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Gong X, Han Y, Wang Y, Huang Z. The Effects of Telerehabilitation in Patients with Voice Disorders: A Systematic Review and Meta-Analysis. J Voice 2024:S0892-1997(24)00180-2. [PMID: 38969543 DOI: 10.1016/j.jvoice.2024.06.008] [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: 03/14/2024] [Revised: 06/08/2024] [Accepted: 06/10/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVES To compare the effects of telerehabilitation (TR) and face-to-face rehabilitation (FTF) methods on the outcomes of adults with voice disorders and to analyze the effectiveness of TR. METHODS Following Boolean Logic, a search strategy was devised, combining subject terms and keywords based on the interventions and populations outlined in the inclusion criteria. We searched PubMed, Cochrane Library, Embase, Web of Science, Scopus, CNKI, Wanfang, CQVIP databases, and manually screened academic conference papers, journal articles, and gray literature to identify eligible randomized controlled trials (RCTs) on remote voice therapy. Two researchers assessed the risk of bias in the included studies using the risk of bias assessment tool for RCTs outlined in the Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0. RESULTS Five trials with a total of 233 patients with voice disorders were included in the study after screening. The results revealed a significant difference in Jitter change values (mean difference [MD]=-0.12, 95%CI [-0.23,-0.01], P = 0.04) between TR and FTF, maximum phonation time (MD=0.76, 95%CI [-0.60,2.13], P = 0.27), Shimmer (MD=-0.04, 95%CI [-0.11,0.03], P = 0.27), voice handicap index (MD=0.87, 95%CI [-1.77,3.50], P = 0.52), and GRBAS(G) (MD=-0.00, 95%CI [-0.01,0.01], P = 0.99) had no significant difference. CONCLUSION TR demonstrates comparable efficacy to FTF in voice treatment and is associated with higher levels of patient satisfaction, making it a viable and effective therapeutic modality. However, given the limited sample size analyzed in this study, further validation of this conclusion necessitates additional RCTs with larger sample sizes. Furthermore, researchers should remain cognizant of the constraints associated with TR and consistently refine treatment protocols to enhance the efficacy of voice therapy.
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Affiliation(s)
- Xinyi Gong
- Department of Rehabilitation of Sciences, Faculty of Education, East China Normal University, Shanghai, China
| | - Yaoxin Han
- Department of Rehabilitation of Sciences, Faculty of Education, East China Normal University, Shanghai, China
| | - Yongli Wang
- Department of Rehabilitation of Sciences, Faculty of Education, East China Normal University, Shanghai, China.
| | - Zhaoming Huang
- Department of Rehabilitation of Sciences, Faculty of Education, East China Normal University, Shanghai, China
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Grillo EU, Corej B, Wolfberg J. Normative Values of Client-Reported Outcome Measures and Self-Ratings of Six Voice Parameters via the VoiceEvalU8 App. J Voice 2024; 38:964.e17-964.e27. [PMID: 34895987 PMCID: PMC9177899 DOI: 10.1016/j.jvoice.2021.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Ecological momentary assessments (EMA) and interventions (EMI) have the potential to assess and offer interventions repeatedly within the client's daily life through mobile app technology. Considering the development of the EMA VoiceEvalU8, the current work provided normative data by comparing traditional (i.e., paper and pencil) and electronic (i.e., VoiceEvalU8 app) administration modalities of client-reported outcome measures and client self-ratings of six voice parameters twice a day in their functional environment. METHODS In Experiment 1, 50 vocally healthy cisgender women and men completed the Voice Handicap Index (VHI)-30, VHI-10, and Vocal Fatigue Index (VFI) with paper and pencil and the VoiceEvalU8 app. The order of administration modality and perceptual scales was randomized for each participant. In Experiment 2, 104 vocally healthy cisgender women and men used the VoiceEvalU8 app across five days in the morning before talking all day and in the evening after talking all day to self-rate six voice parameters (i.e., overall quality, roughness, breathiness, strain, pitch, and loudness) on a scale from 0 - 100. Mann Whitney U tests were run for all measures. Means and standard deviations are reported for descriptive analysis and normative values. RESULTS In Experiment 1, results showed no significant differences between paper and pencil and VoiceEValU8 app administration for the VHI-30, VHI-10, and VFI for vocally healthy adults. Normative values in the current study were consistent with previous literature for the VHI-10 and VFI factor 1 and 2, but slightly higher for the VHI-30 and slightly lower for the VFI factor 3. In Experiment 2, results demonstrated significant differences for all six voice parameters between the morning and evening log sessions. Normative values demonstrated higher self-ratings in the morning as compared to the evening. CONCLUSIONS For vocally healthy adults, completing the VHI-30, VHI-10, and VFI via paper and pencil and the VoiceEvalU8 app yielded the same results. Client self-ratings of six voice parameters on a scale from 0 - 100 twice a day demonstrated that vocally healthy adults perceived voice to be worse in the morning before talking all day as compared to the evening after talking all day. The results from the current work are promising for EMA via the VoiceEvalU8 app and support the need for continued investigations with clients with voice differences, problems, and/or disorders.
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Affiliation(s)
- Elizabeth U Grillo
- Department of Communication Sciences and Disorders, West Chester University, West Chester, Pennsylvania, USA.
| | - Brigit Corej
- Department of Communication Sciences and Disorders, West Chester University, West Chester, Pennsylvania, USA
| | - Jeremy Wolfberg
- Massachusetts General Hospital Institute of Health Professions, Speech-Language Pathology Master's Program, Boston, Massachusetts, USA
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Jaroentonyakorn P, Chinchai S, Bunrayong W, Wanicharoen N, Shibamoto I. The Efficacy of Voice Therapy via Hybrid Group Telepractice Program with Asynchronous Components for Primary School Teachers: A Pilot Study. J Voice 2024:S0892-1997(24)00182-6. [PMID: 38944541 DOI: 10.1016/j.jvoice.2024.06.010] [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: 05/16/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 07/01/2024]
Abstract
PURPOSE To determine the efficacy of a hybrid group telepractice program in voice therapy for primary school teachers. METHOD The participants, consisting of 12 teachers with voice disorders (three males and nine females), participated in 11 sessions of the telepractice program, divided into one training session on vocal hygiene, five practice sessions by themselves, and five group practice sessions in 5weeks. Data on the vocal handicap index (VHI) measure was obtained pre- and post-intervention. The voice analysis included fundamental frequency (local), jitter (local), shimmer (local), harmonic-to-noise ratio (local), and maximum phonation time assessed by Praat software. RESULT The VHI assessment revealed a statistically significant difference (P < 0.05) in the emotional domain. There was no statistically significant difference (P > 0.05) in physical, functional, and total scores. Both males and females had no statistically significant difference (P > 0.05) in mean fundamental frequency. However, there was a statistically significant difference (P < 0.05) in jitter (local), shimmer (local), harmonics-to-noise ratio (local), and the maximum phonation time. CONCLUSION The group telepractice program in voice therapy for primary school teachers was effective. It could be utilized for voice therapy to prevent voice disorder problems in teachers.
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Affiliation(s)
- Piyawan Jaroentonyakorn
- Communication Disorders Division, Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai Province, Thailand
| | - Supaporn Chinchai
- Communication Disorders Division, Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai Province, Thailand.
| | - Wannipa Bunrayong
- Communication Disorders Division, Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai Province, Thailand
| | - Natwipa Wanicharoen
- Communication Disorders Division, Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai Province, Thailand
| | - Isamu Shibamoto
- Department of Speech Language and Hearing Sciences, Seirei Christopher University, Shizuoka, Japan
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Farsi S, Brown MC, Alsup N, Pickett H, Petersen H, Davis K, King D, Tulunay-Ugur OE. The Role of Telemedicine in Voice Therapy. EAR, NOSE & THROAT JOURNAL 2024:1455613241258646. [PMID: 38855826 DOI: 10.1177/01455613241258646] [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: 06/11/2024] Open
Abstract
Introduction: During the COVID-19 pandemic, our institution adopted telemedicine for voice therapy (VT) as an alternative to in-person sessions, which has been integrated into our routine practice following the pandemic. This study aims to explore factors influencing completion rates among the 2 methods. Method: A retrospective chart review at a single tertiary care institution between 2019 and 2021 was conducted. Patient zip codes were used to determine Neighborhood Atlas® Area Deprivation Index (ADI) scores and travel distance to our institution. Demographic data, Voice Handicap Index (VHI) scores, and completion status were extracted. Results: Between 2019 and 2021, 521 patients were referred to VT at our institution, with 29% opting for telemedicine VT (TVT) sessions and 71% choosing in-person sessions. Seventy-four percent was female, and average age was 57.1 years (range:10-89 years old). No statistically significant differences were observed between the 2 groups regarding sex, age, employment status, or insurance type. Participants in the TVT group demonstrated notably higher completion rates compared to the in-person group [70.0% vs 31.6% (P < .001)]. The TVT group also comprised of a higher percentage of white patients, reported longer travel distances and times to reach therapy, but had comparable ADI scores to the in-person group. Moreover, there were no significant differences in pretreatment VHI scores between the 2 groups or between those who completed therapy versus those who did not (P = .501). Conclusion: Our findings indicate that patients utilizing the telemedicine platform had significantly higher VT completion rates compared to patients appearing in person. These results highlight the importance of being able to offer telemedicine-based options in the management of voice patients.
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Affiliation(s)
- Soroush Farsi
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences. Little Rock, AR, USA
| | - Mary C Brown
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences. Little Rock, AR, USA
| | - Nickolas Alsup
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences. Little Rock, AR, USA
| | - Hylan Pickett
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences. Little Rock, AR, USA
| | - Hannah Petersen
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences. Little Rock, AR, USA
| | - Kyle Davis
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, MO, USA
| | - Deanne King
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences. Little Rock, AR, USA
| | - Ozlem E Tulunay-Ugur
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences. Little Rock, AR, USA
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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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de Oliveira AG, Fabbron EMG. Play-Based Strategies for Speech Therapy and Vocal Health Face-to-Face and Distance Learning Actions for Children: An Integrative Literature Review. J Voice 2024; 38:538.e1-538.e10. [PMID: 34732288 DOI: 10.1016/j.jvoice.2021.09.016] [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: 06/07/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Diversifying voice therapy strategies is critical to get children and adolescents to adhere to the therapeutic process. PURPOSE To investigate the face-to-face and distance playful strategies have been used for vocal health education and voice therapy in children and adolescents. METHODS An integrative literature review was carried out based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). A search for full texts was conducted on the Virtual Health Library, Scientific Electronic Library Online (SCIELO) and PuBMed databases using the following descriptors, and their corresponding Medical Subject Headings (MeSH): voice (voz); voice quality (qualidade da voz); dysphonia (disfonia); voice disorders (distúrbios da fala); voice training (treinamento da voz); telemedicine (telemedicina); therapeutics (terapêutica); health promotion (promoção da saúde); group practice (prática de grupo); recreation therapy (terapia recreacional); child (criança); preschool (pré-escolar) and adolescent (adolescente). RESULTS After full reading of the studies, 15 articles were included and categorized into the following topics: face-to-face and distance playful strategies for voice therapy in children; playful strategies with gamification for education and for voice therapy in children; and vocal health educational actions in children. CONCLUSION The study found a higher number of studies that carried out educational actions and playful strategies, while fewer studies were related to the production of materials, gamification and online services for voice therapy in children. Given the proven benefits of this strategy for children, further studies focusing on the development and application of playful strategies, such as the use of gamification, should be conducted in order to stimulate the skills and adherence of this population to therapy.
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Affiliation(s)
- Amanda Gabriela de Oliveira
- Speech Therapist, Specialist in Voice by the Federal Council of Speech Therapy (CFFa), Master of Science from the Bauru School, Dentistry/University of São Paulo (FOB/USP); Doctoral Student in Speech-Language Pathology and Audiology at the School of Philosophy and Sciences/São Paulo State University 'Júlio de Mesquita Filho' (FFC/UNESP) Marília, São Paulo, Brazil; Speech-Language Pathology and Audiology Department, Acoustic and Articulatory Analysis Laboratory (LAAc), School of Philosophy and Sciences/São Paulo State University 'Júlio de Mesquita Filho' (FFC/UNESP), Marília, São Paulo, Brazil and Member of the research group Language Studies, of the Conselho Nacional de Desenvolvimento Científico e Tecnológico (GPEL/CNPq), São Paulo, Brazil.
| | - Eliana Maria Gradim Fabbron
- Speech Therapist, Professor of the Graduated Program in Speech-Language Pathology and Audiology; Speech-Language Pathology and Audiology Department, Acoustic and Articulatory Analysis Laboratory (LAAc), School of Philosophy and Sciences/São Paulo State University 'Júlio de Mesquita Filho' (FFC/UNESP), Marília, São Paulo, Brazil
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Liu H, Hao G, Chen S, Ouyoung L, Liu Y, Li J, Duan H, Li Z, Liu Y, Zhong J, Liu B, Jiang J. Effectiveness and Feasibility of Telepractice on Voice Therapy for Female Teachers in Elementary Schools with Self-Reported Voice Disorders. J Voice 2024; 38:244.e1-244.e13. [PMID: 34583880 DOI: 10.1016/j.jvoice.2021.07.015] [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: 05/02/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this study is to explore the effectiveness of telepractice in voice intervention for female teachers in elementary schools with self-reported voice disorders. METHODS Thirty-five female elementary school teachers with self-reported voice disorders volunteered to participate in the study. They were divided into a telepractice voice intervention group (experimental group N=18) and a face-to-face voice intervention group (control group N=17) based on their employment setting. The exact same treatment protocol was applied to both groups of subjects, except that the intervention group was seen through telepractice, and the control group was seen face-to-face. The treatment protocol includes vocal hygiene education and resonant voice therapy twice a week for a total of eight sessions. Auditory perceptual analysis, acoustic assessment, aerodynamic assessment and self-assessment protocol were conducted before the intervention and one week after the last intervention, and the differences before and after interventions within each group and between groups were compared. RESULTS There was no significant difference in baseline data including age, working years, and voice symptoms between the two groups. Both groups showed significant improvement (P<0.05) in all voice assessment before and after the treatment sessions, except for the Voice Handicap Index-10 (VHI-10) assessment. No statistical difference was found in other pre- and post-intervention voice assessment changes between the two study groups. The control group presented higher improvement in the total score, and the two subdomain assessments of physiology and emotion. CONCLUSIONS Telepractice voice intervention can effectively improve the voice quality of female teachers in elementary schools, and telepractice therapy can be an effective alternative to face-to-face voice intervention.
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Affiliation(s)
| | | | | | | | | | - Jinrang Li
- the Sixth Medical Center of PLA General Hospital
| | | | | | - Yang Liu
- The Sixth Medical Center of PLA General Hospital
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Acevedo K, Guzman M, Ortega A, Aguirre C, Diaz S, Escudero J, Quezada C. Remote Voice Therapy With an Oscillatory Positive Expiratory Pressure Device in Subjects With Vocal Fatigue: A Randomized Controlled Trial. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4801-4811. [PMID: 37971520 DOI: 10.1044/2023_jslhr-23-00357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE The present study aimed at assessing the efficacy of remote voice therapy (telepractice) implemented with Shaker Medic Plus device in subjects with vocal fatigue. METHOD Thirty-six participants were initially enrolled in this study. Twenty-four participants with vocal fatigue were finally randomly assigned to one of two treatment groups: (a) voice treatment with Shaker Medic Plus device plus vocal hygiene program (n = 12) and (b) voice treatment with water resistance therapy (WRT) plus vocal hygiene program (n = 12). Laryngoscopic assessment was conducted on all subjects. Before and after voice therapy, participants underwent (a) self-assessment of voice: Vocal Fatigue Index and Vocal Tract Discomfort Scale and (b) instrumental assessment with aerodynamic, acoustic, and electroglottographic measures. The treatment period included six voice therapy sessions within 6 weeks. Each session lasted 30 min. For both groups, exercises consisted of a sequence of nine phonatory tasks performed with Shaker Medic Plus (experimental group) and WRT (control group). Comparisons for all variables were performed between the experimental group and control group. RESULTS Significant improvements were found for self-reported variables when comparing pre- and postmeasures for both groups. No significant differences were found when comparing groups. No significant main effects or interactions were observed for any of the observed instrumental variables. CONCLUSIONS Remote physiologic voice therapy with Shaker Medic Plus device and water resistance therapy seem to be both effective to improve voice in subjects diagnosed with vocal fatigue. No differences should be expected between these therapeutic protocols when treating patients with vocal fatigue. Moreover, both are effective at reducing tiredness of voice, voice avoidance, physical discomfort associated with voicing, subjective perception of sensory discomfort in throat, and reduction of physical, emotional, and functional impact of voice problems.
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Affiliation(s)
- Karol Acevedo
- Escuela de Fonoaudiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
| | - Marco Guzman
- Department of Communication Sciences and Disorders, Universidad de los Andes, Santiago, Chile
| | - Andrés Ortega
- Department of Ear, Nose, and Throat, Clínica las Condes, Santiago, Chile
| | - Camila Aguirre
- Department of Communication Sciences and Disorders, Universidad de los Andes, Santiago, Chile
| | - Sofía Diaz
- Department of Communication Sciences and Disorders, Universidad de los Andes, Santiago, Chile
| | - Javiera Escudero
- Department of Communication Sciences and Disorders, Universidad de los Andes, Santiago, Chile
| | - Camilo Quezada
- Departamento de Fonoaudiología, Facultad de Medicina, Universidad de Chile, Santiago
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Krekelberg MO, Ruckart JD, Morton-Jones ME, Lacy AL, Madden LL, Ruckart KW. Evaluating Geographic Access to Interdisciplinary Laryngology and Speech-Language Pathology Clinic Models in the Southeast Region of the United States. J Voice 2023:S0892-1997(23)00327-2. [PMID: 37932131 DOI: 10.1016/j.jvoice.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE An interdisciplinary model of care for the evaluation and treatment of voice, swallowing, and upper airway disorders with laryngologists and specialized speech-language pathologists is known to increase revenue, attendance to visits, patient adherence, and most importantly, improve patient outcomes. Individuals who live outside of areas with high population density often have reduced geographic access to this specialized care. The primary aim of this study is to identify the percentage of the population that has an "extended drive time" to access an interdisciplinary clinic in the Southeast region of the United States. STUDY DESIGN NA. METHODS Interdisciplinary laryngology and speech-language pathology clinics were identified via publicly accessible information including an internet search and state department of public health databases. Included clinics had at least one full-time fellowship-trained laryngologist and at least one full-time speech-language pathologist on staff. Descriptive statistics and visual representation of the results were achieved with the use of Smappen, a location intelligence online platform, to identify the percent of the population with a drive time greater than 1 hour. RESULTS 47.24% of the Southeast population of the United States must drive over 1 hour to access an interdisciplinary clinic. Visual representations of these data are included and generated by Smappen. CONCLUSIONS While close geographic proximity does not ensure access to care, it can increase the likelihood that healthcare services will be used. This study identified the population in the Southeast region of the United States with extended drive time to interdisciplinary voice and swallowing centers due to their geographic distance from these centers. The results from this study support the need for increased geographic access to specialty care clinics, specifically voice, swallowing, and upper airway care, and provide insight into potential sites for interdisciplinary centers based on population density in areas that are underserved.
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Affiliation(s)
- Maris O Krekelberg
- Department of Otolaryngology-Head and Neck Surgery, Atrium Health Wake Forest Baptist/Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - James D Ruckart
- Department of Otolaryngology-Head and Neck Surgery, Atrium Health Wake Forest Baptist/Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mariah E Morton-Jones
- Department of Otolaryngology, School of Kinesiology, Auburn University, Auburn, Alabama
| | - Alexa L Lacy
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lyndsay L Madden
- Department of Otolaryngology-Head and Neck Surgery, Atrium Health Wake Forest Baptist/Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kathryn W Ruckart
- Department of Otolaryngology-Head and Neck Surgery, Atrium Health Wake Forest Baptist/Wake Forest University School of Medicine, Winston-Salem, North Carolina.
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Batista DDJ, da Silva RD, Martins AA, de Araújo CM, Santos RS, Filho OG, Taveira KVM, Ribeiro VV. Internal Consistency of the Voice Handicap Index in Individuals With Dysphonia: A Systematic Review and Meta-Analysis. J Voice 2023:S0892-1997(23)00253-9. [PMID: 37778959 DOI: 10.1016/j.jvoice.2023.08.012] [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: 04/14/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To analyze the internal consistency of the Voice Handicap Index (VHI) for evaluating the vocal handicap of individuals with dysphonia. METHODS This is a systematic review. Studies with a cross-sectional design and including a population of individuals with dysphonia, which validated the VHI and analyzed its internal consistency, were included. The following electronic databases were searched: Cochrane Library, EMBASE, LILACS, and PubMed, including Medline, Scopus, and Web of Science. A manual search was performed in gray literature through the Biblioteca Digital Brasileira de Teses e Dissertações and ProQuest Dissertation & Theses. In addition, the list of references of studies selected in the electronic search was mapped, and an expert in the area was consulted. Two reviewers blindly and independently conducted the selection, data extraction, and analysis of the risk of bias, the certainty of the evidence, and good psychometric measures. A meta-analysis was performed with a random effects model using the JAMOVI 2.3.2 software. RESULTS Forty-nine studies were analyzed. In risk of bias assessment, the studies were classified as having inadequate structural validity and very good internal consistency. The analysis of good psychometric properties indicated indeterminate structural validity and insufficient internal consistency. The overall value of Cronbach's alpha was estimated at 0.94, thus suggesting a very good internal consistency. However, there was high heterogeneity. The level of certainty of the evidence was too low for internal consistency. CONCLUSION The VHI proved to be a consistent and reliable patient-reported outcome measure to evaluate voice handicap in individuals with dysphonia; however, studies are heterogeneous, and the certainty of evidence is very low.
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Affiliation(s)
- Denis de Jesus Batista
- Decision Models and Health, Statistics Department, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil; Núcleo de estudos Avançados em Revisões Sistemáticas e Meta-análise (NARSM), Rua Padre Ladislau Kula, 395 - Santo Inácio, Curitiba, PR 82010-210, Brazil; Associated Graduate Program in Speech and Language Therapy, Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte and Universidade Estadual de Ciências da Saúde de Alagoas, Curitiba, Paraná, Brazil.
| | - Rayane Délcia da Silva
- Núcleo de estudos Avançados em Revisões Sistemáticas e Meta-análise (NARSM), Rua Padre Ladislau Kula, 395 - Santo Inácio, Curitiba, PR 82010-210, Brazil; Communication Disorders, Universidade Tuiuti do Paraná, Curitiba, Paraná, Brazil.
| | - Agnes Andrade Martins
- Núcleo de estudos Avançados em Revisões Sistemáticas e Meta-análise (NARSM), Rua Padre Ladislau Kula, 395 - Santo Inácio, Curitiba, PR 82010-210, Brazil; Dentistry, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
| | - Cristiano Miranda de Araújo
- Núcleo de estudos Avançados em Revisões Sistemáticas e Meta-análise (NARSM), Rua Padre Ladislau Kula, 395 - Santo Inácio, Curitiba, PR 82010-210, Brazil; Communication Disorders, Universidade Tuiuti do Paraná, Curitiba, Paraná, Brazil; Dentistry, Universidade Tuiuti do Paraná, Curitiba, Paraná, Brazil.
| | - Rosane Sampaio Santos
- Núcleo de estudos Avançados em Revisões Sistemáticas e Meta-análise (NARSM), Rua Padre Ladislau Kula, 395 - Santo Inácio, Curitiba, PR 82010-210, Brazil; Graduate Program in Communication Disorders, Universidade Tuiuti do Paraná.
| | - Odilon Guariza Filho
- Núcleo de estudos Avançados em Revisões Sistemáticas e Meta-análise (NARSM), Rua Padre Ladislau Kula, 395 - Santo Inácio, Curitiba, PR 82010-210, Brazil; Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.
| | - Karinna Veríssimo Meira Taveira
- Núcleo de estudos Avançados em Revisões Sistemáticas e Meta-análise (NARSM), Rua Padre Ladislau Kula, 395 - Santo Inácio, Curitiba, PR 82010-210, Brazil; Associated Graduate Program in Speech and Language Therapy, Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte and Universidade Estadual de Ciências da Saúde de Alagoas, Curitiba, Paraná, Brazil; Universidade Federal do Rio Grande do Norte, Curitiba, Paraná, Brazil.
| | - Vanessa Veis Ribeiro
- Núcleo de estudos Avançados em Revisões Sistemáticas e Meta-análise (NARSM), Rua Padre Ladislau Kula, 395 - Santo Inácio, Curitiba, PR 82010-210, Brazil; Associated Graduate Program in Speech and Language Therapy, Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte and Universidade Estadual de Ciências da Saúde de Alagoas, Curitiba, Paraná, Brazil; Speech and Language Therapy Course and the Graduate Program in Medical Sciences, Universidade de Brasília, Universidade Federal do Rio Grande do Norte and Universidade Estadual de Ciências da Saúde de Alagoas, Brasília, Distrito Federal, Brazil.
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11
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Diaz JA, Rangarathnam AB, Medina A, Khare VD, Fisher HR. Preliminary Perceptual Findings of Singing After Flow Phonation Voice Exercises for Singers in Training. J Voice 2023:S0892-1997(23)00256-4. [PMID: 37718141 DOI: 10.1016/j.jvoice.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Goals of voice therapy and vocal pedagogy share similar principles and therefore, therapy approaches designed to improve the disordered voice may be equally effective when used to enhance healthy voice and vice versa. The purpose of this study was to investigate the effects of flow phonation voice exercises on vocal characteristics of students in undergraduate vocal music training programs and examine their potential use in vocal pedagogy. METHODS A total of 10 cis females were recruited and were randomized into two groups: an experimental group (group 1, n = 6) receiving five sessions of flow phonation intervention across 5 weeks; and a control group (group 2, n = 4) that did not receive any direct intervention other than vocal hygiene education. Participants provided data pertaining to auditory perception, subjective respiratory measures, voice-related quality of life, and vocal fatigue before and after 5 weeks. Flow phonation exercises consisted of cup bubble blowing, gargling, and stretch and flow. Wilcoxon signed ranks test was administered to compare outcomes across time points and between groups. RESULTS Data indicate statistically significant changes in auditory perception of the singing voice, and voice-related quality of life for the group that received flow phonation exercises alone. No other measures showed statistical significance. DISCUSSION AND CONCLUSION Overall, this study indicates that the use of flow phonation voice exercises has the potential to improve voice instruction within the voice studio. While our target enrollments were not met to achieve optimal statistical power, our hypotheses were at least partially supported. In particular, positive intervention-related changes were observed in self-perceived voice handicap, and auditory perception of singing which were not observed in the control group.
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Affiliation(s)
- Jorge A Diaz
- Department of Communication Sciences and Disorders, Florida International University, Miami, FL
| | | | - Angela Medina
- Department of Communication Sciences and Disorders, Florida International University, Miami, FL
| | | | - Hélène R Fisher
- Department of Speech-Language Pathology, Nova Southeastern University, Fort Lauderdale, FL
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12
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Rameau A, Cox SR, Sussman SH, Odigie E. Addressing disparities in speech-language pathology and laryngology services with telehealth. JOURNAL OF COMMUNICATION DISORDERS 2023; 105:106349. [PMID: 37321106 PMCID: PMC10239150 DOI: 10.1016/j.jcomdis.2023.106349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 05/10/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic disproportionately affected the health and well-being of marginalized communities, and it brought greater awareness to disparities in health care access and utilization. Addressing these disparities is difficult because of their multidimensional nature. Predisposing factors (demographic information, social structure, and beliefs), enabling factors (family and community) and illness levels (perceived and evaluated illness) are thought to jointly contribute to such disparities. Research has demonstrated that disparities in access and utilization of speech-language pathology and laryngology services are the result of racial and ethnic differences, geographic factors, sex, gender, educational background, income level and insurance status. For example, persons from diverse racial and ethnic backgrounds have been found to be less likely to attend or adhere to voice rehabilitation, and they are more likely to delay health care due to language barriers, longer wait times, a lack of transportation and difficulties contacting their physician. The purpose of this paper is to summarize existing research on telehealth, discuss how telehealth offers the potential to eliminate some disparities in the access and utilization of voice care, review its limitations, and encourage continued research in this area. A clinical perspective from a large volume laryngology clinic in a major city in northeastern United States highlights the use of telehealth in the provision of voice care by a laryngologist and speech-language pathologist during and after the COVID19 pandemic.
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Affiliation(s)
- Anaïs Rameau
- Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, NY, United States of America.
| | - Steven R Cox
- Department of Communication Sciences and Disorders, Adelphi University, Garden City, NY, United States of America
| | - Scott H Sussman
- Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, NY, United States of America
| | - Eseosa Odigie
- Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, NY, United States of America
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13
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McGlashan J, Aaen M, White A, Sadolin C. A mixed-method feasibility study of the use of the Complete Vocal Technique (CVT), a pedagogic method to improve the voice and vocal function in singers and actors, in the treatment of patients with muscle tension dysphonia: a study protocol. Pilot Feasibility Stud 2023; 9:88. [PMID: 37226281 DOI: 10.1186/s40814-023-01317-y] [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: 07/03/2022] [Accepted: 05/02/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Muscle tension dysphonia (MTD) results from inefficient or ineffective voice production and is the cause of voice and throat complaints in up to 40% of patients presenting with hoarseness. Standard treatment is voice therapy (SLT-VT) delivered by specialist speech therapists in voice disorders (SLT-V). The Complete Vocal Technique (CVT) is a structured, pedagogic method which helps healthy singers and other performers optimise their vocal function enabling them to produce any sound required. The aim of this feasibility study is to investigate whether CVT administered by a trained, non-clinical CVT practitioner (CVT-P) can be applied to patients with MTD before progressing to a pilot randomised control study of CVT voice therapy (CVT-VT) versus SLT-VT. METHODS/DESIGN In this feasibility study, we use a mixed-method, single-arm, prospective cohort design. The primary aim is to demonstrate whether CVT-VT can improve the voice and vocal function in patients with MTD in a pilot study using multidimensional assessment methods. Secondary aims are to assess whether (1) a CVT-VT study is feasible to perform; (2) is acceptable to patients, the CVT-P and SLT-VTs; and (3) whether CVT-VT differs from existing SLT-VT techniques. A minimum of 10 consecutive patients with a clinical diagnosis of primary MTD (types I-III) will be recruited over a 6-month period. Up to 6 video sessions of CVT-VT will be delivered by a CVT-P using a video link. The primary outcome will be a change in pre-/post-therapy scores of a self-reported patient questionnaire (Voice Handicap Index (VHI)). Secondary outcomes include changes in throat symptoms (Vocal Tract Discomfort Scale), acoustic/electroglottographic and auditory-perceptual measures of voice. Acceptability of the CVT-VT will be assessed prospectively, concurrently and retrospectively both quantitatively and qualitatively. Differences from SLT-VT will be assessed by performing a deductive thematic analysis of CVT-P transcripts of therapy sessions. CONCLUSION This feasibility study will provide important data to support whether to proceed with a randomised controlled pilot study focusing on the effectiveness of the intervention compared to standard SLT-VT. Progression criteria will be based on demonstrating a positive outcome in treatment, successful delivery of the pilot study protocol, acceptability to all stakeholders and satisfactory recruitment rates. TRIAL REGISTRATION ClinicalTrials.gov website ( NCT05365126 Unique Protocol ID: 19ET004). Registered on 06 May 2022.
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Affiliation(s)
- Julian McGlashan
- Ear, Nose and Throat Department, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK.
| | - Mathias Aaen
- Complete Vocal Institute, Kompagnistraede 32A, 1208, Copenhagen K, Denmark
- Honorary Researcher, Ear, Nose and Throat Department, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK
| | - Anna White
- Ear, Nose and Throat Department, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK
| | - Cathrine Sadolin
- Complete Vocal Institute, Kompagnistraede 32A, 1208, Copenhagen K, Denmark
- Honorary Researcher, Ear, Nose and Throat Department, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK
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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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15
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Vance D, Shah P, Sataloff RT. COVID-19: Impact on the Musician and Returning to Singing; A Literature Review. J Voice 2023; 37:292.e1-292.e8. [PMID: 33583675 PMCID: PMC7808728 DOI: 10.1016/j.jvoice.2020.12.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to review current literature of the impact of COVID-19 on musicians and returning to singing. METHODS A comprehensive search of peer-review articles was completed using PubMed, GoogleScholar, Scopus, and Web of Science. The search was completed using many key terms including voice, hoarseness, dysphonia, aphonia, cough, singers, and public speakers. The bibliography from each article found was searched to find additional articles. The search process revealed 56 peer-reviewed articles, 18 primary articles, ranging from the years 2019 to 2020. CONCLUSION COVID-19 has had a major impact on singers and other musicians worldwide. It can affect the voice and can lead to paresis/paralysis of laryngeal nerves to long-term changes in respiratory function. There is a risk from aerosolization/droplet formation transmission with singing, and with playing wind and brass instruments that can be mitigated by following COVID-19 guidelines. Ways to reduce possible transmission during singing and instrument play include virtual rehearsals or performances, mask-wearing, instrument covers, smaller choirs, performing outside, excellent ventilation being socially distanced, shorter rehearsals, regularly cleaning commonly touched surfaces and washing hands, avoiding contact with others, and temperature screening.
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Affiliation(s)
- Dylan Vance
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Priyanka Shah
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
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16
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Rangarathnam B, Paramby T, McCullough GH, Pickett H, Tulunay-Ugur ÖE, Zraick RI. A randomized controlled trial of the effects of flow phonation voice treatment for primary muscle tension dysphonia. JOURNAL OF COMMUNICATION DISORDERS 2023; 101:106290. [PMID: 36502668 PMCID: PMC9905289 DOI: 10.1016/j.jcomdis.2022.106290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 11/13/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The purpose of the study was to investigate the effects of flow phonation voice therapy on laryngeal physiology and vocal quality in persons with primary Muscle Tension Dysphonia (MTD1). METHODS Seventeen participants with a diagnosis of MTD1 completed the study. Participants were randomized to two groups. Group 1 (9 participants) received flow phonation treatment and individualized vocal hygiene education for 12 sessions over six weeks. Group 2 (8 participants) received vocal hygiene education only for three weeks (6 sessions), followed by another three weeks (6 sessions) of both vocal hygiene instruction and flow phonation therapy. Treatment consisted of cup-bubble blowing, gargling, and stretch and flow exercises. Visual-perceptual. auditory-perceptual, acoustic, aerodynamic and voice-related quality-of-life measures were obtained at three time points: before treatment, three weeks after initiation of treatment and after completion of treatment. RESULTS Voice quality was perceived to be significantly improved in both groups. Voice related quality-of-life trended toward improvement for both groups across time points. Changes in aerodynamic and acoustic measures did not reach statistical significance compared to baseline for both groups. Visual comparisons of laryngeal closure patterns demonstrated comparably better outcomes for Group 1. CONCLUSIONS Results of this study indicate flow phonation exercises can potentially be favorably employed for individuals with MTD1. In particular, it appears that the exercises aid in alleviating vocal hyperfunction, as evidenced by visual perceptual stroboscopic analysis, and clinically improved auditory-perceptual measures.
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Affiliation(s)
- Balaji Rangarathnam
- Department of Speech Language Pathology, Midwestern University, United States.
| | - Towino Paramby
- Department of Communication Sciences and Disorders, University of Central Arkansas, United States; Department of University Rehabilitation, UAMS Medical Center, United States
| | - Gary H McCullough
- College of Health Sciences, Appalachian State University, United States
| | - Hylan Pickett
- Department of University Rehabilitation, UAMS Medical Center, United States
| | - Özlem E Tulunay-Ugur
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, United States
| | - Richard I Zraick
- School of Communication Sciences and Disorders, University of Central Florida, United States
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Sundholm N, Shelly S, Wright ML, Reynolds J, Slovarp L, Gillespie AI. Effect of Behavioral Cough Suppression Therapy Delivered via Telehealth. J Voice 2022:S0892-1997(22)00367-8. [PMID: 36550001 DOI: 10.1016/j.jvoice.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS Behavioral cough suppression therapy (BCST) has demonstrated up to 88% effectiveness at treating refractory chronic cough (RCC). With onset of the COVID-19 pandemic, along with many other medical services, BCST shifted to telehealth delivery. Our group hypothesized that BCST delivered via telemedicine by a specialized Speech-Language Pathologist would be comparable to previously reported response to treatment for in-person settings. STUDY DESIGN Retrospective review. METHODS An Emory IRB approved, retrospective review of electronic medical records was completed for RCC patients who received BCST via telehealth from March 2020 through January 2022 at Emory Voice Center. Patients were included in the study if they had a diagnosis of RCC, were referred for BCST, were seen for at least one therapy session in the telehealth setting, and provided Cough Severity Index (CSI) data pre and post-treatment. Patients were excluded if they had incomplete datasets, a known pulmonary condition, structural laryngeal disorders, smoking history, dysphagia, and ACE-inhibitor use. Change in CSI score pre- and post-treatment was calculated to determine treatment effect. Paired-samples t-tests were conducted to compare pre-and post-treatment CSI score change. RESULTS Fifty-one RCC patients were included in this study; 88% were female with an average age of 60 years (SD = 12.68). Post-treatment CSI scores were significantly lower than pretreatment CSI scores (P < 0.0001). These findings are comparable to historical documented CSI change achieved with in-person BCST. CONCLUSIONS This study provides preliminary evidence of the efficacy of BCST via telehealth for treating RCC. The findings of this study support the continued flexibility in speech-language pathology service delivery to include in-person and telehealth platforms for RCC beyond the COVID-19 pandemic.
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Affiliation(s)
| | - Sandeep Shelly
- Emory Voice Center, Emory Healthcare, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
| | - Miranda L Wright
- Department of Communication Science and Disorders, University of Utah, Salt Lake City, Utah
| | - Jane Reynolds
- University of Montana School of Speech-Language-Hearing & Occupational Sciences, Missoula, Montana
| | - Laurie Slovarp
- University of Montana School of Speech-Language-Hearing & Occupational Sciences, Missoula, Montana
| | - Amanda I Gillespie
- Emory Voice Center, Emory Healthcare, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
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Morton ME, Gibson-Young L, Sandage MJ. Framing Disparities in Access to Medical Speech-Language Pathology Care in Rural Alabama. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2847-2860. [PMID: 36327492 DOI: 10.1044/2022_ajslp-22-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Rural-living residents of Alabama depend on rural hospitals and clinics staffed with physicians and allied health professionals including speech-language pathologists (SLPs). The purpose of the exploratory study was to examine the speech-language pathology workforce in health care facilities in nonmetropolitan Alabama counties to determine potential disparities in access and identify medical SLP deserts for rural Alabamians. METHOD The hospitals, rural health clinics, nursing homes, and rehabilitation centers for each of the 37 nonmetropolitan counties were identified through the 2020 Alabama Department of Public Health directories, and phone surveys were completed to determine medical SLP staffing at each facility. Descriptive statistics and regression analysis were conducted. RESULTS The initial review yielded 229 rural health care facilities with 223 ultimately included in the analysis and 176 facilities completing a phone inquiry (76.68%). Sixty-one (35.88%) reported employing at least one SLP and no facility stated staffing SLP assistants. Linear regression indicated a positive, yet moderate effect size between the reported number of SLPs staffed within each county and specific population of the county (r 2 = .519). Anecdotally, facilities reported difficulty in hiring and retaining SLPs due to rural geographical location. CONCLUSIONS The exploratory findings suggest disparities in access to behavioral communication and swallowing care for rural residents in the state. The methodology employed for data collection and analysis may be applied to other states and U.S. territories, in an effort to frame the issue nationally and support rural health care policy across the United States. Further investigation regarding the cost effectiveness of telepractice, the availability of broadband Internet access, the efficacy of community-based service delivery, and the effectiveness of incentivized rural SLP graduate programs is warranted to mitigate the disparities in access.
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Affiliation(s)
| | | | - Mary J Sandage
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
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Guzman M, Ortega A, Rocha C, Salgado L, Quezada C. Efficacy of Voice Therapy With Acapella Choice ® Device in Subjects With Vocal Fatigue Delivered Via Telepractice. J Voice 2022:S0892-1997(22)00229-6. [PMID: 36153205 DOI: 10.1016/j.jvoice.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE The present study aimed at assessing the effectiveness of remote voice therapy (telepractice) implemented with Acapella Choice device in subjects with vocal fatigue. METHODS Thirty participants with vocal fatigue were randomly assigned to one of two treatment groups: (1) voice treatment with acapella Choice device plus vocal hygiene program (n=15), and (2) voice treatment with Water resistance therapy plus vocal hygiene program (n=15). Laryngoscopic assessment was conducted in all subjects to confirm diagnosis. Before and after voice therapy, participants underwent self-assessment of voice. Vocal Fatigue Index (VFI), Voice Handicap Index (VHI), and Vocal tract discomfort scale (VTDS) were used. Treatment period included six voice therapy sessions within 3 weeks, with a frequency of two therapy sessions per week. Each session lasted 30 minutes. For both groups, exercises consisted of a sequence of nine phonatory tasks performed with Acapella Choice (experimental group) and WRT (control group). Comparison for all variables were performed between experimental group and control group. RESULTS Significant improvements were found when comparing Pre and Post measures for both groups. No significant differences were found when comparing Acapella Choice group and WRT group. CONCLUSION Remote physiologic voice therapy with Acapella Choice device and water resistance therapy seem to be both effective to improve voice in subjects diagnosed with vocal fatigue. No differences should be expected between these therapeutic protocols when treating patients with vocal fatigue. Moreover, both are effective at reducing tiredness of voice, voice avoidance, physical discomfort associated with voicing, subjective perception of sensory discomfort in throat, and reduction of physical, emotional, and functional impact of voice problems.
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Affiliation(s)
- Marco Guzman
- Department of Communication Sciences and Disorders, Universidad de los Andes, Chile, Santiago, Chile.
| | - Andrés Ortega
- Department of Ear Nose and Throat, Clínica las Condes, Santiago, Chile
| | - Camila Rocha
- Department of Communication Sciences and Disorders, Universidad de los Andes, Chile, Santiago, Chile
| | - Lia Salgado
- Department of Communication Sciences and Disorders, Universidad de los Andes, Chile, Santiago, Chile
| | - Camilo Quezada
- Departamento de Fonoaudiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Sresuganthi JR, Nallamuthu A, Boominathan P. Comparison of Client-Led Asynchronous and Clinician-Led Synchronous Online Methods for Evaluation of Subjective Vocal Measures in Teachers: A Feasibility Study. J Voice 2022:S0892-1997(22)00127-8. [PMID: 35641382 DOI: 10.1016/j.jvoice.2022.04.015] [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: 02/24/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND COVID-19 has transformed face to face teaching in classrooms to online and hybrid modes. Increased vocal intensity/ pitch to call attention of students and transact in the online class, inappropriate posture (head, neck & upper trunk) while using the laptop and other online tools cause vocal loading leading to voice related concerns in teachers. Tele voice assessment is a feasible alternative means to seek professional help in the current situation and possibly in the future too. Client-led asynchronous and clinician-led synchronous voice recordings for clinical vocal measures among school teachers were compared in this study. METHOD Twenty-five school teachers (21 females & four males) from Chennai consented to the study. Information of voice use, its impact on the day-to-day situations, self-perception of vocal fatigue, and their recorded voice sample (phonation & speaking) were obtained online (asynchronous mode). Within a period of ten days, the clinician-led synchronous session was planned on a mutually convenient time for obtaining voice samples through zoom call. The voice samples obtained were compared for clinical measures and perceptual voice evaluation. RESULTS Participants reported of vocal symptoms and increased vocal fatigue scores. The maximum phonation time values obtained through synchronous mode were lesser when compared to asynchronous mode. Also, variability was noted in the perceptual vocal measures of voice samples obtained through synchronous mode. During synchronous voice recording & evaluation, the background noise, internet stability, audio enhancement feature, and microphone placement & quality could be monitored, and immediate feedback was provided. Additionally, the asynchronous recording can be supplemented for synchronous recording, with clear instructions & demonstration. CONCLUSION This study explored the feasibility of using synchronous and asynchronous voice recording for voice analysis in school teachers. The findings could serve as a base to understand the advantages and challenges of using client-led asynchronous and clinician-led synchronous methods for estimating vocal measures.
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Affiliation(s)
| | - Aishwarya Nallamuthu
- Department of Speech Language & Hearing Sciences, Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamil Nadu, India.
| | - Prakash Boominathan
- Department of Speech Language & Hearing Sciences, Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamil Nadu, India
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Mari G, Marchese MR, Longobardi Y, Proietti I, Marenda ME, Di Cesare T, D'Alatri L. Voice Telerehabilitation in Iatrogenic Unilateral Vocal Fold Paralysis: From Necessity to Opportunity in the COVID-19 Time. J Voice 2022:S0892-1997(22)00108-4. [PMID: 35641380 DOI: 10.1016/j.jvoice.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate results of telerehabilitation (TR) during the coronavirus disease 2019 pandemic for the treatment of dysphonia caused by permanent post-thyroidectomy unilateral vocal fold paralysis (UVFP). METHODS Forty subjects with post-thyroidectomy UVFP (onset <1 month) underwent TR. Videostrobolaryngoscopy, acoustic and perceptual voice analysis and patient self-assessment were carried out in person before, at the end of TR and 6 months later. RESULTS Twenty-five subjects spontaneously recovered full vocal fold motility at some time during follow-up, whereas 15 had a permanent UVFP at the end of the follow-up period. These subjects constituted our study group. At the early posttherapy control 10/15 subjects (66.6%) showed a complete glottal closure, while in 5/15 (33.3%) a glottal gap remained (P = 0.03). These results did not change 6 months after TR. At the late posttherapy control the maximum phonation time improved significantly (P = 0.02). Both post-therapy Voice Handicap Index scores were significantly lower than the pre-therapy ones (P = 0.04). Grade, Breathiness, and Asthenia parameters of the Grade-Roughness-Breathiness-Asthenia-Strain scale improved 6 months after TR (P < 0.05). The number of voice signals suitable for acoustic analysis increased significantly after therapy. Finally, 87% of patients were satisfied with TR. CONCLUSIONS With careful patient selection, TR may be considered as a promising method for voice therapy in postthyroidectomy UVFP.
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Affiliation(s)
- Giorgia Mari
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Maria Raffaella Marchese
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.
| | - Ylenia Longobardi
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Ilaria Proietti
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Maria Elisabetta Marenda
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Tiziana Di Cesare
- Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-Collo e Organi di Senso, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Lucia D'Alatri
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia; Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-Collo e Organi di Senso, Università Cattolica del Sacro Cuore, Roma, Italia
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22
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Gray R, Michael D, Hoffmeister J, Lunos S, Zach S, Butcher L, Weinstein D, Misono S. Patient Satisfaction with Virtual vs In-Person Voice Therapy. J Voice 2022:S0892-1997(22)00081-9. [PMID: 35410780 DOI: 10.1016/j.jvoice.2022.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether there is a difference in patient satisfaction between in-person and virtual voice therapy. METHODS Patient satisfaction answers to the National Research Corporation (NRC) Health patient survey were retrieved for two separate 11 month periods. The first was for an in-person cohort, from April 2019 to February 2020. The second was for a virtual cohort between April 2020 and February 2021. Two group t tests or Wilcoxon rank sum tests were used to compare responses between the in-person and virtual cohorts. The effect of modality of therapy by gender, age, and race was examined by testing interactions with separate ANOVA models. RESULTS Responses were compared between 224 patient satisfaction surveys for the virtual cohort and 309 patient satisfaction surveys for the in-person cohort. Overall, responses were highly favorable in all categories. There were no differences between the in-person and virtual cohorts' responses with respect to three main categories: likelihood of future referral of clinic or provider; communication with provider; and comprehension of the treatment plan. The interaction between modality of therapy delivery and age was significant for the question, "Did you know what to do after your visit," with 18-44 year olds in the in-person group reporting a better understanding of the treatment plan compared to the 18-44 year olds in the virtual therapy cohort (P = 0.004). There were no interactions between modality of therapy and gender, or race. CONCLUSION Virtual delivery of voice therapy was associated with comparable visit satisfaction scores to in-person delivery, with both delivery modalities demonstrating very high satisfaction. Future studies are needed to identify which patients and conditions are most suited for virtual versus in-person delivery of speech-language pathology services in voice clinics.
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Affiliation(s)
- Raluca Gray
- Department of Otolaryngology, Lions Voice Clinic, University of Minnesota, Minneapolis, Minnesota.
| | - Deirdre Michael
- Department of Otolaryngology, Lions Voice Clinic, University of Minnesota, Minneapolis, Minnesota
| | - Jesse Hoffmeister
- Department of Otolaryngology, Lions Voice Clinic, University of Minnesota, Minneapolis, Minnesota
| | - Scott Lunos
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | - Sarah Zach
- Department of Otolaryngology, Lions Voice Clinic, University of Minnesota, Minneapolis, Minnesota
| | - Lisa Butcher
- Department of Otolaryngology, Lions Voice Clinic, University of Minnesota, Minneapolis, Minnesota
| | - Dan Weinstein
- Department of Otolaryngology, Lions Voice Clinic, University of Minnesota, Minneapolis, Minnesota
| | - Stephanie Misono
- Department of Otolaryngology, Lions Voice Clinic, University of Minnesota, Minneapolis, Minnesota
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23
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Myers B, Hary E, Ellerston J, Barkmeier-Kraemer JM. Telepractice Considerations for Evaluation and Treatment of Voice Disorders: Tailoring to Specific Populations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:678-688. [PMID: 35077650 DOI: 10.1044/2021_ajslp-21-00206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The aim of this clinical focus article is to provide recommendations for implementation of telepractice services for the evaluation and treatment of voice disorders and to use case examples to highlight the advantages of this modality of service delivery. METHOD In this clinical focus article, key factors for successful telepractice evaluation and treatment of voice and related disorders are discussed relative to clinical outcome measures. Case examples of telepractice voice therapy are described for a pediatric, transgender, and chronic cough client including associated acoustic, auditory-perceptual, and quality-of-life treatment outcomes. RESULTS Acoustic, perceptual, and quality-of-life outcome measures demonstrated functional voice improvements after treatment using the telepractice modality. The pediatric client showed decreased perceptual voice strain and increased speech intelligibility. The transgender client showed increased habitual speaking fundamental frequency (pitch) and quality of life. The chronic cough client showed improved vocal hygiene and reduced cough severity. CONCLUSIONS A review of the literature shows comparable outcomes for in-person and telepractice voice therapy, but special considerations must be made to ensure therapeutic success. We present three representative types of voice cases that illustrate implementation of voice evaluation and treatment using the telepractice modality. In all three cases, the clients' personal therapeutic goals were achieved without needing to travel to the clinic. Furthermore, asynchronous practice opportunities were found to be positive byproducts of using the telepractice modality.
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Affiliation(s)
- Brett Myers
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
- Voice Disorders Center, University of Utah Health, Salt Lake City
| | - Elizabeth Hary
- Voice Disorders Center, University of Utah Health, Salt Lake City
| | - Julia Ellerston
- Voice Disorders Center, University of Utah Health, Salt Lake City
| | - Julie M Barkmeier-Kraemer
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
- Voice Disorders Center, University of Utah Health, Salt Lake City
- Division of Otolaryngology-Head and Neck Surgery, The University of Utah, Salt Lake City
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24
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Yang A, Kim D, Hwang PH, Lechner M. Telemedicine and Telementoring in Rhinology, Otology, and Laryngology: A Scoping Review. OTO Open 2022; 6:2473974X211072791. [PMID: 35274073 PMCID: PMC8902203 DOI: 10.1177/2473974x211072791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Telemedicine and telementoring have had a significant boost across
all medical and surgical specialties over the last decade and
especially during the COVID-19 pandemic. The aim of this scoping
review is to synthesize the current use of telemedicine and
telementoring in otorhinolaryngology and head and neck
surgery. Data Sources PubMed and Cochrane Library. Review Methods A scoping review search was conducted, which identified 469
articles. Following full-text screening by 2 researchers, 173
articles were eligible for inclusion and further categorized via
relevant subdomains. Conclusions Virtual encounters and telementoring are the 2 main applications of
telemedicine in otolaryngology. These applications can be
classified into 7 subdomains. Different ear, nose, and throat
subspecialties utilized certain telemedicine applications more
than others; for example, almost all articles on patient
engagement tools are rhinology based. Overall, telemedicine is
feasible, showing similar concordance when compared with
traditional methods; it is also cost-effective, with high
patient and provider satisfaction. Implications for Practice Telemedicine in otorhinolaryngology has been widely employed during
the COVID-19 pandemic and has a huge potential, especially with
regard to its distributing quality care to rural areas. However,
it is important to note that with current exponential use, it is
equally crucial to ensure security and privacy and integrate
HIPAA-compliant systems (Health Insurance Portability and
Accountability Act) in the big data era. It is expected that
many more applications developed during the pandemic are here to
stay and will be refined in years to come.
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Affiliation(s)
- Angela Yang
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Dayoung Kim
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Peter H. Hwang
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Matt Lechner
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
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25
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Remote Voice Treatment with Transgender Individuals: A Health Care Equity Opportunity. J Voice 2022; 36:443-444. [PMID: 35165003 PMCID: PMC8832385 DOI: 10.1016/j.jvoice.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 11/20/2022]
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26
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Dahl KL, Weerathunge HR, Buckley DP, Dolling AS, Díaz-Cádiz M, Tracy LF, Stepp CE. Reliability and Accuracy of Expert Auditory-Perceptual Evaluation of Voice via Telepractice Platforms. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2446-2455. [PMID: 34473568 PMCID: PMC9132030 DOI: 10.1044/2021_ajslp-21-00091] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 05/24/2023]
Abstract
Purpose This study assessed the reliability and accuracy of auditory-perceptual voice evaluations by experienced clinicians via telepractice platforms. Method Voice samples from 20 individuals were recorded after transmission via telepractice platforms. Twenty experienced clinicians (10 speech-language pathologists, 10 laryngologists) evaluated the samples for dysphonia percepts (overall severity, roughness, breathiness, and strain) using a modified Consensus Auditory-Perceptual Evaluation of Voice. Reliability was calculated as the mean of squared differences between repeated ratings (intrarater agreement), and between individual and group mean ratings (interrater agreement). Repeated measures analyses of variance were constructed to measure effects of transmission condition (e.g., original recording, WebEx, Zoom), dysphonia percept, and their interaction on intrarater agreement, interrater agreement, and average ratings. Significant effects were evaluated with post hoc Tukey's tests. Results There were significant effects of transmission condition, percept, and their interaction on average ratings, and a significant effect of percept on interrater agreement. Post hoc testing revealed statistically, but not clinically, significant differences in average roughness ratings across transmission conditions, and significant differences in interrater agreement for several percepts. Overall severity had the highest agreement and strain had the lowest. Conclusion Telepractice transmission does not substantially reduce reliability or accuracy of auditory-perceptual voice evaluations by experienced clinicians.
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Affiliation(s)
- Kimberly L. Dahl
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Hasini R. Weerathunge
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston, University, MA
| | - Daniel P. Buckley
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Department of Otolaryngology—Head & Neck Surgery, Boston, University School of Medicine, MA
| | - Anton S. Dolling
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Manuel Díaz-Cádiz
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Lauren F. Tracy
- Department of Otolaryngology—Head & Neck Surgery, Boston, University School of Medicine, MA
| | - Cara E. Stepp
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Department of Otolaryngology—Head & Neck Surgery, Boston, University School of Medicine, MA
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27
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Abstract
Hoarseness is a common problem, typically of transient nature. When hoarseness does not resolve, or when it is associated with concerning symptoms, it is important to consider a wide differential and refer to an otolaryngologist. This article discusses the physiology of the voice and possible causes of dysphonia, and explores when it warrants further work-up by ENT. A discussion of diagnostic techniques and the myriad of tools to treat hoarseness follows. Additionally, the role of reflux in dysphonia is examined with a critical eye to aid in accurate assessment of the patient's complaint.
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Affiliation(s)
- Hayley Born
- Sean Parker Institute for the Voice at Weill Cornell Medicine, New York, NY, USA; Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, 240 East 59th Street, New York, NY, USA. https://twitter.com/drhayleyborn
| | - Anaïs Rameau
- Sean Parker Institute for the Voice at Weill Cornell Medicine, New York, NY, USA; Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, 240 East 59th Street, New York, NY, USA.
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Castillo-Allendes A, Contreras-Ruston F, Cantor L, Codino J, Guzman M, Malebran C, Manzano C, Pavez A, Vaiano T, Wilder F, Behlau M. Terapia de voz en el contexto de la pandemia covid-19; recomendaciones para la práctica clínica. J Voice 2021; 35:808.e1-808.e12. [PMID: 32917457 PMCID: PMC7442931 DOI: 10.1016/j.jvoice.2020.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Since the beginning of the new pandemic, COVID-19 health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment. OBJECTIVE To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists. METHODS A group of 11 experts in voice and swallowing disorders from 5 different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context. RESULTS The clinical guide provides 79 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics. CONCLUSION This guideline should be taken only as recommendations; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.
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Affiliation(s)
- Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Francisco Contreras-Ruston
- Speech-Language Pathology and Audiology Department, Universidad de Valparaíso, San Felipe, Chile,Address correspondence and reprint requests to Francisco Contreras-Ruston, CEV–Centro de Estudos da Voz, Rua Machado Bittencourt, 361, SP 04044-001, Brazil
| | - Lady Cantor
- Department of Collective Health, Universidad Nacional de Colombia, Bogotá, Colombia,Program of Speech and Language Pathology, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Juliana Codino
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan,Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Marco Guzman
- Universidad de los Andes, Chile, Santiago, Chile
| | - Celina Malebran
- Escuela de Fonoaudiología, Universidad Católica Silva Henríquez, Santiago, Chile
| | - Carlos Manzano
- Hospital Médica Sur, Ciudad de México, México,Centro Médico ABC, Ciudad de México, México
| | - Axel Pavez
- Physical Medicine and Rehabilitation Service, Hospital de Urgencia Asistencia Pública. Santiago, Chile
| | - Thays Vaiano
- CEV - Centro de Estudos da Voz, São Paulo, Brazil,Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Fabiana Wilder
- Carrera de Fonoaudiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina,Servicio de Fonoudiología, Hospital de Clínicas “José de San Martin”, Buenos Aires, Argentina
| | - Mara Behlau
- CEV - Centro de Estudos da Voz, São Paulo, Brazil,Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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29
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Castillo-Allendes A, Contreras-Ruston F, Cantor L, Codino J, Guzman M, Malebran C, Manzano C, Pavez A, Vaiano T, Wilder F, Behlau M. Terapia Vocal No Contexto Da Pandemia Do Covid-19; Orientações Para A Prática Clínica. J Voice 2021; 35:808.e13-808.e24. [PMID: 32917460 PMCID: PMC7439998 DOI: 10.1016/j.jvoice.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Since the beginning of the new pandemic, Corona Virus Disease 2019 (COVID-19) health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment. OBJECTIVE To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists. METHODS A group of 11 experts in voice and swallowing disorders from five different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context. RESULT The clinical guide provides 79 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics. CONCLUSION This guideline should be taken only as recommendation; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.
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Affiliation(s)
- Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Francisco Contreras-Ruston
- Speech-Language Pathology and Audiology Department, Universidad de Valparaíso, San Felipe, Chile,Address correspondence and reprint requests to Francisco Contreras-Ruston, CEV–Centro de Estudos da Voz, Rua Machado Bittencourt, 361, SP 04044-001, Brazil
| | - Lady Cantor
- Department of Collective Health, Universidad Nacional de Colombia, Bogotá, Colombia,Program of Speech and Language Pathology, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Juliana Codino
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan,Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Marco Guzman
- Universidad de los Andes, Chile, Santiago, Chile
| | - Celina Malebran
- Escuela de Fonoaudiología, Universidad Católica Silva Henríquez, Santiago, Chile
| | - Carlos Manzano
- Hospital Médica Sur, Ciudad de México, México,Centro Médico ABC, Ciudad de México, México
| | - Axel Pavez
- Physical Medicine and Rehabilitation Service, Hospital de Urgencia Asistencia Pública. Santiago, Chile
| | - Thays Vaiano
- CEV - Centro de Estudos da Voz, São Paulo, Brazil,Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Fabiana Wilder
- Carrera de Fonoaudiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina,Servicio de Fonoudiología, Hospital de Clínicas “José de San Martin,” Buenos Aires, Argentina
| | - Mara Behlau
- CEV - Centro de Estudos da Voz, São Paulo, Brazil,Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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30
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Macoir J, Desmarais C, Martel‐Sauvageau V, Monetta L. Proactive changes in clinical practice as a result of the COVID-19 pandemic: Survey on use of telepractice by Quebec speech-language pathologists. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:1086-1096. [PMID: 34455652 PMCID: PMC8652496 DOI: 10.1111/1460-6984.12669] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/21/2021] [Accepted: 08/09/2021] [Indexed: 05/15/2023]
Abstract
BACKGROUND The coronavirus disease2019 (COVID-19) pandemic has led to important challenges in health and education service delivery. AIMS The present study aimed to document: (i) changes in the use of telepractice by speech-language pathology (SLP) professionals in Quebec since the start of the COVID-19 outbreak; (ii) perceptions of the feasibility of telepractice by SLPs; (iii) barriers to the use of telepractice; and (iv) the perceptions of SLP professionals regarding the main issues of telepractice. METHODS & PROCEDURES An online survey with closed and open, Likert scale and demographic questions was completed by 83 SLPs in Quebec in June and July 2020. OUTCOMES & RESULTS The survey responses showed that within the cohort responding, telepractice use has increased significantly as a response to the COVID-19 pandemic. Most respondents planned to continue using telepractice after the pandemic ends. In addition, the respondents considered telepractice to be adequate for many clinical practices but less so for others (e.g., swallowing disorders, hearing impairment). Most of the reported barriers to the use of telepractice concerned technological problems and a lack of clinical materials for online use. Confidentiality and privacy issues were also raised. CONCLUSIONS & IMPLICATIONS SLP professionals rapidly took advantage of existing technologies in their clinical settings to cope with the pandemic's effects on service delivery. The discrepancy between their perceptions and the evidence in the literature for some practices and populations strengthens the need for more information and education on telepractice. WHAT THIS PAPER ADDS What is already known on the subject The proportion of speech-language pathologists (SLPs) in Canada who use telepractice for clinical activities is unknown. Knowing this information became crucial in the context of the coronavirus disease 2019 (COVID-19) pandemic because non-essential activities were interrupted to halt the spread of the disease. What this paper adds to existing knowledge The findings from this survey study confirmed that the use of telepractice in SLP in Quebec increased significantly during the COVID-19 pandemic. Moreover, the majority of the respondents began using telepractice because of the pandemic, and most planned to continue doing so after it ends. This demonstrates how SLP professionals rapidly took advantage of existing technologies in their clinical settings to cope with the pandemic's effects on service delivery. What are the potential or actual clinical implications of this work? Although the SLPs expressed an overall positive perception of telepractice, they also highlighted barriers to its optimal use. The findings of this study should help employers and regulatory bodies in Quebec to bring down those barriers and make telepractice in SLP a durable, effective and efficient service delivery model.
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Affiliation(s)
- J. Macoir
- Département de réadaptation, Faculté de médecineUniversité LavalQuébecQuebecCanada
- Centre de recherche CERVO – Brain Research CentreQuébecQuebecCanada
| | - C. Desmarais
- Département de réadaptation, Faculté de médecineUniversité LavalQuébecQuebecCanada
- Centre interdisciplinaire de recherche en réadaptation et intégration socialeQuébecQuebecCanada
| | - V. Martel‐Sauvageau
- Département de réadaptation, Faculté de médecineUniversité LavalQuébecQuebecCanada
- Centre interdisciplinaire de recherche en réadaptation et intégration socialeQuébecQuebecCanada
| | - L. Monetta
- Département de réadaptation, Faculté de médecineUniversité LavalQuébecQuebecCanada
- Centre de recherche CERVO – Brain Research CentreQuébecQuebecCanada
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Castillo-Allendes A, Contreras-Ruston F, Cantor-Cutiva LC, Codino J, Guzman M, Malebran C, Manzano C, Pavez A, Vaiano T, Wilder F, Behlau M. Voice Therapy in the Context of the COVID-19 Pandemic: Guidelines for Clinical Practice. J Voice 2021; 35:717-727. [PMID: 32878736 PMCID: PMC7413113 DOI: 10.1016/j.jvoice.2020.08.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Since the beginning of the new pandemic, COVID-19 health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment. OBJECTIVE To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists. METHODS A group of 11 experts in voice and swallowing disorders from five different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context. RESULTS The clinical guide provides 65 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics. CONCLUSION This guideline should be taken only as recommendation; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.
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Affiliation(s)
- Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | | | - Lady Catherine Cantor-Cutiva
- Department of Collective Health, Universidad Nacional de Colombia, Bogotá, Colombia; Program of Speech and Language Pathology, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Juliana Codino
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan; Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Marco Guzman
- Universidad de los Andes, Chile, Santiago, Chile
| | - Celina Malebran
- Escuela de Fonoaudiología, Universidad Católica Silva Henríquez, Santiago, Chile
| | - Carlos Manzano
- Hospital Médica Sur, Ciudad de México, México; Centro Médico ABC, Ciudad de México, México
| | - Axel Pavez
- Physical Medicine and Rehabilitation Service, Hospital de Urgencia Asistencia Pública. Santiago, Chile
| | - Thays Vaiano
- CEV - Centro de Estudos da Voz, São Paulo, Brazil; Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Fabiana Wilder
- Carrera de Fonoaudiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina; Servicio de Fonoudiología, Hospital de Clínicas "José de San Martin", Buenos Aires, Argentina
| | - Mara Behlau
- CEV - Centro de Estudos da Voz, São Paulo, Brazil; Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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Weerathunge HR, Segina RK, Tracy L, Stepp CE. Accuracy of Acoustic Measures of Voice via Telepractice Videoconferencing Platforms. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2586-2599. [PMID: 34157251 PMCID: PMC8632479 DOI: 10.1044/2021_jslhr-20-00625] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/19/2020] [Accepted: 03/23/2021] [Indexed: 05/31/2023]
Abstract
Purpose Telepractice improves patient access to clinical care for voice disorders. Acoustic assessment has the potential to provide critical, objective information during telepractice, yet its validity via telepractice is currently unknown. The current study investigated the accuracy of acoustic measures of voice in a variety of telepractice platforms. Method Twenty-nine voice samples from individuals with dysphonia were transmitted over six video conferencing platforms (Zoom with and without enhancements, Cisco WebEx, Microsoft Teams, Doxy.me, and VSee Messenger). Standard time-, spectral-, and cepstral-based acoustic measures were calculated. The effect of transmission condition on each acoustic measure was assessed using repeated-measures analyses of variance. For those acoustic measures for which transmission condition was a significant factor, linear regression analysis was performed on the difference between the original recording and each telepractice platform, with the overall severity of dysphonia, Internet speed, and ambient noise from the transmitter as predictors. Results Transmission condition was a statistically significant factor for all acoustic measures except for mean fundamental frequency (f o). Ambient noise from the transmitter was a significant predictor of differences between platforms and the original recordings for all acoustic measures except f o measures. All telepractice platforms affected acoustic measures in a statistically significantly manner, although the effects of platforms varied by measure. Conclusions Overall, measures of f o were the least impacted by telepractice transmission. Microsoft Teams had the least and Zoom (with enhancements) had the most pronounced effects on acoustic measures. These results provide valuable insight into the relative validity of acoustic measures of voice when collected via telepractice. Supplemental Material https://doi.org/10.23641/asha.14794812.
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Affiliation(s)
- Hasini R. Weerathunge
- Department of Biomedical Engineering, Boston University, MA
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Roxanne K. Segina
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Lauren Tracy
- Department of Otolaryngology—Head & Neck Surgery, Boston University School of Medicine, MA
| | - Cara E. Stepp
- Department of Biomedical Engineering, Boston University, MA
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Department of Otolaryngology—Head & Neck Surgery, Boston University School of Medicine, MA
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Grillo EU. A Nonrandomized Trial for Student Teachers of an In-Person and Telepractice Global Voice Prevention and Therapy Model With Estill Voice Training Assessed by the VoiceEvalU8 App. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:566-583. [PMID: 33524262 PMCID: PMC8740681 DOI: 10.1044/2020_ajslp-20-00200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/03/2020] [Accepted: 11/03/2020] [Indexed: 05/30/2023]
Abstract
Purpose This study investigated the effects of the in-person and telepractice Global Voice Prevention and Therapy Model (GVPTM) treatment conditions and a control condition with vocally healthy student teachers. Method In this single-blinded, nonrandomized trial, 82 participants completed all aspects of the study. Estill Voice Training was used as the stimulability component of the GVPTM to train multiple new voices meeting all the vocal needs of the student teachers. Outcomes were assessed using acoustic, perceptual, and aerodynamic measures captured by the VoiceEvalU8 app at pre and post in fall and during student teaching in spring. Results Significant improvements were achieved for several acoustic and perceptual measures in the treatment conditions, but not in the control condition. The in-person and telepractice conditions produced similar results. The all-voiced phrase and connected speech were more successful in demonstrating voice change for some of the perturbation measures as compared to sustained /a/. Conclusions The treatment conditions were successful in improving the participants' voices for fundamental frequency and some acoustic perturbation measures while maintaining the improvements during student teaching. In addition, the treatment conditions were successful in decreasing the negative impact of voice-related quality of life and vocal fatigue during student teaching. Future research should address the effectiveness of the various components of the GVPTM, the application of the GVPTM with patients with voice disorders, the relevance of defining auditory-perceptual terms by the anatomy and physiology of the voice production system (i.e., Estill Voice Training), and the continued use of the VoiceEvalU8 app for clinical voice investigations. Supplemental Material https://doi.org/10.23641/asha.13626824.
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Affiliation(s)
- Elizabeth U. Grillo
- Department of Communication Sciences and Disorders, West Chester University, PA
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Kelchner LN, Fredeking JC, Zacharias SC. Using Telepractice to Deliver Pediatric Voice Care in a Changing World: Breaking down Challenges and Learning from Successes. Semin Speech Lang 2021; 42:54-63. [PMID: 33596604 DOI: 10.1055/s-0040-1722320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
For children with voice disorders, access to care has long been a challenge. Reasons for this include the challenge of qualifying children with isolated voice disorders for services within the public-school system as well as a family's geographic proximity to experienced clinicians who are in the healthcare system. Over the past decade, there have been both formal and informal investigations into the use of telepractice to deliver services to communicatively disordered children and adults, including those with voice disorders. Although barriers and obstacles existed, use of telepractice to deliver such services demonstrated both feasibility and, in some studies, effective outcomes. However, prior to spring of 2020, use of telepractice to deliver speech pathology services was not mainstream. This changed when the nation was forced to shut down many of its in-person healthcare and educational delivery due to the COVID-19 pandemic. This article summarizes select relevant literature pertaining to the use of telepractice in speech language pathology over the past decade and provides a case-based discussion of how it was and is currently being used to deliver pediatric voice care.
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Affiliation(s)
- Lisa N Kelchner
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, Ohio
| | - John C Fredeking
- Division of Speech Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Becker DR, Gillespie AI. In the Zoom Where It Happened: Telepractice and the Voice Clinic in 2020. Semin Speech Lang 2021; 42:64-72. [PMID: 33596605 DOI: 10.1055/s-0040-1722750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Telemedicine-conveying medical information virtually for planning, diagnosis, or treatment-has been a part of the American medical system for over 100 years. A constantly evolving modality, telepractice was a supplemental care delivery system for most speech-language pathologists (SLPs) until March 2020 when the COVID-19 pandemic forced clinical operations to halt in-person activities and convert as much as possible to virtual platforms. The purpose of this article is to provide an overview of the need for telepractice prior to and beyond the current pandemic, the efficacy of telepractice for the voice-specialized SLP, limitations of telepractice, and best practices for providing care over telepractice with a specific focus on voice disorder diagnosis and treatment.
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Affiliation(s)
- Diana Rose Becker
- Emory Voice Center, Department of Otolaryngology, Emory Healthcare, Emory University Hospital Midtown, Atlanta, Georgia
| | - Amanda I Gillespie
- Emory Voice Center, Department of Otolaryngology, Emory Healthcare, Emory University Hospital Midtown, Atlanta, Georgia
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Doll EJ, Braden MN, Thibeault SL. COVID-19 and Speech-Language Pathology Clinical Practice of Voice and Upper Airway Disorders. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:63-74. [PMID: 33332145 PMCID: PMC8740584 DOI: 10.1044/2020_ajslp-20-00228] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/20/2020] [Accepted: 10/14/2020] [Indexed: 05/31/2023]
Abstract
Purpose Evaluation and management of voice and upper airway disorders in adults and children, by speech-language pathologists worldwide, have been significantly altered by the COVID-19 pandemic. Secondary to the pathogenic nature of the virus in the respiratory tract and upper airway, it is essential that speech-language pathologists who specialize in these disorders are knowledgeable of current practices to provide evidence-based care while minimizing viral transmission. Understanding how and when SARS-CoV-2 spreads is critical to the development of effective infection prevention within clinical practices. Method We established an evidence-based clinical practice guide for clinicians working with voice and upper airway through a comprehensive evaluation of peer-reviewed journals, non-peer-reviewed manuscripts on preprint servers, national health guidelines, and published and online consensus statements and emerging data. Emphasis was placed on risk mitigation for viral transmission via safe clinical practices, including evaluative procedures, therapy including telehealth, personal protective equipment, room, staffing, and distancing considerations. Results/Conclusions While knowledge relevant to viral transmission of SARS-CoV-2 is rapidly evolving, there is a paucity of literature specific to the evaluation and treatment of voice and upper airway disorders. Within these confines and given the potentially significant high risk of infection secondary to the nature of COVID-19, we summarize current considerations and recommend best practices that maximize risk mitigation whereby ensuring patient and provider safety.
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Jung SI, Lim S, Jo E, Sim HS, Sung JE, Kim YT. The Efficacy of Telepractice Intervention for Children & Adolescents with Speech, Language & Hearing Impairments: a Meta-Analysis. COMMUNICATION SCIENCES & DISORDERS 2020. [DOI: 10.12963/csd.20756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lin FC, Chien HY, Chen SH, Kao YC, Cheng PW, Wang CT. Voice Therapy for Benign Voice Disorders in the Elderly: A Randomized Controlled Trial Comparing Telepractice and Conventional Face-to-Face Therapy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2132-2140. [PMID: 32579859 DOI: 10.1044/2020_jslhr-19-00364] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Previous studies have reported that voice therapy via telepractice is useful for patients with nodules and muscle tension dysphonia. Nevertheless, telepractice for elderly patients with voice disorders has not yet been investigated. We conducted this study to examine the hypothesis that voice therapy via telepractice is not inferior to conventional voice therapy. Method Eighty patients with dysphonia aged more than 55 years participated in this study from September 2016 to June 2018. After screening the inclusion and the exclusion criteria, 69 patients were randomized into telepractice (33 patients) and conventional (36 patients) groups. The outcome measurements included Voice Handicap Index-10, videolaryngostroboscopy, maximum phonation time, auditory-perceptual evaluation, and acoustic analysis. Paired t test, Wilcoxon signed-ranks test, and repeated measures analysis of variance were used to examine treatment outcomes. Results The diagnoses of voice disorders included atrophy (n = 33), unilateral vocal paralysis (n = 13), muscle tension dysphonia (n = 7), nodules (n = 6), and polyps (n = 10). No significant differences were observed in age, sex, and baseline measurements between the two groups. Twenty-five patients in the telepractice group and 24 patients in the control group completed at least four weekly sessions. Significant improvements were observed for all the outcome measures (p < .05) in both groups. Improvements in Voice Handicap Index-10 in the telepractice group (24.84 ± 5.49 to 16.80 ± 8.94) were comparable to those in the conventional group (22.17 ± 7.29 to 13.46 ± 9.95, p = .764). Other parameters also showed comparable improvements between the two groups without statistically significant differences. Conclusions This is the first randomized controlled trial comparing telepractice and conventional voice therapy in elderly patients with voice disorders. The results showed that the effectiveness of voice therapy via telepractice was not inferior to that of conventional voice therapy, indicating that telepractice can be used as an alternative to provide voice care for elderly patients with vocal disorders.
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Affiliation(s)
- Feng-Chuan Lin
- Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
| | - Hsin-Yu Chien
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Sheng Hwa Chen
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Yi-Chia Kao
- Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
- Department of Electric Engineering, Yuan Ze University, Taoyuan, Taiwan
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Lowell SY, Colton RH, Kelley RT, Auld M, Schmitz H. Isolated and Combined Respiratory Training for Muscle Tension Dysphonia: Preliminary Findings. J Voice 2020; 36:361-382. [PMID: 32682682 DOI: 10.1016/j.jvoice.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to determine the feasibility of altering speech breathing patterns and dysphonia severity through training increased levels of lung volume use during speech. It was hypothesized that respiratory-based training would increase lung volume levels during speech as well as improve acoustic voice measures, and that the addition of laryngeal-based treatment would further improve voice acoustics by treatment completion. METHOD A multiple baseline, single subject design was replicated over six participants with primary muscle tension dysphonia as a preliminary investigation of novel respiratory treatment methods. Following four baseline probes (1-4), two phases of treatment were implemented over 6 weeks. Respiratory lung volume-based training (RLVT) and subsequent performance was probed at sessions 5 to 7 and laryngeal-based training was added to the RLVT and probed at sessions 8 to 10. Visual biofeedback was used during RLVT to assist the motor learning process. Respiratory outcome measures of lung volume initiation, termination and excursion were objectively measured using respiratory plethysmography (InductoTrace), and cepstral and spectral-based acoustic measures were also determined at each time point. RESULTS All participants showed improvement in one or more respiratory measures as well as reduced acoustic dysphonia severity following phase 1 of RLVT alone. Two participants achieved further marked improvement in acoustic voice measures after laryngeal-based training was added in phase 2 of treatment, but this was generally also accompanied by further improvement or stabilization of respiratory measures. CONCLUSION Results from this preliminary study support the feasibility of RLVT for improving speech breathing behavior, and suggest that RLVT alone can improve objectively measured dysphonia severity.
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Affiliation(s)
- Soren Y Lowell
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York.
| | - Raymond H Colton
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York
| | - Richard T Kelley
- Department of Otolaryngology & Communication Sciences, SUNY Upstate Medical University, Syracuse, New York
| | - Madeline Auld
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York
| | - Hanna Schmitz
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York
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Implementation of Telemedicine in a Laryngology Practice During the COVID-19 Pandemic: Lessons Learned, Experiences Shared. J Voice 2020; 36:396-402. [PMID: 32778359 PMCID: PMC7309798 DOI: 10.1016/j.jvoice.2020.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022]
Abstract
Objectives The novel coronavirus disease 2019 has posed significant limitations and barriers to providing in-person healthcare. We aim to provide a summary of learned experiences and important considerations for implementing and offering telehealth to provide laryngology subspecialty care during the COVID-19 pandemic and thereafter. Materials and Methods Four laryngologists and a voice-specialized speech-language pathologist from a tertiary-care academic Voice and Swallowing Center were engaged in a structured group consensus conference. Participants shared input, experiences, and practice patterns employed via telemedicine (via telephone or video-communication) during the early COVID-19 era. Results Key identified areas of consideration when offering telemedicine included (1) how to set up and structure a telemedicine visit and maintain patient confidentiality, (2) patient examination and treatment initiation, (3) optimization of the tele-visit, (4) limitations and recognition of when a tele-visit is insufficient for patient care needs, (5) billing/reimbursement considerations. Group consensus for the aforementioned topics is summarized and discussed. Conclusion During the COVID-19 pandemic, a telemedicine model can be effectively employed to improve patient access to subspecialty laryngology care, including a multidisciplinary care approach, with initiation of various therapeutic interventions. A major limitation given the preclusion of in-person assessment is the lack of access to laryngoscopy, which can likely be delayed safely in the majority of individuals.
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Zughni LA, Gillespie AI, Hatcher JL, Rubin AD, Giliberto JP. Telemedicine and the Interdisciplinary Clinic Model: During the COVID-19 Pandemic and Beyond. Otolaryngol Head Neck Surg 2020; 163:673-675. [PMID: 32484731 DOI: 10.1177/0194599820932167] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The emergence of the novel coronavirus disease 2019 (COVID-19) and the subsequent need for physical distancing have necessitated a swift change in health care delivery. Prior to the COVID-19 outbreak, many institutions utilized an interdisciplinary clinic model including both a laryngologist and a speech-language pathologist for the evaluation of patients with voice, swallowing, and upper airway disorders. To improve access, many providers are pursuing the use of interdisciplinary telemedicine to provide individualized patient-centered care while allowing for physical distancing. The purpose of this commentary is to review the current literature regarding telemedicine in laryngology and speech-language pathology as well as the current and future states of practice for interdisciplinary tele-evaluations.
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Affiliation(s)
- Lisa A Zughni
- Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, USA
| | - Amanda I Gillespie
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Jeanne L Hatcher
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Adam D Rubin
- Lakeshore Ear, Nose, and Throat Center, St Clair Shores, Michigan, USA
| | - John Paul Giliberto
- Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, USA
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Weidner K, Lowman J. Telepractice for Adult Speech-Language Pathology Services: A Systematic Review. ACTA ACUST UNITED AC 2020. [DOI: 10.1044/2019_persp-19-00146] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
We conducted a systematic review of the literature regarding adult telepractice services (screening, assessment, and treatment) from approximately 2014 to 2019.
Method
Thirty-one relevant studies were identified from a literature search, assessed for quality, and reported.
Results
Included studies illustrated feasibility, efficacy, diagnostic accuracy, and noninferiority of various speech-language pathology services across adult populations, including chronic aphasia, Parkinson's disease, dysphagia, and primary progressive aphasia. Technical aspects of the equipment and software used to deliver services were discussed. Some general themes were noted as areas for future research.
Conclusion
Overall, results of the review continue to support the use of telepractice as an appropriate service delivery model in speech-language pathology for adults. Strong research designs, including experimental control, across multiple well-described settings are still needed to definitively determine effectiveness of telepractice services.
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Affiliation(s)
- Kristen Weidner
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington
| | - Joneen Lowman
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington
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Meerschman I, Claeys S, Bettens K, Bruneel L, D'haeseleer E, Van Lierde K. Massed Versus Spaced Practice in Vocology: Effect of a Short-Term Intensive Voice Therapy Versus a Long-Term Traditional Voice Therapy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:611-630. [PMID: 30950739 DOI: 10.1044/2018_jslhr-s-18-0013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The aim of this study was to compare the effect of a short-term intensive voice therapy (IVT) with a long-term traditional voice therapy (TVT) on the vocal quality, vocal capacities, psychosocial impact, vocal tract discomfort, laryngological anatomy/physiology, and session attendance of patients with dysphonia. An additional comparison was made between an individual IVT (IVT-I) and a group IVT (IVT-G). Method A longitudinal, prospective controlled trial was used. Forty-six adults diagnosed with dysphonia were assigned to 1 of the 3 treatment groups. The IVT groups practiced with a frequency of 1 hr 20 min a day and a duration of 2 weeks. The TVT group practiced with a frequency of two 30-min sessions a week and a duration of 6 months. Both therapy programs were content-identical and guided by the same voice therapist. A multidimensional voice assessment consisting of both objective (maximum performance task, aerodynamic measurements, voice range profile, acoustic analysis, multiparametric voice quality indices) and subjective (subject's self-report, auditory-perceptual evaluation, flexible videolaryngostroboscopy) outcomes was used to evaluate the participants' voice. Results IVT made an equal progress in only 2 weeks and 12 hr of therapy compared with TVT that needed 6 months and 24 hr of therapy. IVT-I and IVT-G showed comparable results. Session attendance was clearly higher in IVT compared with TVT. Long-term follow-up results (1 year) were positive for the 3 groups, except for the self-reported psychosocial impact that increased in the IVT-I group. Conclusions Short-term IVT is at least equally effective in treating patients with dysphonia as long-term TVT. Group treatment seemed as effective as individual treatment. Attendance and cost-effectiveness are important advantages of IVT. A potential drawback might be an insufficient psychosocial progress. The golden mean between intensive and traditional treatment might therefore be an achievable, effective, and efficient solution for everyday clinical practice. Supplemental Material https://doi.org/10.23641/asha.7761872.
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Affiliation(s)
- Iris Meerschman
- Department of Rehabilitation Sciences, Research group: Speech, Language and Hearing Sciences, Ghent University, Belgium
| | - Sofie Claeys
- Department of Otorhinolaryngology, Ghent University, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Research group: Speech, Language and Hearing Sciences, Ghent University, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Research group: Speech, Language and Hearing Sciences, Ghent University, Belgium
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Research group: Speech, Language and Hearing Sciences, Ghent University, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Research group: Speech, Language and Hearing Sciences, Ghent University, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
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Grillo EU. Building a Successful Voice Telepractice Program. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2019; 4:100-110. [PMID: 31544152 PMCID: PMC6754185 DOI: 10.1044/2018_pers-sig3-2018-0014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Telepractice offers prevention, assessment, treatment, and consultation at a distance. This article provides an overview of telepractice with specific considerations and examples related to voice across licensure requirements, state and federal laws, reimbursement, documentation, and telepractice methods. CONCLUSION As technology continues to advance and as client demand for telepractice services increases, practitioners need to create successful telepractice programs.
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Affiliation(s)
- Elizabeth U. Grillo
- Department of Communication Sciences and Disorders, West Chester University, PA
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DePietro JD, Rubin S, Stein DJ, Golan H, Noordzij JP. Laryngeal Manipulation for Dysphagia with Muscle Tension Dysphonia. Dysphagia 2018; 33:468-473. [PMID: 29372358 DOI: 10.1007/s00455-018-9875-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/05/2018] [Indexed: 11/29/2022]
Abstract
The purpose of the article is to describe the use of laryngeal manipulation as a treatment for dysphagia resulting from excessive paralaryngeal muscle tension and to identify the patients likely to have symptomatic improvement. This is a retrospective single-center case series. A retrospective review identified patients from 2007 to 2013 with laryngeal manipulation for muscle tension dysphagia in an academic Otolaryngology practice. Subjects with dysphagia not attributable to an anatomic cause who attended therapy at least one time were included in the study. The primary outcome of the study was subjective improvement in dysphagia symptoms (yes/no) during follow-up. Symptoms, demographic information, treatment, and response to therapy were recorded. The Kruskal-Wallis test was used for analysis of continuous variables, while a Chi-squared test or fisher's exact test was used for analysis of all categorical variables. Forty-four subjects were included, consisting of 37 women and 7 men. Subjective improvement in dysphagia was seen in 34 subjects (77.3%). No significant differences were seen in improvement based on gender (p = 0.3223), race (p = 0.4317), number of sessions with a speech pathologist (p = 0.3198), or presenting symptoms including hoarseness (p = 0.0853), pain (p = 1.000), globus (p = 0.2834), and cough (p = 1.000). We found subjective improvement with laryngeal manipulation as reported during follow-up visits to clinic among individuals with muscle tension dysphagia. Patient age, presenting symptoms, and number of therapy sessions were not found to be significantly associated with resolution of symptoms.
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Affiliation(s)
- Joseph D DePietro
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Samuel Rubin
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Daniel J Stein
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Hadas Golan
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - J Pieter Noordzij
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, 820 Harrison Avenue, Boston, MA, 02118, USA.
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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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Bowen AJ, Huang TL, Benninger MS, Bryson PC. Medialization Laryngoplasty in the Elderly: Outcomes and Expectations. Otolaryngol Head Neck Surg 2017; 157:664-669. [DOI: 10.1177/0194599817718783] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To describe the profile and outcomes of elderly patients undergoing medialization laryngoplasty for vocal cord paralysis. Study Design Case series with retrospective review. Setting Tertiary care hospital. Subjects and Methods Patients were included in the study if they were >65 years old at the time of medialization laryngoplasty between 2008 and 2015. Patient comorbidities, anticoagulation status, disease etiology, and physical examination findings were recorded with postoperative length of stay, complications, pre- and posttreatment voice outcomes with the Voice Handicap Index (at 6 weeks, 4 months, 8 months, and 1 year), and postprocedural interventions (revision injections, surgery, therapy). Results A total of 112 patients met the eligibility criteria. Iatrogenic injury to the recurrent laryngeal nerve (50%) was the most common etiology, followed by idiopathic (31%) causes. Sixty percent of patients were receiving long-term antiplatelet and/or anticoagulation therapy. All but 14 patients on aspirin therapy stopped their antiplatelet/anticoagulation therapy prior to surgery. Most patients were discharged on the day of surgery. Postprocedure Voice Handicap Index scores significantly improved ( P < .001) by 47%, 53%, 64%, and 57% at each of the 4 measured postprocedure dates, respectively. Two patients had major nonsurgical complications postoperatively requiring inpatient hospitalization. Chi-square analysis revealed no differences between intraoperative aspirin use, sex, or comorbidities and the incidence of complications ( P > .05). Conclusion The clinical profile and outcomes of our patients undergoing medialization laryngoplasty are comparable to those seen in younger cohorts. Medialization laryngoplasty is a safe and successful option for elderly patients with vocal cord paralysis and vocal handicap.
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Affiliation(s)
| | | | | | - Paul C. Bryson
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
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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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Desjardins M, Halstead L, Cooke M, Bonilha HS. A Systematic Review of Voice Therapy: What “Effectiveness” Really Implies. J Voice 2017; 31:392.e13-392.e32. [DOI: 10.1016/j.jvoice.2016.10.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/29/2016] [Accepted: 10/04/2016] [Indexed: 12/31/2022]
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Lavaissiéri P, Melo PED. Prototype app for voice therapy: a peer review. Codas 2017; 29:e20150300. [PMID: 28300955 DOI: 10.1590/2317-1782/20172015300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 06/16/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Voice speech therapy promotes changes in patients' voice-related habits and rehabilitation. Speech-language therapists use a host of materials ranging from pictures to electronic resources and computer tools as aids in this process. Mobile technology is attractive, interactive and a nearly constant feature in the daily routine of a large part of the population and has a growing application in healthcare. To develop a prototype application for voice therapy, submit it to peer assessment, and to improve the initial prototype based on these assessments. METHODS a prototype of the Q-Voz application was developed based on Apple's Human Interface Guidelines. The prototype was analyzed by seven speech therapists who work in the voice area. Improvements to the product were made based on these assessments. RESULTS all features of the application were considered satisfactory by most evaluators. All evaluators found the application very useful; evaluators reported that patients would find it easier to make changes in voice behavior with the application than without it; the evaluators stated they would use this application with their patients with dysphonia and in the process of rehabilitation and that the application offers useful tools for voice self-management. Based on the suggestions provided, six improvements were made to the prototype. CONCLUSION the prototype Q-Voz Application was developed and evaluated by seven judges and subsequently improved. All evaluators stated they would use the application with their patients undergoing rehabilitation, indicating that the Q-Voz Application for mobile devices can be considered an auxiliary tool for voice speech therapy.
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