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PI did decided reorganize the methodology for this study and will resubmit in the future.
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Evaluate if adding expiratory muscle strength training to traditional voice therapy for individuals with dysphonia due to glottal insufficiency improves maximal expiratory pressure, acoustic and aerodynamic measures (i.e. amplitude, maximum phonation time, peak expiratory flow), and voice related quality of life.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Unilateral vocal fold paralysis standard of care voice therapy | Experimental | The participants will receive the standard of voice therapy including improved breath coordination, sustained humming and vowels, vocal glides, resonant voice therapy, and relations techniques. |
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| Unilateral paralysis standard of care voice therapy plus EMST | Experimental | The participants will receive the standard of voice therapy including improved breath coordination, sustained humming and vowels, vocal glides, resonant voice therapy, and relations techniques. EMST consists of blowing into respiratory device at a measure threshold pressure. As strength improves threshold resistance will be increased. |
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| Parkinson's disease standard of care voice therapy plus EMST | Experimental | The participants will receive the standard of voice therapy including improved breath coordination, sustained humming and vowels, vocal glides, resonant voice therapy, and relations techniques. EMST consists of blowing into respiratory device at a measure threshold pressure. As strength improves threshold resistance will be increased. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Standard of care voice therapy | Other | Exercises will include improved breath coordination, sustained humming and vowels, vocal glides, resonant voice therapy, and relaxation techniques to the neck and shoulder |
| Measure | Description | Time Frame |
|---|---|---|
| Maximum expiratory pressure | Maximum expiratory pressure, in cm of H2O, will be measured to evaluate how much pressure a participant can blow into a respiratory pressure meter. | 16 weeks |
| Amplitude | Amplitude of voice, in decibels, will be measured using Voice Range Profile on Kay Pentax CSL and will be compared to gender matched normative values for normal and loud volumes. | 16 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Fundamental frequency | Fundamental frequency, measured in herz, will be obtained using the Analysis of Dysphonia in Speech and Voice on Kay Pentax Computerized Speech Lab. | 16 weeks |
| Dynamic pitch range |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Adam T Lloyd, SLP-D, MM, MA | University of Miami | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Miami | Miami | Florida | 33136 | United States |
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| ID | Term |
|---|---|
| D055154 | Dysphonia |
| D014826 | Vocal Cord Paralysis |
| ID | Term |
|---|---|
| D014832 | Voice Disorders |
| D007818 | Laryngeal Diseases |
| D012140 | Respiratory Tract Diseases |
| D010038 | Otorhinolaryngologic Diseases |
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| Expiratory muscle strength training (EMST) | Other | EMST150 used at 75% of their maximum expiratory pressure. Participants will be directed to perform 5 sets of 5 breaths, 5 days per week, for 5 weeks, at the pressure threshold established in therapy. Maximum expiratory pressure will then be determined at the beginning of each therapy session and recalibration of the device will be performed if indicated. |
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Dynamic pitch range will be measured using Voice Range Profile on Kay Pentax Computerized Speech Lab.
| 16 weeks |
| Cepstral Peak Prominence (CPP) | Cepstral Peak Prominence will be obtained using the Analysis of Dysphonia in Speech and Voice on Kay Pentax Computerized Speech Lab. | 16 weeks |
| Cepstral spectral index of dysphonia (CSID) | Cepstral spectral index of dysphonia, will be obtained using the Analysis of Dysphonia in Speech and Voice on Kay Pentax Computerized Speech Lab. | 16 weeks |
| Voice Handicap Index | This is quality of life assessment tool quantifying perception of the impact of their vocal disorder on various aspects of lifestyle. It is 30-questions in length and is divided into 3 subscales including emotional, physical, and functional, divided into 10 questions each. Each question scored from 0-4. Total score range from 0-120. Higher score indicates increased handicap. | 16 weeks |
| Maximum phonation time | The patient will be asked to inhale deeply and sustain the vowel /a/ at a comfortable loudness level for a many seconds as possible. | 16 weeks |
| Peak expiratory flow rate | Peak expiratory flow rate, measured in units of liters per minute, will be measured for purposes of measuring cough function. | 16 weeks |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D020421 | Vagus Nerve Diseases |
| D003389 | Cranial Nerve Diseases |
| D010243 | Paralysis |