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Brisson V, Fournier C, Pelletier A, Joyal M, Defoy L, Tremblay P. Vocal Health and Vocal Health Knowledge Among Occupational Voice Users in the Province of Quebec. J Voice 2024; 38:799.e15-799.e27. [PMID: 35082049 DOI: 10.1016/j.jvoice.2021.12.016] [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: 10/05/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022]
Abstract
Voice disorders are frequent among occupational voice users such as teachers. Although these disorders can have serious personal and professional consequences, they are not often recognized as occupational diseases and little attention is paid to their prevention. This study aimed to provide a portrait of the self-reported vocal health and vocal health knowledge of occupational voice users in Quebec, Canada, and to identify risk factors associated with voice disorder symptoms. We conducted an online survey targeting occupational voice users in the province of Quebec, Canada, with a focus on those involved in teaching or training. The final sample, after excluding incomplete surveys, included 808 respondents (665 women, M = 41.5 ± 10.4 years old). The survey responses were analyzed using descriptive and inferential statistics. Results indicated that 9.8% of the respondents had a history of a diagnosed voice disorder and 68.8% of the respondents experienced at least one voice symptom on a regular basis. Ordinal logistic regressions revealed that several personal and environmental factors are associated with an increased risk of developing voice disorders symptoms: being a woman, suffering from a breathing disorder, allergies, acid reflux and/or hearing impairment, having less work experience, working with elementary school children and/or with continuous or speech noise in the background. Most of the respondents (94.6%) had never received information regarding voice disorders during their academic training and less than half of them (47.7%) knew which professionals can treat voice disorders. These findings highlight the need for formal vocal health education among both occupational voice users and their employers to improve prevention and treatment for voice disorders in an at-risk population.
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Affiliation(s)
- Valérie Brisson
- Université Laval, Faculté de Médecine, Département de Réadaptation, Quebec City, Canada; CERVO Brain Research Center, Quebec City, Canada
| | - Constance Fournier
- Université Laval, Faculté de Médecine, Département de Réadaptation, Quebec City, Canada
| | - Alicia Pelletier
- Université Laval, Faculté de Médecine, Département de Réadaptation, Quebec City, Canada
| | | | - Lyne Defoy
- CHU de Quebec-Université Laval, Hôpital St-François d'Assise, Quebec City, Canada
| | - Pascale Tremblay
- Université Laval, Faculté de Médecine, Département de Réadaptation, Quebec City, Canada; CERVO Brain Research Center, Quebec City, Canada.
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Gray H, Coman L, Walton C, Thorning S, Cardell E, Weir KA. A Comparison of Voice and Psychotherapeutic Treatments for Adults With Functional Voice Disorders: A Systematic Review. J Voice 2024; 38:542.e9-542.e27. [PMID: 34772593 DOI: 10.1016/j.jvoice.2021.09.018] [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: 07/08/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the effect of traditional voice therapy and cognitive therapy on the voice and client-wellbeing outcomes in adults with functional voice disorders (FVD). METHODS A systematic review of English articles was conducted using Medline (Ovid), Embase (Elsevier), CINAHL (Ebsco), The Cochrane Central Register of Controlled Trials (CENTRAL), PsychInfo (Ebsco) and Speechbite from inception to current date. Additional studies were identified through bibliographies and authors were contacted when further information was required from an article. All study designs were included with pretest/posttest outcome measures related to voice. Independent extraction of studies was completed by three authors using predefined data fields and quality assessment tools. RESULTS Outcomes of 23 studies (2 RCTs and 21 cohort or case studies) are summarised using a narrative style due to heterogeneity of interventions and outcome scales used. Overall research quality of included studies was low, with many cohort and case studies lacking controls, blinding and robust outcome measures. CONCLUSIONS There are some benefits to pairing cognitive behavioural therapy (CBT) with traditional voice therapy for FVD including improved voice quality, psychosocial wellbeing and prevention of relapse. It is feasible to train speech-language pathologists (SLPs) in CBT-enhanced voice therapy. Further high-quality research is needed, however, to guide the clinical implementation of CBT for the management of FVD.
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Affiliation(s)
- Heidi Gray
- Speech Pathology Service, Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia.
| | - Leah Coman
- Speech Pathology Service, Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Chloe Walton
- Speech Pathology Service, Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Sarah Thorning
- Research Governance and Development, Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Elizabeth Cardell
- School of Medicine and Dentistry; and Menzies Health Institute Queensland, Gold Coast campus, Griffith University, Southport, Queensland, Australia
| | - Kelly A Weir
- School of Health Sciences & Social Work; and Menzies Health Institute Queensland, Gold Coast campus, Griffith University, Southport, Queensland, Australia; Allied Health Research, Gold Coast Health, Southport, Queensland, Australia
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Rubino M, Dietrich M, Abbott KV. Initial Theoretical Discussion of Identity as Barrier and Facilitator in Voice Habilitation and Rehabilitation. J Voice 2023:S0892-1997(23)00295-3. [PMID: 37867071 DOI: 10.1016/j.jvoice.2023.09.020] [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: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES The purpose of this paper is to review seminal identity theories grounded in social psychology and one concept from voice science and explain how this group may point to identity factors facilitating or impeding voice habilitation and rehabilitation. METHODS Identity theories from the social psychology literature (Dramaturgical Theory, Self-Categorization Theory, Self-Determination Theory, Identity Negotiation Theory) and vocal congruence are described. Concepts are synthesized with voice science research to explore potential identity-behavior relations at play in voice habilitation and rehabilitation. RESULTS Applicable concepts from social psychology and voice science suggest identity-related processes by which a client may or may not develop a voice difference/disorder, seek intervention, and achieve goals in intervention. A bidirectional relationship between identity and behavior has been well-established in the social psychology literature. However, the relevance of vocal behavior has yet to be formally examined within this literature. Importantly, although connections between behavioral tendencies and voice disorders as well as the contribution of identity to gender-affirming voice treatment have been established in the voice science literature, the consideration of identity's possible role in voice habilitation and rehabilitation in cis gender individuals has thus far been scant. CONCLUSIONS Research into identity and voice habilitation and rehabilitation may help to improve voice intervention outcomes. A possible adjunct to human studies is agent-based modeling or other computational approaches to assess the myriad factors that may be relevant within this line of inquiry.
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Affiliation(s)
- Marianna Rubino
- Department of Communication Sciences and Disorders, University of Houston, Houston, Texas.
| | - Maria Dietrich
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Katherine Verdolini Abbott
- Department of Linguistics and Cognitive Science, University of Delaware, Newark, Delaware; Department of Communication Sciences and Disorders, University of Delaware, Newark, Delaware
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Aldridge-Waddon L, Hiles C, Spence V, Hotton M. Clinical Psychology and Voice Disorders: A Meta-Analytic Review of Studies Assessing Psychological Characteristics Across Individuals With and Without Voice Disorders. J Voice 2023:S0892-1997(23)00287-4. [PMID: 37806904 DOI: 10.1016/j.jvoice.2023.09.012] [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: 07/18/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES Clinical voice disorders are heterogenous conditions capturing problems with voice production and control. Psychological conceptualizations of voice disorders posit that mood, anxiety, and personality characteristics contribute to the development and maintenance of voice symptoms. This review brings together research comparing these psychological characteristics across groups with and without voice disorders, with the aim of profiling group differences. METHODS A systematic search of PubMed, CINAHL, Ovid (PsycInfo, MEDLINE, Embase), and Web of Science databases was conducted, with studies required to assess psychological characteristics between samples with and without voice disorders. Relative study quality and risk of bias were formally evaluated, synthesizing results via meta-analysis (estimating standardized mean difference; SMD) and narrative synthesis. RESULTS Thirty-nine studies (N = 4740) were reviewed. Marked psychological differences were observed between case-control groups, including significantly higher self-reported features of depression (SMD = 0.50), state anxiety (SMD = 0.58), trait anxiety (SMD = 0.52), health anxiety (SMD = 0.57), and neuroticism (SMD = 0.47) in voice disorder groups. However, less consistent patterns of difference were observed between voice disorder types, including minimal quantitative differences between functional and organic diagnoses. CONCLUSIONS Findings underline and formulate the psychological features associated with experiencing a voice disorder, indicating individuals with voice disorders present with considerable psychological needs that may benefit from clinical psychology input.
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Affiliation(s)
- Luke Aldridge-Waddon
- Oxford Institute for Clinical Psychology Training and Research, Oxford Health NHS Foundation Trust, UK.
| | - Chloe Hiles
- Oxford Institute for Clinical Psychology Training and Research, Oxford Health NHS Foundation Trust, UK
| | - Victoria Spence
- VoiceFit Specialist Speech Therapy Services, VoiceFit Specialist Speech Therapy Services, UK
| | - Matthew Hotton
- Oxford Institute for Clinical Psychology Training and Research, Oxford Health NHS Foundation Trust, UK; Psychological Medicine, Oxford University Hospitals NHS Foundation Trust, UK
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5
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House A. Life events and functional neurological disorders. Psychol Med 2023; 53:4823-4824. [PMID: 35264276 DOI: 10.1017/s0033291722000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Helou LB, Welch B, Hoch S, Gartner-Schmidt J. Self-Reported Stress, Trauma, and Prevalence of Laryngoresponders in the General Population. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-16. [PMID: 37319403 DOI: 10.1044/2023_jslhr-22-00669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION It has been proposed that some individuals are "laryngoresponders" (LRs) in that their stress manifests in the laryngeal region and laryngeal functions (e.g., voice and breathing). Preliminary data support the notion that LRs might differ from nonlaryngoresponders (NLRs) in their self-reported past trauma and recent stress. The purpose of this study was to establish the point prevalence of self-identified LRs in the general population. METHOD Using a web-based questionnaire, participants reported up to 13 stress-vulnerable bodily regions and described symptom nature and severity for each region. At the end of the questionnaire, they were explicitly prompted to report whether their laryngeal region or its functions were affected by stress. Participants were categorized a posteriori as Unprompted LRs, Prompted LRs, Inconsistent LRs, or NLRs. We compared LR and NLR groups on the Perceived Stress Scale (PSS-10) and the Childhood Trauma Questionnaire (CTQ-SF). We also redistributed the survey to a subset of participants to establish grouping reliability. RESULTS A total of 1,217 adults responded to the survey, and 995 provided complete data sets. Of those, 15.7% were classified as Unprompted LRs, 26.7% as Prompted LRs, 3% as Inconsistent LRs, and 54.6% as NLRs. Unprompted LRs demonstrated significantly higher/worse PSS-10 and CTQ-SF scores than all other groups. Reliability of LR classification was moderate upon follow-up, κ = .62, 95% confidence interval [0.47, 0.77]. CONCLUSIONS Unprompted LRs described their symptoms in ways that were indistinguishable from patients with functional voice disorders (e.g., throat clenches, voice gets tired easily, lose my voice, voice gets hoarse). The method of self-report solicitation impacted the resulting response. Specifically, the report of larynx-related symptoms differed substantially depending on whether or not the participants were directly prompted to consider the larynx and its related functions.
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Affiliation(s)
- Leah B Helou
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA
| | - Brett Welch
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA
| | - Sarah Hoch
- Department of Otolaryngology, Heersink School of Medicine, The University of Alabama at Birmingham
| | - Jackie Gartner-Schmidt
- Department of Speech-Language Pathology, College of Health and Wellness, Carlow University, Pittsburgh, PA
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Mayne GV, Namazi M. Social Determinants of Health: Implications for Voice Disorders and Their Treatment. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1050-1064. [PMID: 37059074 DOI: 10.1044/2023_ajslp-21-00183] [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 Adverse childhood experiences (ACEs) and related conditions, such as discrimination, are social determinants of health (SDOHs). Critical race theory (CRT) is a lens through which to understand SDOHs in a way that may impact our clinical care. When prolonged or chronic, SDOHs might cause toxic stress and trauma, which, in turn, adversely affect health and are shown to be relevant for some voice disorders. The goals of this tutorial are to (a) review the literature on SDOHs that potentially contribute to disparities; (b) discuss explanatory models and theories that describe how psychosocial factors influence health; (c) relate the foregoing information to voice disorders, highlighting functional voice disorders (FVDs) as a particular case in point; and (d) describe how trauma-informed care can improve patient outcomes and advance health equity for vulnerable populations. CONCLUSIONS This tutorial concludes with a call for heightened awareness of the role that SDOHs such as structural and individual discrimination may play in voice disorders, and a call for research into SDOHs, traumatic stress, and health disparities in this patient population. A call is also made for more universal practice of trauma-informed care in the clinical voice domain.
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Affiliation(s)
- Geneva V Mayne
- School of Communication Disorders and Deafness, Kean University, Union, NJ
| | - Mahchid Namazi
- School of Communication Disorders and Deafness, Kean University, Union, NJ
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Abur D, MacPherson MK, Shembel AC, Stepp CE. Acoustic Measures of Voice and Physiologic Measures of Autonomic Arousal During Speech as a Function of Cognitive Load in Older Adults. J Voice 2023; 37:194-202. [PMID: 33509665 PMCID: PMC8310524 DOI: 10.1016/j.jvoice.2020.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/01/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to determine the relationships among cognitive loading, autonomic arousal, and acoustic measures of voice in healthy older adults. STUDY DESIGN Prospective and observational. METHODS Twelve healthy older adults (six females) produced a sentence containing an embedded Stroop task in each of two cognitive load conditions: congruent and incongruent. Three physiologic measures of autonomic arousal (pulse volume amplitude, pulse period, and skin conductance response amplitude) and four acoustic measures of voice (cepstral peak prominence, low-to-high spectral energy ratio, fundamental frequency, and sound pressure level) were analyzed in each cognitive load condition. RESULTS A logistic regression model was used to predict the cognitive load condition using participant as a categorical predictor and the four acoustic measures and three autonomic measures as continuous predictors. Skin conductance response amplitude and pulse volume amplitude were both predictive of cognitive load; however, no acoustic measures of voice were statistically significant predictors of cognitive load for older adults. CONCLUSIONS These findings support the idea that increased cognitive load is associated with increased autonomic nervous system activity in older adults. The lack of changes in acoustic measures of voice with increased cognitive load may result from age-related changes in vocal quality and speech subsystems.
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Affiliation(s)
- Defne Abur
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Megan K MacPherson
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant, MI.
| | - Adrianna C Shembel
- NYU Langone Health, Department of Otolaryngology-Head and Neck Surgery, New York University, New York, NY
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, MA; Department of Biomedical Engineering, Boston University, Boston, MA; Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA
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Seeman MV. Use of metaphors when treating unexplained medical symptoms. World J Clin Cases 2023; 11:332-341. [PMID: 36686355 PMCID: PMC9850979 DOI: 10.12998/wjcc.v11.i2.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/02/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
The words one chooses to describe personal pain mirror current usage, but may also hold echoes of an individual’s lived experience. They may provide clues to the origin of physical symptoms that are medically hard to explain. The aim of this commentary is to propose, on the basis of the available literature, that verbal metaphors can prove effective in the psychotherapy of such conditions. I provide a case history of a 45 year old woman referred to psychiatry because of extreme ‘burning’ pain in her mouth and tongue. She had been to numerous doctors, had undergone a variety of tests, had tried many medical treatments, and had been prescribed a number of different pharmaceutical agents. She had changed her diet, done her daily dental mouth exercises, drunk a lot of water, but the burning continued and interfered, with her job (she was a teacher), her friendships, and her everyday life. This made her angry and recalcitrant to therapy, but the metaphor ‘burning with rage,’ as applicable to her pain, worked to establish a good alliance that led to a decrease of symptoms. Burning Mouth Syndrome is a medically unexplained condition of complex etiology that psychotherapy alone cannot reverse. The literature bears out, however, that the use of metaphors can help to open avenues of psychological exploration that accelerate adaptation to pain and improve quality life.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto M5S 1A1, Ontario, Canada
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10
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Desjardins M, Apfelbach C, Rubino M, Verdolini Abbott K. Integrative Review and Framework of Suggested Mechanisms in Primary Muscle Tension Dysphonia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1867-1893. [PMID: 35446683 PMCID: PMC9559660 DOI: 10.1044/2022_jslhr-21-00575] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 05/26/2023]
Abstract
PURPOSE Despite the high prevalence of primary muscle tension dysphonia (MTD-1), its underlying mechanisms and their interrelationships have yet to be fully identified. The objectives of this integrative review were (a) to describe and classify the suggested underlying mechanisms for MTD-1, (b) to appraise the empirical evidence supporting each of the proposed mechanisms, and (c) to summarize the information in an integrative model. METHOD PubMed, Scopus, and CINAHL were searched for all publications pertaining to muscle tension dysphonia. Papers were retained if they included theoretical or empirical data pertaining to underlying mechanisms of MTD-1. A total of 921 papers initially qualified for screening, of which 100 remained for consideration in this review. Underlying mechanisms of MTD-1 were extracted using a consensus approach. RESULTS Seven broad categories of putative mechanisms involved in MTD-1 were identified: psychosocial, autonomic, sensorimotor, respiratory, postural, inflammatory, and neuromuscular. These categories were further divided into 19 subcategories detailed in the body of this review article. Based on the reviewed evidence, our proposed integrative model presents MTD-1 as an idiosyncratic motor adaptation to physiological perturbation or perceived threat. Under this model, physiologically or psychologically aversive stimuli can instigate a series of motor adaptations at multiple levels of the nervous system, ultimately disturbing muscle activation patterns and their biomechanical outcomes. Importantly, these adaptations appear to have the potential to become chronic even after threatening stimuli are withdrawn. CONCLUSIONS The proposed model highlights the importance of personalized rehabilitation in MTD-1 treatment. Limitations of the literature are discussed to provide guidance for future research aimed at improving our understanding of MTD-1. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19586065.
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Affiliation(s)
- Maude Desjardins
- Department of Communication Sciences & Disorders, University of Delaware, Newark
| | | | - Marianna Rubino
- Department of Communication Sciences & Disorders, University of Delaware, Newark
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Sahota PBK, D’Mello RJ, Shanbhag V, Nanjundaswamy MH, Ganjekar S, Kashyap H, Chandra PS. Finding One’s Voice: Psychotherapy for Dissociative Motor Disorders in the Indian Context. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Baker J, Barnett C, Cavalli L, Dietrich M, Dixon L, Duffy JR, Elias A, Fraser DE, Freeburn JL, Gregory C, McKenzie K, Miller N, Patterson J, Roth C, Roy N, Short J, Utianski R, van Mersbergen M, Vertigan A, Carson A, Stone J, McWhirter L. Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy. J Neurol Neurosurg Psychiatry 2021; 92:1112-1125. [PMID: 34210802 DOI: 10.1136/jnnp-2021-326767] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/25/2021] [Indexed: 12/14/2022]
Abstract
Communication problems (eg, dysphonia, dysfluency and language and articulation disorders), swallowing disorders (dysphagia and globus), cough and upper airway symptoms, resulting from functional neurological disorder (FND), are commonly encountered by speech and language professionals. However, there are few descriptions in the literature of the most effective practical management approaches. This consensus document aims to provide recommendations for assessment and intervention that are relevant to both adults and young people. An international panel of speech and language professionals with expertise in FND were approached to take part. Participants responded individually by email to a set of key questions regarding best practice for assessment and interventions. Next, a video conference was held in which participants discussed and debated the answers to these key questions, aiming to achieve consensus on each issue. Drafts of the collated consensus recommendations were circulated until consensus was achieved. FND should be diagnosed on the basis of positive clinical features. Speech and language therapy for FND should address illness beliefs, self-directed attention and abnormal movement patterns through a process of education, symptomatic treatment and cognitive behavioural therapy within a supportive therapeutic environment. We provide specific examples of these strategies for different symptoms. Speech and language professionals have a key role in the management of people with communication and related symptoms of FND. It is intended that these expert recommendations serve as both a practical toolkit and a starting point for further research into evidence-based treatments.
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Affiliation(s)
- Janet Baker
- Speech Pathology, Flinders University, Adelaide, South Australia, Australia
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Caroline Barnett
- South Warwickshire NHS Foundation Trust, Warwick, Warwickshire, UK
| | - Lesley Cavalli
- Department of Speech & Language Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, London, UK
- Division of Psychology and Language Sciences, University College London, London, London, UK
| | - Maria Dietrich
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Lorna Dixon
- National Hospital for Neurology and Neurosurgery, London, London, UK
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Annie Elias
- Speech and Language Therapy, Kent Community Health NHS Foundation Trust, Ashford, Kent, UK
| | - Diane E Fraser
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, Edinburgh, UK
| | | | | | | | - Nick Miller
- Speech Language Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Jo Patterson
- University of Liverpool, Liverpool, Merseyside, UK
| | - Carole Roth
- Speech Pathology Division, Naval Medical Center San Diego, San Diego, California, USA
| | - Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah, USA
- Division of Otolaryngology - Head and Neck Surgery (Adjunct), The University of Utah, Salt Lake City, Utah, USA
| | | | - Rene Utianski
- Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Speech Pathology and Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Miriam van Mersbergen
- School of Communication Sciences and Disorders, Institute for Intelligent Systems, The University of Memphis, Memphis, Tennessee, USA
| | - Anne Vertigan
- Speech Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia
- Centre for Healthy Lungs, Hunter Medical Research Institute; School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Alan Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Edinburgh, UK
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Piersiala K, Akst LM, Hillel AT, Best SR. Chronic Pain Syndromes and Their Laryngeal Manifestations. JAMA Otolaryngol Head Neck Surg 2021; 146:543-549. [PMID: 32352483 DOI: 10.1001/jamaoto.2020.0530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), and chronic fatigue syndrome (CFS) are traditionally considered as distinct entities grouped under chronic pain syndrome (CPS) of an unknown origin. However, these 3 disorders may exist on a spectrum with a shared pathophysiology. Objective To investigate whether the clinical presentation of FMS, IBS, and CFS is similar in a population presenting with voice and laryngeal disorders. Design, Setting, and Participants This case series was a retrospective review of the medical records and clinical notes of patients treated between January 1, 2016, and December 31, 2017, at the Johns Hopkins Voice Center in Baltimore, Maryland. Patients with at least 1 CPS of interest (FMS, IBS, or CFS) were included (n = 215), along with patients without such diagnoses (n = 4034). Diagnoses, demographic, and comorbidity data were reviewed. Diagnoses related to voice and laryngeal disorders were subdivided into 5 main categories (laryngeal pathology, functional voice disorders, airway problems, swallowing problems, and other diagnoses). Main Outcomes and Measures Prevalence and odds ratios of 45 voice and laryngeal disorders were reviewed. Odds ratios (ORs) were calculated by comparing patients with CPS with control patients. Results In total, 4249 individuals were identified; 215 (5.1%) had at least 1 CPS and 4034 (94.9%) were control participants. Patients with CPS were 3 times more likely to be women compared with the control group (173 of 215 [80.5%] vs 2318 of 4034 [57.5%]; OR, 3.156; 95% CI, 2.392-4.296), and the CPS group had a mean (SD) age of 57.80 (15.30) years compared with the mean (SD) age of 55.77 (16.97) years for the control group. Patients with CPS were more likely to present with functional voice disorders (OR, 1.812; 95% CI, 1.396-2.353) and less likely to present with laryngeal pathology (OR, 0.774; 95% CI, 0.610-0.982) or airway problems (OR, 0.474; 95% CI, 0.285-0.789). Conclusions and Relevance The voice and airway presentation of patients with FMS, IBS, and/or CFS appears to be indistinguishable from each other. This finding suggests that these 3 diseases share upper airway symptoms.
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Affiliation(s)
- Krzysztof Piersiala
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.,Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
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Affiliation(s)
- Richard A A Kanaan
- Department of Psychiatry, Austin Health,University of Melbourne,Heidelberg, VIC 3084,Australia
| | - Thomas K J Craig
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College,London,UK
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15
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Roy N, Dietrich M, Blomgren M, Heller A, Houtz DR, Lee J. Exploring the Neural Bases of Primary Muscle Tension Dysphonia: A Case Study Using Functional Magnetic Resonance Imaging. J Voice 2019; 33:183-194. [DOI: 10.1016/j.jvoice.2017.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 01/17/2023]
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16
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Holmqvist-Jämsén S, Johansson A, Santtila P, Westberg L, von der Pahlen B, Simberg S. Investigating the Role of Salivary Cortisol on Vocal Symptoms. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:2781-2791. [PMID: 28915296 DOI: 10.1044/2017_jslhr-s-16-0058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/19/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE We investigated whether participants who reported more often occurring vocal symptoms showed higher salivary cortisol levels and if such possible associations were different for men and women. METHOD The participants (N = 170; men n = 49, women n = 121) consisted of a population-based sample of Finnish twins born between 1961 and 1989. The participants submitted saliva samples for hormone analysis and completed a web questionnaire including questions regarding the occurrence of 6 vocal symptoms during the past 12 months. The data were analyzed using the generalized estimated equations method. RESULTS A composite variable of the vocal symptoms showed a significant positive association with salivary cortisol levels (p < .001). Three of the 6 vocal symptoms were significantly associated with the level of cortisol when analyzed separately (p values less than .05). The results showed no gender difference regarding the effect of salivary cortisol on vocal symptoms. CONCLUSIONS There was a positive association between the occurrence of vocal symptoms and salivary cortisol levels. Participants with higher cortisol levels reported more often occurring vocal symptoms. This could have a connection to the influence of stress on vocal symptoms because stress is a known risk factor of vocal symptoms and salivary cortisol can be seen as a biomarker for stress.
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Affiliation(s)
| | - Ada Johansson
- Faculty of Arts, Psychology and Theology, Åbo Akademi University, Turku, Finland
- Department of Psychology and Speech-Language Pathology, Faculty of Social Sciences, University of Turku, Turku, Finland
| | - Pekka Santtila
- Faculty of Arts, Psychology and Theology, Åbo Akademi University, Turku, Finland
| | - Lars Westberg
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - Susanna Simberg
- Faculty of Arts, Psychology and Theology, Åbo Akademi University, Turku, Finland
- Department of Special Needs Education, Faculty of Educational Sciences, University of Oslo, Norway
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17
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Functional Voice Disorders: The Importance of the Psychologist in Clinical Voice Assessment. J Voice 2017; 31:507.e13-507.e22. [DOI: 10.1016/j.jvoice.2016.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/12/2016] [Accepted: 10/20/2016] [Indexed: 11/17/2022]
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18
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Kenny C. Assessment practices of Irish speech and language therapists in the evaluation of voice disorders. LOGOP PHONIATR VOCO 2017; 42:12-21. [PMID: 28049390 DOI: 10.3109/14015439.2015.1121291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
It is commonly accepted that the evaluation of voice disorders ought to include extensive perceptual, psychometric, and instrumental measurements. This serves to encapsulate the wide-reaching effects of such a disorder, from the physical impairment in voice production to the psycho-social impact of having a dysphonic voice. In spite of this, no international gold standard exists by which voice disorders should be evaluated, and so speech and language therapists (SLTs) are often tasked with developing an assessment battery for use in their own clinics. The purpose of this study is to determine whether the evaluation of voice disorders by Irish SLTs on a national scale is suitably comprehensive, with particular reference to the guidelines published by the European Laryngological Society. A total of 49 SLTs working in a variety of settings responded anonymously to an electronic survey regarding their assessment practices. Results indicate that therapists are comprehensive in non-instrumental evaluation of voice, but lack both access to and training in instrumental assessment techniques.
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Affiliation(s)
- Ciarán Kenny
- a Speech and Language Therapy Department , Tallaght Hospital , Dublin , Ireland
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19
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Mattei A, Revis J, Giovanni A. Personality traits inventory in patients with vocal nodules. Eur Arch Otorhinolaryngol 2016; 274:1911-1917. [DOI: 10.1007/s00405-016-4421-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
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20
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MacPherson MK, Abur D, Stepp CE. Acoustic Measures of Voice and Physiologic Measures of Autonomic Arousal during Speech as a Function of Cognitive Load. J Voice 2016; 31:504.e1-504.e9. [PMID: 27939119 DOI: 10.1016/j.jvoice.2016.10.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to determine the relationship among cognitive load condition and measures of autonomic arousal and voice production in healthy adults. STUDY DESIGN A prospective study design was conducted. METHODS Sixteen healthy young adults (eight men, eight women) produced a sentence containing an embedded Stroop task in each of two cognitive load conditions: congruent and incongruent. In both conditions, participants said the font color of the color words instead of the word text. In the incongruent condition, font color differed from the word text, creating an increase in cognitive load relative to the congruent condition in which font color and word text matched. Three physiologic measures of autonomic arousal (pulse volume amplitude, pulse period, and skin conductance response amplitude) and four acoustic measures of voice (sound pressure level, fundamental frequency, cepstral peak prominence, and low-to-high spectral energy ratio) were analyzed for eight sentence productions in each cognitive load condition per participant. RESULTS A logistic regression model was constructed to predict the cognitive load condition (congruent or incongruent) using subject as a categorical predictor and the three autonomic measures and four acoustic measures as continuous predictors. It revealed that skin conductance response amplitude, cepstral peak prominence, and low-to-high spectral energy ratio were significantly associated with cognitive load condition. CONCLUSIONS During speech produced under increased cognitive load, healthy young adults show changes in physiologic markers of heightened autonomic arousal and acoustic measures of voice quality. Future work is necessary to examine these measures in older adults and individuals with voice disorders.
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Affiliation(s)
- Megan K MacPherson
- Department of Communication Science and Disorders, Florida State University, Tallahassee, FL.
| | - Defne Abur
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA; Department of Biomedical Engineering, Boston University, Boston, MA; Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, MA
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21
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Nicholson TR, Aybek S, Craig T, Harris T, Wojcik W, David AS, Kanaan RA. Life events and escape in conversion disorder. Psychol Med 2016; 46:2617-2626. [PMID: 27377290 PMCID: PMC4988265 DOI: 10.1017/s0033291716000714] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Psychological models of conversion disorder (CD) traditionally assume that psychosocial stressors are identifiable around symptom onset. In the face of limited supportive evidence such models are being challenged. METHOD Forty-three motor CD patients, 28 depression patients and 28 healthy controls were assessed using the Life Events and Difficulties Schedule in the year before symptom onset. A novel 'escape' rating for events was developed to test the Freudian theory that physical symptoms of CD could provide escape from stressors, a form of 'secondary gain'. RESULTS CD patients had significantly more severe life events and 'escape' events than controls. In the month before symptom onset at least one severe event was identified in 56% of CD patients - significantly more than 21% of depression patients [odds ratio (OR) 4.63, 95% confidence interval (CI) 1.56-13.70] and healthy controls (OR 5.81, 95% CI 1.86-18.2). In the same time period 53% of CD patients had at least one 'high escape' event - again significantly higher than 14% in depression patients (OR 6.90, 95% CI 2.05-23.6) and 0% in healthy controls. Previous sexual abuse was more commonly reported in CD than controls, and in one third of female patients was contextually relevant to life events at symptom onset. The majority (88%) of life events of potential aetiological relevance were not identified by routine clinical assessments. Nine per cent of CD patients had no identifiable severe life events. CONCLUSIONS Evidence was found supporting the psychological model of CD, the Freudian notion of escape and the potential aetiological relevance of childhood traumas in some patients. Uncovering stressors of potential aetiological relevance requires thorough psychosocial evaluation.
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Affiliation(s)
- T. R. Nicholson
- Section of Cognitive Neuropsychiatry,
Institute of Psychiatry Psychology & Neuroscience, King's
College, London, UK
| | - S. Aybek
- Section of Cognitive Neuropsychiatry,
Institute of Psychiatry Psychology & Neuroscience, King's
College, London, UK
- Laboratory for Behavioral Neurology and Imaging of
Cognition, Fundamental Neurosciences Department,
Geneva University, Geneva,
Switzerland
| | - T. Craig
- Health Services Research Department,
Institute of Psychiatry Psychology & Neuroscience, King's
College, London, UK
| | - T. Harris
- Health Services Research Department,
Institute of Psychiatry Psychology & Neuroscience, King's
College, London, UK
| | - W. Wojcik
- Department of Psychological Medicine,
Institute of Psychiatry Psychology & Neuroscience, King's
College, London, UK
| | - A. S. David
- Section of Cognitive Neuropsychiatry,
Institute of Psychiatry Psychology & Neuroscience, King's
College, London, UK
| | - R. A Kanaan
- Department of Psychiatry,
University of Melbourne, Austin Health,
Heidelberg, Victoria,
Australia
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22
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Baker J. Functional voice disorders: Clinical presentations and differential diagnosis. HANDBOOK OF CLINICAL NEUROLOGY 2016; 139:389-405. [PMID: 27719859 DOI: 10.1016/b978-0-12-801772-2.00034-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this chapter, an overview of the heterogeneous group of functional voice disorders is given, including the psychogenic voice disorder (PVD) and hyperfunctional or muscle tension voice disorder (MTVD) subgroups. Reference is made to prevalence and demographic data, with empiric evidence for psychosocial factors commonly associated with the onset and maintenance of these disorders. Clinical features that distinguish between the different presentations of PVD and MTVD are described. While there are some shared characteristics, key differences between these two subgroups indicate that PVD more closely resembles the psychogenic movement disorders and a range of other functional neurologic disorders. Assessment procedures and auditory-perceptual features of the voice that distinguish these disorders from the neurologically based voice disorders are discussed, with case examples highlighting ambiguous features that may influence differential diagnosis. The clinical profiles of PVD and MTVD affirm approaches to clinical management by speech-language pathologists that integrate symptomatic behavioral voice therapy with "top-down" models of counseling or psychotherapy. They also support the proposition that PVD may be construed as a subtype of functional neurologic disorders.
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Affiliation(s)
- J Baker
- Speech Pathology and Audiology, School of Health Sciences, Flinders University, Adelaide, Australia.
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Roelofs K, pasman J. Stress, childhood trauma, and cognitive functions in functional neurologic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016; 139:139-155. [DOI: 10.1016/b978-0-12-801772-2.00013-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Baker J, Oates JM, Leeson E, Woodford H, Bond MJ. Patterns of Emotional Expression and Responses to Health and Illness in Women With Functional Voice Disorders (MTVD) and a Comparison Group. J Voice 2014; 28:762-9. [DOI: 10.1016/j.jvoice.2014.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/12/2014] [Indexed: 10/25/2022]
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