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Kervin SR, Harris KJ, Urbano M, Curtis JA. The Relationship Between Speech-Language Pathologists' Perceptions of Clinical Terminology and Its Use in Voice Therapy with Adults. J Voice 2024:S0892-1997(24)00241-8. [PMID: 39214773 DOI: 10.1016/j.jvoice.2024.07.030] [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: 06/25/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES The terminology used by speech-language pathologists (SLPs) during voice therapy is important for treatment outcomes because it can impact both patient self-efficacy and adherence. However, little is known about what factors influence the terminology that SLPs choose to use. Understanding this gap is important to ultimately optimize voice therapy outcomes. Therefore, the primary aims of this study were to (1) assess the relationship between reported clinician-perceived positivity and (2) assess the relationship between clinician-perceived positivity and clinical endorsement for use. We hypothesized that clinician-perceived positivity would be one important factor driving how frequently clinicians use or avoid specific terms, and if they think the term should be used by other SLPs in clinical practice. DESIGN/METHODS This prospective study was conducted as an online survey of SLPs and SLP clinical fellows who evaluate and treat adult voice patients. The survey presented respondents with a total of 46 voice-related terms and prompted respondents to rate: (1) how frequently they use a specific voice-related term ("frequency of use"); (2) how positive or negative they perceive a specific voice-related term to be ("perceived positivity"); and (3) if they feel a specific voice-related term should versus should not be used in clinical practice ("clinical endorsement"). Inferential statistics were used to examine the relationship between perceived positivity and frequency of use, and perceived positivity and clinical endorsement. Summary statistics were used to describe frequency of use across all terms. RESULTS One hundred twelve respondents completed the survey. Clinician-perceived positivity of voice-related terminology was significantly related to its reported self-reported frequency of use (β = 1.946; 95% CI: 1.701-2.191; P < 0.0005) and clinical endorsement of use by others (β = 4.103; 95% CI: 3.750-4.456; P < 0.0005). Both of these relationships exhibited relatively large effect sizes. CONCLUSIONS This study was an important first step at identifying factors that influence SLP's use of specific terminology in voice therapy. Specifically, an SLP's perceived positivity of clinical terminology strongly influenced the frequency with which they reported using that term in voice therapy and whether or not they thought that term should be used with patients by other SLPs in voice therapy. Future work should investigate clinician characteristics that might affect terminology use, include more diverse sampling, utilize self-selected terminology or audio recordings of therapy interactions, and assess direct effects of terminology use on patient outcomes.
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Affiliation(s)
- Sarah R Kervin
- Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York.
| | - Kaila J Harris
- Voice and Speech Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Megan Urbano
- USF Health Voice Center, USF ENT North Tampa Campus, Tampa, Florida
| | - James A Curtis
- Aerodigestive Innovations Research Lab (AIR), Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medical College of Cornell University, New York, New York
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Hashemnia SS, Seifpanahi MS, Baghban K, Miresmaeili A, Khazaei S. The Immediate Effect of Straw Phonation in Children With Repaired Cleft Palate. J Voice 2024:S0892-1997(24)00201-7. [PMID: 39095240 DOI: 10.1016/j.jvoice.2024.06.023] [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: 04/12/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE This study aims to investigate the immediate effect of straw phonation on the phonation of Persian-speaking children with repaired cleft palate. STUDY DESIGN Quasi-experimental preintervention and postintervention. METHODS Seventeen children with repaired cleft palate and velopharyngeal dysfunction were investigated. A control group was established comprising children without a cleft palate (control group), carefully matched in terms of age and gender. All participants underwent straw phonation and assessment. The assessments were made two times: at baseline and immediately after straw phonation. Each participant performs straw phonation (a short straw measuring 3 mm in inner diameter and 20 cm in length) once for 3 minutes. The acoustic analysis including parameters, such as jitter, shimmer, harmonics-to-noise ratio (HNR), cepstral peak prominence (CPP) parameters, as well as the electroglottography (closed quotient [CQ]) analysis were performed at pretreatment and immediately after treatment. RESULTS Compared with the pretreatment values, after-treatment observation demonstrated a significant reduction in Jitter % and Shimmer %, and a significant enhancement in HNR and CPP among children with repaired cleft palate. There is no significant difference in intragroup data in the CPP and CQ in pretreatment. CONCLUSIONS The proposed straw phonation technique results in an immediate positive change in the quality of voice in both groups. Moreover, assessments in the clinical group showed a significant decrease in shimmer and jitter perturbation, alongside elevated levels of HNR and CPP subsequent to straw phonation, irrespective of the phonatory task.
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Affiliation(s)
- Seyede Saghar Hashemnia
- Department of Speech Therapy, School of Rehabilitation Sciences, Hamadan University of Medical Science, Hamadan, Iran.
| | - Mohammad-Sadegh Seifpanahi
- Department of Speech Therapy, School of Rehabilitation Sciences, Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Kowsar Baghban
- Department of Speech Therapy, School of Rehabilitation Sciences, Hamadan University of Medical Science, Hamadan, Iran.
| | - Amirfarhang Miresmaeili
- Dental Research Center, Department of Orthodontics, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Salman Khazaei
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
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Grillo EU, Wolfberg J, Perta K, Van Stan J, Steinhauer K. Connecting Auditory-Perceptual Prompts Used in Voice Therapy to Anatomy and Physiology: Application to the Estill Voice Model and the Rehabilitation Treatment Specification System. J Voice 2024:S0892-1997(24)00207-8. [PMID: 39043532 DOI: 10.1016/j.jvoice.2024.06.025] [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: 05/04/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/25/2024]
Abstract
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.
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Affiliation(s)
- Elizabeth U Grillo
- Department of Communication Sciences and Disorders, West Chester University of Pennsylvania, West Chester, Pennsylvania.
| | - Jeremy Wolfberg
- Center for Laryngeal Surgery and Voice Rehabilitation at Massachusetts General Hospital, Boston, Massachusetts; MGH Institute of Health Professions, Boston, Massachusetts
| | - Karen Perta
- Department of Communication Sciences and Disorders, Elmhurst University, Elmhurst, Illinois
| | - Jarrad Van Stan
- Center for Laryngeal Surgery and Voice Rehabilitation at Massachusetts General Hospital, Boston, Massachusetts; MGH Institute of Health Professions, Boston, Massachusetts; Department of Surgery at Harvard Medical School, Boston, Massachusetts
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Van Stan JH, Roy N, Stemple J, Gartner-Schmidt J, Gillespie AI, Whyte J, Duffy J, Turkstra L. Rehabilitation Treatment Specification System: Content and Criterion Validity Across Evidence-Based Voice Therapies for Muscle Tension Dysphonia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1774-1791. [PMID: 38597797 PMCID: PMC11253635 DOI: 10.1044/2024_ajslp-23-00362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/11/2024] [Accepted: 02/20/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Systematically improving voice therapy outcomes is challenging as the clinician actions (i.e., active ingredients) responsible for improved patient functioning (i.e., targets) are relatively unknown. The theory-driven Rehabilitation Treatment Specification System (RTSS) and standard, voice-specific terminology based on the RTSS (RTSS-Voice) may help address this problem. This qualitative study evaluated if the RTSS and RTSS-Voice can describe four evidence-based voice therapies for muscle tension dysphonia without missing critical aspects (content validity) and identify commonalities and differences across them (criterion validity). METHOD Qualitative interviews were completed between the clinicians (protocol experts) who developed and/or popularized the vocal function exercises, laryngeal reposturing, circumlaryngeal massage, and conversation training therapies as well as RTSS experts to produce RTSS specifications that met two consensus criteria: (a) The protocol expert agreed that the specification represented their treatment theory, and (b) the RTSS experts agreed that the specifications correctly adhered to both the RTSS framework and the RTSS-Voice's standard terminology. RESULTS The RTSS and RTSS-Voice comprehensively described voice therapy variations across and within the four diverse treatment programs, needing only the addition of one new target: overall auditory-perceptual severity. CONCLUSIONS The RTSS and RTSS-Voice exhibited strong content validity. The standard RTSS-Voice terminology helped identify, for the first time, commonalities and differences in treatment ingredients, targets, and mechanisms of action across four treatments developed for the same patient population. In the long term, the RTSS and RTSS-Voice could provide the framework for an ever-growing collection of clinically meaningful and evidence-based therapy algorithms with potential to improve research, education, and clinical care. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25537624.
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Affiliation(s)
- Jarrad H. Van Stan
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | | | | | | | | | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA
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Ohlsson AC, Li Y, Gustavsson I, Hofling K, Wahle U, Österlind C, Iwarsson J. Voice Therapy Outcome: A Comparison Between Imitation Model Voice Therapy and Verbal Instructions Model Voice Therapy. J Voice 2024; 38:903-910. [PMID: 35227553 DOI: 10.1016/j.jvoice.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/18/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim was to compare voice outcomes over time in patients treated with Imitation Model voice therapy and Verbal Instructions Model voice therapy. METHODS A prospective clinical trial was performed with 56 consecutive patients diagnosed with a primary or secondary functional voice disorder. Thirty-one patients were included for voice therapy following the Imitation Model and 25 patients for the Verbal Instructions Model. Assessments included a self-rated Voice Handicap Index, self-perceived hoarseness and vocal fatigue, perceptual voice evaluation by a Speech Language Pathologist, and maximum Voice Range Profiles. All assessments were completed before therapy, at end of therapy, at six-months posttherapy follow-up and 12-months posttherapy follow-up. For maximum Voice Range Profiles group differences were also compared for effects from end-of-treatment to follow-up assessments. Linear mixed models were used for analysis. RESULTS Comparison between treatment groups showed significantly larger long-term improvement from the baseline, for verbal instructions model as compared to imitation model for Voice Handicap Index total, and also the physical and emotional subscales, while there was no difference between groups for the functional subscale. Also, voice quality improved more after verbal instructions model, as compared to imitation model, at end of therapy. Results from self-rated hoarseness and vocal fatigue showed no difference between groups. There was no difference between treatment groups in the change of maximum Voice Range Profile from end-of-treatment to follow-up assessments. CONCLUSIONS The study showed that both Imitation Model voice therapy and Verbal Instructions Model voice therapy improved voice function. Compared to Imitation Model, the Verbal Instructions model showed larger long-term effect on physical and emotional aspects of voice function in everyday life. The two approaches for voice therapy might have different impacts on patients' learning.
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Affiliation(s)
- Ann-Christine Ohlsson
- Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Ying Li
- Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Inger Gustavsson
- Department of Speech Language Pathology, ENT Clinic, Hospital of South of Älvsborg, Borås, Sweden
| | - Kerstin Hofling
- Department of Speech Language Pathology, Hospital of Skaraborg (SkaS) Lidköping, Lidköping, Sweden
| | - Ulrika Wahle
- Department of Logopedics and Phoniatrics, ENT Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Claes Österlind
- Department of Speech Language Pathology, NU- healthcare, Trollhättan, Sweden
| | - Jenny Iwarsson
- Department of Scandinavian Studies and Linguistics, Audiologopedics, Copenhagen University, Copenhagen S, Denmark
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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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7
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Rubino M, Abbott KV. Scoping Review of Voice Therapy Adherence. J Voice 2024; 38:426-434. [PMID: 34911636 DOI: 10.1016/j.jvoice.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this scoping review was to summarize key findings in the voice therapy adherence literature for individuals with phonotraumatic lesions. The particular focus was to identify how adherence has been defined and measured (operationalization and criteria for successful adherence) and to describe variables which were found to have a positive, neutral, or negative relationship with adherence to voice therapy. METHODS Data were identified and charted using the PRISMA-ScR protocol via searches of CINAHL, PsycINFO, Pubmed, SCOPUS, and Web of Science. RESULTS Literature mining revealed that adherence is rarely defined but is usually operationalized. "Successful completion of therapy" was the most common operationalization. Most variables studied in this field have been found to have no relationship with adherence. An incidental finding was that, most frequently, researchers have repeatedly studied variables which have already been documented to have no relationship with adherence. CONCLUSION Research into voice therapy adherence is still emerging, and few if any variables have been identified which are strongly associated with adherence to voice therapy for people with phonotraumatic lesions. Inspiration for future research may be drawn from other disciplines, which point to relationship variables as central to the adherence process. Examination of such variables is currently underrepresented in the voice therapy literature; we suggest this and other gaps for pursuit in future research.
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Affiliation(s)
- Marianna Rubino
- Department of Communication Sciences and Disorders, University of Delaware, Newark, Delaware.
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Leyns C, Corthals P, Cosyns M, Papeleu T, Van Borsel J, Morsomme D, T'Sjoen G, D'haeseleer E. Acoustic and Perceptual Effects of Articulation Exercises in Transgender Women. J Voice 2024; 38:246.e15-246.e25. [PMID: 34384662 DOI: 10.1016/j.jvoice.2021.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study measured the impact of articulation exercises using a cork and articulation exercises for lip spreading on the formant frequencies of vowels and listener perceptions of femininity in transgender women. METHODS Thirteen transgender women were recorded before and after the cork exercise and before and after the lip spreading exercise. Speech samples included continuous speech during reading and were analyzed using Praat software. Vowel formant frequencies (F1, F2, F3, F4, F5) and vowel space were determined. A listening experiment was organized using naïve cisgender women and cisgender men rating audio samples of continuous speech. Masculinity/femininity, vocal quality and age were rated, using a visual analogue scale (VAS). RESULTS Concerning vowel formant frequencies, F2 /a/ and F5 /u/ significantly increased after the lip spreading exercise, as well as F3 /a/, F3 /u/ and F4 /a/ after the cork exercise. The lip spreading exercise had more impact on the F2 /a/ than the cork exercise. Vowel space did not change after the exercises. The fundamental frequency (fo) increased simultaneously during both exercises. Both articulation exercises were associated with significantly increased listener perceptions of femininity of the voice. CONCLUSION Subtle changes in formant frequencies can be observed after performing articulation exercises, but not in every formant frequency or vowel. Cisgender listeners rated the speech of the transgender women more feminine after the exercises. Further research with a more extensive therapy program and listening experiment is needed to examine these preliminary findings.
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Affiliation(s)
- Clara Leyns
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Paul Corthals
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Marjan Cosyns
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium; Sciensano, Belgian institute for health, Brussels, Belgium
| | - Tine Papeleu
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - John Van Borsel
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Dominique Morsomme
- Department of Speech and Language Therapy, University of Liège, Liège, Belgium
| | - Guy T'Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium; Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium; Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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Perta K, Bae Y, Vuolo J, Bressmann T, Fox R. The Role of Instructions in Motor Learning of Oral Versus Nasalized Speech Targets. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4398-4413. [PMID: 37870844 DOI: 10.1044/2023_jslhr-23-00267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
PURPOSE The purpose of this study was to investigate how general, implicit instructions with auditory-perceptual emphasis; specific, explicit instructions with biomechanical focus; or both affect learning of oral-nasal balance control in speech. METHOD Thirty healthy, vocally untrained participants were assigned to one of three instructional groups (i.e., implicit, explicit, and integrated) and learned to produce oral versus nasalized vowel-, syllable-, and phrase-level targets during once-weekly sessions over 4 weeks. Learning gains and performance variability were analyzed using nasometry. RESULTS We observed a significant main effect of instruction type on learning gains at phrase level (p = .016). Specifically, the integrated group (M = 59.8%) significantly outperformed the explicit group (M = 37.9%) and numerically outperformed the implicit group (M = 45.1%). For nasalized phrase targets, results revealed a significant main effect of instruction type on performance variability (p = .042), but pairwise comparisons between instruction groups were not significant. CONCLUSIONS The integration of implicit processes via auditory-perceptual modeling and explicit processes via relevant biomechanical directives resulted in larger motor learning gains, especially at higher levels of task complexity (i.e., phrase) compared to providing implicit or explicit instruction alone. The higher performance variability (i.e., less stable productions) that was sometimes induced by explicit instruction did not negatively impact learning when integrated with implicit instruction. Clinical implications for speech/voice therapy models are discussed.
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Affiliation(s)
- Karen Perta
- Department of Hearing, Speech and Language Sciences, Ohio University, Athens
| | - Youkyung Bae
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Janet Vuolo
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Tim Bressmann
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Robert Fox
- Department of Speech and Hearing Science, The Ohio State University, Columbus
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Ishikawa K, Li H, Coster E. The Effect of Noise on Initiation and Maintenance of Clear Speech and Associated Mental Demand. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4180-4190. [PMID: 37793611 DOI: 10.1044/2023_jslhr-23-00157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND/OBJECTIVES The objectives of this study were to explore (a) the influence of different types of background noise and their informational content on the ability of speakers to initiate and maintain clear speech (CS), a widely utilized technique for enhancing speech intelligibility, and (b) the impact of background noise and CS usage on speakers' mental demand. METHOD Five adult females were asked to read sentences using both habitual and CS under four distinct noise conditions: quiet, multitalker (MT) noise, reversed multitalker (RevMT) noise, and speech-shaped (SS) noise. Following this, speakers rated their perceived level of mental demand for each speaking condition using the modified NASA Task Load Index scale. A two-part listening experiment with 48 listeners was conducted to evaluate the speakers' effectiveness in initiating and maintaining CS. RESULTS Speakers initiated CS more successfully in noise than in quiet, with better performance observed in the presence of RevMT noise as compared to SS noise. Regarding the maintenance of CS, none of the speakers were successful in a quiet environment. Furthermore, the ability to maintain CS was most adversely affected in MT noise, followed by RevMT noise and SS noise. CONCLUSIONS Our findings suggest that the effect of background noise on speech production is complex and multifaceted. The noise type affected speakers' ability to initiate and maintain CS as well as the mental demand associated with the speech task. The results underscore the importance of considering the characteristics of background noise and cognitive aspects of speech production when training and evaluating speakers' performance.
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Affiliation(s)
- Keiko Ishikawa
- Department of Communication Science and Disorders, University of Kentucky, Lexington
| | - Hannah Li
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign
| | - Elisabeth Coster
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign
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Boominathan P, Mahalingam S, Arunachalam R, Venkatesh L. An eclectic Voice Therapy Program for the Treatment of Hyperfunctional Voice Disorders (HFVD). J Voice 2023; 37:969.e1-969.e21. [PMID: 34261583 DOI: 10.1016/j.jvoice.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE An eclectic voice therapy program includes sequenced and structured set of exercises combining direct and indirect intervention methods. Tailor-made exercise prescription with specific cultural adaptations are needed to provide a holistic change to voice quality.1 This study detailed the construction of an exercise prescription for participants with hyperfunctional voice disorder [HFVD] in the Indian context. METHOD The exercise program was developed based on literature related to vocal therapy approaches and delivery methods. Adaptations were introduced to a selected set of exercises. Five voice experts verified the exercises and their prescription for content and feasibility of use in the Indian context. Modification suggested by the experts were included for framing the final version of the exercise program. This structured therapy program was planned for 6 weeks (30 minutes duration/session offered individually twice per week, with a gap of two days between sessions in a week) with the goals to improve voice quality, flexibility, and endurance while speaking. Five participants with HFVD partook in the study for pilot testing. Stroboscopy, perceptual voice analysis, Dysphonia Severity Index (DSI) and Vocal Fatigue Index in Tamil (VFI-T) were used to report the therapy outcomes. Participants' report on the learning process and generalization of the program were documented. Wilcoxon-signed rank test was used to test the pre-post outcome measures. RESULTS An eclectic voice therapy program, i.e., Comprehensive Voice Habilitation Program [CVHP] was constructed and it included vocal hygiene instructions, warm-up & cool-down, easy onset, resonant voice, and carry over exercises. Participants completed the program in 14-18 sessions (over 7 to 9 weeks of therapy). All participants showed significant changes in vocal fold movement patterns, reduction in ventricular hyperadduction, overall grade of voice quality, DSI and VFI-T. Participants reported that pictorial illustrations, feedback, and monitoring sheets were useful in learning the exercises. CONCLUSION CVHP showed significant change in the voice-related outcome measures and was a viable program for treating HFVD.
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Affiliation(s)
- Prakash Boominathan
- Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India.
| | - Shenbagavalli Mahalingam
- Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
| | - Ravikumar Arunachalam
- SRM Institute of Science & Technology, Kattankulathur, Chengalpattu, Tamil Nadu, India
| | - Lakshmi Venkatesh
- Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
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12
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Daşdöğen Ü, Awan SN, Bottalico P, Iglesias A, Getchell N, Abbott KV. The Influence of Multisensory Input On Voice Perception and Production Using Immersive Virtual Reality. J Voice 2023:S0892-1997(23)00235-7. [PMID: 37739864 DOI: 10.1016/j.jvoice.2023.07.026] [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: 04/20/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES The purpose was to examine the influence of auditory vs visual vs combined audiovisual input on perception and production of one's own voice, using immersive virtual reality technology. METHODS Thirty-one vocally healthy men and women were investigated under 18 sensory input conditions, using immersive virtual reality technology. Conditions included two auditory rooms with varying reverberation times, two visual rooms with varying volumes, and the combination of audiovisual conditions. All conditions were repeated with and without background noise. Speech tasks included counting, sustained vowel phonation, an all-voiced sentence from the Consensus Auditory-Perceptual Evaluation of Voice, and the first sentence from the Rainbow Passage, randomly ordered. Perception outcome measures were participants' self-reported perceptions of their vocal loudness, vocal effort, and vocal comfort in speech. Production outcome measures were sound pressure level (SPL) and spectral moments (spectral mean and standard deviation in Hz, skewness, and kurtosis). Statistical analyses used self-reported vocal effort, vocal loudness, and vocal comfort in percent (0 = "not at all," 100 = extremely), SPL in dB, and spectral moments in Hz. The reference level was a baseline audiovisual deprivation condition. RESULTS Results suggested (i) increased self-perceived vocal loudness and effort, and decreased comfort, with increasing room volume, speaker-to-listener distance, audiovisual input, and background noise, and (ii) increased SPL and fluctuations in spectral moments across conditions. CONCLUSIONS Not only auditory, but also visual and audiovisual input influenced voice perception and production in ways that have not been previously documented. Findings contribute to the basic science understanding the role of visual, audiovisual and auditory input in voice perception and production, and also to models of voice training and therapy. The findings also set the foundation for the use of virtual reality in voice and speech training, as a potentially power solution to the generalization problem.
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Affiliation(s)
- Ümit Daşdöğen
- Mount Sinai Health System, Department of Otolaryngology, New York, NY.
| | - Shaheen N Awan
- University of Central Florida, Communication Sciences and Disorders, Orlando, FL
| | - Pasquale Bottalico
- University of Illinois Urbana-Champaign, Department of Speech and Hearing Science, Champaign, IL
| | - Aquiles Iglesias
- University of Delaware, Communication Sciences and Disorders, Newark, DE
| | - Nancy Getchell
- University of Delaware, Kinesiology & Applied Physiology, Newark, DE
| | - Katherine Verdolini Abbott
- Mount Sinai Health System, Department of Otolaryngology, New York, NY; University of Illinois Urbana-Champaign, Department of Speech and Hearing Science, Champaign, IL
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13
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Cutchin GM, Shelly S, Petty B, van Leer E, Tripp RM, Klein AM, Gillespie AI. A Comparison of Voice Therapy Attendance Rates Between In-Person and Telepractice. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1154-1164. [PMID: 36958015 DOI: 10.1044/2022_ajslp-22-00113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE This study sought to investigate whether a significant difference exists in attendance, cancellations, and no-shows between in-person therapy and telepractice. The authors hypothesized that telepractice no-show and cancellation rates would be less than in-person no-show and cancellation rates. METHOD This retrospective study manually reviewed and analyzed attendance, no-show, and cancellation data over a 3-month span of in-person-only visits (September 2019-November 2019) and a 3-month span of telepractice visits (September 2020-November 2020) conducted at the Emory Voice Center, a tertiary care practice in urban Atlanta, Georgia. Additionally, data were collected for each patient's full course of therapy outside of the 3-month windows and analyzed for attendance, no-show, and cancellation patterns. RESULTS Data from 521 patients were available for review from the selected time frame. In 2019 (in-person), 157 patients met inclusion criteria, and in 2020 (telepractice), 176 patients were included. Therapy initiation, therapy attendance, and no-show rates had significant increases in the telepractice year, and cancellations made greater than 24 hr before the appointments had a significant decrease in the telepractice year. Furthermore, the overall course of therapy showed significantly fewer missed appointments and more attended appointments in the telepractice year. CONCLUSIONS Patients participating in voice therapy via telepractice are more likely to initiate treatment and attend treatment and less likely to cancel sessions compared with patients receiving treatment in person. These data combined with extant data on telepractice treatment efficacy indicate that telepractice should be considered standard of care and offered to all patients seeking treatment, as it removes many reported barriers to treatment.
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Affiliation(s)
- Grace M Cutchin
- Department of Otolaryngology, Washington University in St. Louis
| | - Sandeep Shelly
- Department of Otolaryngology, Emory University, Atlanta, GA
| | - Brian Petty
- Department of Otolaryngology, Emory University, Atlanta, GA
| | - Eva van Leer
- Department of Communication Sciences and Disorders, Georgia State University, Atlanta
| | - Raquel M Tripp
- Department of Otolaryngology, Emory University, Atlanta, GA
| | - Adam M Klein
- Department of Otolaryngology, Emory University, Atlanta, GA
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14
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Ishikawa K, Pietrowicz M, Charney S, Orbelo D. Landmark-based analysis of speech differentiates conversational from clear speech in speakers with muscle tension dysphonia. JASA EXPRESS LETTERS 2023; 3:2888596. [PMID: 37140265 DOI: 10.1121/10.0019354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/18/2023] [Indexed: 05/05/2023]
Abstract
This study evaluated the feasibility of differentiating conversational and clear speech produced by individuals with muscle tension dysphonia (MTD) using landmark-based analysis of speech (LMBAS). Thirty-four adult speakers with MTD recorded conversational and clear speech, with 27 of them able to produce clear speech. The recordings of these individuals were analyzed with the open-source LMBAS program, SpeechMark®, matlab Toolbox version 1.1.2. The results indicated that glottal landmarks, burst onset landmarks, and the duration between glottal landmarks differentiated conversational speech from clear speech. LMBAS shows potential as an approach for detecting the difference between conversational and clear speech in dysphonic individuals.
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Affiliation(s)
- Keiko Ishikawa
- Department of Communication Sciences and Disorders, University of Kentucky, 900 South Limestone, Lexington, Kentucky 40536-0200, USA
| | - Mary Pietrowicz
- Applied Research Institute, University of Illinois at Urbana-Champaign 2100 South Oak Street, Suite 206, Champaign, Illinois 61820, USA
| | - Sara Charney
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, Arizona 85054, USA
| | - Diana Orbelo
- Department of Otolaryngology-Head and Neck Surgery, Mayo Medical School, 200 1st Street Southwest, Rochester, Minnesota 55905, , , ,
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15
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Shelly S, Rothenberger SD, Gartner-Schmidt J, Gillespie AI. Assessing Candidacy for Conversation Training Therapy: The Role of Patient Perception. J Voice 2023:S0892-1997(23)00044-9. [PMID: 36907679 PMCID: PMC10492888 DOI: 10.1016/j.jvoice.2023.02.008] [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: 09/29/2022] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Voice therapy is the primary treatment modality for voice rehabilitation. Specific patient-ability factors beyond patient-characteristic factors (eg, disorder diagnosis, age, etc.), that influence individual patient responses to voice treatment remain largely unknown. The goal of the current study was to determine the relationship between patient-perceived improvements in both the sound and feel of voice during stimulability assessment and voice therapy outcomes. STUDY DESIGN Prospective Cohort study. METHODS This study was a single-arm, single-center, prospective study. Fifty patients with primary muscle tension dysphonia and benign vocal fold lesions were enrolled. Patients read the first four sentences of the Rainbow Passage and were asked if they experienced a change in the feel or sound of their voice following the stimulability prompt. Patients then completed four sessions of conversation training therapy (CTT) voice therapy and followed up one-week and three-months after their last therapy session, for a total of six time-points. Demographic data were collected at baseline, and voice handicap index 10 (VHI-10) scores were collected at each follow-up time-point. The primary exposure variables were CTT intervention and patient perception of voice change to stimulability probes. The primary outcome was change in VHI-10 score. RESULTS On average, VHI-10 scores improved for all participants following CTT treatment. All participants heard a change in the sound of voice with stimulability prompts. Descriptively, patients who reported a positive change in the feel of their voice after stimulability testing recovered faster (ie, experienced a sharper decline in VHI-10) compared to those who did not note a change in feel of voice during stimulability testing. However, the rate of change over time was not significantly different between groups. CONCLUSION Patient self-perception of a change in the sound and feel of voice in response to stimulability probes during initial evaluation is an important factor in treatment outcomes. Patients who perceive an improved feel of their voice production after stimulability probes may respond to voice therapy more quickly.
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Affiliation(s)
- Sandeep Shelly
- Department of Otolaryngology-Head and Neck Surgery, Emory Voice Center, Emory University, Atlanta, Georgia
| | - Scott D Rothenberger
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Amanda I Gillespie
- Department of Otolaryngology-Head and Neck Surgery, Emory Voice Center, Emory University, Atlanta, Georgia.
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16
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Vinney LA, Tripp R, Shelly S, Gillespie A. Indexing Cognitive Resource Usage for Acquisition of Initial Voice Therapy Targets. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:717-732. [PMID: 36701805 DOI: 10.1044/2022_ajslp-22-00197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE The purpose of this study was to index cognitive resource usage for acquisition of initial targets of two common voice therapy techniques (resonant voice therapy [RVT] and conversation training therapy [CTT]) based on the theorized depletion effect (i.e., when an initial task requiring high cognitive load leads to poorer performance on a subsequent task). METHOD Eleven vocally healthy participants, ages 23-41 years, read aloud the Rainbow Passage and produced consonant-vowel resonant targets (/mi, ma, mu/) followed by a baseline computerized Stroop task and a 15-min washout. Following this baseline period, participants watched and interacted with two videos instructing them in RVT or CTT initial targets. After viewing each video and practicing the associated vocal skills, participants rated the degree of mental effort required to engage in the target vocal technique on a modified Borg scale. Participants recorded their attempts at RVT on /mi, ma, mu/ and CTT on the Rainbow Passage, which were later rated by three voice-specialized speech-language pathologists as to how representative they were of each respective target technique. Changes in fundamental frequency and average auditory-perceptual ratings from baseline were examined to determine if participants adjusted their technique from RVT and CTT baseline to acquisition. RESULTS Performance on the Stroop task was, on average, worse post CTT than post RVT, but both post-CTT and post-RVT Stroop scores were poorer than baseline. These results suggest that both treatment techniques taxed cognitive resources but that CTT was more cognitively taxing than RVT. However, despite differences in raw averages, no statistically significant differences were found between the baseline, post-CTT, and post-RVT Stroop scores, likely due to the small sample size. Participant ratings of mental effort for CTT and RVT were statistically similar. Likewise, poorer post-RVT Stroop scores were associated with participants' greater perceived mental effort with RVT acquisition, but there was no significant association between mental effort ratings for CTT acquisition and post-CTT Stroop scores. Significantly higher fundamental frequency and perceived ratings of the accuracy of technique from baseline to acquisition for both CTT and RVT were found, providing evidence of vocal behavior changes as a result of each technique. CONCLUSIONS Brief exposure to initial treatment tasks in CTT is more cognitively depleting than initial RVT tasks. Results also indicate that vocally healthy participants are able to make a voice change in response to a brief therapy prompt. Finally, participant-rated measures of mental effort and secondary measures of cognitive depletion do not always correlate.
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Affiliation(s)
| | - Raquel Tripp
- Department of Communicative Sciences and Disorders, New York University, NY
| | - Sandeep Shelly
- Emory Voice Center, Department of Otolarynngology-Head and Neck Surgery, Emory University, Atlanta, GA
| | - Amanda Gillespie
- Emory Voice Center, Department of Otolarynngology-Head and Neck Surgery, Emory University, Atlanta, GA
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17
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Gartner-Schmidt JL. The New Normal - Virtual and Hybrid Presentations: Developing Content, Designing Slides, and Delivery Guidelines. EAR, NOSE & THROAT JOURNAL 2023; 101:20S-28S. [PMID: 36860095 DOI: 10.1177/01455613231158799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE To outline best practices for virtual and hybrid presentation effectiveness. METHODS Retrospective review of recommendations from world experts in how to develop a solid story, design slides that visually communicate, and improve delivery skills that connect with the audience. Virtual and hybrid presenting is not as strongly dependent on all the new technical and software means as supposed. Presentation basics remain critical. RESULT Best practice in presentation effectiveness will statistically decrease the incidence of and risk factors for Nodding-off Episodes per Lecture (NOELs). CONCLUSION The future of presenting is here, and it is mostly online. Mastering the presentation basics and understanding the limitations and opportunities for this new virtual/hybrid presentation space will allow presenters the reach and influence their message deserves.
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18
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Schenck A, Hilger AI, Levant S, Kim JH, Lester-Smith RA, Larson C. The Effect of Pitch and Loudness Auditory Feedback Perturbations on Vocal Quality During Sustained Phonation. J Voice 2023; 37:37-47. [PMID: 33191054 DOI: 10.1016/j.jvoice.2020.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Dysphonia is a reduction in vocal quality that impacts communication and is often an early sign of a voice disorder. There is little information regarding the effects of auditory feedback control of loudness and pitch on voice quality. In this study, we used both loudness-shift and pitch-shift paradigms to study the relationship between auditory feedback control and vocal quality as measured by smoothed cepstral peak prominence (CPPS), which reflects the harmonicity of the voice signal. STUDY DESIGN Experimental, mixed design. METHODS We applied 200 ms loudness-shifts (± 0, 3, or 6 dB) and pitch-shifts (± 0, 50, and 100 cents) to auditory feedback during sustained vowel production in 25 healthy adults. We then measured CPPS before and after the loudness-shift or pitch-shift to investigate the effect of changes in auditory feedback on vocal harmonicity. RESULTS & CONCLUSIONS Results showed that, on average, CPPS significantly decreased between the first half of the measured segment and the last half of the segment in the absence of auditory feedback shifts, suggesting that voice quality may be reduced across longer vowels over time. Upward and downward shifts in loudness auditory feedback caused a relative increase in CPPS, indicating an improvement in vocal harmonicity, even in cases when vocal intensity was reduced. Pitch alterations had inconsistent and minimal effects. We propose that there may be a control mechanism for voice quality that increases harmonicity of the voice signal to improve voice audibility (ie, ability to be heard) in the presence of unpredictable variability in voice intensity.
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Affiliation(s)
- Alexandra Schenck
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
| | - Allison I Hilger
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
| | - Samuel Levant
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
| | - Jason H Kim
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
| | - Rosemary A Lester-Smith
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles Larson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois.
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19
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Siqueira LTD, Vitor JDS, Brasolotto AG, de Andrade EC, Silverio KCA. Can Vocal Therapy With Transcutaneous Electrical Nerve Stimulation (TENS) Followed by Vocal Exercises Reduce Benign Laryngeal Lesions in Dysphonic Women?: Randomized, Blind Clinical Trial. J Voice 2022:S0892-1997(22)00238-7. [PMID: 36068131 DOI: 10.1016/j.jvoice.2022.08.006] [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: 05/24/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the effectiveness of vocal therapy with the use of low-frequency transcutaneous electrical nerve stimulation (TENS) followed by voice exercises on vocal fold lesion size, vocal quality and quality of life in dysphonic women. METHODS 27 women with vocal nodules participated, randomized into to: experimental group (EG)-13 women who received vocal therapy with 12 sessions of 20 min of TENS application (pulse:200μs, frequency:10Hz, motor threshold intensity, electrodes positioned in the trapezius muscle [descending fibers and submandibular region, bilaterally]). Each TENS session was followed by 30 min of vocal exercises; and the Control Group (CG)- 14 women who received 12 sessions with 20 min of application of placebo TENS (same conditions EG, but without receiving the stimulus electric), followed by 30 min of vocal exercise. Before, immediately after and one month after vocal therapy, participants underwent vocal recording for acoustic analysis, vocal self-assessment, laryngological examination and answered voice-related quality of life (V-RQOL) protocol. RESULTS There was reduction in the size of vocal fold lesions only in the EG, immediately after treatment and one month after treatment. Acoustic analysis showed decreases in SPI values immediately after and one month after treatment in both groups. There was improvement in voice self-perception in both groups after treatment and one month after, but no significant difference in V-RQOL values. CONCLUSION TENS followed by vocal exercises produced results similar to vocal therapy without TENS regarding voice quality, self-perception and quality of life in voice. However, vocal therapy with low-frequency TENS followed by vocal exercise was effective in reducing vocal fold lesion size in dysphonic women.
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Affiliation(s)
- Larissa Thaís Donalonso Siqueira
- Speech-Language Pathology and Audiology Department, Universidade Federal do Rio Grande do Norte, Rua General Cordeiro de Faria, s/n - Petrópolis, Natal, Rio Grande do Norte 59012-570, Brazil.
| | - Jhonatan da Silva Vitor
- Speech Language-Pathologist, Bauru School of Dentistry, São Paulo College, São Paulo, Brazil
| | - Alcione Ghedini Brasolotto
- Speech-Language Pathology and Audiology Department, Bauru School of Dentistry, São Paulo College, Bauru, São Paulo, Brazil
| | | | - Kelly Cristina Alves Silverio
- Speech-Language Pathology and Audiology Department, Bauru School of Dentistry, São Paulo College, Bauru, São Paulo, Brazil
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20
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Gartner-Schmidt JL, Belsky MA, Awan S, Gillespie AI. Clinician and Patient Perception of a Voice Therapy Program Utilizing a Variably Occluded Face Mask: A Pilot Study. Folia Phoniatr Logop 2022; 74:381-391. [PMID: 35203078 DOI: 10.1159/000523686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/11/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The purpose of this investigation was to assess clinician and patient feedback about voice therapy using a variably occluded face mask (VOFM) and to determine if voice therapy augmented via a VOFM would result in favorable changes in patient self-perceived handicap, as well as acoustic and aerodynamic measures. METHODS/DESIGN This pilot study used a prospective, pre-post single group design. Eleven patients with dysphonia due to primary muscle tension dysphonia (8) or benign vocal fold lesions (3) were recruited. Data collected included patient and clinician feedback of voice therapy using a VOFM, voice handicap index (VHI)-10, acoustic and aerodynamic measures. Data were collected before treatment (baseline) and 1-week post-therapy. Wilcoxon signed-rank tests were used to compare data pre- and post-therapy. RESULTS Statistically significant improvement was observed for the VHI-10 with a median delta of -7. Clinician feedback generally reported that patients liked the VOFM, using the VOFM within the first two sessions of therapy, and within less than 10 min of use. All clinicians ranked the conversation level of the hierarchy as the most effective level. Three themes emerged from the Therapy Feedback Form: the VOFM was a (1) "Facilitator for Sensation," (2) a "Physical Tool," and that there was (3) "No Program Needed" to use the VOFM in voice therapy. There was a statistically significant improvement in cepstral peak prominence (p = 0.0329) and cepstral spectral index of dysphonia (p = 0.0164) in sustained vowels. DISCUSSION This pilot study represents the first investigation into clinician and patient perceptions of using a VOFM. Reported measures via patient perception, as well as clinician perceptions, and some acoustic and aerodynamic measures showed that participants got better with VOFM voice therapy. Last, in general, both clinicians and patients liked utilizing a VOFM in voice therapy.
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Affiliation(s)
- Jackie L Gartner-Schmidt
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael A Belsky
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shaheen Awan
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida, USA
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21
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Van Stan JH, Whyte J, Duffy JR, Barkmeier-Kraemer J, Doyle P, Gherson S, Kelchner L, Muise J, Petty B, Roy N, Stemple J, Thibeault S, Tolejano CJ. Voice Therapy According to the Rehabilitation Treatment Specification System: Expert Consensus Ingredients and Targets. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2169-2201. [PMID: 34464550 PMCID: PMC8702840 DOI: 10.1044/2021_ajslp-21-00076] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/27/2021] [Accepted: 05/19/2021] [Indexed: 05/09/2023]
Abstract
Purpose Clinical trials have demonstrated that standardized voice treatment programs are effective for some patients, but identifying the unique individual treatment ingredients specifically responsible for observed improvements remains elusive. To address this problem, the authors used a taxonomy of voice therapy, the Rehabilitation Treatment Specification System (RTSS), and a Delphi process to develop the RTSS-Voice (expert consensus categories of measurable and unique voice treatment ingredients and targets). Method Initial targets and ingredients were derived from a taxonomy of voice therapy. Through six Delphi Rounds, 10 vocal rehabilitation experts rated the measurability and uniqueness of individual treatment targets and ingredients. After each round, revisions (guided by the experts' feedback) were finalized among a primary reader (a voice therapy expert) and two external readers (rehabilitation experts outside the field of voice). Consensus was established when the label and definition of an ingredient or target reached a supramajority threshold (≥ 8 of 10 expert agreement). Results Thirty-five target and 19 ingredient categories were agreed to be measurable, unique, and accurate reflections of the rules and terminology of the RTSS. Operational definitions for each category included differences in the way ingredients are delivered and the way individual targets are modified by those ingredients. Conclusions The consensus labels and operationalized ingredients and targets making up the RTSS-Voice have potential to improve voice therapy research, practice, and education/training. The methods used to develop these lists may be useful for other speech, language, and hearing treatment specifications. Supplemental Material https://doi.org/10.23641/asha.15243357.
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Affiliation(s)
- Jarrad H. Van Stan
- Harvard Medical School, Boston, MA
- 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
| | | | | | | | | | | | - Jason Muise
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
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22
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Bick E, Dumberger LD, Farquhar DR, Davis H, Ramsey E, Buckmire RA, Shah RN. Does Voice Therapy Improve Vocal Outcomes in Vocal Fold Atrophy? Ann Otol Rhinol Laryngol 2021; 130:602-608. [PMID: 32862670 PMCID: PMC9969873 DOI: 10.1177/0003489420952464] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Vocal fold atrophy is increasingly identified in the geriatric population. Current literature shows varying outcomes with voice therapy. Our goal was to analyze multidimensional vocal outcomes of these patients who underwent voice therapy. Secondary aims included determining compliance and analyzing differences in patients who undergo surgery. METHODS 197 patients with vocal fold atrophy were included and reviewed. Patients were categorized by treatment received. Patient-reported, perceptual, aerodynamic, and acoustic voice outcomes were analyzed before and after therapeutic intervention. Changes were calculated and significance determined using Wilcoxon signed-rank and rank-sum tests. RESULTS 89(45%) received no therapy, 43(22%) incomplete therapy, 51(26%) complete therapy, 8(4%) surgery only, and 6(3%) therapy followed by surgery. Those who completed voice therapy showed significant improvement in voice related quality of life (VRQOL) (P = .0225), glottal function index (GFI) (P < .001), grade, roughness, breathiness, asthenia, strain (GRBAS) (P < .001), maximum phonation time (MPT) (P = .0081), and fundamental frequency in women (P = .0024). No significant changes were found in mean airflow. When comparing patients who underwent surgery versus voice therapy, statistically significant differences were present between pre-treatment VRQOL (P = .0269) and GFI (P = .0166). CONCLUSIONS Only 29% of patients with vocal atrophy completed voice therapy when recommended. Within this patient cohort, voice therapy results in significant improvement in multidimensional voice outcomes. Patients with vocal atrophy that undergo surgical treatment differ from those treated with voice therapy alone in their pre-treatment patient-reported measures.
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Affiliation(s)
- Emma Bick
- University of North Carolina School of Medicine
| | | | - Douglas R. Farquhar
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine
| | | | | | - Robert A. Buckmire
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine
| | - Rupali N. Shah
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine
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23
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Grillo EU. Functional Voice Assessment and Therapy Methods Supported by Telepractice, VoiceEvalU8, and Estill Voice Training. Semin Speech Lang 2021; 42:41-53. [PMID: 33596603 DOI: 10.1055/s-0040-1722753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Elizabeth U Grillo
- Department of Communication Sciences and Disorders, West Chester University, West Chester, Pennsylvania
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24
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Gartner-Schmidt J, Gillespie AI. Conversation Training Therapy: Let's Talk It Through. Semin Speech Lang 2021; 42:32-40. [PMID: 33596602 DOI: 10.1055/s-0040-1722751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This article introduces a novel approach to voice therapy called conversation training therapy (CTT). CTT is the first voice therapy approach to remove the therapeutic hierarchy common in most treatment programs. Rather, CTT uses patient-driven conversation as the sole stimuli in therapy to increase perceptual awareness of voice production in conversational speech. The genesis as to why CTT was developed, as well as the conceptual, theoretical, and component parts of CTT, will be explained. In addition, this article will offer examples of the language of therapy, as it applies to CTT and how to trouble-shoot if problems arise. Medical documentation relevant to CTT will also be outlined. Last, results from a recent efficacy study on CTT will be reported.
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Affiliation(s)
- Jackie Gartner-Schmidt
- Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amanda I Gillespie
- Emory Voice Center, Department of Otolaryngology, Emory University School of Medicine, Emory University Hospital Midtown, Atlanta, Georgia
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van Leer E, Lewis B, Porcaro N. Effect of an iOS App on Voice Therapy Adherence and Motivation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:210-227. [PMID: 33476177 PMCID: PMC8740599 DOI: 10.1044/2020_ajslp-19-00213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 12/17/2019] [Accepted: 09/28/2020] [Indexed: 05/22/2023]
Abstract
Purpose Patients commonly report difficulties adhering to voice therapy. An iOS app was developed in our lab that assists practice via reminder notifications, instructional recordings, and cepstral peak prominence analysis results. The purpose of this study was to assess the effect of such homework support modality on adherence behavior and associated motivation in a comparison of app support and written homework instructions and to assess the usability and utility of the app. Method Thirty-four individuals exhibiting adducted hyperfunction were randomized to receive either written homework instructions or the app when practicing resonant voice exercises for 3 weeks. All patients digitally audio-recorded all home practice, provided self-reported estimates of generalization, and completed weekly motivation scales. Results App support significantly increased practice frequency but did not affect self-reported generalization or motivation. Practice was significantly predicted by System Usability Scale scores. Utility of reminders and instructions were good, but cepstral peak prominence feedback was considered useful to only a subset of participants. Conclusion Interactive mobile therapy support can significantly increase practice of resonant voice homework without influencing motivation.
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Affiliation(s)
- Eva van Leer
- Department of Communication Sciences and Disorders, Georgia State University, Atlanta
| | - Brittney Lewis
- Autonomous Reanimation and Evacuation Program, The Geneva Foundation, San Antonio, TX
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Timmons Sund L, Bhatt NK, Ference EH, Kim W, Johns MM. Respiratory Particle Emission During Voice Assessment and Therapy Tasks in a Single Subject. J Voice 2020; 36:784-792. [PMID: 33268220 PMCID: PMC7582043 DOI: 10.1016/j.jvoice.2020.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 01/20/2023]
Abstract
Introduction SARS-CoV-2 is transmitted via respiratory particles. Respiratory particle emission is impacted by manner of breathing and voicing, as well as intersubject variability. Assessment and treatment of voice disorders may include tasks that increase respiratory particle emission beyond typical breathing and speaking. This could increase the risk of disease transmission via respiratory particles. Methods Respiratory particle emission was measured during a single-subject, repeated measures clinical simulation of acoustic and aerodynamic assessment and voice therapy tasks. An optical particle sizer was used to measure particle count (1–10 μm in diameter). Assessment and therapy tasks were completed in three conditions: (1) 15 cm from the device, (2) 1 m from the device, and (3) 1 m from the device with the subject wearing a surgical mask. Results Condition 1 generated the highest particle count, with a median of 5.1 (13) additional particles above baseline, which was statistically significant (U = 381.5, P= 0.002). In condition 1, therapy and acoustic tasks combined produced more particles compared to the baseline and speech tasks, with a median difference of 6.5 additional particles per time point (U = 309.0, P= 0.002). This difference was not significant for conditions 2 and 3. Peak particle generation occurred in specific phonatory tasks, which was most pronounced in condition 1. Voice therapy tasks during condition 1 generated the highest peaks of normalized total particles with classical singing and expiratory muscle strength training. There was a significant difference in the amount of particle generation between condition 1 and 2, with a median difference of 5.2 particles (U = 461.0, P= 0.002). The particle count difference between conditions 2 and 3 was 2.1 (U = 282.0, P= 0.292), and this difference was not significant. The normalized total particles were assessed over time for each condition. For all conditions, there was no significant accumulation of particles. Conclusions For a single subject, production of voice assessment and therapy tasks combined resulted in an increased number of respiratory particles compared to speech and baseline (1–10 μm). EMST and classical singing generated the greatest concentration of particles. Respiratory particle counts were higher at 15 cm from the particle sizer compared to 1 m from the particle sizer, suggesting that physical distancing may reduce immediate clinician exposure to respiratory particles. Particle concentration did not accumulate over time.
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Affiliation(s)
- Lauren Timmons Sund
- USC Voice Center, USC Caruso Department of Otolaryngology - Head and Neck Surgery at Keck Medicine of USC, University of Southern California, Los Angeles, California
| | - Neel K Bhatt
- USC Voice Center, USC Caruso Department of Otolaryngology - Head and Neck Surgery at Keck Medicine of USC, University of Southern California, Los Angeles, California
| | - Elisabeth H Ference
- USC Caruso Department of Otolaryngology - Head and Neck Surgery at Keck Medicine of USC, University of Southern California, Los Angeles, California
| | - Wihan Kim
- USC Caruso Department of Otolaryngology - Head and Neck Surgery at Keck Medicine of USC, University of Southern California, Los Angeles, California
| | - Michael M Johns
- USC Voice Center, USC Caruso Department of Otolaryngology - Head and Neck Surgery at Keck Medicine of USC, University of Southern California, Los Angeles, California.
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Meerschman I, Van Lierde K, Redman YG, Becker L, Benoy A, Kissel I, Leyns C, Daelman J, D'haeseleer E. Immediate Effects of a Semi-Occluded Water Resistance Ventilation Mask on Objective and Subjective Vocal Outcomes in Musical Theater Students. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:661-673. [PMID: 32196393 DOI: 10.1044/2019_jslhr-19-00042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Traditional semi-occluded vocal tract exercises (SOVTEs) are restricted to single-phoneme tasks due to the semi-occlusion at the mouth, which hinders full articulation, continuous speech, and singing. Innovative SOVTEs should overcome this limitation by creating the semi-occlusion outside the oral cavity. Purpose The purpose of this study was to investigate the immediate effects of a semi-occluded water resistance ventilation mask, which allows for continuous speech and singing, on objective (voice range, multiparametric voice quality indices) and subjective (auditory-perceptual, self-report) vocal outcomes in musical theater students. Method A pre-/posttest randomized controlled trial was used. Twenty-four musical theater students (16 women and eight men, with a mean age of 21 years) were randomly assigned into a study group and a control group. The study group received a vocal warm-up session with the innovative water resistance ventilation mask (tube attached to the mask "outside" the mouth), whereas the control group received the traditional water resistance approach (tube "inside" the mouth). Both sessions lasted 30 min and were similar with respect to vocal demand tasks. A multidimensional voice assessment including objective and subjective outcomes was performed pre- and posttraining by an assessor blinded to group allocation. Results The Dysphonia Severity Index significantly and similarly increased (improved) in both the study and control groups, whereas the Acoustic Voice Quality Index solely decreased (improved) in the control group. The intensity range significantly decreased (worsened) and the semitone range significantly increased (improved) in the study group, whereas no differences in voice range profile were found in the control group. Auditory-perceptually, a more strenuous speaking voice was noticed after the use of the traditional water resistance approach. The subjects perceived both SOVTEs as comfortable vocal warm-up exercises that decrease the amount of effort during speaking and singing, with a slight preference for the water resistance ventilation mask. Conclusions Both the innovative water resistance ventilation mask and the traditional water resistance exercise seem effective vocal warm-up exercises for musical theater students. The additional articulatory freedom of the mask might increase the phonatory comfort and the practical implementation of SOVTEs in the daily vocal warm-up of (future) elite vocal performers. The hypothesis of a higher transfer to continuous speech or singing in the mask condition has not been supported by the current study. Larger scale investigation and longer term follow-up studies are needed to confirm these preliminary results. Supplemental Material https://doi.org/10.23641/asha.11991549.
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Affiliation(s)
- Iris Meerschman
- Speech-Language Pathology Research Group, Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Kristiane Van Lierde
- Speech-Language Pathology Research Group, Department of Rehabilitation Sciences, Ghent University, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | | | - Lidia Becker
- Speech and Language and Audiology Department, Medicine School, Federal University of Rio de Janeiro, Brazil
| | - Ayla Benoy
- Berlaar, Antwerp, Belgium
- Duffel, Antwerp, Belgium
| | - Imke Kissel
- Speech-Language Pathology Research Group, Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Clara Leyns
- Speech-Language Pathology Research Group, Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Julie Daelman
- Speech-Language Pathology Research Group, Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Evelien D'haeseleer
- Speech-Language Pathology Research Group, Department of Rehabilitation Sciences, Ghent University, Belgium
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Gillespie AI, Yabes J, Rosen CA, Gartner-Schmidt JL. Efficacy of Conversation Training Therapy for Patients With Benign Vocal Fold Lesions and Muscle Tension Dysphonia Compared to Historical Matched Control Patients. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:4062-4079. [PMID: 31619107 PMCID: PMC7203518 DOI: 10.1044/2019_jslhr-s-19-0136] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/08/2019] [Accepted: 08/08/2019] [Indexed: 05/22/2023]
Abstract
Purpose Conversation training therapy (CTT) is the 1st voice therapy approach to eliminate the traditional therapeutic hierarchy and use patient-driven conversation as the sole therapeutic stimulus. The purpose of this investigation was to determine the efficacy of CTT compared to standard-of-care voice therapy approaches for the treatment of patients with voice disorders. Method A prospective study of CTT treatment outcomes in adults with dysphonia due to primary muscle tension dysphonia or benign vocal fold lesions compared to age, gender, and diagnosis historical matched control (HMC) patients was used. The primary outcome was change in Voice Handicap Index-10 (VHI-10); secondary outcomes included acoustic, aerodynamic, and auditory-perceptual outcomes. Data were collected before treatment (baseline), at the start of each therapy session, 1 week after the final therapy session (short-term follow-up), and 3 months after the final therapy session (long-term follow-up). Results For the CTT group, statistically significant improvements were observed for VHI-10. Though statistically significant improvements were observed for the VHI-10 for the HMC group, the CTT group saw significantly greater improvement in VHI-10. Furthermore, equivalent gains were observed following only 2 sessions of CTT compared to 4-8 sessions of traditional therapy. Significant improvements in the CTT group were observed for cepstral peak prominence in a vowel, fundamental frequency, Cepstral Spectral Index of Dysphonia in a vowel and connected speech, vocal intensity, average airflow in speech in a reading passage, number of breaths and duration of reading passage, and auditory-perceptual measurement of overall voice severity. Conclusions Results support the hypothesis that training voice techniques in the context of spontaneous conversational speech improves patient perception of voice handicap and acoustic, aerodynamic, and auditory-perceptual voice outcomes both immediately following treatment and at long-term follow-up. CTT participants also demonstrated significantly larger decreases in VHI-10 compared to HMC participants who received standard-of-care, nonconversational, hierarchical-based voice therapy.
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Affiliation(s)
| | - Jonathan Yabes
- Department of Biostatistics, University of Pittsburgh, PA
| | - Clark A. Rosen
- Department of Otolaryngology, University of California, San Francisco
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Awan SN, Gartner-Schmidt JL, Timmons LK, Gillespie AI. Effects of a Variably Occluded Face Mask on the Aerodynamic and Acoustic Characteristics of Connected Speech in Patients With and Without Voice Disorders. J Voice 2019; 33:809.e1-809.e10. [DOI: 10.1016/j.jvoice.2018.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/05/2018] [Indexed: 11/16/2022]
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Transmasculine Voice Modification: A Case Study. J Voice 2019; 34:903-910. [PMID: 31153772 DOI: 10.1016/j.jvoice.2019.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 11/22/2022]
Abstract
This case study measured the effects of manual laryngeal therapy on the fundamental frequency (fo), formant frequencies, estimated vocal tract length, and listener perception of masculinity of a 32-year-old transmasculine individual. The participant began testosterone therapy 1.5 years prior to the study. Two therapy approaches were administered sequentially in a single session: (1) passive circumlaryngeal massage and manual laryngeal reposturing, and (2) active laryngeal reposturing with voicing. Acoustic recordings were collected before and after each treatment and 3 days after the session. Speaking fo decreased from 124 Hz to 120 Hz after passive training, and to 108 Hz after active training. Estimated vocal tract length increased from 17.0 cm to 17.3 cm after passive training, and to 19.4 cm after active training. Eight listeners evaluated the masculinity of the participant's speech; his voice was rated as most masculine at the end of the training session. All measures returned to baseline at follow-up. Overall, both acoustic and perceptual changes were observed in one transmasculine individual who participated in manual laryngeal therapy, even after significant testosterone-induced voice changes had already occurred; however, changes were not maintained in the follow-up. This study adds to scant literature on effective approaches to and proposed outcome measures for voice masculinization in transmasculine individuals.
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Voice-Specialized Speech-Language Pathologist's Criteria for Discharge from Voice Therapy. J Voice 2018; 32:332-339. [DOI: 10.1016/j.jvoice.2017.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 11/17/2022]
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Emerging techniques in assessment and treatment of muscle tension dysphonia. Curr Opin Otolaryngol Head Neck Surg 2017; 25:447-452. [DOI: 10.1097/moo.0000000000000405] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grillo EU. An Online Telepractice Model for the Prevention of Voice Disorders in Vocally Healthy Student Teachers Evaluated by a Smartphone Application. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2017; 2:63-78. [PMID: 28890933 PMCID: PMC5590670 DOI: 10.1044/persp2.sig3.63] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article describes the Global Voice Prevention Model (GVPM) facilitated with student teachers at West Chester University and the VoiceEvalU8 smartphone application (app) used to assess the effectiveness of the GVPM. Twenty-one participants completed 1 of 3 conditions (i.e., in-person GVPM, telepractice GVPM, and control). The in-person and telepractice conditions ran for 4 weeks during fall 2016, with 1 week dedicated to vocal education and vocal hygiene and 3 weeks spent in vocal training. The control condition ran for 1 week and included only vocal education and vocal hygiene. The VoiceEvalU8 app was used at pre- and post-condition twice a day for 5 days to record acoustic, perceptual, and aerodynamic voice measures. The study is ongoing; therefore, preliminary acoustic results for fundamental frequency (F0) and jitter% are presented from pre- to post-condition. During spring 2017, the participants were student teaching and using the VoiceEvalU8 app to record the voice measures before and after teaching all day. A new group of participants will be enrolled fall 2017 for selection into 1 of the 3 conditions and then continue on to student teaching spring 2018.
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Affiliation(s)
- Elizabeth U Grillo
- Department of Communication Sciences and Disorders, West Chester University, West Chester, PA
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Murray ESH, Girouard KL, Cler MJ, Stepp CE. Development of an Electronic Documentation System for Voice Therapy: A New Teaching and Clinical Research Tool. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2016; 1:63-73. [PMID: 30101197 PMCID: PMC6086365 DOI: 10.1044/persp1.sig3.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although research on the outcomes of the treatment of voice disorders is widely discussed, there is a lack of information regarding the specifics of the methods and tasks undertaken during the therapy sessions. One reason may be a lack of a clear, standardized method of documentation for the voice therapy. Therefore this article discusses the development of a new electronic documentation system for voice therapy. The goals of this documentation system are to create a user-friendly, flexible system, which implements the standard terminology and structure proposed in the recent voice therapy taxonomy (Van Stan, Roy, Awan, Stemple, & Hillman, 2015). This documentation system stores all the information from the therapy session in a local database, which is accessible for analysis within or between patients. This allows large-scale datasets to be compiled for future clinical research. This documentation system includes definitions for all terminology, and includes hierarchies, which are not required, but can be followed for additional structure. This documentation system can be used as a teaching tool, with the ability to accommodate the needs of both the novice and expert clinician.
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Affiliation(s)
| | | | - Meredith J Cler
- Graduate Program for Neuroscience, Boston University, Boston, MA
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA
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