Zorgtraject stem – logopedisch deel
Prof. Ellen Rombouts – 2024-2025
De stem in de logopedisch praktijk ................................................................................................ 4
Stemgebruikers ........................................................................................................................ 4
Beroepssprekers....................................................................................................................... 4
Aspecten van de stem ............................................................................................................... 4
De normale optimale stem ........................................................................................................ 5
Fonatie efficiëntie .................................................................................................................. 5
Stembelasting en belastbaarheid ........................................................................................... 6
Impact van stemproblemen ....................................................................................................... 7
Biopsychosociaal model ........................................................................................................ 7
Stemklachten ........................................................................................................................ 7
Preventie stemstoornis .......................................................................................................... 8
Stemergonomie/preventie ......................................................................................................... 8
Zorgproces ............................................................................................................................ 8
Preventie .............................................................................................................................. 8
Ergonomie ............................................................................................................................ 8
Stemergonomie ..................................................................................................................... 8
Preventie stem-behandeling ................................................................................................... 9
Stem-wellness ...................................................................................................................... 9
Stemmisbruiken en negatieve factoren (stel je werkt bij vrt) ...................................................... 9
Diagnostiek .................................................................................................................................10
Herhaling ................................................................................................................................10
Zorgproces ..............................................................................................................................11
Diagnose .................................................................................................................................11
Anamnese ...............................................................................................................................11
Klinisch stemonderzoek ...........................................................................................................12
Laryngeale toestand ..........................................................................................................12
Akoestische analyse..........................................................................................................12
Aerodynamische beoordeling ............................................................................................15
Perceptueel onderzoek ......................................................................................................16
Zelfbeoordeling door cliënt ................................................................................................21
Limitatieve lijst ........................................................................................................................22
Logopedische behandelingstechnieken ........................................................................................24
Zorgproces ..............................................................................................................................24
Indirecte behandeling ..............................................................................................................24
1
, Componenten ......................................................................................................................24
Stem-wellness .....................................................................................................................24
1. Stemopvoeding .................................................................................................................25
2. Stemhygiëne.....................................................................................................................26
3. Counseling .......................................................................................................................26
Directe behandeling .................................................................................................................28
1. Houding ...........................................................................................................................28
2. Ademhaling ......................................................................................................................29
3. Fonatie .............................................................................................................................30
Sluiting bevorderen ...........................................................................................................30
Opening bevorderen ..........................................................................................................31
Spanning verminderen .......................................................................................................31
Toonhoogte ......................................................................................................................34
Stabiliseren ......................................................................................................................35
4. Resonantie .......................................................................................................................35
5. Articulatie ....................................................................................................................37
6. Prosodie ......................................................................................................................37
Programma’s of methodes .......................................................................................................38
Vocal function exercises (VFE) ...........................................................................................38
Confidential voice therapy .................................................................................................39
Lee Silverman voice treatment (LSVT) .................................................................................39
Pitch limiting voice treatment .............................................................................................40
Nasaleren .........................................................................................................................40
Accent methode ...............................................................................................................40
Ademritmische therapie van Coblenzer ..............................................................................41
Estill voice training ............................................................................................................41
Nog vele andere methodes! ...............................................................................................41
Samenvattende principes in stembehandeling ...........................................................................41
Historisch gegroeid ...........................................................................................................41
Evidence based handelen ..................................................................................................42
Principes behandeling .......................................................................................................42
Individueel of in groep? ......................................................................................................42
Motivatie cliënt .................................................................................................................42
Hou rekening met noden ....................................................................................................42
Glottal fry debat (examen!!) ...............................................................................................42
Specifieke doelgroepen ...............................................................................................................44
Kinderen en adolescenten ........................................................................................................44
Kinder dysfonie .................................................................................................................44
2
, Stemplooinoduli ...............................................................................................................44
Aandachtspunten .............................................................................................................45
Aangepast materiaal .........................................................................................................45
Mutatiestoornis (puberphonia) ...........................................................................................45
Logopedische behandeling ................................................................................................45
Ouderen – presbyfonie .............................................................................................................46
Veroudering ......................................................................................................................46
Behandeling opstarten? .....................................................................................................46
Behandeling .....................................................................................................................46
Neurogene etiologie .................................................................................................................47
Stemplooiparalyse ............................................................................................................47
3
, De stem in de logopedisch praktijk
Stemgebruikers
Koufmann en Isaacson:
• Groep 1: elite vocal performers
o Zangers etc
o Met zeer kleine stemproblemen al grote gevolgen voor hun beroep
• Groep 2: professional voice users (occupational)
o Leerkrachten etc
o Als zij last hebben van hun stem dan gaat hun beroepsuitvoering ook wel verslechteren
• Groep 3: non vocal professionals
o Politieker etc (veel vergaderingen moeten doen)
o Kunnen beroep nog wel behoorlijk goed uitoefenen, mits stemproblemen
• Groep 4: non vocal non professionals
o Landbouwers etc (handwerk)
o Kunnen beroep nog perfect uitoefenen mits stemproblemen
Omezzano:
• Professionele stemgebruikers
o Zangers, nieuwslezers, etc
• Zij die niet weten dat ze professionele stemgebruikers zijn
o Leerkrachten etc
• Amateurs
o Landbouwers etc
Beroepssprekers
= allemaal mensen waarbij hun stem belangrijk is voor hun beroep
• Luid praten en veel praten: leerkrachten, toneelspelers
• Zacht praten en veel praten: telefonisten, verkopers
• Luid praten en weinig praten: bevelvoerenden zoals officieren
• Zacht praten en weinig praten: radio- en televisiepresentatoren
Aspecten van de stem
Stemklank:
- Toonhoogte
- Luidheid
4
Prof. Ellen Rombouts – 2024-2025
De stem in de logopedisch praktijk ................................................................................................ 4
Stemgebruikers ........................................................................................................................ 4
Beroepssprekers....................................................................................................................... 4
Aspecten van de stem ............................................................................................................... 4
De normale optimale stem ........................................................................................................ 5
Fonatie efficiëntie .................................................................................................................. 5
Stembelasting en belastbaarheid ........................................................................................... 6
Impact van stemproblemen ....................................................................................................... 7
Biopsychosociaal model ........................................................................................................ 7
Stemklachten ........................................................................................................................ 7
Preventie stemstoornis .......................................................................................................... 8
Stemergonomie/preventie ......................................................................................................... 8
Zorgproces ............................................................................................................................ 8
Preventie .............................................................................................................................. 8
Ergonomie ............................................................................................................................ 8
Stemergonomie ..................................................................................................................... 8
Preventie stem-behandeling ................................................................................................... 9
Stem-wellness ...................................................................................................................... 9
Stemmisbruiken en negatieve factoren (stel je werkt bij vrt) ...................................................... 9
Diagnostiek .................................................................................................................................10
Herhaling ................................................................................................................................10
Zorgproces ..............................................................................................................................11
Diagnose .................................................................................................................................11
Anamnese ...............................................................................................................................11
Klinisch stemonderzoek ...........................................................................................................12
Laryngeale toestand ..........................................................................................................12
Akoestische analyse..........................................................................................................12
Aerodynamische beoordeling ............................................................................................15
Perceptueel onderzoek ......................................................................................................16
Zelfbeoordeling door cliënt ................................................................................................21
Limitatieve lijst ........................................................................................................................22
Logopedische behandelingstechnieken ........................................................................................24
Zorgproces ..............................................................................................................................24
Indirecte behandeling ..............................................................................................................24
1
, Componenten ......................................................................................................................24
Stem-wellness .....................................................................................................................24
1. Stemopvoeding .................................................................................................................25
2. Stemhygiëne.....................................................................................................................26
3. Counseling .......................................................................................................................26
Directe behandeling .................................................................................................................28
1. Houding ...........................................................................................................................28
2. Ademhaling ......................................................................................................................29
3. Fonatie .............................................................................................................................30
Sluiting bevorderen ...........................................................................................................30
Opening bevorderen ..........................................................................................................31
Spanning verminderen .......................................................................................................31
Toonhoogte ......................................................................................................................34
Stabiliseren ......................................................................................................................35
4. Resonantie .......................................................................................................................35
5. Articulatie ....................................................................................................................37
6. Prosodie ......................................................................................................................37
Programma’s of methodes .......................................................................................................38
Vocal function exercises (VFE) ...........................................................................................38
Confidential voice therapy .................................................................................................39
Lee Silverman voice treatment (LSVT) .................................................................................39
Pitch limiting voice treatment .............................................................................................40
Nasaleren .........................................................................................................................40
Accent methode ...............................................................................................................40
Ademritmische therapie van Coblenzer ..............................................................................41
Estill voice training ............................................................................................................41
Nog vele andere methodes! ...............................................................................................41
Samenvattende principes in stembehandeling ...........................................................................41
Historisch gegroeid ...........................................................................................................41
Evidence based handelen ..................................................................................................42
Principes behandeling .......................................................................................................42
Individueel of in groep? ......................................................................................................42
Motivatie cliënt .................................................................................................................42
Hou rekening met noden ....................................................................................................42
Glottal fry debat (examen!!) ...............................................................................................42
Specifieke doelgroepen ...............................................................................................................44
Kinderen en adolescenten ........................................................................................................44
Kinder dysfonie .................................................................................................................44
2
, Stemplooinoduli ...............................................................................................................44
Aandachtspunten .............................................................................................................45
Aangepast materiaal .........................................................................................................45
Mutatiestoornis (puberphonia) ...........................................................................................45
Logopedische behandeling ................................................................................................45
Ouderen – presbyfonie .............................................................................................................46
Veroudering ......................................................................................................................46
Behandeling opstarten? .....................................................................................................46
Behandeling .....................................................................................................................46
Neurogene etiologie .................................................................................................................47
Stemplooiparalyse ............................................................................................................47
3
, De stem in de logopedisch praktijk
Stemgebruikers
Koufmann en Isaacson:
• Groep 1: elite vocal performers
o Zangers etc
o Met zeer kleine stemproblemen al grote gevolgen voor hun beroep
• Groep 2: professional voice users (occupational)
o Leerkrachten etc
o Als zij last hebben van hun stem dan gaat hun beroepsuitvoering ook wel verslechteren
• Groep 3: non vocal professionals
o Politieker etc (veel vergaderingen moeten doen)
o Kunnen beroep nog wel behoorlijk goed uitoefenen, mits stemproblemen
• Groep 4: non vocal non professionals
o Landbouwers etc (handwerk)
o Kunnen beroep nog perfect uitoefenen mits stemproblemen
Omezzano:
• Professionele stemgebruikers
o Zangers, nieuwslezers, etc
• Zij die niet weten dat ze professionele stemgebruikers zijn
o Leerkrachten etc
• Amateurs
o Landbouwers etc
Beroepssprekers
= allemaal mensen waarbij hun stem belangrijk is voor hun beroep
• Luid praten en veel praten: leerkrachten, toneelspelers
• Zacht praten en veel praten: telefonisten, verkopers
• Luid praten en weinig praten: bevelvoerenden zoals officieren
• Zacht praten en weinig praten: radio- en televisiepresentatoren
Aspecten van de stem
Stemklank:
- Toonhoogte
- Luidheid
4
