taught with both unarticulated and articulated targets. The exhaled /u/ phoneme (voiced and voiceless) is used for the unarticulated targets in order to direct the airflow in a column from the lips to achieve a visual cue—an easy, steady airflow stream felt on the lips or seen by an uplifted piece of tissue. Articulated targets involve changing the shape of the oropharynx to produce differing consonant-vowel tasks and, ultimately, connected speech.

The patient goes through the four skill levels, but if problems recur, they can return to the previous level until they reach functional performance. In addition, if a patient can skip a level, they are also permitted to go through the hierarchical levels as fast as individually needed.

voice courses

How Can You Determine if Flow Phonation Is Right for Your Patient?

Determining the most appropriate voice therapy technique is crucial for patient improvement and success. Flow Phonation seeks to reestablish vocal balance and gives a conceptual framework toward efficient voicing for patients. Flow Phonation is best for patients who have increased muscle tension and who frequently exhibit breath-holding tendencies during phonation.

For more information pertaining to Flow Phonation, how to implement it in your practice, and troubleshooting techniques, watch Dr. Gartner-Schmidt’s MedBridge course, “Flow Phonation.”

  1. Stone, R. E. (1993). Management of functional voice disorders: Functional dysphonia. In J. C. Stemple (Ed.), Voice therapy: Clinical studies (pp. 255–263). Ann Arbor, MI: Mosby.
  2. Gartner-Schmidt, J. (2010). Flow phonation. In J. Stemple & L. T. Fry (Eds.), Voice therapy: Clinical case studies (3rd ed.) Abingdon: Plural Publishing.
  3. Gartner-Schmidt, J. (2008). Flow phonation. In A. Behrman (Ed.), The complete voice therapy workbook. San Diego: Plural Publishing.