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Tsai MJ, Wang CT, Fu S, Lin FC. Effect of intensive water resistance phonation therapy for people with presbyphonia: A pilot study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:728-736. [PMID: 37908078 DOI: 10.1080/17549507.2023.2261660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Purpose: The aim of this pilot study was to explore the efficacy of an intensive 3 week water resistance phonation (WRP) therapy program for people with presbyphonia.Method: Participants included 13 people with presbyphonia who received intensive WRP therapy. All participants completed eight sessions of therapy over 3 weeks. Auditory perceptual ratings, and acoustic and aerodynamic assessments were performed before and after treatment. Participants also completed the voice-related quality of life questionnaire before and after the treatment.Result: After 3 weeks of intensive voice therapy, significant improvements were demonstrated in acoustic, aerodynamic, and auditory perceptual parameters, as well as patient perceptions of voice-related quality of life. Acoustically, it was found there were significant decreases in shimmer (p = 0.019), noise-to-harmonic ratio (p = 0.016), and smoothed cepstral peak prominence (p = 0.001). Perceptually, the clients with presbyphonia showed significant reductions in the ratings of the overall grade, roughness, asthenia, and strain. Moreover, there was a significant increase in the total score of the Mandarin version of the Voice-Related Quality of Life measure post-therapy.Conclusion: The investigation provides preliminary evidence that people with presbyphonia can improve their vocal function and voice-related quality of life through intensive WRP therapy within a short period of time.
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Affiliation(s)
- Ming-Jhen Tsai
- Department of Otorhinolaryngology - Head & Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electric Engineering, Yuan-Ze University, Taoyuan, Taiwan
| | - Sherry Fu
- Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan
- Lower School, Taipei American School, Taipei, Taiwan
| | - Feng-Chuan Lin
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Meerschman I, D'haeseleer E, Vanderhasselt MA, Claeys S, Vonck K, Vergauwe R, Van Nuffelen G, Desuter G, Roy N, Van Lierde K. Exploring autonomic dysfunction in functional dysphonia: A protocol for a case-control study and a randomized controlled trial. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 39254146 DOI: 10.1111/1460-6984.13111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 06/24/2024] [Accepted: 08/19/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Although psychological factors have been implicated in patients with functional dysphonia (FD), conventional voice therapy (CVT) typically targets the aberrant voice symptoms exclusively. Yet, CVT is not always successful, and in view of the significant adverse quality of life impact combined with the financial burden on the healthcare system and society, research is needed to elucidate the underlying psychophysiology of FD and improve treatment outcomes. OBJECTIVES The first objective of this research project is to compare the occurrence and frequency of symptoms and/or disorders related to autonomic nervous system (ANS) dysfunction in patients with FD with gender- and age-matched vocally healthy controls, using a case-control study. The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (i.e., ANS therapy: heart rate variability (HRV) biofeedback) on both autonomic function and voice function versus CVT alone or in combination with ANS therapy (i.e., ANS therapy + CVT), using a randomized controlled trial (RCT). METHODS Case-control study: Autonomic (dys)function of patients with FD will be compared with gender- and age-matched vocally healthy controls, using both physiological measures (e.g., HRV, skin conductance level) and psychological patient-reported outcome measures (PROMs, e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). RCT: The FD group will be randomly assigned to the innovative ANS therapy group, the CVT group or the ANS therapy + CVT group. All patients received 1 month of treatment with 20 min of daily practice. Both the autonomic assessment and the voice assessment will be performed pretherapy and immediately after therapy by assessors blinded to group allocation and study phase. EXPECTED RESULTS Higher occurrences of symptoms and/or disorders related to autonomic dysfunction are expected in patients with FD compared with vocally healthy controls. Physiological outcomes: lower HRV, lower cardiac pre-ejection period, higher respiration rate and higher skin conductance level are hypothesized in patients with FD compared with vocally healthy controls. Psychological PROMs: higher self-report of feelings/symptoms related to autonomic dysfunction (e.g., perceived stress, anxiety) is expected in patients with FD compared with vocally healthy controls. The autonomic function is hypothesized to improve more after the ANS therapy and the ANS therapy + CVT compared with the CVT only. Voice function is expected to improve more after the ANS therapy + CVT compared with the ANS therapy and the CVT alone. WHAT THIS PAPER ADDS What is already known on the subject Autonomic dysfunction is well recognized in the field of psychology but remains understudied in the area of voice. Given that the vagus nerve, innervating the larynx, also helps to regulate the ANS, and psychological symptoms commonly observed in patients with FD may reflect ANS dysregulation, research in this area is needed. There is some preliminary evidence that autonomic dysfunction might indeed be associated with FD. However, physiological ANS measures are needed, as well as validated psychological PROMs. What this paper adds to the existing knowledge The first objective of this study is to investigate the occurrence and frequency of symptoms and/or disorders related to autonomic dysfunction in patients with FD as compared with a gender- and age-matched vocally healthy control group. Autonomic (dys)function will be determined by employing both physiological measures (e.g., HRV, skin conductance level) and psychological PROMs (e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (HRV biofeedback) versus CVT alone or in combination with ANS therapy. What are the potential or actual clinical implications of this work? Success rates of symptomatic CVT for FD are highly variable. This study is expected to lead to innovative results related to the pathogenesis and psychophysiology of FD, a prevalent voice disorder associated with a significant adverse quality of life impact and a substantial financial burden on the healthcare system and society. The results of this study will lead to crucial new insights into both the diagnosis and treatment of FD, contributing to evidence-based practice in the field of voice.
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Affiliation(s)
- Iris Meerschman
- Centre for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Evelien D'haeseleer
- Centre for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Royal Conservatory Brussels, Musical Department, Brussels, Belgium
| | - Marie-Anne Vanderhasselt
- Ghent Experimental Psychiatry (GHEP) Lab, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Sofie Claeys
- Department of Otorhinolaryngology, Department of Head and Skin, Ghent University Hospital, Ghent, Belgium
| | - Kristl Vonck
- Department of Neurology, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Riet Vergauwe
- Ghent Experimental Psychiatry (GHEP) Lab, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Gwen Van Nuffelen
- Department of Otorhinolaryngology and Head and Neck Surgery, Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Gauthier Desuter
- Department of Otorhinolaryngology and Head and Neck Surgery, Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Nelson Roy
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City, UT, USA
| | - Kristiane Van Lierde
- Centre for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Faculty of Humanities, Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
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Bane M, Angadi V, Andreatta R, Stemple J. Effect of Clinical Expertise on Efficacy of Vocal Function Exercises in Individuals With Typical Voice. J Voice 2023:S0892-1997(23)00361-2. [PMID: 37996344 PMCID: PMC11111589 DOI: 10.1016/j.jvoice.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES/HYPOTHESIS To determine the effect of clinical expertise on efficacy of Vocal Function Exercises (VFEs) as measured by change in percent of maximum phonation time goal attained. The hypothesis was that clinical expertise would result in greater increases in percent of maximum phonation time goal attained. STUDY DESIGN Randomized controlled trial. METHODS A convenience sample of 19 individuals with typical voice was recruited in a university academic clinic setting. All participants completed baseline assessment and 17 completed all study procedures. Participants were randomized to receive VFEs from an expert voice clinician with more than 40 years' experience (expert group (EG)) or from a master's student in Communication Sciences and Disorders trained in VFEs (novice group (NG)). The primary outcome measure was change in percent of maximum phonation time goal attained during VFE tasks 1 and 4. RESULTS Mean change scores for maximum phonation time were 27.71 (P = 0.001) and 25.31 (P = 0.003) for EG and NG, respectively. Both groups improved significantly on the primary outcome measure, but the difference between groups was not statistically significant (P = 0.759). A Hedges'-g effect size of -0.14 [-1.10, 0.81] was obtained comparing EG and NG groups, indicating a small negative effect of limited clinical expertise on VFE outcomes in individuals with typical voice. CONCLUSIONS Speech-language pathologists with varied levels of expertise are capable of efficaciously administering VFEs in individuals with typical voice.
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Affiliation(s)
- Maria Bane
- University of Kentucky Department of Communication Sciences and Disorders, 900 South Limestone, Lexington, Kentucky 40536.
| | - Vrushali Angadi
- University of Kentucky Department of Communication Sciences and Disorders, 900 South Limestone, Lexington, Kentucky 40536
| | - Richard Andreatta
- University of Kentucky Department of Communication Sciences and Disorders, 900 South Limestone, Lexington, Kentucky 40536
| | - Joseph Stemple
- University of Kentucky Department of Communication Sciences and Disorders, 900 South Limestone, Lexington, Kentucky 40536
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Chang CW, Fu S, Yu YH, Hsieh LC. Bi-Weekly Voice Therapy Versus Weekly Voice Therapy for Muscle Tension Dysphonia. J Voice 2023:S0892-1997(23)00211-4. [PMID: 37661523 DOI: 10.1016/j.jvoice.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES To compare the outcomes of bi-weekly voice therapy (BWVT) with weekly voice therapy on perception, acoustics, and quality of life for individuals with muscle tension dysphonia (MTD). METHODS Thirty participants with MTD were enrolled either BWVT (40 min/session, two sessions per week for 4 weeks) or weekly voice therapy (40 min/session, once a week for 8 weeks). Auditory perceptual ratings, acoustic parameters, and the Mandarin version of the voice-related quality of life questionnaire (MV-RQOL) scores were statistically analyzed before and after treatment. RESULTS There were significant improvements in the voice qualities such as overall grade, roughness, asthenia, and strain in both groups after treatment. Acoustics analyses showed that fundamental frequency, speaking fundamental frequency, jitter, shimmer, and cepstral peak prominence significantly improved in both groups after treatment. For the MV-RQOL questionnaire scores, the result also demonstrated that both groups felt significant improvements in voice-related quality of life after treatment. However, there were no significant differences between the two groups of treatment effects. CONCLUSIONS Patients with MTD can restore voice qualities and quality of life if they are able to complete a full course of voice therapy, regardless of the intensity of voice therapy. However, if they can receive the BWVT, they would be able to regain their voice faster. The results of this study can be provided as a reference for clinicians when treating patients with MTD.
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Affiliation(s)
- Chin-Wen Chang
- Department of Otolaryngology Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan; Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan
| | - Sherry Fu
- Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan; Lower School, Taipei American School, Taipei, Taiwan
| | - Yi-Hsuan Yu
- Department of Otolaryngology Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan; Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan
| | - Li-Chun Hsieh
- Department of Otolaryngology Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan; Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
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Ribeiro VV, Nascimento W, da Silva RC, Gonçalves FM, Santos RS, Behlau M, de Araujo CM, Taveira KVM. Evidence on Vocal Interventions in Adults: A Scoping Review. J Voice 2023:S0892-1997(23)00101-7. [PMID: 37149394 DOI: 10.1016/j.jvoice.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To map the evidence on vocal intervention in people over 18 years old. METHODS A literature search was conducted using the following electronic databases: Cochrane Library, EMBASE, Latin American and Caribbean Literature on Health Sciences (LILACS), LIVIVO, Pubmed/Medline, Scopus, SpeechBITE, and Web of Science. Gray literature was also used as an information source through searches on Google Scholar, Open Grey, ProQuest Dissertation and Thesis, and the Brazilian digital library of theses and dissertations. Systematic reviews (SR) with a population of individuals over 18 years old were included. The included reviews addressed speech-language pathology interventions in the vocal area with reports of their respective outcome. The methodological quality of the included systematic reviews was analyzed using the AMSTAR II tool. Quantitative analysis was performed by frequency distribution, and qualitative research was analyzed through narrative synthesis. RESULTS A total of 2,443 references were retrieved, among which 20 studies met the inclusion criteria. The included studies had critically low quality, lacking the use of population, intervention, comparison, and outcome (PICO) components. Among the included SRs, 40% were made in Brazil, 45% were published in the Journal of Voice, and 75% analyzed dysphonic patients. The most frequent intervention was voice therapy (direct therapy associated with indirect therapy approaches). Positive results were observed in most of the outcomes for all studies. CONCLUSION Voice therapy was described as inducing positive effects for voice rehabilitation. However, due to the critically low quality of studies, the literature did not enable us to understand the best results for each intervention. Well-designed studies are necessary to clarify the relationship between the intervention goal and how the intervention was evaluated.
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Affiliation(s)
- Vanessa Veis Ribeiro
- Speech-language Pathology Course, Universidade de Brasília, Brasília, Distrito Federal, Brazil; Associated Postgraduate Program in Speech-Language Pathology, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil.
| | - Weslania Nascimento
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain
| | - Rebeca Cardoso da Silva
- Speech-language Pathology Departament, Universidade Federal de Sergipe, Lagarto, Sergipe, Brazil
| | - Flavio Magno Gonçalves
- Postgraduate Program in Communication Disorders, Universidade Tuiuti do Paraná, Curitiba, Paraná, Brazil
| | - Rosane Sampaio Santos
- Postgraduate Program in Communication Disorders, Universidade Tuiuti do Paraná, Curitiba, Paraná, Brazil
| | - Mara Behlau
- Postgraduate Program in Communication Disorders, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Karinna Veríssimo Meira Taveira
- Department of Morphology- Center of Biosciences, Associated Postgraduate Program in Speech-Language Pathology, Universidade Federal do Rio Grande do Note, Natal, Rio Grande do Norte, Brazil
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Kissel I, Papeleu T, Verbeke J, Van Lierde K, Meerschman I, D'haeseleer E. Immediate effects of a semi-occluded water-resistance ventilation mask on vocal outcomes in women with dysphonia. JOURNAL OF COMMUNICATION DISORDERS 2023; 103:106331. [PMID: 37098295 DOI: 10.1016/j.jcomdis.2023.106331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Semi-occluded vocal tract exercises (SOVTEs) are frequently used exercises in voice therapy. An important shortcoming to most SOVTEs is the inability to include continuous speech in these exercises. A variation of water-resistance therapy (WRT), during which a patient phonates through a resonance tube ending in water, was developed to include continuous speech: the semi-occluded water resistance ventilation mask (SOVM-WR). The current study investigated the immediate effects of this innovative technique on vocal outcomes of women with dysphonia. METHODS A pretest-posttest randomized controlled trial was performed. Twenty female participants were randomly assigned to the experimental SOVM-WR group or the WRT (control) group. A blinded multidimensional voice assessment was conducted before and after a 30-minute therapy session with the assigned technique. RESULTS No significant changes were found in acoustic or auditory-perceptual vocal outcomes in either of the groups, except for a significant increase in lowest frequency in both groups. Patient-reported outcomes (PROMs) showed significant improvements of vocal comfort, vocal effort, and voice quality in both groups, and participants indicated that they would use the techniques at home. CONCLUSIONS The similar results of the SOVM-WR to WRT and promising PROMs confirm its suitability as an alternative to the latter technique. Potential reasons for a lack of improvement of objective and auditory-perceptual vocal outcomes are vocal fatigue, tube dimensions and immersion, and the small sample size. Large-scale and longitudinal research is needed to examine whether the SOVM-WR has a higher transfer to spontaneous speech than WRT after a full therapy program.
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Affiliation(s)
- Imke Kissel
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Tine Papeleu
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Jolien Verbeke
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Kristiane Van Lierde
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Faculty of Humanities, Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Iris Meerschman
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Evelien D'haeseleer
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; Royal Conservatory Brussels, Musical Department, Brussels, Belgium
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Bane M, Angadi V, Andreatta R, Stemple J. The Effect of Maximum Phonation Time Goal on Efficacy of Vocal Function Exercises. J Voice 2023:S0892-1997(23)00098-X. [PMID: 37105793 PMCID: PMC10598240 DOI: 10.1016/j.jvoice.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES/ HYPOTHESIS To determine the effect of maximum phonation time goal on efficacy of Vocal Function Exercises (VFEs) as measured by percent of maximum phonation time goal attained. The hypothesis was that provision of a maximum phonation time goal would result in greater increases in percent of maximum phonation time goal attained. STUDY DESIGN Randomized controlled trial. METHODS A convenience sample of individuals with normal voice were recruited in a university academic clinic setting. Of 34 participants who volunteered for the study, 28 completed baseline assessment and 19 completed all study procedures. Participants were randomized to complete VFEs with knowledge of their maximum phonation time goal (standard goal, SG), with knowledge of their maximum phonation time goal after three weeks (delayed goal, DG), or without knowledge of their maximum phonation time goal (no goal, NG). The primary outcome measure was percent of maximum phonation time goal obtained during VFE tasks one and four. RESULTS Mean change scores for maximum phonation time were 32.50 (SG), 34.55 (DG), and 21.02 (NG). Hedges' g effect sizes of -0.10 (-1.19, 0.99) and 0.56 (-0.55, 1.67) were obtained comparing DG and SG groups, and NG and SG groups, respectively. CONCLUSIONS Absence of maximum phonation time goal attenuates VFE efficacy; maximum phonation time goal is an active ingredient within VFEs.
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Affiliation(s)
- Maria Bane
- Department of Communication Sciences and Disorders, University of Kentucky, 900 South Limestone, Lexington, KY 40536.
| | - Vrushali Angadi
- Department of Communication Sciences and Disorders, University of Kentucky, 900 South Limestone, Lexington, KY 40536
| | - Richard Andreatta
- Department of Communication Sciences and Disorders, University of Kentucky, 900 South Limestone, Lexington, KY 40536
| | - Joseph Stemple
- Department of Communication Sciences and Disorders, University of Kentucky, 900 South Limestone, Lexington, KY 40536
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Quinn S, Oates J, Dacakis G. The Experiences of Trans and Gender Diverse Clients in an Intensive Voice Training Program: A Mixed-Methodological Study. J Voice 2023; 37:292.e15-292.e33. [PMID: 33546939 DOI: 10.1016/j.jvoice.2020.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
Intensive schedules in behavioral voice therapy and training have been proposed to have a range of positive benefits including enhanced outcomes, high client and clinician satisfaction, and reduced client attrition. In the sub-field of behavioral voice training for trans and gender diverse clients, intensive schedules may also present a means of increasing service access opportunities for a vulnerable population. Despite the proposed benefits there has been limited research investigating client experiences in intensive voice training programs. The current study utilized a mixed-methodological approach to compare participant experiences in an intensively scheduled (three 45-minute sessions per week, over 4 weeks) versus a traditionally scheduled (one 45-minute session per week, over 12 weeks) voice training program for trans and gender diverse participants aiming to develop a perceptually feminine-sounding voice. Participant experiences were compared using a satisfaction questionnaire delivered to both training groups as well as thematic analysis of semi-structured interviews conducted with participants in the intensive group. Results suggested that individuals in the intensive training program had both positive and negative experiences related to the intensive schedule, but all viewed the program favorably and expressed a preference for intensive training based on their experiences. However, it was also found that overall satisfaction and attrition did not differ significantly between the intensive and traditional training groups and that many factors contributing to participant satisfaction in the intensive program were unrelated to the intensive schedule. Results from the current study also suggest that experiences in intensive programs may be highly variable and mediated by factors such as clients' individual personalities and preferences. The current study concludes that intensive schedules present a viable alternative to traditional schedules in practice, with additional considerations and directions for future research also discussed.
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Affiliation(s)
- Sterling Quinn
- Discipline of Speech Pathology, La Trobe University, Bundoora, Australia.
| | - Jennifer Oates
- Discipline of Speech Pathology, La Trobe University, Bundoora, Australia
| | - Georgia Dacakis
- Discipline of Speech Pathology, La Trobe University, Bundoora, Australia
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White A, Carding P, Booth V, Logan P. Pre- and post-operative voice therapy (PaPOV): Development of an intervention for patients with benign vocal fold lesions. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:94-110. [PMID: 36047250 PMCID: PMC10086784 DOI: 10.1111/1460-6984.12771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pre- and post-operative voice therapy may improve voice and quality-of-life outcomes for patients undergoing phonosurgery to remove benign vocal fold lesions (BVFLs). However, what constitutes voice therapy in this population is poorly described, resulting in a poor evidence base, lack of clinical guidelines and unwarranted variation in management. In order to develop the evidence base, a robust, iterative process of intervention development work should precede feasibility testing and effectiveness studies. METHODS & PROCEDURES Guidance for developing complex interventions, drawing on evidence, theory and modelling, was used to inform the development of a pre- and post-operative voice therapy intervention entitled 'PaPOV'. Data from four sources of evidence were synthesized using a published triangulation protocol. Data from a systematic review, national survey of current practice, expert interview study, and patient and public involvement conversations were used to populate a triangulation matrix, outlining components of a PaPOV. Data were coded to reflect areas of agreement, dissonance and silence with each component of the intervention. Based on this evidence, an assessment of convergence for each intervention component could be made. OUTCOMES & RESULTS In total, 61 components of the PaPOV intervention were explored. Of these, 27 were categorized as having stability of consensus according to a priori criteria. A total of 34 failed to meet the criteria. This was more frequently due to silence (27) rather than dissonance (seven) in the data. By evidencing areas of agreement and stability of consensus across data sources, the validity of individual findings has been enhanced. Furthermore, the study has exposed specific areas of the intervention that lack consensus and require exploration through further intervention development studies. CONCLUSIONS & IMPLICATIONS This systematic triangulation process has contributed to the development of a PaPOV intervention for patients with BVFLs. Exploration of specific components relating to the intervention will allow outstanding questions to be answered in preparation for feasibility testing. WHAT THIS PAPER ADDS What is already known on the subject BVFLs cause dysphonia by preventing vocal fold closure, impacting on vibratory characteristics and increasing compensatory muscle tension. Management for these patients is variable with them being offered phonosurgery, voice therapy, pharmacological management or a combined approach. Pre- and post-operative voice therapy may improve both voice and quality-of-life outcomes. This patient group has unique complexities when considering voice therapy, including surgical preparation, wound healing and epithelial mobilization. What this paper adds to existing knowledge This study uses a robust triangulation process to synthesize current evidence and patient experiences in order to inform the development of a PaPOV. It outlines some of the key components and considerations when delivering pre- and post-operative voice therapy to adults with BVFLs. Furthermore, it serves as a methodological example for intervention development in complex interventions, highlighting key guidance and recommended processes for developing and evaluating complex interventions. What are the potential or actual clinical implications of this work? The 61 components discussed as potential 'ingredients' for a PaPOV enable clinicians to reflect on key considerations when planning and delivering voice therapy to adults with BVFLs. This study highlights the pitfalls both clinically and in research of failing to describe interventions adequately and the benefits of using accurate, specific and agreed terminology in clinical practice, such as that outlined in the Rehabilitation Treatment Specification System (TRSS).
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Affiliation(s)
- Anna White
- Centre for Rehabilitation and Ageing Research, Academic Unit of Injury, Inflammation and Recovery Sciences, School of MedicineUniversity of NottinghamNottinghamUK
| | - Paul Carding
- Faculty of Health and Life SciencesOxford Institute of Nursing, Midwifery and Allied Health ResearchOxfordUK
| | - Vicky Booth
- Centre for Rehabilitation and Ageing Research, Academic Unit of Injury, Inflammation and Recovery Sciences, School of MedicineUniversity of NottinghamNottinghamUK
| | - Pip Logan
- Centre for Rehabilitation and Ageing Research, Academic Unit of Injury, Inflammation and Recovery Sciences, School of MedicineUniversity of NottinghamNottinghamUK
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Christmann MK, Gonçalves DDS, Cielo CA. Finger Kazoo Intensive Short-term Vocal Therapy: Vocal and Aerodynamic Measurements in Female Teachers. J Voice 2022:S0892-1997(22)00352-6. [PMID: 36517329 DOI: 10.1016/j.jvoice.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE to verify the effect after short-term intensive therapy with the Finger Kazoo technique on vocal and aerodynamic measures of dysphonic female teachers. METHOD blind randomized clinical trial. Fifteen female teachers without structural disorders of vocal folds and nine with vocal nodules participated in the study groups. Yet, nine female teachers without structural disorders and eight with vocal nodules in the control groups. The following variables were measured pre and post-therapy: minimum and maximum fundamental frequency: forced vital capacity; simple phonic coefficient; compound phonic coefficient; ratio between maximum phonation time of /a/ and expected maximum phonation time. RESULTS no statistical significance was observed in the intra and intergroup analyses in any of the measures. CONCLUSION in this group of female teachers, it was not possible to show a positive effect of short-term and intensive therapy with the Finger Kazoo technique on the vocal measures of minimum and maximum fundamental frequency, forced vital capacity, simple phonic coefficient, compound phonic coefficient, and the relationship between maximum phonation time of /a/ and expected maximum phonation time.
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Affiliation(s)
- Mara Keli Christmann
- Speech Therapy Departament, Voice Laboratory Voz, Federal University of Santa Maria, RS, Brazil; Universidade do Vale do Itajaí (UNIVALI), Itajaí, SC, Brazil; Associação Educacional Luterana Bom Jesus (IELUSC), Joinville, SC, Brazil
| | | | - Carla Aparecida Cielo
- Speech Therapy Departament, Voice Laboratory Voz, Federal University of Santa Maria, RS, Brazil
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Fujiki RB, Thibeault SL. Pediatric Voice Therapy: How Many Sessions to Discharge? AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2663-2674. [PMID: 36198045 PMCID: PMC9911102 DOI: 10.1044/2022_ajslp-22-00111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/14/2022] [Accepted: 07/11/2022] [Indexed: 05/03/2023]
Abstract
PURPOSE Voice therapy is the primary treatment for children presenting with benign morphological vocal fold changes. This study examined the number of voice therapy sessions required to meet treatment goals and identified factors that predicted treatment length for pediatric voice patients. METHOD An observational cohort design was employed. Data were extracted from the University of Wisconsin-Madison Voice and Swallow Outcome Database. This study examined 62 children who completed a course of voice therapy with a speech-language pathologist (SLP) addressing dysphonia caused by benign vocal fold lesions. Extracted data included patient demographics, auditory-perceptual assessments, acoustic and aerodynamic voice measures, videostroboscopy ratings, and medical comorbidities. Linear regression was used to identify predictors of number of therapy sessions. RESULTS Patients received an average of 7.5 sessions of voice therapy prior to discharge. Baseline auditory-perceptual assessment of dysphonia (p = .032), phonation threshold pressure (PTP, p = .005), Glottal Function Index (GFI) score (p = .006), and glottic closure pattern (p = .023) were significant predictors of number of voice therapy sessions. These measures, as well as hourglass glottic closure, predicted longer intervention duration. The regression model had an overall r 2 of .62. CONCLUSIONS Pediatric voice therapy addressing benign vocal fold lesions and/or laryngeal edema required an average of 7.54 sessions before voice outcomes were sufficiently improved for discharge. More severe overall SLP ratings of dysphonia, GFI scores, PTP, or hourglass glottic closure pattern significantly predicted increased number of therapy sessions prior to discharge. Future work should determine what other factors affect treatment duration and how the efficiency of pediatric voice therapy can be maximized.
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12
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Bane M, Morton M, Angadi V, Andreatta R, Stemple J. Vocal Function Exercises With and Without Maximally Sustained Phonation: A Randomized Controlled Trial of Individuals With Normal Voice. J Voice 2022:S0892-1997(22)00317-4. [PMID: 36379827 PMCID: PMC10175512 DOI: 10.1016/j.jvoice.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine the effect of maximally sustained phonation on efficacy of Vocal Function Exercises as measured by percent of maximum phonation time goal attained. The hypothesis was that maximally sustained phonation would result in greater improvements in percent of maximum phonation time goal attained. STUDY DESIGN Randomized controlled trial. METHODS A convenience sample of individuals with normal voice were recruited in a university academic clinic setting. Of 34 participants who volunteered for the study, 31 completed baseline assessment and 23 completed all study procedures. Participants were randomized to complete Vocal Function Exercises (traditional group TG), modified Vocal Function Exercises with reduced requirement for maximally sustained phonation (midpoint group MG), or modified Vocal Function Exercises with removed requirement for maximally sustained phonation (baseline group BG). The primary outcome measure was percent of maximum phonation time goal obtained during Vocal Function Exercises. RESULTS The MG (p = 0.008) and TG (p = 0.001) groups significantly improved percent of maximum phonation time goal attained after six weeks of exercise, while the BG group (p = 0.0202) did not (ɑ = 0.0125). Difference among groups was not statistically significant (p = 0.67, ɑ = 0.0125). Hedges' g effect sizes of 0.29 (-0.66, 1.25) and 0.51 (-0.57, 1.58) were obtained comparing MG and TG groups, and BG and TG groups, respectively. CONCLUSIONS Greater requirements for maximally sustained phonation improved efficacy of Vocal Function Exercises in enhancing normal voice as measured by percent of maximum phonation time goal attained. Maximally sustained phonation may be modified to some extent while preserving efficacy of Vocal Function Exercises, however complete elimination of maximally sustained phonation may attenuate improvement. Additional research in a clinical population is warranted.
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Affiliation(s)
- Maria Bane
- University of Kentucky Department of Communication Sciences and Disorders, Lexington, Kentucky.
| | - Mariah Morton
- University of Kentucky Department of Communication Sciences and Disorders, Lexington, Kentucky
| | - Vrushali Angadi
- University of Kentucky Department of Communication Sciences and Disorders, Lexington, Kentucky
| | - Richard Andreatta
- University of Kentucky Department of Communication Sciences and Disorders, Lexington, Kentucky
| | - Joseph Stemple
- University of Kentucky Department of Communication Sciences and Disorders, Lexington, Kentucky
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13
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Venkatraman Y, Ganesan S, Mahalingam S, Boominathan P. An E-Survey of Current Voice Therapy Practices Amongst Speech Language Pathologists (SLPs) in India. Indian J Otolaryngol Head Neck Surg 2022; 74:1902-1909. [PMID: 36452593 PMCID: PMC9702298 DOI: 10.1007/s12070-020-01910-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/08/2020] [Indexed: 11/29/2022] Open
Abstract
In India, Speech Language Pathologists (SLPs) generally work with ENT surgeons and use a variety of treatment approaches, service delivery methods, feedback modes, and outcome measures in clinical practice while dealing with voice disorders. The practice preferences of the SLPs are based on theoretical and practical exposure during their graduate course, guidance from professional bodies, evidence-based practices, etc. The facilities in the work setting also determine the practice style of the SLP. This study reports information on demographics of the SLPs, nature of patients served, intervention methods, and evidence-based practices followed by the SLPs via an E-survey. Analysis of the survey from 55 SLPs in India, who work in the area of voice revealed that most SLPs had postgraduate (67.27%; n = 37) and doctorate degree (23.63%; n = 13) and worked in medical-related settings (81.81%; n = 45). Therapeutic approaches were practiced as stated in literature by 43.64% (n = 24) of SLPs. Although 56.36% (n = 31) of SLPs modified therapeutic approaches based on the client's needs (75%), literacy (16.66%) and cultural variations (8.33%). Attending Continuing Education Programs and training workshops were required to practice voice. Voice therapy methods (protocols) used by the SLPs were not uniform across India. The development of an indigenous protocol/method for voice therapy is the need of the hour.
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Affiliation(s)
- Yamini Venkatraman
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research (DU), Porur, Chennai, 116 India
| | - Suryakala Ganesan
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research (DU), Porur, Chennai, 116 India
| | - Shenbagavalli Mahalingam
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research (DU), Porur, Chennai, 116 India
| | - Prakash Boominathan
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research (DU), Porur, Chennai, 116 India
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14
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Andrade LKFD, Dutka JDCR, Ferreira GZ, Pinto MDB, Pegoraro-Krook MI. Influence of an Intensive Speech Therapy Program on the Speech of Individuals with Cleft Lip and Palate. Int Arch Otorhinolaryngol 2022; 27:e3-e9. [PMID: 36714906 PMCID: PMC9879641 DOI: 10.1055/s-0041-1730300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/21/2020] [Indexed: 02/01/2023] Open
Abstract
Introduction Compensatory articulations are speech disorders due to the attempt of the individual with cleft palate/velopharyngeal dysfunction to generate intraoral pressure to produce high-pressure consonants. Speech therapy is the indicated intervention for their correction, and an intensive speech therapy meets the facilitating conditions for the correction of glottal stop articulation, which is the most common compensatory articulation. Objective To investigate the influence of an intensive speech therapy program (ISTP) to correct glottal stop articulation in the speech of individuals with cleft palate. Methods Speech recordings of 37 operated cleft palate participants of both genders (mean age = 19 years old) were rated by 3 experienced speech/language pathologists. Their task was to rate the presence and absence of glottal stops in the 6 Brazilian Portuguese occlusive consonants (p, b, t, d, k, g) distributed within several places in 6 sentences. Results Out of the 325 pretherapy target consonants rated with glottal stop, 197 (61%) remained with this error, and 128 (39%) no longer presented it. The comparison of the pre- and posttherapy results showed: a) a statical significance for the p1, p2, p3, p4, t1, k1, k2 and d6 consonants (McNemar test; p < 0.05); b) a statistical significance for the p consonant in relation to the k, b, d, g consonants and for the t consonant in relation to the b, d, and g consonants (chi-squared test; p < 0.05) in the comparison of the proportion improvement among the 6 occlusive consonants. Conclusion The ISTP influenced the correction of glottal stops in the speech of individuals with cleft palate.
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Affiliation(s)
- Laura Katarine Félix de Andrade
- Program in Rehabilitation Sciences, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil,Address for correspondence Laura Katarine Félix de Andrade, PhD Student Hospital of Rehabilitation of Craniofacial Anomalies, Universidade de São PauloRua Silvio Marchiore, 3-20, Bauru (SP)Brasil 17012-900
| | - Jeniffer de Cássia Rillo Dutka
- Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry, University of São Paulo, Bauru - SP, Brazil
| | - Gabriela Zuin Ferreira
- Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry, University of São Paulo, Bauru - SP, Brazil
| | - Maria Daniela Borro Pinto
- Speech Department, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
| | - Maria Inês Pegoraro-Krook
- Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry, University of São Paulo, Bauru - SP, Brazil
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Ziltzer RS, van der Woerd B, Sund LT, Johns MM. Cricothyroid Muscle Botulinum Toxin Chemodenervation to Treat Recalcitrant High-Pitched Functional Dysphonia in an Adult Male. J Voice 2022:S0892-1997(22)00167-9. [PMID: 35843832 DOI: 10.1016/j.jvoice.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/10/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Functional dysphonia occurs in the absence of structural or neurologic laryngeal abnormalities with various manifestations including aphonia and inappropriate vocal pitch. Voice therapy is the first-line treatment, and literature on treatment options for functional dysphonia unresponsive to voice therapy is limited. METHODS Retrospective medical records review and report of a case. RESULTS We report a unique case of an adult male with recalcitrant high-pitched functional dysphonia of adult-onset that was successfully treated with a single cricothyroid muscle botulinum toxin (Botox) chemodenervation injection. CONCLUSION Cricothyroid muscle botulinum toxin chemodenervation can be an effective treatment for recalcitrant functional dysphonia.
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Affiliation(s)
- Ryan S Ziltzer
- Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Benjamin van der Woerd
- USC Voice Center, USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck Medicine of USC, Los Angeles, California
| | - Lauren Timmons Sund
- USC Voice Center, USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck Medicine of USC, Los Angeles, California
| | - Michael M Johns
- USC Voice Center, USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck Medicine of USC, Los Angeles, California.
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Wenke R, Coman L, Walton C, Madill C, Theodoros D, Bishop C, Stabler P, Lawrie M, O'Neill J, Gray H, Cardell EA. Effectiveness of Intensive Voice Therapy Versus Weekly Therapy for Muscle Tension Dysphonia: A Noninferiority Randomised Controlled Trial With Nested Focus Group. J Voice 2021; 37:466.e17-466.e34. [PMID: 33741236 DOI: 10.1016/j.jvoice.2021.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the noninferiority of intensive voice therapy and compare its effects with weekly voice therapy on multidimensional outcomes of voice and well-being, satisfaction, and attendance in people with muscle tension dysphonia (MTD). The study further aimed to explore clinician's perceptions of barriers and enablers to implementation of intensive therapy. STUDY DESIGN Noninferiority randomised controlled trial with nested focus group. METHODS Twenty adults with MTD were randomised to receive either weekly voice therapy (1 hour per week for 8 weeks) or intensive voice therapy (1 hour, 4 days per week for 2 weeks). Participants were assessed by a blinded assessor twice before treatment, once post treatment and once at 4 weeks follow up on the primary outcome measure VHI and a range of secondary auditory-perceptual, acoustic, and patient (i.e., VoiSS, satisfaction) and clinician reported outcome measures (i.e., AusTOMs, attendance rates). Five Speech Language Pathologists also participated in a focus group to explore barriers and enablers to implementing intensive therapy, with questions and analyses guided by the Theoretical Domains Framework. RESULTS While noninferiority for the primary outcome measure VHI was not confirmed, secondary outcome measures revealed comparable within group clinically important improvements for VoiSS and the AusTOMs, as well as selected acoustic and auditory-perceptual measures for both groups. A trend of more improvements being maintained in the intensive group was identified. Comparably high satisfaction and attendance was also found between groups. Clinicians reported more enablers than barriers to providing intensive therapy which included beliefs that it led to greater progression and consolidation of patient learning, was supported by the local context and was associated with positive emotions. Barriers related to difficulties with booking and scheduling and the belief that intensive therapy was not for all patients. CONCLUSIONS While the current study was likely underpowered to establish non-inferiority of intensive therapy, secondary outcomes suggested that intensive therapy may produce comparable benefits to voice, wellbeing, satisfaction and attendance compared to weekly therapy and may be a viable therapy option for individuals with MTD. When implementing intensive therapy, clinicians should consider patient's preferences and availability, as well as systems which allow for flexible booking and therapy provision for patients. Clear recommendations for future research including the use of a larger sample and telehealth are also provided.
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Affiliation(s)
- Rachel Wenke
- Speech Pathology Services, Gold Coast Hospital & Health Service, Southport, Queensland, Australia; Allied Health Research, Gold Coast Hospital & Health Service, Southport, Queensland, Australia; School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia.
| | - Leah Coman
- Speech Pathology Services, Gold Coast Hospital & Health Service, Southport, Queensland, Australia
| | - Chloe Walton
- Speech Pathology, Logan & Beaudesert Health Service, Metro South Health, Meadowbrook, Queensland, Australia
| | - Catherine Madill
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Lidcombe, New South Wales, Australia
| | - Deborah Theodoros
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Carol Bishop
- Speech Pathology Services, Gold Coast Hospital & Health Service, Southport, Queensland, Australia
| | - Penny Stabler
- Speech Pathology Services, Gold Coast Hospital & Health Service, Southport, Queensland, Australia
| | - Melissa Lawrie
- Speech Pathology Services, Gold Coast Hospital & Health Service, Southport, Queensland, Australia; School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia
| | - John O'Neill
- Ear, Nose and Throat Department, Gold Coast Hospital & Health Service, Southport, Queensland, Australia
| | - Heidi Gray
- Speech Pathology Services, Gold Coast Hospital & Health Service, Southport, Queensland, Australia
| | - Elizabeth A Cardell
- School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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Christmann MK, Scapini F, Lima JPDM, Gonçalves BFDT, Bastilha GR, Cielo CA. Aerodynamic Vocal Measurements in Female Teachers: Finger Kazoo Intensive Short-Term Vocal Therapy. J Voice 2021; 35:259-270. [DOI: 10.1016/j.jvoice.2019.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 10/25/2022]
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Christmann MK, Scapini F, Lima JPDM, Gonçalves BFDT, Bastilha GR, Cielo CA. Voice-Related Quality of Life, Anxiety, and Depression in Female Teachers: Finger Kazoo Intensive Short-Term Vocal Therapy. J Voice 2020; 36:736.e1-736.e15. [PMID: 33032885 DOI: 10.1016/j.jvoice.2020.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Among professional voice users, teachers are subject to higher risks of developing occupational dysphonia due to their abusive use of the voice, usually under unfavorable conditions. OBJECTIVES Quantify the vocal self-perception, the voice-related quality of life, and the anxiety, and depression symptoms, of dysphonic female teachers, after a brief and intensive short-term voice therapy using the finger kazoo technique. METHODS Blinded, randomized, and controlled clinical trial. Questionnaires applied to two study groups (15 subjects without structural laryngeal disorder in one group, and nine subjects with vocal nodules in the other), and to two control groups (9 subjects without structural laryngeal disorder in one group, and eight subjects with vocal nodules in the other). RESULTS The Vocal Tract Discomfort Scale, the Voice Activity and Participation Profile, the Voice Symptom Scale, and the Voice-Related Quality of Life Protocol, showed significant improvement in both study groups. The Vocal Perception Protocol showed that negative vocal self-perception reduced significantly in subjects without structural alteration of the vocal folds in the study group. Anxiety symptoms improved significantly in subjects with vocal nodules in the study group; depression symptoms improved significantly in subjects with vocal nodules in the control group, and in subjects without structural alteration of the vocal folds in the study group. CONCLUSION Brief and intensive short-term voice therapy using the finger kazoo technique provided improvement in the vocal self-perception, the voice-related quality of life, and in the symptoms of anxiety and depression in dysphonic teachers, more evidently in teachers with vocal nodules.
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Affiliation(s)
- Mara Keli Christmann
- Universidade do Vale do Itajaí (UNIVALI), Itajaí, SC, Brazil; Associação Educacional Luterana Bom Jesus (IELUSC), Joinville, SC, Brazil; Departamento de Fonoaudiologia, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.
| | - Fabricio Scapini
- Departamento de Clínica Médica, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | | | | | | | - Carla Aparecida Cielo
- Departamento de Fonoaudiologia, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
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19
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Meerschman I, Van Lierde K, Claeys S, D'haeseleer E. The Patient's Opinion Regarding Different Service Delivery Models for Voice Therapy. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1466-1474. [PMID: 32459102 DOI: 10.1044/2020_ajslp-19-00128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The purpose of this study was to compare the voice patient's opinion regarding three service delivery models for voice therapy: a short-term intensive voice therapy with individual sessions (IVT-I), a short-term intensive voice therapy with group sessions (IVT-G), or a long-term traditional voice therapy with individual sessions (TVT). Method Forty-six adult voice patients who followed either IVT-I, IVT-G, or TVT were contacted by e-mail with the request to fill in an online questionnaire reviewing their opinion about the received therapy. Several items concerning satisfaction, progress, time-related variables, transfer, and need for further therapy were scored by means of visual analog scales. Participants were also asked whether or not they continued voice therapy after the study. Results There were no significant differences between the three groups regarding the patients' perception of vocal quality improvement, degree of resolution of the voice disorder, duration of one session, total therapy duration, degree of transfer, need for further therapy, and actual continuation of therapy. A higher satisfaction rate was found for patients of the IVT-I and TVT groups than patients of the IVT-G group. The IVT-I group rated the therapy as too frequent compared with the TVT group who rated the frequency as optimal. Conclusion Results suggest that patients are equally satisfied and perceive a similar progress after individual short-term intensive voice therapy and individual long-term traditional voice therapy. This finding creates flexibility in selecting time-related variables depending on the specific case and situation. Patients who received individual therapy were more satisfied than patients who received group therapy. Future larger scale investigation is needed to confirm these results.
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Affiliation(s)
- Iris Meerschman
- Department of Rehabilitation Sciences, Speech-Language Pathology, Ghent University, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Speech-Language Pathology, Ghent University, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Sofie Claeys
- Department of Otorhinolaryngology, Ghent University, Belgium
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Speech-Language Pathology, Ghent University, Belgium
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Pre- and Postoperative Voice Therapy for Benign Vocal Fold Lesions: Factors Influencing a Complex Intervention. J Voice 2020; 36:59-67. [DOI: 10.1016/j.jvoice.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/27/2020] [Accepted: 04/06/2020] [Indexed: 01/18/2023]
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White A. Management of benign vocal fold lesions: current perspectives on the role for voice therapy. Curr Opin Otolaryngol Head Neck Surg 2019; 27:185-190. [PMID: 30893134 DOI: 10.1097/moo.0000000000000536] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Benign vocal fold lesions (BVFLs) cause dysphonia by preventing full vocal fold closure, interrupting vibratory characteristics and increasing compensatory muscle tension. Management includes phonosurgery, voice therapy, pharmacological treatment or more commonly a combination of these interventions. This review aims to present current perspectives on the management of BVFLs, particularly exploring the role of voice therapy. RECENT FINDINGS The review highlights variation in the management of BVFLs. There is evidence that phonosurgery is a well tolerated and effective intervention for BVFLs. Primary voice therapy can frequently prevent surgery in vocal fold nodules and some types of polyps. Used as an adjunct to phonosurgery, preoperative and postoperative voice therapy can improve patient-reported outcomes and acoustic parameters of the voice. However, heterogeneity of studies and poor descriptions of intervention components prevent a robust analysis of the impact of voice therapy. SUMMARY The current evidence consists of low-level studies using mixed aetiology groups, which compromises internal and external validity. There are a few exceptions to this. Poor reporting and heterogeneous methodologies lead to difficulties determining the components of a voice therapy intervention for this population. Consequently, we are unable to evaluate, which intervention elements are beneficial to patients.
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Affiliation(s)
- Anna White
- Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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22
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Ruoppolo G, Longo L, Pescerelli P, Mango C, Nicastri M, Flaccadoro F, Mancini P, Greco A, De Vincentiis M. CoQ10 and Vitamin A Supplementation Support Voice Rehabilitation. A Double-Blind, Randomized, Controlled, Three-Period Cross-Over Pilot Study. Front Pharmacol 2019; 10:939. [PMID: 31551767 PMCID: PMC6747928 DOI: 10.3389/fphar.2019.00939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/22/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate the effectiveness of an adjuvant therapy (CoQ10 in its water-soluble form and vitamin A) in supporting voice rehabilitation in a large group of patients with muscle tension dysphonia (MTD). Study Design: Twelve-week, double-blind, randomized, controlled, three-period cross-over pilot study. The primary endpoint was the change in the Dysphonia Severity Index (DSI) over the 12-week study period. Secondary endpoints were the changes in the subcomponents of DSI, including MPT, F0-high, I-low, and jitter. Exploratory endpoints were the changes in the Shimmer and in Voice Handicap Index (VHI). Methods: Patients were randomly assigned in a 1:1 ratio to two counter-balanced arms. Group A (ADJ-PLA) patients were administered QTer 300 mg and Vit A acetate 500.000 Ul/g 1 mg twice daily for a 4-week intervention period, followed by a 4-week period of wash-out, and then were submitted to a last 4-week period of placebo. Patients in Group B (PLB-ADJ) were given the treatment period in reverse order. Both groups received a 45-min voice therapy in a group format once a day for 4 weeks during the first and the second active periods. The therapy was held during the wash-out period. Results: The analysis of main time effect indicated a trend toward recovery of vocal function regardless of group assignment. A significant time by group effect was found on DSI [F = 3.4 (2.5, 80.5), p = 0.03], F0-high [F = 4.5 (2.6, 82.9), p = 0.008] and Shimmer [F = 3.6 (1.5, 46.9), p = 0.048], under CoQ10 and Vit A treatment, with a small effect size. There was no significant time by group effect on the other study measures, namely MPT, I-low, VHI. Conclusions: A trend toward recovery of vocal function was observed in all the patients, likely due to voice rehabilitation. The improvement of DSI was greater under CoQ10 and Vitamin treatment, indicating a more pronounced improvement of vocal quality under adjuvant therapy. The study protocol was reviewed and approved by the Ethics Committee of Policlinico Umberto I Hospital, Rome, Italy Rif. 3069/13.02.2014.
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Affiliation(s)
- Giovanni Ruoppolo
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
- *Correspondence: Ruoppolo Giovanni,
| | - Lucia Longo
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | | | - Chiara Mango
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Maria Nicastri
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Flavia Flaccadoro
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Patrizia Mancini
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Marco De Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
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Godoy J, Silverio K, Brasolotto A. Effectiveness of Vocal Therapy for the Elderly When Applying Conventional and Intensive Approaches: A Randomized Clinical Trial. J Voice 2019; 33:809.e19-809.e26. [DOI: 10.1016/j.jvoice.2018.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/26/2018] [Indexed: 11/16/2022]
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24
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Behlau M. The 2016 G. Paul Moore Lecture: Lessons in Voice Rehabilitation: Journal of Voice and Clinical Practice. J Voice 2019; 33:669-681. [PMID: 29567050 DOI: 10.1016/j.jvoice.2018.02.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 02/22/2018] [Indexed: 12/19/2022]
Abstract
This Paul Moore Lecture honors the contributions made by authors to the Journal of Voice during a period of 30 years, from 1987. Fifty articles were selected and included under the following five topics: (1) normalcy of the larynx and voice; (2) the clinical speech-language pathologist's evaluation; (3) the patient's perspective; (4) the core of vocal rehabilitation; and (5) behavioral versus organic dysphonias. The analysis reflects a vivid landscape of the specific area and significant advances in knowledge. It also shows the valuable interdependence between science and clinical practice. The topics highlight the following information: (1) The physical appearance of a healthy larynx varies across individuals with normal voices. (2) The voice is not a binary descriptor (normal versus abnormal) but a variable measure, with many cultural influences on the perceptual auditory analysis of a voice. (3) The clinical speech-language pathologist assessment is multidimensional and multiparametric, with both subjective and objective analyses. The patients' opinion about the impact of a voice problem on his or her quality of life is significant when proposing a treatment. Therefore, it is also included in the initial assessment. (4) Vocal rehabilitation is a nonlinear process that combines direct and indirect approaches. Evidence of the positive effect of voice therapy is now well established. (5) Behavioral dysphonias may be linked to self-regulation of the use of voice and this needs to be taken into consideration. Although organic dysphonias are not necessarily the result of harmful vocal behaviors, they too can benefit from vocal rehabilitation.
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Affiliation(s)
- Mara Behlau
- "Centro de Estudos da Voz" - CEV, São Paulo, Brazil; "Universidade Federal de São Paulo-UNIFESP", São Paulo, Brazil.
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Brockmann-Bauser M, Balandat B, Bohlender JE. Immediate Lip Trill Effects on the Standard Diagnostic Measures Voice Range Profile, Jitter, Maximum Phonation Time, and Dysphonia Severity Index. J Voice 2019; 34:874-883. [PMID: 31196690 DOI: 10.1016/j.jvoice.2019.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Semi-occluded vocal tract exercises are widely applied to improve vocal performance in speakers, singers, and voice patients. This study investigates immediate lip trill effects on standard voice assessment measures including voice range profiles, jitter, maximum phonation time, and Dysphonia Severity Index in vocally healthy women. STUDY DESIGN Experimental study. SETTING Otolaryngology clinic within tertiary hospital. SUBJECTS AND METHODS Twenty-five vocally healthy women between 19 and 58 years (mean 38.4) were assessed before and after 3 minutes of standardized lip trill training combined with defined voice fundamental frequency and intensity modulations. Main outcome measures were fundamental frequency (F0) during counting (F0 counting), the singing voice range profile parameters minimum, maximum and range of F0 and voice sound pressure level (voice SPL), jitter (%), maximum phonation time (MPT), and the Dysphonia Severity Index (DSI). Wilcoxon signed rank test was applied to determine significant changes after exercise. RESULTS After exercise the singing F0 and SPL range significantly increased from 549 (SD 217) to 612 (238) Hz and 45.1 (10.1) to 47.3 (9.8) dBA, resepctively (P<0.05). Maximum voice SPL significantly increased from 90.9 (10.3) to 94 (9.7) dBA (P<0.05). Mean F0 during counting showed a highly significant increase from 198 (SD 25.6) to 209 Hz (SD 25.4, P<0.01). No significant changes were found for all other parameters. CONCLUSIONS In vocally healthy women, lip trill training immediately facilitates increases in mean F0 during counting, and singing F0 and SPL range. Future studies should investigate, if changes to these parameters indicate immediate responsiveness to voice exercise also in voice patients, and if these findings transfer to long-term effects through prolonged training.
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Affiliation(s)
- M Brockmann-Bauser
- University Hospital Zürich, Department of Phoniatrics and Speech Pathology, Zurich, Switzerland; University of Zürich, Zurich, Switzerland.
| | - B Balandat
- University Hospital Zürich, Department of Phoniatrics and Speech Pathology, Zurich, Switzerland; University of Zürich, Zurich, Switzerland
| | - J E Bohlender
- University Hospital Zürich, Department of Phoniatrics and Speech Pathology, Zurich, Switzerland; University of Zürich, Zurich, Switzerland
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Meerschman I, Claeys S, Bettens K, Bruneel L, D'haeseleer E, Van Lierde K. Massed Versus Spaced Practice in Vocology: Effect of a Short-Term Intensive Voice Therapy Versus a Long-Term Traditional Voice Therapy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:611-630. [PMID: 30950739 DOI: 10.1044/2018_jslhr-s-18-0013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The aim of this study was to compare the effect of a short-term intensive voice therapy (IVT) with a long-term traditional voice therapy (TVT) on the vocal quality, vocal capacities, psychosocial impact, vocal tract discomfort, laryngological anatomy/physiology, and session attendance of patients with dysphonia. An additional comparison was made between an individual IVT (IVT-I) and a group IVT (IVT-G). Method A longitudinal, prospective controlled trial was used. Forty-six adults diagnosed with dysphonia were assigned to 1 of the 3 treatment groups. The IVT groups practiced with a frequency of 1 hr 20 min a day and a duration of 2 weeks. The TVT group practiced with a frequency of two 30-min sessions a week and a duration of 6 months. Both therapy programs were content-identical and guided by the same voice therapist. A multidimensional voice assessment consisting of both objective (maximum performance task, aerodynamic measurements, voice range profile, acoustic analysis, multiparametric voice quality indices) and subjective (subject's self-report, auditory-perceptual evaluation, flexible videolaryngostroboscopy) outcomes was used to evaluate the participants' voice. Results IVT made an equal progress in only 2 weeks and 12 hr of therapy compared with TVT that needed 6 months and 24 hr of therapy. IVT-I and IVT-G showed comparable results. Session attendance was clearly higher in IVT compared with TVT. Long-term follow-up results (1 year) were positive for the 3 groups, except for the self-reported psychosocial impact that increased in the IVT-I group. Conclusions Short-term IVT is at least equally effective in treating patients with dysphonia as long-term TVT. Group treatment seemed as effective as individual treatment. Attendance and cost-effectiveness are important advantages of IVT. A potential drawback might be an insufficient psychosocial progress. The golden mean between intensive and traditional treatment might therefore be an achievable, effective, and efficient solution for everyday clinical practice. Supplemental Material https://doi.org/10.23641/asha.7761872.
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Affiliation(s)
- Iris Meerschman
- Department of Rehabilitation Sciences, Research group: Speech, Language and Hearing Sciences, Ghent University, Belgium
| | - Sofie Claeys
- Department of Otorhinolaryngology, Ghent University, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Research group: Speech, Language and Hearing Sciences, Ghent University, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Research group: Speech, Language and Hearing Sciences, Ghent University, Belgium
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Research group: Speech, Language and Hearing Sciences, Ghent University, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Research group: Speech, Language and Hearing Sciences, Ghent University, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
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Gallena SK, Johnson AT, Vossoughi J. Short-Term Intensive Therapy and Outcomes for Athletes With Paradoxical Vocal Fold Motion Disorder. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:83-95. [PMID: 30453332 DOI: 10.1044/2018_ajslp-17-0223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The aim of the study was to develop a treatment for athletes with paradoxical vocal fold motion disorder (PVFMD) based on exercise physiology and learning theory principles and administer it over a preestablished time frame. Method A prospective, repeated-measures, within-subject group design was used. Eleven adolescent/teen athletes diagnosed with PVFMD via laryngoscopy received short-term intensive (STI) therapy. Eight of the athletes returned for extended follow-up. Changes in postexercise inspiratory ( R i) and expiratory ( R e) resistances and Modified Borg Dyspnea Scale (MBDS) ratings collected at baseline were compared immediately posttreatment and at extended follow-up. Dyspnea Index scores were collected at baseline and at extended follow-up. Two no-treatment control athletes with PVFMD participated in two exercise challenges-baseline and 6 weeks later. Results Immediately after STI therapy, athletes attained significant improvement in R i, R e, and MBDS ratings. These changes were maintained at extended follow-up as well as a significant change in Dyspnea Index scores. The 2 control athletes who were reassessed 6 weeks after baseline experienced negative changes in postexercise R i and MBDS ratings. Conclusion STI therapy that incorporated individuality, specificity, and variable practice effectively changed outcome measures posttreatment with further improvement observed at extended follow-up. These results provide preliminary evidence for STI therapy for PVFMD.
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Affiliation(s)
- Sally K Gallena
- Department of Speech-Language Pathology, Loyola University Maryland, Baltimore
| | - Arthur T Johnson
- Fischell Department of Bioengineering, University of Maryland, College Park
| | - Jafar Vossoughi
- Fischell Department of Bioengineering, University of Maryland, College Park
- Engineering and Scientific Research Associates, Brookeville, MD
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Bane M, Angadi V, Dressler E, Andreatta R, Stemple J. Vocal function exercises for normal voice: The effects of varying dosage. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:37-45. [PMID: 28925286 PMCID: PMC6207485 DOI: 10.1080/17549507.2017.1373858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE This study examined the effect of varying dosage of vocal function exercise (VFE) home practice on attainment of pre-established maximum phonation time (MPT) goals in individuals with normal voice. High dosage VFE practice was expected to result in greatest MPT. The overarching goal of this study was to contribute to a VFE dosage-response curve, potentially including a point of observable toxicity. METHOD Twenty-eight females ages 18-25 with normal voice participated in this pre-post longitudinal group study. Participants were randomly assigned to one of three experimental groups and completed a six-week VFE protocol with practice twice daily. The low dosage group performed each exercise once, the traditional group twice, and the high dosage group four times. The primary outcome measure was MPT as performed on the fourth VFE using the prescribed semi-occluded vocal tract posture. RESULT No toxic effects were observed. MPT increased for all participants, with significant improvement for traditional and high dosage groups. CONCLUSION High dosage VFEs may yield more rapid improvement in MPT, however benefits must be weighed against the risk of increased attrition. Low dosage VFEs insufficiently improved MPT. Further research on dosage is warranted, and should include individuals with disordered voice.
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Affiliation(s)
- Maria Bane
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
| | - Vrushali Angadi
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
| | - Emily Dressler
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
| | - Richard Andreatta
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
| | - Joseph Stemple
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
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Fraga BFD, Almeida STD, Santana MG, Cassol M. Efficacy of Myofunctional Therapy Associated with Voice Therapy in the Rehabilitation of Neurogenic Oropharyngeal Dysphagia: a pilot study. Int Arch Otorhinolaryngol 2018; 22:225-230. [PMID: 29983759 PMCID: PMC6033588 DOI: 10.1055/s-0037-1605597] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/11/2017] [Indexed: 12/28/2022] Open
Abstract
Introduction Dysphagia causes changes in the laryngeal and stomatognathic structures; however, the use of vocal exercises is poorly described. Objective To verify whether the therapy consisting of myofunctional exercises associated with vocal exercises is more effective in rehabilitating deglutition in stroke patients. Methods This is a pilot study made up of two distinct groups: a control group, which performed only myofunctional exercises, and an experimental group, which performed myofunctional and vocal exercises. The assessment used for oral intake was the functional oral intake scale (FOIS). Results The FOIS levels reveal that the pre-therapy median of the experimental group was 4, and increased to 7 after therapy, while in the control group the values were 5 and 6 respectively. Thus, the experimental group had a statistically significant difference between the pre- and post-therapy assessments ( p = 0.039), which indicates that the combination of myofunctional and vocal exercises was more effective in improving the oral intake levels than the myofunctional exercises alone ( p = 0.059). On the other hand, the control group also improved, albeit at a lower rate compared with the experimental group; hence, there was no statistically significant difference between the groups post-therapy ( p = 0.126). Conclusion This pilot study showed indications that using vocal exercises in swallowing rehabilitation in stroke patients was able to yield a greater increase in the oral intake levels. Nevertheless, further controlled blind clinical trials with larger samples are required to confirm such evidence, as this study points to the feasibility of conducting this type of research.
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Affiliation(s)
- Bruno Francisco de Fraga
- Rehabilitation Post-Graduation Program (PPGCR), Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Sheila Tamanini de Almeida
- Department of Speech Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Márcia Grassi Santana
- Speech Therapy Service, Irmandade da Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Mauriceia Cassol
- Department of Speech Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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Meerschman I, Van Lierde K, Van Puyvelde C, Bostyn A, Claeys S, D'haeseleer E. Massed versus spaced practice in vocology: effect of a short-term intensive voice training versus a longer-term traditional voice training. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:393-404. [PMID: 29205707 DOI: 10.1111/1460-6984.12358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND In contrast with most medical and pharmaceutical therapies, the optimal dosage for voice therapy or training is unknown. AIMS The aim of this study was to compare the effect of a short-term intensive voice training (IVT) with a longer-term traditional voice training (TVT) on the vocal quality and vocal capacities of vocally healthy non-professional voice users. METHODS & PROCEDURES A pre-/post-test randomized control group design with follow-up measurements was used. Twenty healthy female non-professional voice users with a mean age of 21.7 years (range = 20-24 years) were randomly assigned into a short-term IVT group (n = 10) or a longer-term TVT group (n = 10). Both groups received an identical 6-h lasting voice training. Only the distribution of practice varied between the groups: 2 h a day for 3 consecutive days for the IVT group versus two 30-min sessions a week for 6 weeks for the TVT group. In both groups, a voice assessment protocol consisting of subjective (questionnaire, participant's self-report, auditory-perceptual evaluation) and objective (maximum performance task, acoustic analysis, voice range profile, dysphonia severity index) measurements and determinations was used to evaluate the participants' voice pre- and post-training and at 6 weeks follow-up. Groups were compared over time using linear mixed models and generalized linear mixed models. Within-group effects of time were determined using post-hoc pairwise comparisons with Bonferroni corrections. OUTCOMES & RESULTS No significant time-by-group interactions were found for any of the outcome measures, indicating no significant differences in evolution over time between the groups. Significant time effects were found for maximum phonation time, lowest intensity, lowest frequency, highest frequency and dysphonia severity index, all improving over time in both groups. More in-depth within-group analyses indicate a preference for the IVT group regarding the evolution of maximum phonation time, lowest frequency and dysphonia severity index, and a preference for the TVT group regarding the evolution of lowest intensity. CONCLUSIONS & IMPLICATIONS Short-term IVT may be equally, or even more, effective in training vocally healthy non-professional voice users compared with longer-term TVT.
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Affiliation(s)
- Iris Meerschman
- Department of Speech-Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Speech-Language and Hearing Sciences, Ghent University, Ghent, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Caro Van Puyvelde
- Department of Speech-Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Astrid Bostyn
- Department of Speech-Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Sofie Claeys
- Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - Evelien D'haeseleer
- Department of Speech-Language and Hearing Sciences, Ghent University, Ghent, Belgium
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Phyland D. The Measurement and Effects of Vocal Load in Singing Performance. How Much Singing Can a Singer Sing if a Singer Can Sing Songs? ACTA ACUST UNITED AC 2017. [DOI: 10.1044/persp2.sig3.79] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Singing as both an art form and physical activity demands a level of health and skill fitness to meet performance demands. The determination of performance fitness relies on performers' self-evaluations of their vocal capacity for performance, based, amongst other factors, on the current vocal status and ability to manage the associated vocal load. Measurement of load and the impact on the vocal mechanism is complex and influenced by many intrinsic and extrinsic factors. Researchers have attempted to quantify vocal load effects by measuring physical impact stress on the vocal folds, self-reported perceived exertion, and/or clinical evaluation of physiologic, acoustic, or perceptual changes. Most studies have been conducted in laboratory rather than in performance contexts and studies on singers are substantially lacking. Heavy vocal load has been causally associated with the development of voice disorders, although the exact relationship and thresholds for acquiring laryngeal pathology require further elucidation, and little is also known about the development of voice disorders among singers. Further understanding of the short-term and cumulative effect on the vocal folds of performing as a singer and the nature and prevalence of voice problems among singers is crucial to the determination of appropriate prevention and therapeutic management.
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Affiliation(s)
- Debra Phyland
- Department of Surgery, Faculty Medicine, Nursing & Health Sciences, Monash University
Clayton, Victoria, Australia
- Department Otolaryngology, Head & Neck Surgery, Monash Health
Clayton, Victoria, Australia
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Carding P, Bos-Clark M, Fu S, Gillivan-Murphy P, Jones S, Walton C. Evaluating the efficacy of voice therapy for functional, organic and neurological voice disorders. Clin Otolaryngol 2016; 42:201-217. [DOI: 10.1111/coa.12765] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 11/28/2022]
Affiliation(s)
- P. Carding
- Speech Pathology; Australian National Catholic University; Brisbane Qld Australia
| | - M. Bos-Clark
- Royal Devon and Exeter NHS Trust and University of ST Mark and St John; Plymouth UK
| | - S. Fu
- Department of Audiology and Speech Pathology; MacKay Medical College; New Taipei City Taiwan
| | | | - S.M. Jones
- University Hospital of South Manchester; Manchester UK
| | - C. Walton
- Speech Pathology; Australian National Catholic University; Brisbane Qld Australia
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Fu S, Theodoros D, Ward EC. Long-term effects of an intensive voice treatment for vocal fold nodules. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 18:77-88. [PMID: 28425364 DOI: 10.3109/17549507.2015.1081286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of the current study was to examine the long-term effects of intensive voice treatment for vocal fold nodules, compared to outcomes for patients treated with traditional voice therapy. It was hypothesised that intensive treatment would provide comparable maintenance of vocal function, voice quality, and patients' perception of quality-of-life when compared with traditional treatment at 6 month follow-up. METHOD Thirty-six women diagnosed with bilateral vocal fold nodules who were treated with either traditional (n = 20; once a week for 8 weeks) or intensive (n = 16; eight sessions within 3 weeks) therapy. Each participant completed voice, stroboscopic, and acoustic assessments and the Voice Handicap Index before, immediately post and 6 months post-treatment. RESULT Results revealed most improved perceptual, stroboscopic and acoustic parameters were maintained in both groups at 6 months post-treatment, with no significant differences between the two groups. In addition, both groups maintained satisfaction on their perception of vocal function, with no significant difference between the two groups. CONCLUSION The investigation provided further evidence that individuals with vocal fold nodules are able to maintain improved voice quality and vocal health following intensive voice treatment to a similar degree to traditional voice treatment.
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Affiliation(s)
- Sherry Fu
- a School of Health and Rehabilitation Sciences, University of Queensland , Brisbane , Australia and
| | - Deborah Theodoros
- a School of Health and Rehabilitation Sciences, University of Queensland , Brisbane , Australia and
| | - Elizabeth C Ward
- a School of Health and Rehabilitation Sciences, University of Queensland , Brisbane , Australia and
- b Centre for Functioning and Health Research, Queensland Health , Brisbane , 4102 Australia
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Behlau M, Madazio G, Oliveira G. Functional dysphonia: strategies to improve patient outcomes. PATIENT-RELATED OUTCOME MEASURES 2015; 6:243-53. [PMID: 26664248 PMCID: PMC4671799 DOI: 10.2147/prom.s68631] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Functional dysphonia (FD) refers to a voice problem in the absence of a physical condition. It is a multifaceted voice disorder. There is no consensus with regard to its definition and inclusion criteria for diagnosis. FD has many predisposing and precipitating factors, which may include genetic susceptibility, psychological traits, and the vocal behavior itself. The assessment of voice disorders should be multidimensional. In addition to the clinical examination, auditory-perceptual, acoustic, and self-assessment analyses are very important. Self-assessment was introduced in the field of voice 25 years ago and has produced a major impact in the clinical and scientific scenario. The choice of treatment for FD is vocal rehabilitation by means of direct therapy; however, compliance has been an issue, except for cases of functional aphonia or when an intensive training is administered. Nevertheless, there are currently no controlled studies that have explored the different options of treatment regimens for these patients. Strategies to improve patient outcome involve proper multidisciplinary diagnosis in order to exclude neurological and psychiatric disorders, careful voice documentation with quantitative measurement and qualitative description of the vocal deviation for comparison after treatment, acoustic evaluation to gather data on the mechanism involved in voice production, self-assessment questionnaires to map the impact of the voice problem on the basis of the patient’s perspective, referral to psychological evaluation in cases of suspected clinical anxiety and/or depression, identification of dysfunctional coping strategies, self-regulation data to assist patients with their vocal load, and direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patient’s recovery. An international multicentric effort, involving a large population of voice-disordered patients with no physical pathology, could produce enough data for achieving a consensus regarding this complex problem.
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Affiliation(s)
- Mara Behlau
- Voice Department, Centro de Estudos da Voz - CEV, São Paulo, Brazil
| | - Glaucya Madazio
- Voice Department, Centro de Estudos da Voz - CEV, São Paulo, Brazil
| | - Gisele Oliveira
- Voice Department, Centro de Estudos da Voz - CEV, São Paulo, Brazil
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De Bodt M, Patteeuw T, Versele A. Temporal Variables in Voice Therapy. J Voice 2015; 29:611-7. [DOI: 10.1016/j.jvoice.2014.12.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/02/2014] [Indexed: 11/30/2022]
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Fu S, Theodoros DG, Ward EC. Intensive Versus Traditional Voice Therapy for Vocal Nodules: Perceptual, Physiological, Acoustic and Aerodynamic Changes. J Voice 2015; 29:260.e31-44. [DOI: 10.1016/j.jvoice.2014.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/05/2014] [Indexed: 11/16/2022]
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Byeon H. Gender differences in risk factors of benign vocal fold disease in Korea: the fifth Korea National Health and Nutritional Examination Survey. LOGOP PHONIATR VOCO 2015; 41:85-91. [PMID: 25698081 DOI: 10.3109/14015439.2015.1004365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to confirm the prevalence rate of benign vocal fold disease (BVFD) based on gender in the Korean adult population and investigate potential risk factors of BVFD. Subjects were 8,677 non-institutionalized civilian adults over the age of 19 (3,788 males and 4,899 females) who completed the laryngeal examination of the fifth Korea National Health and Nutrition Examination Survey. Poisson regression analyses were conducted to examine the potential risk factors of BVFD. The prevalence rates of BVFD were similar in men (2.7%) and women (2.6%). When adjusted for covariates, men with self-reported voice problems had a 6.7 times greater risk (RR 6.72, 95% CI 4.17-10.84) of BVFD (P < 0.01). In addition, women with self-reported voice problems (RR 4.71, 95% CI 3.01-7.37) and current smokers (RR 1.97, 95% CI 1.01-3.81) were more likely to have BVFD (P < 0.01). There are gender differences in the risk factors of BVFD. In order to prevent BVFD, the enactment of guidelines reflecting gender differences is required.
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Affiliation(s)
- Haewon Byeon
- a Department of Speech Language Pathology & Audiology , Nambu University , Gwangju , Republic of Korea.,b Speech-Language Pathology Center, Nambu University , Gwangju , Republic of Korea
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Is More Intensive Better? Client and Service Provider Outcomes for Intensive Versus Standard Therapy Schedules for Functional Voice Disorders. J Voice 2014; 28:652.e31-652.e43. [DOI: 10.1016/j.jvoice.2014.02.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/14/2014] [Indexed: 12/22/2022]
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Iwarsson J. Facilitating behavioral learning and habit change in voice therapy—theoretic premises and practical strategies. LOGOP PHONIATR VOCO 2014; 40:179-86. [DOI: 10.3109/14015439.2014.936498] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Behlau M, Madazio G, Pacheco C, Gielow I. Intensive Short-Term Voice Therapy: The Brazilian Experience. ACTA ACUST UNITED AC 2014. [DOI: 10.1044/vvd24.2.98] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Granqvist S, Simberg S, Hertegård S, Holmqvist S, Larsson H, Lindestad PÅ, Södersten M, Hammarberg B. Resonance tube phonation in water: High-speed imaging, electroglottographic and oral pressure observations of vocal fold vibrations - a pilot study. LOGOP PHONIATR VOCO 2014; 40:113-21. [DOI: 10.3109/14015439.2014.913682] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Behlau M, Pontes P, Vieira VP, Yamasaki R, Madazio G. Presentation of the Comprehensive Vocal Rehabilitation Program for the treatment of behavioral dysphonia. Codas 2013; 25:492-6. [DOI: 10.1590/s2317-17822013000500015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/18/2013] [Indexed: 11/22/2022] Open
Abstract
Voice rehabilitation is the main treatment option in cases of behavioral dysphonia, and it has the purpose of enhancing the quality of vocal production and voice-related life aspects. Several efforts have been made to offer a clinical practice that is based on evidence, including the development of specific therapeutic protocols as an option for clinical and scientific improvement. It is necessary to define the focus/objective of the dysphonia treatment, type of approach, and duration in order to establish the intervention criteria. This paper describes the organization of a program of behavioral dysphonia treatment, based on an approach that has been used for over twenty years, named Comprehensive Vocal Rehabilitation Program, and also to present its concepts, theory, and practical fundamentals. The program has an eclectic approach and associates body work, glottal source, resonance, and breathing coordination in addition to knowledge about vocal hygiene and communicative behavior. The initial proposal suggests a minimum time of intervention of six therapeutic sessions that can be adapted according to the patient' s learning curve and development. The goal is to offer a rational and structured therapeutic approach that can be reproduced in other scenarios.
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Affiliation(s)
- Mara Behlau
- Centro de Estudos da Voz, Brazil; Universidade Federal de Sao Paulo, Brazil
| | - Paulo Pontes
- Universidade Federal de Sao Paulo, Brazil; Instituto da Laringe, Brazil
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Functional Hoarseness in Children: Short-Term Play Therapy With Family Dynamic Counseling as Therapy of Choice. J Voice 2013; 27:579-88. [PMID: 23683805 DOI: 10.1016/j.jvoice.2013.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 01/14/2013] [Indexed: 11/23/2022]
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Roy N. Optimal dose-response relationships in voice therapy. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2012; 14:419-423. [PMID: 22574765 DOI: 10.3109/17549507.2012.686119] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Like other areas of speech-language pathology, the behavioural management of voice disorders lacks precision regarding optimal dose-response relationships. In voice therapy, dosing can presumably vary from no measurable effect (i.e., no observable benefit or adverse effect), to ideal dose (maximum benefit with no adverse effects), to doses that produce toxic or harmful effects on voice production. Practicing specific vocal exercises will inevitably increase vocal load. At ideal doses, these exercises may be non-toxic and beneficial, while at intermediate or high doses, the same exercises may actually be toxic or damaging to vocal fold tissues. In pharmacology, toxicity is a critical concept, yet it is rarely considered in voice therapy, with little known regarding "effective" concentrations of specific voice therapies vs "toxic" concentrations. The potential for vocal fold tissue damage related to overdosing on specific vocal exercises has been under-studied. In this commentary, the issue of dosing will be explored within the context of voice therapy, with particular emphasis placed on possible "overdosing".
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Byeon HW, Hwang YJ. Gender Differences in Risk Factors of Self-reported Voice Problems. ACTA ACUST UNITED AC 2012. [DOI: 10.13064/ksss.2012.4.1.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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