By Gerriann Jackson, MS, CCC-SLP | Founder and Director, VoiceOver Speech Pathology
We attend Fall Voice each year because the quality of the care we provide depends on continuing to deepen my understanding of the voice. Reviewing research, exchanging experiences with colleagues, and considering new ideas all contribute to how we assess a concern and help someone work toward a meaningful goal. For our patients and coaching clients, that goal might be a conversation without fatigue, a dependable voice throughout the workday, or greater ease and expression in performance.
Two sessions serviced as timely reminders while adding valuable additions to treatment and assessment options. One addressed the influence of connective tissue disorders and hypermobility on voice and the other explored and explained the interplay between voice and motor speech. Both reinforced the importance of assessing and treating with the full range of knowledge and tools at our disposal to target and individual’s concern with focused efficiency. Why I Attend the Fall Voice Conference Every Year
This attention to the individual is central to our voice habilitation and rehabilitation services as well as our voice coaching services. Learn more about how we support vocal health and development at VoiceOver.
Together at Fall Voice
Fall Voice 2026 and Hypermobility
Connective Tissue and Hypermobility Spectrum Disorders: Clinical Implications for Voice and Airway Care
Presented by Nina Callahan, MS, CCC-SLP; Claire Ligon, M.Ed., CCC-SLP, PAVA-RV; and Stacey Menton, MM, MA, CCC-SLP.
A strained voice tells us that speaking requires excess effort. It does not, by itself, explain why. In our work with muscle tension dysphonia, a voice disorder involving excessive muscular effort, we consider what that tension is accomplishing. Muscles may be working harder to compensate for weakness, incomplete vocal fold closure, or difficulty coordinating breathing with voice. The resulting strain is part of a larger pattern that needs to be understood.
This session brought connective tissue into that discussion. Connective tissue helps support the structures of the body, including the larynx, or voice box. In hypermobility disorders, such as hypermobile Ehlers-Danlos syndrome, joint movement and tissue support deserve particular attention. A muscle that feels tight may also be working to stabilize an area that lacks sufficient support. Reducing tension without addressing that demand leaves an important part of the problem unresolved.
For someone whose voice feels persistently tight or tiring, this distinction matters. Treatment must address both the excessive effort and the support needed for comfortable voice production. The presenters described gentle release paired with carefully dosed activity, beginning with low demands and progressing according to the person’s response. The emphasis was on developing coordination and capacity while respecting the individual’s tissue and joint characteristics. This approach is consistent with the broader emphasis on stability, movement control, and gradual progression in the Ehlers-Danlos Society’s physical therapy guidance.
Familiar voice exercises also require that individual attention. The session included semi-occluded vocal tract exercises, a family of techniques that includes voicing through a straw. These techniques have a long history in voice training; voice scientist Ingo R. Titze’s research explains important aspects of their mechanics. In the setting of hypermobility, the choice of exercise, physical support, and amount of practice should reflect what the person’s voice can sustain comfortably. An exercise is useful because of how it serves that person’s needs.
The discussion also expanded my consideration of intermittent arytenoid subluxation: a partial shift at one of the small joints that help position the vocal folds. In a 2025 case report by Stacey M. Menton and colleagues, a patient with hypermobile Ehlers-Danlos syndrome initially appeared to have vocal fold paralysis. Imaging performed during movement revealed intermittent subluxation. This single case does not establish how frequently it occurs, but it illustrates why a fluctuating voice problem sometimes requires an assessment that captures movement over time.
A history of unusual joint flexibility, instability, or symptoms that come and go therefore belongs in the conversation about a voice concern. It can help us recognize when hypermobility screening and further medical assessment are warranted. When symptoms and examination findings do not align, collaboration with a laryngologist—a physician specializing in the voice and larynx—helps clarify what is happening.
The value of this session was its deeper explanation of a familiar complaint. Vocal tension can represent the body’s attempt to meet a demand it is struggling to manage. Recognizing that relationship helps us choose treatment that eases effort while developing the support needed to sustain a more comfortable voice.
If hypermobility is part of your medical history and speaking has become effortful, contact VoiceOver to discuss an evaluation. Referring clinicians are welcome to share relevant findings and concerns about fluctuating symptoms.
Fall Voice 2026 and the Connection Between Voice and Speech
Adjusting Our Filter: Unifying Concepts of Voice and Speech Production in the Evaluation of Voice and Motor Speech Disorders
Presented by Allison Aaron, MS, CCC-SLP, doctoral candidate; Stephen Damico, MS, CCC-SLP; and Bradley Hoff, MA, CCC-SLP, PAVA-RV.
Every conversation involves a coordinated sequence of movement. Breathing supports vocal fold vibration; the tongue, lips, and jaw shape sound into words; timing and intonation give those words meaning. Voice is part of this integrated activity. The term “motor speech” refers to the planning and control of the movements that make speaking possible.
This relationship has long informed the treatment of neurologic conditions. Darley, Aronson, and Brown’s landmark 1969 work described patterns of dysarthria, a group of motor speech disorders that affect how speech is produced. Their work considered voice alongside other features of speech, a connection that remains central to understanding conditions such as Parkinson’s disease.
In Parkinson’s, reduced vocal loudness occurs within a broader disturbance of movement and sensory feedback. A person’s perception of speaking loudly enough may differ from what a listener hears. Treatment therefore addresses both production and the person’s sense of the effort required. LSVT LOUD, originating with Lorraine Ramig and Carolyn Mead Bonitati, is an established example of this connection between voice treatment and motor speech rehabilitation. Research supports its effects on vocal loudness in Parkinson’s disease.
The session’s contribution was to extend that familiar understanding more deliberately into everyday voice care. A voice complaint is experienced while someone is speaking: answering a question, leading a meeting, teaching, or talking with family. Working with the coordination of speech gives us a direct way to address the vocal effort, clarity, and expression that matter in those situations.
Conversation Training Therapy, or CTT, makes this connection explicit. Developed initially by Jackie Gartner-Schmidt and Amanda I. Gillespie, then refined with expert clinicians and patient input, CTT uses conversation as the setting for treatment from the beginning. Attention to clear speech, physical sensation, sound, and intonation helps a person explore more effective voice production while communicating something meaningful. The conversation itself becomes an opportunity to learn and practice.
A 2019 study by Gillespie, Yabes, Rosen, and Gartner-Schmidt found improvements in the reported impact of voice problems and several voice measures among adults with muscle tension dysphonia or benign vocal fold lesions. For patients, the appeal of this approach is practical: the work takes place within the activity they want to improve. For a professional whose voice must remain dependable under changing demands, that connection to actual communication is particularly relevant.
This session reinforced my view that voice treatment should reflect the complexity of speaking. Considering breath, vocal production, articulation, and expression together allows us to work toward a voice that functions more comfortably in the person’s life. The same integrated understanding informs coaching, with goals shaped around the client’s professional and personal demands.
Explore our voice habilitation and rehabilitation services for support with vocal function, or contact us to discuss the demands you place on your voice.
What Fall Voice 2026 Brings to VoiceOver’s Patient and Client Care
These sessions strengthened two aspects of my approach to assessment and treatment. Hypermobility adds another consideration when vocal tension, fatigue, or fluctuating symptoms need explanation. It directs attention to tissue support and joint stability, with treatment that balances release and carefully developed capacity. The voice and motor speech discussion reinforces the importance of assessing and treating voice within the coordinated act of speaking.
For patients and referral sources, the benefit is a more complete account of the problem and a clearer rationale for care. For coaching clients, it is an understanding of vocal function that supports the way they need to communicate. In both settings, our responsibility is to consider the evidence alongside the person’s history, experience, and goals, and use that information to guide the work we do together.
That is why we return to Fall Voice year after year. Continuing education and thoughtful exchange with colleagues deepen the judgment that experience brings. We come back with new considerations for assessment, a broader understanding of treatment, and ideas to examine carefully on behalf of the patients and clients who trust us with their voices.
To discuss a voice concern, coaching goal, or referral, contact VoiceOver Speech Pathology in Rochester, New York.
