Quantitative Assessment of Learning and Retention in Virtual Vocal Function Exercises

Purpose Successful voice therapy requires the patient to learn new vocal behaviors, but little is currently known regarding how vocal motor skills are improved and retained. To quantitatively characterize the motor learning process in a clinically meaningful context, a virtual task was developed based on the Vocal Function Exercises. In the virtual task, subjects control a computational model of a ball floating on a column of airflow via modifications to mean airflow (L/s) and intensity (dB-C) to keep the ball within a target range representing a normative ratio (dB × s/L). Method One vocally healthy female and one female with nonphonotraumatic vocal hyperfunction practiced the task for 11 days and completed retention testing 1 and 6 months later. The mapping between the two execution variables (airflow and intensity) and one error measure (proximity to the normative ratio) was evaluated by quantifying distributional variability (tolerance cost and noise cost) and temporal variability (scaling index of detrended fluctuation analysis). Results Both subjects reduced their error over practice and retained their performance 6 months later. Tolerance cost and noise cost were positively correlated with decreases in error during early practice and late practice, respectively. After extended practice, temporal variability was modulated to align with the task's solution manifold. Conclusions These case studies illustrated, in a healthy control and a patient with nonphonotraumatic vocal hyperfunction, that the virtual floating ball task produces quantitative measures characterizing the learning process. Future work will further investigate the task's potential to enhance clinical assessment and treatments involving voice control. Supplemental Material https://doi.org/10.23641/asha.13322891

Adapting Vocal Function Exercises for Voice Masculinization

Purpose The aim of this clinical focus article is to discuss the role of gender-diverse vocal function exercises (VFEs) in the context of voice and communication therapy for transgender men. Current literature on behavioral intervention with this population is very limited, and we present gender-diverse VFEs as a reasonable intervention approach. Method We developed a protocol for VFEs specific to voice masculinization, and we present a case study in which this technique was used for a transmasculine client who had not undergone hormone replacement therapy. Results Clinical measurements (acoustic, perceptual, and client self-rating) were collected before and after a course of voice therapy. Findings demonstrate decreased habitual speaking pitch and improved voice-related quality of life at the end of therapy, indicating successful outcomes for voice masculinization. Conclusions The recommended protocol for gender-diverse VFEs allows the trans male client to efficiently strengthen and coordinate the subsystems of voice production, particularly in the lower limits of his range. This clinical focus article also describes the need for strong research evidence to support all treatment modalities for transmasculine therapy, and this protocol offers one avenue for future investigations.

A COOPERATION BETWEEN VOCAL TEACHER AND SPEECH AND LANGUAGE THERAPIST IN THE TREATMENT OF MULTIFACTORIAL VOICE DISORDERS

The aetiology of voice disorders is multifactorial. Neglecting of vocal hygiene and medical factors are common causes of voice disorders. The critical elements of the holistic approach to voice therapy are postural alignment, breathing and support, phonation and the speaking voice. The aim of the study is to make an analysis of the efficiency of the interdisciplinary treatment approach in a client with multifactorial voice disorders. Methods. This is a case study. The 57 years old female with moderate functional dysphonia received intervention by the vocal teacher and speech-language therapist. The following voice assessment methods were used in the study: a gathering of anamnesis, voice acoustic analysis, voice self-assessment. The vocal teacher used the following treatment methods: postural alignment exercises, Anna Sims’s breathing exercises, vocal and articulation exercises. Stemple’s Vocal function exercises, resonance therapy and biofeedback, were used by the speech-language therapist.Results. The harmonisation of posture, breathing, vocal folds vibration was achieved during the therapy. The objective measurements demonstrate improvement in Dysphonia Severity Index as well as the Voice Handicap Index. The client demonstrated satisfaction with the improvement of voice function.Conclusion. The cooperation of vocal teacher and speech-language therapist diversifies therapeutic approaches which allow finding unique, client-oriented intervention and achieving positive output.