Accent Modification, Voicework, and ALS: A Case Study in Prolonging the Ability to Speak

ABSTRACT

This article is a qualitative retrospective case study detailing voice and speech training for a woman living with bulbar onset amyotrophic lateral sclerosis (ALS); the training focused on specific breathing and accent changes in order to prolong her ability to speak without the use of assistive technology for as long as possible. Based on the results of the case, this article offers a potential plan for palliative training for people with bulbar onset ALS, which includes training in Knight–Thompson Speechwork and Fitzmaurice Voicework immediately after diagnosis. The methodology follows qualitative case study design within applied social science and education. The article defines the parameters of the case by exploring ALS and the voice and speech methods used to coach, and includes a chronological narrative as well as field notes and interviews in order to give analysis and implications.

KEYWORDS:

• ALS
• Fitzmaurice Voicework
• Knight–Thompson Speechwork
• accent modification
• palliative care
• patient-centered care

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. Terry gave her written consent to have her real first name used in this article.

2. Unless otherwise noted, all of the quotations in this article are from interviews or email correspondence with Terry. The date of each communication is noted after the quote.

3. For an explanation of Knight–Thompson Speechwork, see Thompson, Caban, and Singer (2017).

4. The full arc is explained in Speaking with Skill (Knight 2012).

5. For an explanation of Fitzmaurice Voicework, see Morrison, Kotzubei, and Seiple (2017) and Watson and Nayak (2014).

6. For more information on FVC, visit http://www.worker health.org/breathingtestresults.html or https://www.healthline.com/health/spirometry#results.

7. Terry shared with me her Spirometry Reports from a four month period in 2015. They show FVC values chronologically from April to July increasing from 2.61, to 2.76, to 2.77, and then to 2.86.

8. For an example of speech modification in the case of visit squamous cell carcinoma, see https://www.uptodate.com/contents/speech-and-swallowing-rehabilitation-of-the-patient-with-head-and-neck-cancer.

9. For more information about these Howcast accent videos, see https://www.howcast.com/videos/500463-dialect-training-accent-training/.

10. As defined by Knight (2012).

11. For more information about tremoring, refer to Watson and Nayak (2014) and to Fitzmaurice and Kotzubei (2005).

12. For a more in-depth explanation of FV Destructuring and Restructuring, please refer to Morgan’s (2008) Constructing the Holistic Actor: Fitzmaurice Voicework.

13. For information about the VASTA’s Yahoo group and for access, see https://www.vasta.org/vastavox-listserv.

14. For a complete understanding of KTS, see Knight (2012).

15. This concept comes from John C. Wells (1982), who defines 24 lexical sets as a means to understand and define accents of English.

16. The focus line is a metaphorical concept from Fitzmaurice Voicework that encourages muscular engagement and alignment in the vocal tract and other communicative benefits. See Watson and Nayak (2014) for more details.

17. An Example of Terry speaking in Voice One and Voice Two in January 2015 is available here: https://youtu.be/5qtoSpQBHhg.

18. Examples of Terry speaking in Voice One and Voice Two in November 2015 and April 2017, respectively, are available here: https://youtu.be/_62KoPLxbnE

https://youtu.be/9Xb9F1Ep5-M.

19. See https://alsadotorg.wordpress.com/2018/01/05/award-winning-playwrights-the-voice-bank-is-one-woman-show-about-fight-to-keep-speaking-with-als/#more-4199.

20. See https://alsnewstoday.com/2018/02/09/als-learning-how-to-speak-breathe-with-ease/.

21. See http://alsandwellness.blogspot.com/2018/03/als-dysarthria-use-these-innovative.html.

22. That performance of The Voice Bank can be viewed here: https://youtu.be/0zqeY7CYJHI.

Additional information

Notes on contributors

Andrea Caban

Andrea Caban is an Assistant Professor and Head of Voice and Speech at CSU Long Beach. An award-winning solo artist, she has performed her original works in Colombia, the UK, South Africa, Costa Rica, Spain, and across the US. She is Associate Director and Master Teacher of Knight–Thompson Speechwork, an Associate Teacher of Fitzmaurice Voicework, Associate Editor for the Voice and Speech Review, and Associate Specialist in the UCI Department of Neurology. Current research: Arts-Based Research theatrical performance forms including auto-ethnography, community-based theatre, and investigative theatre on themes of social justice, women, and/or patient-centered care. Dialect expert on HowCast.com, theatrical production coach, and speaker coach for TED talks. MFA, UC Irvine.