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Both phrase length and speech rate are important factors for natural sounding, intelligible speech. Phrase length is dependent on the maximum phonation time of the patient and therefore this term is included in this section as well. Exercises to increase maximum phonation time (both on vowels and running speech) increase possibilities to vary phrase length and give the patient insight in his or her skills. Both a too long and too short phrase length may appear unnatural. Focusing on the natural pauses is therefore important. Speech rate should not decrease or increase as a consequence of the use of an automatic speech valve and only should be adjusted when it is influencing intelligibility in a negative way.