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Wolfberg J, Whyte J, Doyle P, Gherson S, Muise J, Petty B, Tolejano CJ, Hillman RE, Stadelman-Cohen T, Van Stan JH. Rehabilitation Treatment Specification System for Voice Therapy: Application to Everyday Clinical Care. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:814-830. [PMID: 38101322 PMCID: PMC11001165 DOI: 10.1044/2023_ajslp-23-00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/15/2023] [Accepted: 11/04/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Rehabilitation intervention descriptions often do not explicitly identify active ingredients or how those ingredients lead to changes in patient functioning. The Rehabilitation Treatment Specification System (RTSS) provides guidance to identify the critical aspects of any rehabilitation therapy and supported the development of standardly named ingredients and targets in voice therapy (Rehabilitation Treatment Specification System for Voice Therapy [RTSS-Voice]). This study sought to test the content validity of the RTSS-Voice and determine if the RTSS-Voice can be used to identify commonalities and differences in treatment (criterion validity) across clinicians in everyday clinical practice. METHOD Five speech-language pathologists from different institutions videotaped one therapy session for 59 patients diagnosed with a voice or upper airway disorder. Specifications were created for each video, and iterative rounds of revisions were completed with the treating clinician and two RTSS experts until consensus was reached on each specification. RESULTS All 59 sessions were specified without the addition of any targets or ingredients. There were two frequent targets: (a) increased volition and (b) decreased strained voice quality. There were three frequent ingredients: (a) information regarding the patient's capability and motivation to perform a therapeutic behavior, (b) knowledge of results feedback, and (c) opportunities to practice voicing with improved resonance and mean airflow. Across sessions treating vocal hyperfunction, there was large variability across clinicians regarding the types and number of treatment components introduced, types of feedback provided, and vocal practice within spontaneous speech and negative practice. CONCLUSIONS The RTSS and the RTSS-Voice demonstrated strong content validity, as they comprehensively characterized 59 therapy sessions. They also demonstrated strong criterion validity, as commonalities and differences were identified in everyday voice therapy for vocal hyperfunction across multiple clinicians. Future work to translate RTSS principles and RTSS-Voice terms into clinical documentation can help to understand how clinician and patient variability impacts outcomes and bridge the research-practice gap. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24796875.
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Affiliation(s)
- Jeremy Wolfberg
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston
- MGH Institute of Health Professions, Boston, MA
| | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA
| | - Patricia Doyle
- University of Connecticut School of Medicine, Farmington
| | | | - Jason Muise
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston
- MGH Institute of Health Professions, Boston, MA
| | | | | | - Robert E. Hillman
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston
- MGH Institute of Health Professions, Boston, MA
- Harvard Medical School, Boston, MA
| | - Tara Stadelman-Cohen
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Jarrad H. Van Stan
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston
- MGH Institute of Health Professions, Boston, MA
- Harvard Medical School, Boston, MA
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Batista DDJ, Duarte JMDT, Siqueira LTD, Almeida AA, Lopes LW, Ribeiro VV. Volitional and Non-volitional Devices Used in Voice Therapy and Training: A Scoping Review-Part A. J Voice 2023:S0892-1997(23)00348-X. [PMID: 38155057 DOI: 10.1016/j.jvoice.2023.10.027] [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: 07/31/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To map the volitional and non-volitional devices used by speech and language pathologists (SLPs) in voice training and therapy and characterize their use in research on voice interventions. METHODS This scoping review is the first part of a larger study. The electronic search was carried out by mapping the references in PubMed/Medline, LILACS/BVS, Scopus, Web of Science, EMBASE, and the Cochrane Library, and the manual search was carried out in the grey literature. Two blind independent reviewers selected and extracted data; divergences were solved by consensus. The data extracted in this part of the study were the authorship and year of publication, country, study design, sample characteristics, intervention modality, ingredient, target, mechanism of action, dosage, and outcome measures. They were addressed with descriptive analysis. RESULTS Publications that use devices as ingredients are mostly from the last two decades, mainly carried out in the United States of America and Brazil, in adults of both sexes with behavioral dysphonia. Forty-two types of devices were used, many of them with similar approaches but different nomenclatures. Most devices were used voluntarily, focusing on vocal function, and aiming to increase source and filter interaction. Most studies used silicone tubes. The most reported technical specification to apply the ingredient was surface electrodes on the neck. Device dosage was time-controlled, and the most used outcomes were self-assessment and acoustic analysis. CONCLUSION Devices are currently used as ingredients in vocal interventions, with a greater focus on increasing the source and filter interaction, associated with silicone tubes (the most used devices in these studies), which have been dosed with performance time. Outcomes were measured with self-assessment instruments.
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Affiliation(s)
- Denis de Jesus Batista
- Center for Exact and Natural Sciences, Postgraduate program in Decision Models and Health of Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil; Health Sciences Center, Associated Postgraduate Program in Speech-Language Pathology and Audiology at the Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte, and Universidade Estadual de Ciências da Saúde de Alagoas, João Pessoa, Paraíba, Brazil
| | - João M da Trindade Duarte
- Center for Human Sciences, Letters and Arts, Postgraduate program in Linguistics of Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | - Larissa T D Siqueira
- Department of Speech-Language Pathology and Audiology of the Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Anna A Almeida
- Health Sciences Center, Associated Postgraduate Program in Speech-Language Pathology and Audiology at the Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte, and Universidade Estadual de Ciências da Saúde de Alagoas, João Pessoa, Paraíba, Brazil; Department of Speech-Language Pathology and Audiology, Graduate Program in Linguistics, and Graduate Program in Decision Models and Health of the Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | - Leonardo W Lopes
- Health Sciences Center, Associated Postgraduate Program in Speech-Language Pathology and Audiology at the Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte, and Universidade Estadual de Ciências da Saúde de Alagoas, João Pessoa, Paraíba, Brazil; Department of Speech-Language Pathology and Audiology, Graduate Program in Linguistics, and Graduate Program in Decision Models and Health of the Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | - Vanessa V Ribeiro
- Health Sciences Center, Associated Postgraduate Program in Speech-Language Pathology and Audiology at the Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte, and Universidade Estadual de Ciências da Saúde de Alagoas, João Pessoa, Paraíba, Brazil; Faculty of Medicine, Speech-Language Pathology and Audiology course and the Postgraduate Program in Medical Sciences of the Universidade de Brasília, Brasília, Distrito Federal, Brazil.
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Bottalico P, Nudelman CJ. Do-It-Yourself Voice Dosimeter Device: A Tutorial and Performance Results. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-15. [PMID: 37263017 DOI: 10.1044/2023_jslhr-23-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Voice dosimeters gather voice production data in the daily lives of individuals with voice disorders. Additionally, voice dosimeters aid in understanding the pathophysiology of voice disorders. Previously, several voice dosimeters were commercially available. However, these devices have been discontinued and are not available to clinicians and researchers alike. In this tutorial, instructions for a low-cost, easy-to-assemble voice dosimeter are provided. This do-it-yourself (DIY) voice dosimeter is further validated based on performance results. METHOD Ten vocally healthy participants wore the DIY voice dosimeter. They produced a sustained /a/ vowel and read a text with three different vocal efforts. These tasks were recorded by the DIY voice dosimeter and a reference microphone simultaneously. The expanded uncertainty of the mean error in the estimation of four voice acoustic parameters as measured by the DIY dosimeter was performed by comparing the signals acquired through the reference microphone and the dosimeter. RESULTS For measures of sound pressure level, the DIY voice dosimeter had a mean error of -0.68 dB with an uncertainty of 0.56 dB. For fundamental frequency, the mean error was 1.56 Hz for female participants and 1.11 Hz for male participants, with an uncertainty of 0.62 Hz and 0.34 Hz for female and male participants, respectively. Cepstral peak prominence smoothed and L1 minus L2 had mean errors (uncertainty) of -0.06 dB (0.27 dB) and 2.20 dB (0.72 dB). CONCLUSION The mean error and uncertainties for the DIY voice dosimeter are comparable to those for the most accurate voice dosimeters that were previously on the market.
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Affiliation(s)
- Pasquale Bottalico
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign
| | - Charles J Nudelman
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign
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Nudelman CJ, Codino J, Fry AC, Bottalico P, Rubin AD. Voice Biofeedback via Bone Conduction Headphones: Effects on Acoustic Voice Parameters and Self-Reported Vocal Effort in Individuals With Voice Disorders. J Voice 2022:S0892-1997(22)00320-4. [PMID: 36372674 DOI: 10.1016/j.jvoice.2022.10.014] [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: 08/23/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE This study explores sidetone amplification (amplified playback of one's own voice) provided via bone conduction in participants with voice disorders. The effects of bone conduction feedback on acoustic voice parameters and vocal effort ratings are examined. METHODS Speech samples of 47 participants with voice disorders were recorded in three auditory feedback conditions: two with sidetone amplification delivered via bone conduction and one condition with no alteration of the feedback. After each task, the participants rated their vocal effort on a visual analog scale. The voice recordings were evaluated by a speech-language pathologist through the GRBAS scale and processed to calculate the within-participant centered sound pressure level (SPL) values, the mean pitch strength (PS), the time dose (Dt%), and cepstral peak prominence smoothed (CPPS). The effects of the feedback conditions on these acoustic parameters and vocal effort ratings were analyzed. RESULTS The high sidetone amplification condition resulted in a statistically significant decrease in the within-participant centered SPL values and mean pitch strength across all participants. The feedback conditions had no statistically significant effects on the vocal effort ratings, time dose (Dt%), or CPPS. CONCLUSIONS This study provides an evidence that bone conduction sidetone amplification contributes to a consistent adaptation in the within-participant centered SPL values (ΔSPL) in patients with vocal hyperfunction, glottal insufficiency, and organic/neurological laryngeal pathologies compared to conditions with no feedback.
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Affiliation(s)
- Charles J Nudelman
- Department of Speech and Hearing Science, University of Illinois Urbana-Champaign, Champaign, Illinois.
| | - Juliana Codino
- Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Adam C Fry
- Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Pasquale Bottalico
- Department of Speech and Hearing Science, University of Illinois Urbana-Champaign, Champaign, Illinois
| | - Adam D Rubin
- Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
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Cortés JP, Lin JZ, Marks KL, Espinoza VM, Ibarra EJ, Zañartu M, Hillman RE, Mehta DD. Ambulatory Monitoring of Subglottal Pressure Estimated from Neck-Surface Vibration in Individuals with and without Voice Disorders. APPLIED SCIENCES (BASEL, SWITZERLAND) 2022; 12:10692. [PMID: 36777332 PMCID: PMC9910342 DOI: 10.3390/app122110692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The aerodynamic voice assessment of subglottal air pressure can discriminate between speakers with typical voices from patients with voice disorders, with further evidence validating subglottal pressure as a clinical outcome measure. Although estimating subglottal pressure during phonation is an important component of a standard voice assessment, current methods for estimating subglottal pressure rely on non-natural speech tasks in a clinical or laboratory setting. This study reports on the validation of a method for subglottal pressure estimation in individuals with and without voice disorders that can be translated to connected speech to enable the monitoring of vocal function and behavior in real-world settings. During a laboratory calibration session, a participant-specific multiple regression model was derived to estimate subglottal pressure from a neck-surface vibration signal that can be recorded during natural speech production. The model was derived for vocally typical individuals and patients diagnosed with phonotraumatic vocal fold lesions, primary muscle tension dysphonia, and unilateral vocal fold paralysis. Estimates of subglottal pressure using the developed method exhibited significantly lower error than alternative methods in the literature, with average errors ranging from 1.13 to 2.08 cm H2O for the participant groups. The model was then applied during activities of daily living, thus yielding ambulatory estimates of subglottal pressure for the first time in these populations. Results point to the feasibility and potential of real-time monitoring of subglottal pressure during an individual's daily life for the prevention, assessment, and treatment of voice disorders.
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Affiliation(s)
- Juan P. Cortés
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile
| | - Jon Z. Lin
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Katherine L. Marks
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA 02114, USA
- Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA 02129, USA
- Speech, Language & Hearing Sciences Department, College of Health & Rehabilitation: Sargent College, Boston University, Boston, MA 02215, USA
| | | | - Emiro J. Ibarra
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile
| | - Matías Zañartu
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile
| | - Robert E. Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA 02114, USA
- Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA 02129, USA
- Department of Surgery, Massachusetts General Hospital–Harvard Medical School, Boston, MA 02114, USA
- Speech and Hearing Bioscience and Technology, Division of Medical Sciences, Harvard Medical School, Boston, MA 02115, USA
| | - Daryush D. Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA 02114, USA
- Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA 02129, USA
- Department of Surgery, Massachusetts General Hospital–Harvard Medical School, Boston, MA 02114, USA
- Speech and Hearing Bioscience and Technology, Division of Medical Sciences, Harvard Medical School, Boston, MA 02115, USA
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