Throwback (2016): Stimulability techniques for voice assessment and intervention

The beauty of stimulability assessment: It helps us develop meaningful goals for our clients and determine benefits of our interventions. We often use it for articulation disorders, but did you know we should also be applying stimulability assessment in our clients with voice disorders?

Recall that stimulability refers to “an individual’s ability to modify a behavior when provided models or cues.” Powell reminds us that good stimulability occurs when the client is able to produce a target more accurately after a model or cue.

This study validated a “clear speech” technique that you can apply to your caseload for both children AND adults with voice and related disorders (i.e.: voice and resonance imbalances associated with hearing impairment). Yay for broad applicability!

The “clear speech” technique stems from an intelligibility strategy commonly applied to individuals with hearing impairment and the general premises of voice diction. Unlike other techniques that apply hierarchical methods, clear speech is a stimulability task for connected speech.

Clear speech stimulability assessment simply involves instructing the client to use “crisp, clear consonants” and “precise articulation.” The SLP additionally instructs the client to “vary their intonation or pitch” while completing a reading task using clear speech (e.g. in this study, The Rainbow Passage). Essentially, you are cueing your client to over-aspirate their pressure consonants or enunciate, increase breath support, and enhance posture for breath support and phonation. A perceptual improvement in voice following this task can be an indicator your client may benefit from behavioral voice intervention strategies.

This study also assessed changes in acoustic and aerodynamic measures, as well as patient and clinician ratings of perceptual changes following the “clear speech” stimulability task. Statistically significant improvements in both perceptual quality and aerodynamic changes of the voice were noted after completing the task.

The findings? Immediate improvements in voice were possible after instructing clients to use clear speech methods. Patients with muscle tension dysphonia showed the greatest improvement.

Side note: These kinds of improvements are also often reported as prognostic indicators for overall success in behavioral voice therapy.

Another side note: These results are similar to results of studies assessing stimulability following trials of both resonant voice and flow phonation techniques.


And if you have access to voice instrumentation such as the Phonatory Aerodynamic System (PAS) or Analysis of Dysphonia in Speech and Voice software (ADSV), as was used in this study, you can also apply this method to monitoring treatment outcomes or progress and as a means of quantifying pre-treatment change.

Overall, this study provides a helpful reminder that stimulability assessment is beneficial and something we should be doing consistently across various types of voice disorders. Remember—therapy is both diagnostic and therapeutic, and stimulability assessment can guide our treatment decisions.


Gillespie, A., & Gartner-Schmidt, J. (2016). Immediate effect of stimulability assessment on acoustic, aerodynamic, and patient-perceptual measures of voice. Journal of Voice. doi:10.1013/j.jvoice.2015.06.004.