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The following
is a case study taken from Anthroposophical
Therapeutic Speech by Barbara Denjean-von Stryk
and Dietrich von Bonin
Case
History E: Vocal Nodules. Male patient, aged 37,
architect
1.1
Period of
Treatment
January to October
1997, thirteen sessions of thirty minutes each.
2.1
First
Impression
The patient is
about two metres tall, slim, his haircut is in the ‘Che Guevara’
style, he is well-groomed. He says that he does not know anything
about this kind of therapy, but since his doctor recommended it, he
has decided to give it a try.
2.2
Biographical and
Medical Aspects
The patient is
thirty-seven, happily married, no children. He is an architect in a
joint office with other architects. At present he is without
commissions, which means that he is de facto out of
work.
Medical Diagnosis:
Vocal nodules, that is to say a hardening on the vocal chords which
bother him when speaking. Having been removed by surgery, they
reappeared very quickly. Prognosis: Irreparable. Accompanying
symptoms were hoarseness and a certain inhibition during
conversations.
2.1
Speech
Diagnosis
Stance: There seems to be a disfluency
in the area of larynx and collarbone; his head is slightly bent
back, as a consequence the chin in slightly protruding; his
shoulders are slightly pulled forward. In contrast to this, his
arms and legs appear to be loose and relaxed.
Breathing: When the patient speaks
it sounds as if he is holding his breath.
Voice: Sonorous, ‘stuck’ way back in
his throat.
Articulation:His articulation is not
formed, not at any of the placements. This gives the impression of
purely vocalic, sonorous sound.
Thinking: The patient expresses
himself in a simple but clear way.
3.1 Therapeutic
Aim
Short-term: Lure his voice forward.
Activate his exhalation in speaking. Make him seize his limbs
harmoniously. Find support in articulating.
Medium-term: Relieve the strain on the
vocal chords by practising regularly.
Long-term: Stabilize this ‘relieved’
way of speaking and transfer it to his everyday
language.
3.1
Course of
Therapy
a)
The Means of
Therapy
The patient is
willing to practise by himself, which is a necessary prerequisite
since he can only come once in a fortnight only, the journey taking
him five hours altogether. Due to unexpected professional
commitments there were often two to four weeks between individual
sessions.
1. A basic
constitutional exercise was stepping the hexameter with arms
coming
down while
speaking (approach with neurasthenic patients). Taking hold of the
limbs in speaking; activating the breathing.
2. Pfiffig
pfeifen…(Piffling fifer) a) with the tip of the toes on every
pf; b) with an arm
gesture. These two
ways were to be practised which the patient did very intensively.
To balance out he also practised the exercise gently from the
eighth session. We started with the first stanza of the exercise,
gradually including also the other two. Focusing on the pf
also made it possible to activate the labial placement
(lips).
3. Wuchtig wogt
Wirbelwind…(Warning warblers wallow weightily) B
while
bouncing a ball.
To further support the labial placement and activate the
exhalation.
Sequence
from the 8th session:
1.
Hexameter
2. Pfiffig
pfeifen…(Pifling fifer)
3. Zuwider
zwingen…(Tu-whit twinkle ‘twas) (with arm
movement)
4. Halt hebe
hurtig…(Halt! habit hoarding) (stamping in a standing
position)
5. Wuchtig
wogt…(Warning warblers!) Pfui, pfeife pfiffige…(Fie, fifer
fifing) (bouncing a ball)
In the second part
of the therapy session we would do various exercises to fully grasp
the different placement; Protzig preist…(Proxy prized);
Tritt dort…(Trip dauntless); Marsch schmachtender …(March
smarten ten).
b)
Therapeutic
Process
To begin with the
lip placement was seized actively, followed by the tongue/tooth
placement and then the palate placement. This went along with
activating the exhalation in speaking and directed movements of the
arms and legs.
The patient
practised regularly, diligently and consistently. At a certain
point of the therapy he managed to shape a part of the sequence
competently by himself, which proved that he was able to connect
with the true quality of the work.
Steps of
Development
- First his
hoarseness disappeared in the sessions but was still there in his
everyday speech.
- Next the
hoarseness disappeared in his everyday speech, reappearing only
occasionally on the telephone.
- Before the summer
holidays the patient finally went for a control check-up which
shows that the vocal nodules had nearly completely
disappeared.
- After the summer
holidays the patient was informed after another examination that
the nodules were gone and he was free of symptoms.
Interestingly
enough the patient had more than enough commissions from June and
needed to draw up a waiting list after the summer
holidays.
4.1
Findings at the
End of the Therapy
Due to the fact
that he practised regularly and consistently, the patient was able
to learn how to relieve his vocal chords, even in his everyday
speech. His speaking on the exhalation improved greatly. The more
active articulation brought his voice forward to the right
place.
5.1
Recommendations
Since the
improvement was due to his active practising, it would be good to
continue this process adding further sequences from time to time
(once in six or twelve months), so that the patient will ultimately
be able to make a habit of grasping all the sounds (the vowels in
particular which are most closely connected with the voice) in a
healthy way.
© Copyright 2005 Katherine Rudolph, Exploring The Word In Colour
And Speech
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