Full Goal

Following semi-occluded vocal tract (SOVT) warm-up (straw phonation or lip trills) and given clinician modeling and tactile/proprioceptive feedback, patient will produce a resonant voice (forward focus, easy onset, sustained loft into chest) in CV-VC syllables, words, and carrier phrases with at least 80% of trials judged resonant on clinician perceptual rating across 3 consecutive sessions, as measured by clinician perceptual rating (Resonant/Strained/Breathy) and patient self-rating on a visual analog scale, with periodic acoustic capture (CPP, smoothed CPPS).

Individualization Guidance

Before using this goal, verify:

• Laryngeal imaging exists. Voice goals without recent stroboscopy (or at minimum flexible laryngoscopy) are clinically and medico-legally weak. The differential between primary MTD, secondary MTD over a lesion, and other pathology shapes everything about the goal. Document the ENT/laryngology report referenced.
• MTD subtype matters. Morrison’s MTD types I–IV have different patterns of laryngeal posturing. Resonant voice therapy is more directly indicated for Type I and some Type II patterns. Type IV (bowing/aphonia) may require a different approach.
• SOVT exercise selection. Straw phonation, lip trills, /v/ or /z/ prolongation, and tube phonation are all SOVT options. Choose based on patient comfort and acoustic response. Document which exercise is used so the goal is reproducible.
• Perceptual rating must be reliable. Train at least one other rater for inter-rater reliability on the perceptual scale. Single-rater perceptual data can drift over time without anyone noticing.
• CPP/CPPS acoustic measures. Cepstral peak prominence is more robust to environmental noise than perturbation measures (jitter/shimmer). If your facility doesn’t have CPPS, document why and rely on perceptual rating with patient self-report as a check.
• Behavioral comorbidities. Reflux, chronic cough, vocal hyperfunction patterns, and stress all interact with voice. A voice goal without paired behavioral targets (hydration, reflux management, voice rest after speaking events) often plateaus.

Clinical Notes

The 80% perceptual-rating criterion is set within session because resonant voice is taught moment by moment. The “3 consecutive sessions” extension catches whether the patient maintains the production across days, not just within a single trained block.

Capturing both clinician perceptual rating and patient self-report on every probe creates a triangulation. Divergence between the two is clinically meaningful: when the patient rates voice as “resonant” and the clinician rates it as “strained,” that’s a self-perception calibration issue and shapes the next session.

Periodic CPP/CPPS capture (not every session — e.g., baseline, mid-treatment, discharge) provides objective acoustic anchoring. CPPS is sensitive to dysphonia and tracks with perceptual ratings of voice quality. Cite the CPPS values in the discharge summary.

This goal is at the syllable-to-phrase level. Generalization to conversational speech and patient-specific vocal demands (teaching, singing, calling out at work) is separate goals.

CMS skilled-service rationale: the clinician’s judgment about how to fade SOVT scaffolding into resonant voice production at increasing levels of phonetic complexity is the skill. Without that judgment, this is vocal warm-up, not therapy.

Related Goals

• (No companion voice goal yet — see ASHA Voice Disorders Practice Portal for related goal patterns including vocal hygiene and vocal function exercises.)