Preliminary Investigation of Four Voice Therapy Concepts in a Single-Subject Design with Four Professional Teachers

PURPOSE

The Global Voice Prevention and Therapy Model (GVPTM) with the Estill Voice Model (EVM) involves four concepts: 1) training multiple new voice targets to meet all the vocal demands of the client, 2) using an integrated implicit-explicit instructional approach, 3) switching between voice targets, and 4) facilitating voice practice in a bottom-up speech hierarchy. As a preliminary investigation into the four concepts, the current study compared the GVPTM with EVM to a modified version of the GVPTM (MGVPTM) with EVM that eliminated concepts 1 (only one new resonant voice was trained) and 3 (no switching between voice targets) and kept concepts 2 and 4.

METHODS

Four professional teachers were randomized into one of two conditions in a single-subject design counterbalanced with alternating treatments and baselines (ie, A1BA2CA3 or A1CA2BA3). In condition 1 (A1BA2CA3), the GVPTM was first followed by MGVPTM. In condition 2 (A1CA2BA3), the MGVPTM was first followed by the GVPTM. Baseline measures included fundamental frequency (fo), participant self-ratings of overall voice quality, roughness, and strain, the Voice Handicap Index (VHI)-10, Vocal Fatigue Index (VFI), survey questions, and answers to questions via an exit interview.

RESULTS

The results indicated significant differences for fo and self-ratings of overall vocal quality, roughness, and strain from pre to post for the GVPTM and MGVPTM. VHI-10 and VFI factors 1, 2, and 3 yielded no differences from pre to post. Overall, the participants viewed all four concepts in the GVPTM favorably and suggested it was limiting to learn only one new resonant voice with no switching between voice targets in the MGVPTM.

CONCLUSIONS

Speech-language pathologists may consider using all four concepts in voice therapy sessions represented via targets, ingredients, and mechanisms of action of the Rehabilitation Treatment Specification System.

Connecting Auditory-Perceptual Prompts Used in Voice Therapy to Anatomy and Physiology: Application to the Estill Voice Model and the Rehabilitation Treatment Specification System

PURPOSE

This clinical tutorial will present the concept of applying auditory-perceptual prompts (implicit instruction) typically used in voice therapy to the anatomy and physiology of the voice production system (explicit instruction) via the Estill Voice Model (EVM) and the Rehabilitation Treatment Specification System (RTSS).

METHODS

EVM offers an integrated implicit-explicit instructional approach to voice training allowing for isolated practice of vocal structures (explicit) that interact to produce functional voice qualities (implicit), such as modal speech and louder projected voice qualities. In EVM, voice quality is correlated with the specific anatomy and physiologic adjustments via 13 Estill Figures and Options (eg, Larynx Figure has three options: High, Mid, and Low). RTSS provides a framework to connect client change in functioning (ie, target) with clinician action (ie, ingredients). Mechanisms of action connect the target to the ingredients by hypothesizing how the treatment is expected to work.

RESULTS

Evidence is provided for connecting auditory-perpetual voice prompts with the anatomy and physiology of voice and supporting an integrated implicit-explicit approach to voice therapy. The concept of linking commonly used implicit auditory-perceptual prompts used in voice therapy (eg, humming, loud "aahh") to explicit anatomy and physiology training (eg, 13 Estill Figures and Options) is demonstrated using EVM and the RTSS framework with case studies and video examples.

CONCLUSIONS

Clinicians may choose to use anatomy and physiology of voice to define and provide explicit instruction for typically used implicit auditory-perceptual prompts. Future research is warranted to test the concept applied to voice therapy models in the literature across prevention and treatment of voice disorders.

Effect of Practice Structure and Feedback Frequency on Voice Motor Learning in Older Adults

OBJECTIVES

The long-term goal of this research is to advance the rehabilitation of voice disorders through the study and development of efficacious treatment regimes based upon motor learning principles. This study examined the effect of contextual interference (CI) of practice structure with knowledge of results (KR) feedback on motor learning of a novel voice task, "Twang," by hypophonic, novice, and expert older adults.

STUDY DESIGN

Prospective, randomized controlled mixed design.

METHODS

A total of 92 adults, age 55-80, recruited from the following motor skill levels: 1) Hypophonic voice; 2) Novice-untrained vocalists; 3) Expert-trained vocalists were randomly assigned to four different interventions and examined during acquisition, retention, and transfer phases of motor learning. Participants from each skill-level practiced the novel task, "Twang," according to the randomly assigned Practice Structure/KR combinations: 1) Blocked practice/100%KR; 2) Blocked practice/55% KR; 3) Random practice/100%KR; 4) Random practice/55% KR.

RESULTS

During the motor performance phase, our results mirrored those reported in the limb motor learning literature for CI: A Blocked practice structure enhanced short-term effects of motor acquisition for novice, expert, and hypophonic subjects. The only significant result for KR occurred when paired with Random Practice in the hypophonic subject group: 100% KR paired with Blocked practice increased motor performance, but degraded motor learning.

CONCLUSIONS

Fundamental motor learning principles were explored within the context of a voice training paradigm. Practice with a high CI and low frequency of KR degraded performance during short-term acquisition but enhanced long-term performance effects of motor learning. Voice clinicians and teachers may benefit by implementing motor learning theory into practice during training and treatment sessions.

Biofeedback electromiográfico y electroglotográfico aplicado a la terapia vocal: una revisión sistemática

La electromiografía y electroglotografía son técnicas de exploración que, combinadas con el biofeedback, permiten en el emisor ajustes musculares para la mejora de la función fonatoria. Nos proponemos, pues, determinar los efectos del biofeedback electromiográfico para aumentar o disminuir el tono en los músculos que intervienen de manera indirecta o directa en la producción de la voz, identificar los efectos del biofeedback electroglográfico para producir cambios en el patrón vibratorio de los pliegues vocales y, finalmente, determinar la frecuencia del biofeedback en el tratamiento vocal, a partir de una revisión sistemática de los trabajos publicados desde el año 2000 en revistas logopédicas y laringológicas. El análisis de los estudios obtenidos en el proceso de documentación sugiere que el uso del biofeedback electromiográfico y electroglotográfico puede producir cambios perdurables en el tiempo sobre el patrón vibratorio de los pliegues vocales y en la actividad muscular de la producción vocal, de manera que podría ser un instrumento útil añadido a la intervención vocal basadaen la evidencia. Los datos relativos a la frecuencia de uso necesaria de este instrumento, sin embargo, no parecen concluyentes.

Functional Voice Assessment and Therapy Methods Supported by Telepractice, VoiceEvalU8, and Estill Voice Training

Functional assessment and therapy methods are necessary for a client-centered approach that addresses the client's vocal needs across all environments. The purpose of this article is to present the approach with the intent to encourage discussion and implementation among educators, clinicians, researchers, and students. The functional approach is defined and its importance is described within the context of the World Health Organization's International Classification of Functioning, Disability, and Health with support provided by synchronous and asynchronous telepractice, the VoiceEvalU8 app, server, and web portal, and a framework that defines voice qualities (e.g., resonance, twang, loud, and others) by the anatomy and physiology of the voice production system (i.e., Estill Figures for Voice). Case scenarios are presented to highlight application of the functional voice approach.