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When the patient has acquired easy phonation, more specific exercises addressing fluency, loudness, intonation, stress and pitch modulation, articulation, and speech rate are provided, in order to obtain an optimal voice and intelligible speech. After all, intelligible speech is the most important aspect when it comes to communication with the environment.

The voice is pulmonary driven and consequently tracheoesophageal speech can be as fluent as normal speech. Some training in extending maximum phonation time and phrase length can be helpful to reach normal phrase length. By counting as long as possible on one intake of breath, the patient becomes more aware of his vocal capacities. Paragraph reading and focusing on using the natural pauses for inhalation can be helpful in achieving natural speech.

Training in enlarging pitch and loudness ranges and achieving insight in the capacities of the voice when it comes to pitch and loudness is an important aspect of improving naturalness and liveliness of tracheoesophageal speech. Singing is often used as an instrument to extend the possibilities and control over pitch and loudness.

Speech rate is often very personal and usually not easy to change. However, when the speech rate is too fast and negatively influences speech intelligibility it is important to slow it down.

Achieving intelligible speech, with an optimal voice quality as close to normal voice as possible, is the ultimate goal of voice rehabilitation. Therefore, it is important not only to address voice quality but also intelligibility. Specific articulation exercises, for instance for voiced-voiceless distinction can be necessary.

In general, functional speech is obtained within a very short time, often already during the first therapy session. Most patients will leave the hospital with intelligible speech after only a few days of practice. After discharge from the hospital, the voice and speech therapy is continued on an outpatient basis, until an optimal result has been achieved.