Deconstructing Voice Therapy: Towards Enhanced Communication Outcomes

Emory University, Atlanta GA

Investigators

Abstract

Abstract Optimization of voice therapy is a public health imperative, crucial for the social, emotional, occupational, and economic well-being of the 23 million Americans experiencing voice disorders at any time. Behavioral voice therapy, the primary treatment for over 80% of patients with hyperfunctional voice disorders, faces high attrition rates and lacks long-term effectiveness data. One problem with most voice therapy models is they often fail in generalizing treatment techniques to daily life, leading to prolonged treatment times and high dropout rates. Hierarchical voice therapy models, while ubiquitous, have not been empirically validated for long-term outcomes and may contribute to these challenges by delaying the application of therapeutic skills to real-life settings. In contrast, we introduced the first non-hierarchical delivery method, Conversation Training Therapy (CTT), which delivers treatment components in patient generated conversation from the onset, aiming to immediately integrate improved voice quality into everyday communication. The primary component of CTT is clear speech, which directs the speaker to use crisp, clear consonants and precise articulation. Patients focus on the sensation of articulating speech sounds while talking. Unlike other voice therapy approaches that focus on a set of phonemes (e.g. nasals in resonant voice), the stimuli in CTT are not phonemically restricted, enabling patients to practice at the conversational level from the outset and improve accuracy with practice over time. Understanding the impact of specific treatment components and their proposed mechanisms of action on treatment targets, particularly long-term outcomes, is critical to advancing clinical voice care and comparative effectiveness research. The non-hierarchical delivery method and use of clear speech distinguish CTT from other voice treatments. Thus, the effects of these components on voice treatment outcomes are priorities for investigation. Isolating the hierarchy by comparing a non-hierarchical delivery method to a reproducible hierarchical delivery with the same components, and investigation of the effects of clear speech on dysphonic speakers are necessary steps to determine how these components influence outcomes. If delivery method (hierarchical vs. non-hierarchical) and clear speech components are critical mechanisms of change, this knowledge will inform future voice therapy comparative effectiveness trials, contribute to the refinement of existing treatments, and aid in the development of novel treatment approaches. This proposal aims to rigorously test patient outcomes associated with non-hierarchical delivery of CTT compared to hierarchical delivery, and determine the relationship between clear speech, voice quality, and voice outcomes. The importance of this proposal lies in its potential for both practical and theoretical impact beyond any specific therapy approach for voice rehabilitation. This research further aligns with the NIDCD 2023-27 strategic plan, aiming to establish evidence-based practices that enhance health outcomes across voice therapies.