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Ohlsson AC, Li Y, Gustavsson I, Hofling K, Wahle U, Österlind C, Iwarsson J. Voice Therapy Outcome: A Comparison Between Imitation Model Voice Therapy and Verbal Instructions Model Voice Therapy. J Voice 2024; 38:903-910. [PMID: 35227553 DOI: 10.1016/j.jvoice.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/18/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim was to compare voice outcomes over time in patients treated with Imitation Model voice therapy and Verbal Instructions Model voice therapy. METHODS A prospective clinical trial was performed with 56 consecutive patients diagnosed with a primary or secondary functional voice disorder. Thirty-one patients were included for voice therapy following the Imitation Model and 25 patients for the Verbal Instructions Model. Assessments included a self-rated Voice Handicap Index, self-perceived hoarseness and vocal fatigue, perceptual voice evaluation by a Speech Language Pathologist, and maximum Voice Range Profiles. All assessments were completed before therapy, at end of therapy, at six-months posttherapy follow-up and 12-months posttherapy follow-up. For maximum Voice Range Profiles group differences were also compared for effects from end-of-treatment to follow-up assessments. Linear mixed models were used for analysis. RESULTS Comparison between treatment groups showed significantly larger long-term improvement from the baseline, for verbal instructions model as compared to imitation model for Voice Handicap Index total, and also the physical and emotional subscales, while there was no difference between groups for the functional subscale. Also, voice quality improved more after verbal instructions model, as compared to imitation model, at end of therapy. Results from self-rated hoarseness and vocal fatigue showed no difference between groups. There was no difference between treatment groups in the change of maximum Voice Range Profile from end-of-treatment to follow-up assessments. CONCLUSIONS The study showed that both Imitation Model voice therapy and Verbal Instructions Model voice therapy improved voice function. Compared to Imitation Model, the Verbal Instructions model showed larger long-term effect on physical and emotional aspects of voice function in everyday life. The two approaches for voice therapy might have different impacts on patients' learning.
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Affiliation(s)
- Ann-Christine Ohlsson
- Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Ying Li
- Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Inger Gustavsson
- Department of Speech Language Pathology, ENT Clinic, Hospital of South of Älvsborg, Borås, Sweden
| | - Kerstin Hofling
- Department of Speech Language Pathology, Hospital of Skaraborg (SkaS) Lidköping, Lidköping, Sweden
| | - Ulrika Wahle
- Department of Logopedics and Phoniatrics, ENT Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Claes Österlind
- Department of Speech Language Pathology, NU- healthcare, Trollhättan, Sweden
| | - Jenny Iwarsson
- Department of Scandinavian Studies and Linguistics, Audiologopedics, Copenhagen University, Copenhagen S, Denmark
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Leyns C, Adriaansen A, Daelman J, Bostyn L, Meerschman I, T'Sjoen G, D'haeseleer E. Long-term Acoustic Effects of Gender-Affirming Voice Training in Transgender Women. J Voice 2024:S0892-1997(24)00123-1. [PMID: 38704279 DOI: 10.1016/j.jvoice.2024.04.007] [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: 01/31/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES One role of a speech-language pathologist (SLP) is to help transgender clients in developing a healthy, gender-congruent communication. Transgender women frequently approach SLPs to train their voices to sound more feminine, however, long-term acoustic effects of the training needs to be rigorously examined in effectiveness studies. The aim of this study was to investigate the long-term effects (follow-up 1: 3months and follow-up 2: 1year after last session) of gender-affirming voice training for transgender women, in terms of acoustic parameters. STUDY DESIGN This study was a randomized sham-controlled trial with a cross-over design. METHODS Twenty-six transgender women were included for follow-up 1 and 18 for follow-up 2. All participants received 14weeks of gender-affirming voice training (4weeks sham training, 10weeks of voice feminization training: 5weeks pitch elevation training and 5weeks articulation-resonance training), but in a different order. Speech samples were recorded with Praat at four different time points (pre, post, follow-up 1, follow-up 2). Acoustic analysis included fo of sustained vowel /a:/, reading and spontaneous speech. Formant frequencies (F1-F2-F3) of vowels /a/, /i/, and /u/ were determined and vowel space was calculated. A linear mixed model was used to compare the acoustic voice measurements between measurements (pre - post, pre - follow-up 1, pre - follow-up 2, post - follow-up 1, post - follow-up 2, follow-up 1 - follow-up 2). RESULTS Most of the fo measurements and formant frequencies that increased immediately after the intervention, were stable at both follow-up measurements. The median fo during the sustained vowel, reading and spontaneous speech stayed increased at both follow-ups compared to the pre-measurement. However, a decrease of 16 Hz/1.7 ST (reading) and 12 Hz/1.5 ST (spontaneous speech) was detected between the post-measurement (169 Hz for reading, 144 Hz for spontaneous speech) and 1year after the last session (153 Hz and 132 Hz, respectively). The lower limit of fo did not change during reading and spontaneous speech, both directly after the intervention and during both follow-ups. F1-2 of vowel /a/ and the vowel space increased after the intervention and both follow-ups. Individual analyses showed that more aspects should be controlled after the intervention, such as exercises that were performed at home, or the duration of extra gender-affirming voice training sessions. CONCLUSIONS After 10 sessions of voice feminization training and follow-up measurements after 3months and 1year, stable increases were found for some formant frequencies and fo measurements, but not all of them. More time should be spent on increasing the fifth percentile of fo, as the lower limit of fo also contributes to the perception of more feminine voice.
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Affiliation(s)
- Clara Leyns
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Anke Adriaansen
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Julie Daelman
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Liese Bostyn
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Iris Meerschman
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Guy T'Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium; Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Evelien D'haeseleer
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; Musical Department, School of Arts, Royal Conservatory Brussels, Brussels, Belgium
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Södersten M, Oates J, Sand A, Granqvist S, Quinn S, Dacakis G, Nygren U. Gender-Affirming Voice Training for Trans Women: Acoustic Outcomes and Their Associations With Listener Perceptions Related to Gender. J Voice 2024:S0892-1997(24)00023-7. [PMID: 38503674 DOI: 10.1016/j.jvoice.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES To investigate acoustic outcomes of gender-affirming voice training for trans women wanting to develop a female sounding voice and to describe what happens acoustically when male sounding voices become more female sounding. STUDY DESIGN Prospective treatment study with repeated measures. METHODS N = 74 trans women completed a voice training program of 8-12 sessions and had their voices audio recorded twice before and twice after training. Reference data were obtained from N = 40 cisgender speakers. Fundamental frequency (fo), formant frequencies (F1-F4), sound pressure level (Leq), and level difference between first and second harmonic (L1-L2) were extracted from a reading passage and spontaneous speech. N = 79 naive listeners provided gender-related ratings of participants' audio recordings. A linear mixed-effects model was used to estimate average training effects. Individual level analyses determined how changes in acoustic data were related to listeners' ratings. RESULTS Group data showed substantial training effects on fo (average, minimum, and maximum) and formant frequencies. Individual data demonstrated that many participants also increased Leq and some increased L1-L2. Measures that most strongly predicted listener ratings of a female sounding voice were: fo, average formant frequency, and Leq. CONCLUSIONS This is the largest prospective study reporting on acoustic outcomes of gender-affirming voice training for trans women. We confirm findings from previous smaller scale studies by demonstrating that listener perceptions of male and female sounding voices are related to acoustic voice features, and that voice training for trans women wanting to sound female is associated with desirable acoustic changes, indicating training effectiveness. Although acoustic measures can be a valuable indicator of training effectiveness, particularly from the perspective of clinicians and researchers, we contend that a combination of outcome measures, including client perspectives, are needed to provide comprehensive evaluation of gender-affirming voice training that is relevant for all stakeholders.
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Affiliation(s)
- Maria Södersten
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden.
| | - Jennifer Oates
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Anders Sand
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Svante Granqvist
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Sterling Quinn
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Georgia Dacakis
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Ulrika Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
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Oates J, Södersten M, Quinn S, Nygren U, Dacakis G, Kelly V, Smith G, Sand A. Gender-Affirming Voice Training for Trans Women: Effectiveness of Training on Patient-Reported Outcomes and Listener Perceptions of Voice. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4206-4235. [PMID: 37844617 DOI: 10.1044/2023_jslhr-23-00258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
PURPOSE Although speech-language pathologists have provided gender-affirming voice training for trans women since the 1970s, evidence for this training's effectiveness remains weak. Our study aimed to redress limitations of earlier studies and evaluate voice training effects on outcomes important to trans women. METHOD Seventy-four trans women (19-54 years old) who wanted a more female-sounding voice were recruited through two health facilities and provided with an eight- to 12-session voice training program based on contemporary literature, usual clinical practice, and client-centered care principles. Self-reported outcomes and an audio-recorded reading sample were collected 3 months before, immediately before and after, and 3 months after training. Forty cisgender speakers were audio-recorded reading the same sample material as comparison voices. Seventy-nine naive listeners made gender-related voice ratings of an extract from these audio recordings. Training effectiveness was evaluated using group-level analyses (linear mixed-effects models) and individual-level analyses to establish what proportion of participants improved to a predetermined relevant degree. RESULTS Group-level analyses demonstrated positive training effects, maintained 3 months posttraining, for trans women's vocal satisfaction, perceptions of voice-related social participation, and self- and listener perceptions of their voices. Individual-level analyses also demonstrated positive effects. Two thirds of trans women increased vocal satisfaction to a relevant degree, one third who reported restricted social participation before training reduced this restriction to a relevant degree, and all were rated more female-sounding after training (although not all to a relevant degree). CONCLUSIONS All trans women participants made progress toward their voice goals and maintained those gains at follow-up. These findings provide evidence that gender-affirming speech-language pathology services warrant prioritization. Further research is warranted to investigate factors predicting outcomes of voice training for trans women.
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Affiliation(s)
- Jennifer Oates
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Maria Södersten
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Sterling Quinn
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Ulrika Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Georgia Dacakis
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Victoria Kelly
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Georgina Smith
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Anders Sand
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Aguiar ACD, Almeida LNA, Pernambuco L, Ramos N, Andrade JMD, Behlau M, Almeida AA. Urica-VV Scale: A New Research Perspective of The Stage of Readiness for Treatment in Patients with Dysphonia. J Voice 2023; 37:807-821. [PMID: 34272143 DOI: 10.1016/j.jvoice.2021.06.004] [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: 03/06/2021] [Revised: 05/31/2021] [Accepted: 06/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To obtain evidence of validity for the URICA-V scale and estimate the psychometric properties of its items based on item response theory (IRT). METHOD A total of 658 individuals of both sexes over 18 years of age were allocated into two groups: with dysphonia group (WDG) and vocally healthy group (VHG). A digital database was constructed with personal and professional data and item-by-item responses on the URICA-V scale. Subsequently, Cronbach's alpha, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), application of IRT using Samejima's model and ROC curve analysis were used to obtain the cutoff point for the URICA-V scale. RESULTS A different version of the original URICA-V scale was obtained. Of the 32 items from the original protocol, 25 better explained the instrument and were regrouped into two domains: contemplation and maintenance. It was possible to identify which items generated higher difficulty (b) and discrimination (a) values and which contributed to the presentation of a calculation based on the theta of each participant. The ROC curve was analyzed, and a cutoff point of -0.236 was established; establishing a cutoff point facilitates the decision of which individuals are in a state of readiness for voice treatment. CONCLUSION The present study provided evidence that allows us to propose the URICA-Voice validated (URICA-VV) scale within a more contemporary perspective and with a reduced number of items and domains. In addition, a cutoff point was obtained based on IRT to measure, with greater accuracy, sensitivity and specificity, the stage of readiness and to differentiate individuals who have an indication for speech therapy.
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Affiliation(s)
- Alexandra Christine de Aguiar
- Speech therapist. Master's degree in Speech Therapy and Doctoral Student in Decision and Health Models from Federal University of Paraíba (Universidade Federal da Paraíba - UFPB)
| | - Larissa Nadjara Alves Almeida
- Speech therapist. PhD in Decision and Health Models from Federal University of Paraíba (Federal University of Paraíba - UFPB)
| | - Leandro Pernambuco
- Speech therapist. Professor, Department of Speech Therapy, Federal University of Paraíba
| | - Noemi Ramos
- Speech therapist. Master's degree in Decision and Health Models from Federal University of Paraíba (Federal University of Paraíba - UFPB)
| | - Josemberg Moura de Andrade
- Psychologist. Professor, Department of Social and Work Psychology, University of Brasília (Universidade de Brasília - UnB)
| | - Mara Behlau
- Speech therapist. Professor, Graduate Program in Human Communication Disorders, Federal University of São Paulo - (Universidade Federal de São Paulo - UNIFESP). Centro de Estudos da Voz, São Paulo - SP
| | - Anna Alice Almeida
- Speech therapist. Professor, Department of Speech Therapy, Federal University of Paraíba.
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Kissel I, Papeleu T, Verbeke J, Van Lierde K, Meerschman I, D'haeseleer E. Immediate effects of a semi-occluded water-resistance ventilation mask on vocal outcomes in women with dysphonia. JOURNAL OF COMMUNICATION DISORDERS 2023; 103:106331. [PMID: 37098295 DOI: 10.1016/j.jcomdis.2023.106331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Semi-occluded vocal tract exercises (SOVTEs) are frequently used exercises in voice therapy. An important shortcoming to most SOVTEs is the inability to include continuous speech in these exercises. A variation of water-resistance therapy (WRT), during which a patient phonates through a resonance tube ending in water, was developed to include continuous speech: the semi-occluded water resistance ventilation mask (SOVM-WR). The current study investigated the immediate effects of this innovative technique on vocal outcomes of women with dysphonia. METHODS A pretest-posttest randomized controlled trial was performed. Twenty female participants were randomly assigned to the experimental SOVM-WR group or the WRT (control) group. A blinded multidimensional voice assessment was conducted before and after a 30-minute therapy session with the assigned technique. RESULTS No significant changes were found in acoustic or auditory-perceptual vocal outcomes in either of the groups, except for a significant increase in lowest frequency in both groups. Patient-reported outcomes (PROMs) showed significant improvements of vocal comfort, vocal effort, and voice quality in both groups, and participants indicated that they would use the techniques at home. CONCLUSIONS The similar results of the SOVM-WR to WRT and promising PROMs confirm its suitability as an alternative to the latter technique. Potential reasons for a lack of improvement of objective and auditory-perceptual vocal outcomes are vocal fatigue, tube dimensions and immersion, and the small sample size. Large-scale and longitudinal research is needed to examine whether the SOVM-WR has a higher transfer to spontaneous speech than WRT after a full therapy program.
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Affiliation(s)
- Imke Kissel
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Tine Papeleu
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Jolien Verbeke
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Kristiane Van Lierde
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Faculty of Humanities, Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Iris Meerschman
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Evelien D'haeseleer
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; Royal Conservatory Brussels, Musical Department, Brussels, Belgium
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Leyns C, Daelman J, Adriaansen A, Tomassen P, Morsomme D, T'Sjoen G, D'haeseleer E. Short-Term Acoustic Effects of Speech Therapy in Transgender Women: A Randomized Controlled Trial. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:145-168. [PMID: 36455242 DOI: 10.1044/2022_ajslp-22-00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE This study measured and compared the acoustic short-term effects of pitch elevation training (PET) and articulation-resonance training (ART) and the combination of both programs, in transgender women. METHOD A randomized controlled study with cross-over design was used. Thirty transgender women were included and received 14 weeks of speech training. All participants started with 4 weeks of sham training; after which they were randomly assigned to one of two groups: One group continued with PET (5 weeks), followed by ART (5 weeks); the second group received both trainings in opposite order. Participants were recorded 4 times, in between the training blocks: pre, post 1 (after sham), post 2 (after training 1), and post 3 (after training 2). Speech samples included a sustained vowel, continuous speech during reading, and spontaneous speech and were analyzed using Praat software. Fundamental frequency (f o), intensity, voice range profile, vowel formant frequencies (F 1-2-3-4-5 of /a/-/i/-/u/), formant contrasts, vowel space, and vocal quality (Acoustic Voice Quality Index) were determined. RESULTS AND CONCLUSIONS Fundamental frequencies increased after both the PET and ART program, with a higher increase after PET. The combination of both interventions showed a mean increase of the f o of 49 Hz during a sustained vowel, 49 Hz during reading, and 29 Hz during spontaneous speech. However, the lower limit (percentile 5) of the f o during spontaneous speech did not change. Higher values were detected for F 1-2 of /a/, F 3 of /u/, and vowel space after PET and ART separately. F 1-2-3 of /a/, F 1-3-4 of /u/, vowel space, and formant contrasts increased after the combination of PET and ART; hence, the combination induced more increases in formant frequencies. Intensity and voice quality measurements did not change. No order effect was detected; that is, starting with PET or ART did not change the outcome.
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Affiliation(s)
- Clara Leyns
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Julie Daelman
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Anke Adriaansen
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Peter Tomassen
- Department of Head and Neck Surgery, Ghent University Hospital, Belgium
| | | | - Guy T'Sjoen
- Department of Endocrinology, Ghent University Hospital, Belgium
- Center for Sexology and Gender, Ghent University Hospital, Belgium
| | - Evelien D'haeseleer
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Belgium
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Sirpa P, Paula S, Terhi A, Niemitalo-Haapola E, Anneli Y, Leena R. A Randomized Controlled Trial With Female Teachers: Are there Differences Between and Within the Outcomes in Voice Therapy Groups With and Without Carryover Strategies? J Voice 2022:S0892-1997(22)00191-6. [PMID: 35902298 DOI: 10.1016/j.jvoice.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE We investigated if outcomes differ between voice therapy groups systematically using carryover strategies (attempts to generalize new vocal skills outside the clinic) and voice therapy with no emphasis on any generalizing process (here referred to as traditional voice therapy). METHOD A randomized controlled trial was conducted. Participants (53 female teachers with voice disorders) were randomly allocated into three groups: Carryover (a group receiving voice therapy using carryover strategies), Trad (a group receiving voice therapy with no emphasis on any generalizing process), Controls (a group on an eight-week non-therapy period). Prior to the trial a direct laryngoscopy was performed with a videolaryngostroboscopy system and/or nasofaryngofiberoscope with stroboscopy. Before and after therapy and at follow-up a voice evaluation protocol was implemented consisting of subjective assessments (Questionnaire on Voice Symptoms, and the Voice Activity and Participation Profile; VAPP), and objective measurements (voice sample recordings, acoustic analysis [SPL, sound pressure level; f0, fundamental frequency; alpha-ratio, tilt of the sound spectrum slope]). RESULTS No differences were found between the groups. Several significant changes occurred within the groups between initial phase vs. post-therapy and initial phase vs. follow-up. In the Carryover group text reading the alpha-ratio became lower (P = 0.011) and spontaneous speech f0 increased (P = 0.024) after the therapy and [a:] SPL increased (P = 0.042) at follow-up. In the Trad group post-therapy [a:] alpha-ratio became lower (P = 0.012) and spontaneous speech f0 decreased (P = 0.034). After therapy VAPP scores showed improvement in voice-related quality of life in both therapy groups (Carryover P = 0.003; Trad P = 0.01) but only in Carryover at follow-up (P = 0.000). Voice symptoms decreased in the Carryover group post-therapy (P = 0.001) and at follow-up (P = 0.000) and after Controls' eight-week non-therapy period (P = 0.003). CONCLUSION The results showed that carryover strategies give no additional advantages in voice therapy. However, the decreasing trend in the Carryover group's voice complaints at follow-up would suggest that carryover strategies may have long-lasting effects. The results also confirm that voice therapy is efficient in improving voice-related quality of life.
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Affiliation(s)
- Pirilä Sirpa
- Faculty of Social Sciences, University of Tampere, Tampere, Finland.
| | - Saarentaus Paula
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Ansamaa Terhi
- Department of Otorhinolaryngology, Oulu University Hospital, Oulu, Finland
| | - Elina Niemitalo-Haapola
- Faculty of Humanities/Logopedics, Child Language Research, University of Oulu, Oulu, Finland
| | - Yliherva Anneli
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Rantala Leena
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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Bartlett RS, Carpenter AM, Chapman LK. A Systematic Review of Adherence Strategies for Adult Populations in Speech-Language Pathology Treatment. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1501-1516. [PMID: 35320678 DOI: 10.1044/2022_ajslp-21-00255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Speech-language pathologists (SLPs) often advise adult patients to complete at-home programs in order to improve outcomes. Despite this widespread practice, relatively little is known about treatment adherence. The purposes of this systematic review were to identify adherence strategies and adherence tracking methods used by adult populations that are commonly treated by SLPs (i.e., dysphagia, aphasia, traumatic brain injury, dysphonia, dysarthria), and to identify the efficacy of these strategies. METHOD The systematic review was conducted in accordance with A Measurement Tool to Assess Systematic Reviews guidelines. A comprehensive literature search was performed in three databases (CINAHL, PubMed, and Web of Science). RESULTS Of the 679 articles found, 18 were selected for analysis. Two thirds of the included articles received the second highest rating on the 5-point JAMA Quality Rating Scheme. Interventions designed to alter treatment adherence included (most to least frequent) computer programs, portable devices/phone apps, alarm reminders, instructional DVDs, check-ins from a clinician/volunteer, and wearable device. Adherence reporting methods included (most to least frequent) self-report diaries, computer program/app-aided collection, wearable device, and clinician/volunteer observation. Of the articles that reported practice frequency, 58% found that adherence strategies improved practice frequency as compared to control. Of the articles that reported treatment outcomes, 66% found that adherence strategies were associated with improved treatment outcomes as compared to control. CONCLUSIONS The paucity of publications reviewed suggests that treatment adherence is considerably understudied in speech-language pathology. A clearer understanding of how to improve the design of adherence strategies could yield highly valuable clinical outcomes. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19393793.
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Dacakis G, Erasmus J, Nygren U, Oates J, Quinn S, Södersten M. Development and Initial Psychometric Evaluation of the Self-Efficacy Scale for Voice Modification in Trans Women. J Voice 2022:S0892-1997(22)00078-9. [PMID: 35513936 DOI: 10.1016/j.jvoice.2022.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To develop a self-efficacy questionnaire for voice modification related to gender affirmation and to examine the internal consistency and test-retest reliability of the questionnaire among a cohort of trans women. METHODS This study was undertaken in two phases. In phase I, four Speech- Language Pathologists (SLPs) and four trans women informed the development of the Self-Efficacy Scale for Voice Modification in Trans Women (SES-VMTW). In phase II, using classical test theory, data from 31 Australian and 27 Swedish trans women who completed the SES-VMTW twice with an interim period of 3-6 weeks were analyzed for internal consistency and test-retest reliability. During this second phase, the 19 items of the SES-VMTW were subcategorized by consensus among the authors into like groups. RESULTS Phase I resulted in the 19-item SES-VMTW and four subcategories were identified: 1) Change (items related to changing voice); 2) Perception (items related to the ability to perceive changes in voice; 3) Psychological (items related to engaging in voice practice despite psychological barriers; 4) Logistical (items related to engaging in voice practice despite logistical barriers). In Phase II, initial psychometric analysis was applied to the full questionnaire as well as to the subcategories. The Cronbach's alpha for the full questionnaire (α = 0.86) at both the test and retest timepoints indicates a high level of internal consistency. Item-total correlation analysis indicated that individual items correlated with the questionnaire total score, but that they generally correlated more strongly with the total score for the relevant subcategory. The Cronbach's alpha for the four subcategories of the SES-VMTW were variable but all coefficients exceeded 0.6, thus supporting the reliability of the new scale. Good test-retest reliability was demonstrated for the full questionnaire (intraclass correlation coefficient = 0.84; 95% confidence interval, 0.73-0.90, P < 0.001) and was moderate to good for the four subcategories. CONCLUSION The findings of the current study are promising, suggesting that both the full SES-VMTW and the four subcategories can provide consistent and reliable insight into self-efficacy for trans women aiming to modify their voice as part of their gender affirmation.
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Affiliation(s)
- Georgia Dacakis
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Jaco Erasmus
- Gender Clinic, Monash Health, Clayton, Victoria, Australia
| | - Ulrika Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Jennifer Oates
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Sterling Quinn
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Maria Södersten
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
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Gartner-Schmidt JL, Belsky MA, Awan S, Gillespie AI. Clinician and Patient Perception of a Voice Therapy Program Utilizing a Variably Occluded Face Mask: A Pilot Study. Folia Phoniatr Logop 2022; 74:381-391. [PMID: 35203078 DOI: 10.1159/000523686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/11/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The purpose of this investigation was to assess clinician and patient feedback about voice therapy using a variably occluded face mask (VOFM) and to determine if voice therapy augmented via a VOFM would result in favorable changes in patient self-perceived handicap, as well as acoustic and aerodynamic measures. METHODS/DESIGN This pilot study used a prospective, pre-post single group design. Eleven patients with dysphonia due to primary muscle tension dysphonia (8) or benign vocal fold lesions (3) were recruited. Data collected included patient and clinician feedback of voice therapy using a VOFM, voice handicap index (VHI)-10, acoustic and aerodynamic measures. Data were collected before treatment (baseline) and 1-week post-therapy. Wilcoxon signed-rank tests were used to compare data pre- and post-therapy. RESULTS Statistically significant improvement was observed for the VHI-10 with a median delta of -7. Clinician feedback generally reported that patients liked the VOFM, using the VOFM within the first two sessions of therapy, and within less than 10 min of use. All clinicians ranked the conversation level of the hierarchy as the most effective level. Three themes emerged from the Therapy Feedback Form: the VOFM was a (1) "Facilitator for Sensation," (2) a "Physical Tool," and that there was (3) "No Program Needed" to use the VOFM in voice therapy. There was a statistically significant improvement in cepstral peak prominence (p = 0.0329) and cepstral spectral index of dysphonia (p = 0.0164) in sustained vowels. DISCUSSION This pilot study represents the first investigation into clinician and patient perceptions of using a VOFM. Reported measures via patient perception, as well as clinician perceptions, and some acoustic and aerodynamic measures showed that participants got better with VOFM voice therapy. Last, in general, both clinicians and patients liked utilizing a VOFM in voice therapy.
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Affiliation(s)
- Jackie L Gartner-Schmidt
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael A Belsky
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shaheen Awan
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida, USA
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Active Ingredients of Voice Therapy for Muscle Tension Voice Disorders: A Retrospective Data Audit. J Clin Med 2021; 10:jcm10184135. [PMID: 34575246 PMCID: PMC8469541 DOI: 10.3390/jcm10184135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Although voice therapy is the first line treatment for muscle-tension voice disorders (MTVD), no clinical research has investigated the role of specific active ingredients. This study aimed to evaluate the efficacy of active ingredients in the treatment of MTVD. A retrospective review of a clinical voice database was conducted on 68 MTVD patients who were treated using the optimal phonation task (OPT) and sob voice quality (SVQ), as well as two different processes: task variation and negative practice (NP). Mixed-model analysis was performed on auditory–perceptual and acoustic data from voice recordings at baseline and after each technique. Active ingredients were evaluated using effect sizes. Significant overall treatment effects were observed for the treatment program. Effect sizes ranged from 0.34 (post-NP) to 0.387 (post-SVQ) for overall severity ratings. Effect sizes ranged from 0.237 (post-SVQ) to 0.445 (post-NP) for a smoothed cepstral peak prominence measure. The treatment effects did not depend upon the MTVD type (primary or secondary), treating clinicians, nor the number of sessions and days between sessions. Implementation of individual techniques that promote improved voice quality and processes that support learning resulted in improved habitual voice quality. Both voice techniques and processes can be considered as active ingredients in voice therapy.
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Morsomme D, Remacle A. Can ambulatory biofeedback help a transgender woman speak at a higher pitch? LOGOP PHONIATR VOCO 2021; 47:125-132. [PMID: 33660586 DOI: 10.1080/14015439.2021.1881158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: Voice feminization for transgender women remains a challenge. The fundamental frequency of the voice (fo) is one of the main parameters contributing to the perception of gender. One of the aims of voice therapy is to help transgender women acquire a new vocal motor behavior to increase their fo. We hypothesized that ambulatory biofeedback could help extend the new vocal behavior to daily life.Materials and methods: This prospective case study assessed the impact of two weeks of ambulatory vibrotactile biofeedback (VTBF) applied to one transgender woman, following two weeks of voice therapy (three 60-minute sessions). The VTBF was activated when the participant's voice was lower than 150 Hz for more than 500 ms and was accompanied by two 60-minute counseling sessions.Results: The results showed that mean fo monitored in daily activities tended to increase following the two weeks of voice therapy (Δ = 8 Hz or 1 semitone) and then increased significantly immediately after the two weeks of VTBF (Δ = 13 Hz or 1.5 semitones). The increase in mean fo from day to day and the decrease in the activation percentage from the first to the second week of VTBF (Δ = 6%) indicated a gradual integration of the motor behavior, making it possible to achieve the targeted female frequency.Conclusions: The results suggest that ambulatory VTBF helped the participant to generalize the techniques acquired during the voice therapy sessions to real-life communication situations. These results are promising for therapeutic programs that integrate tools that can be used outside the clinical context. Design: Prospective case study.
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Affiliation(s)
- Dominique Morsomme
- Voice Unit, Department of Speech and Language Therapy, University of Liège, Liège, Belgium
| | - Angélique Remacle
- Voice Unit, Department of Speech and Language Therapy, University of Liège, Liège, Belgium.,Fund for Scientific Research FNRS, Brussels, Belgium
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Gartner-Schmidt J, Gillespie AI. Conversation Training Therapy: Let's Talk It Through. Semin Speech Lang 2021; 42:32-40. [PMID: 33596602 DOI: 10.1055/s-0040-1722751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This article introduces a novel approach to voice therapy called conversation training therapy (CTT). CTT is the first voice therapy approach to remove the therapeutic hierarchy common in most treatment programs. Rather, CTT uses patient-driven conversation as the sole stimuli in therapy to increase perceptual awareness of voice production in conversational speech. The genesis as to why CTT was developed, as well as the conceptual, theoretical, and component parts of CTT, will be explained. In addition, this article will offer examples of the language of therapy, as it applies to CTT and how to trouble-shoot if problems arise. Medical documentation relevant to CTT will also be outlined. Last, results from a recent efficacy study on CTT will be reported.
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Affiliation(s)
- Jackie Gartner-Schmidt
- Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amanda I Gillespie
- Emory Voice Center, Department of Otolaryngology, Emory University School of Medicine, Emory University Hospital Midtown, Atlanta, Georgia
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15
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Helou LB, Gartner-Schmidt JL, Hapner ER, Schneider SL, Van Stan JH. Mapping Meta-Therapy in Voice Interventions onto the Rehabilitation Treatment Specification System. Semin Speech Lang 2021; 42:5-18. [PMID: 33596600 PMCID: PMC7935442 DOI: 10.1055/s-0040-1722756] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Meta-therapy refers to the clinical dialogue via which direct and indirect voice treatments are introduced and discussed, and which helps build a useful conceptual framework for voice therapy. Meta-therapy was idiosyncratically defined in previous work. However, the current colloquial narrative of meta-therapy is not standardized or specific enough to be reliably taught, rigorously studied, or clinically delivered with high fidelity. Therefore, this article uses a standard framework (the Rehabilitation Treatment Specification System or RTSS) to further articulate and operationalize meta-therapy in vocal rehabilitation. Meta-therapy's conceptual framework generally aligns with the RTSS's treatment theory and associated concepts; e.g., the treatment component and its underlying ingredients, mechanisms of action, and target. Because the treatment theories in meta-therapy most frequently involve mechanisms of action related to information processing, they primarily map onto the RTSS's Representations treatment components. The treatment targets in meta-therapy are often focused on changes in the patient's cognitions, knowledge, beliefs, attitudes, intentions, and/or awareness regarding voice-related modifications. The ingredients in meta-therapy are frequently clinician actions conveying information with the goal of appropriately shaping the patient's mental representations, and are delivered with verbal cues, stories, analogies, etc. This manuscript provides specific examples of how meta-therapy is applied in clinical voice practice. Considerations for future investigation of meta-therapy are proposed.
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Affiliation(s)
- Leah B. Helou
- Department of Communication Science & Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jacqueline L. Gartner-Schmidt
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Edie R. Hapner
- Department of Otolaryngology, UAB Voice Center, University of Alabama, Birmingham, Birmingham, Alabama
| | - Sarah L. Schneider
- UCSF Voice and Swallowing Center, Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco
| | - Jarrad H. Van Stan
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Center for Laryngeal Surgery and Voice Rehabilitation, Boston, Massachusetts
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts
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Speech Pathology Intervention for Chronic Refractory Cough: A Pilot Study Examining the Benefit of Using Prerecorded Videos as an Adjunct to Therapy. J Voice 2020; 34:647.e7-647.e14. [DOI: 10.1016/j.jvoice.2018.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 11/17/2022]
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Gillespie AI, Yabes J, Rosen CA, Gartner-Schmidt JL. Efficacy of Conversation Training Therapy for Patients With Benign Vocal Fold Lesions and Muscle Tension Dysphonia Compared to Historical Matched Control Patients. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:4062-4079. [PMID: 31619107 PMCID: PMC7203518 DOI: 10.1044/2019_jslhr-s-19-0136] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/08/2019] [Accepted: 08/08/2019] [Indexed: 05/22/2023]
Abstract
Purpose Conversation training therapy (CTT) is the 1st voice therapy approach to eliminate the traditional therapeutic hierarchy and use patient-driven conversation as the sole therapeutic stimulus. The purpose of this investigation was to determine the efficacy of CTT compared to standard-of-care voice therapy approaches for the treatment of patients with voice disorders. Method A prospective study of CTT treatment outcomes in adults with dysphonia due to primary muscle tension dysphonia or benign vocal fold lesions compared to age, gender, and diagnosis historical matched control (HMC) patients was used. The primary outcome was change in Voice Handicap Index-10 (VHI-10); secondary outcomes included acoustic, aerodynamic, and auditory-perceptual outcomes. Data were collected before treatment (baseline), at the start of each therapy session, 1 week after the final therapy session (short-term follow-up), and 3 months after the final therapy session (long-term follow-up). Results For the CTT group, statistically significant improvements were observed for VHI-10. Though statistically significant improvements were observed for the VHI-10 for the HMC group, the CTT group saw significantly greater improvement in VHI-10. Furthermore, equivalent gains were observed following only 2 sessions of CTT compared to 4-8 sessions of traditional therapy. Significant improvements in the CTT group were observed for cepstral peak prominence in a vowel, fundamental frequency, Cepstral Spectral Index of Dysphonia in a vowel and connected speech, vocal intensity, average airflow in speech in a reading passage, number of breaths and duration of reading passage, and auditory-perceptual measurement of overall voice severity. Conclusions Results support the hypothesis that training voice techniques in the context of spontaneous conversational speech improves patient perception of voice handicap and acoustic, aerodynamic, and auditory-perceptual voice outcomes both immediately following treatment and at long-term follow-up. CTT participants also demonstrated significantly larger decreases in VHI-10 compared to HMC participants who received standard-of-care, nonconversational, hierarchical-based voice therapy.
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Affiliation(s)
| | - Jonathan Yabes
- Department of Biostatistics, University of Pittsburgh, PA
| | - Clark A. Rosen
- Department of Otolaryngology, University of California, San Francisco
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Hu Y, Zhu L, Zhou M, Li J, Maguire P, Sun H, Wang D. Exploring the Influence of Ethical Leadership on Voice Behavior: How Leader-Member Exchange, Psychological Safety and Psychological Empowerment Influence Employees' Willingness to Speak Out. Front Psychol 2018; 9:1718. [PMID: 30258392 PMCID: PMC6143838 DOI: 10.3389/fpsyg.2018.01718] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/24/2018] [Indexed: 12/02/2022] Open
Abstract
The study of voice behavior examines the inclination of staff and team members to speak up and contribute ideas to the team. In this article, we investigate how factors such as leader-member exchange (LMX), psychological safety and psychological empowerment influence such behavior. Our findings, which are based on a sample of 308 employees working for a state-owned telecommunications company in China, indicate that ethical leadership promotes employees' voice behavior through enhanced LMX, which also leads to greater feelings of psychological safety and psychological empowerment. The theoretical and practical implications of these results are discussed.
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Affiliation(s)
- Yixin Hu
- School of Psychology, Shandong Normal University, Jinan, China
| | - Liping Zhu
- School of Psychology, Shandong Normal University, Jinan, China
| | - Mengmeng Zhou
- School of Psychology, Shandong Normal University, Jinan, China
| | - Jie Li
- School of Management, Shanghai University, Shanghai, China
| | - Phil Maguire
- Department of Computer Science, National University of Ireland, Maynooth, Ireland
| | - Haichao Sun
- School of Psychology, Shandong Normal University, Jinan, China
| | - Dawei Wang
- School of Psychology, Shandong Normal University, Jinan, China
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Wang H, Zhuge P, You H, Zhang Y, Zhang Z. Comparison of the efficacy of vocal training and vocal microsurgery in patients with early vocal fold polyp. Braz J Otorhinolaryngol 2018; 85:678-684. [PMID: 29784620 PMCID: PMC9443021 DOI: 10.1016/j.bjorl.2018.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 03/13/2018] [Accepted: 03/29/2018] [Indexed: 02/03/2023] Open
Abstract
Introduction Vocal fold polyp is a benign proliferative disease in the superficial lamina propria of the vocal fold, and vocal microsurgery can improve the voice quality of patients with vocal fold polyp. In preliminary studies, we found that vocal training could improve the vocal quality of patients with early vocal fold polyp. Objective This study aimed to compare the efficacies of vocal training and vocal microsurgery in patients with early vocal fold polyp. Methods A total of 38 patients with early vocal fold polyp underwent 3 months of vocal training (VT group); another 31 patients with early vocal fold polyp underwent vocal microsurgery (VM group). All subjects were assessed using laryngostroboscopy, voice handicap index, and dysphonia severity index, and the efficacies of vocal training and vocal microsurgery were compared. Results The cure rates of vocal training and vocal microsurgery were 31.6% (12/38) and 100% (31/31), respectively. The intragroup paired-sample t-test showed that the post treatment vocal handicap index, maximum phonation time, highest frequency (F0-high), lowest intensity (I-low), and dysphonia severity index in both the VT and VM groups were better than those before treatment, except for the jitter value. The intergroup independent-sample t-test revealed that the emotional values of vocal handicap index (t = − 2.22, p = 0.03), maximum phonation time (t = 2.54, p = 0.013), jitter (t = − 2.11, p = 0.03), and dysphonia severity index (t = 3.24, p = 0.002) in the VT group were better than those in the VM group. Conclusions Both, vocal training and vocal microsurgery could improve the voice quality of patients with early vocal fold polyp, and these methods present different advantages.
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Affiliation(s)
- Hanqing Wang
- Jinhua Central Hospital, Department of Otolaryngology, Jinhua, China
| | - Pan Zhuge
- Jinhua Central Hospital, Department of Otolaryngology, Jinhua, China.
| | - Huihua You
- Jinhua Central Hospital, Department of Otolaryngology, Jinhua, China
| | - Yulan Zhang
- Jinhua Central Hospital, Department of Otolaryngology, Jinhua, China
| | - Zhifeng Zhang
- Jinhua Central Hospital, Department of Otolaryngology, Jinhua, China
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Meerschman I, Van Lierde K, Van Puyvelde C, Bostyn A, Claeys S, D'haeseleer E. Massed versus spaced practice in vocology: effect of a short-term intensive voice training versus a longer-term traditional voice training. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:393-404. [PMID: 29205707 DOI: 10.1111/1460-6984.12358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND In contrast with most medical and pharmaceutical therapies, the optimal dosage for voice therapy or training is unknown. AIMS The aim of this study was to compare the effect of a short-term intensive voice training (IVT) with a longer-term traditional voice training (TVT) on the vocal quality and vocal capacities of vocally healthy non-professional voice users. METHODS & PROCEDURES A pre-/post-test randomized control group design with follow-up measurements was used. Twenty healthy female non-professional voice users with a mean age of 21.7 years (range = 20-24 years) were randomly assigned into a short-term IVT group (n = 10) or a longer-term TVT group (n = 10). Both groups received an identical 6-h lasting voice training. Only the distribution of practice varied between the groups: 2 h a day for 3 consecutive days for the IVT group versus two 30-min sessions a week for 6 weeks for the TVT group. In both groups, a voice assessment protocol consisting of subjective (questionnaire, participant's self-report, auditory-perceptual evaluation) and objective (maximum performance task, acoustic analysis, voice range profile, dysphonia severity index) measurements and determinations was used to evaluate the participants' voice pre- and post-training and at 6 weeks follow-up. Groups were compared over time using linear mixed models and generalized linear mixed models. Within-group effects of time were determined using post-hoc pairwise comparisons with Bonferroni corrections. OUTCOMES & RESULTS No significant time-by-group interactions were found for any of the outcome measures, indicating no significant differences in evolution over time between the groups. Significant time effects were found for maximum phonation time, lowest intensity, lowest frequency, highest frequency and dysphonia severity index, all improving over time in both groups. More in-depth within-group analyses indicate a preference for the IVT group regarding the evolution of maximum phonation time, lowest frequency and dysphonia severity index, and a preference for the TVT group regarding the evolution of lowest intensity. CONCLUSIONS & IMPLICATIONS Short-term IVT may be equally, or even more, effective in training vocally healthy non-professional voice users compared with longer-term TVT.
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Affiliation(s)
- Iris Meerschman
- Department of Speech-Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Speech-Language and Hearing Sciences, Ghent University, Ghent, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Caro Van Puyvelde
- Department of Speech-Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Astrid Bostyn
- Department of Speech-Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Sofie Claeys
- Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - Evelien D'haeseleer
- Department of Speech-Language and Hearing Sciences, Ghent University, Ghent, Belgium
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