Two methods of relaxing laryngeal musculature were investigated in adults with hyperfunctional dysphonia. Assessments were conducted pre‐treatment, post‐treatment and at three month follow‐up. Measures included the level of superficial laryngeal tension using an electromyogram, control of vocal fold vibration using Fx traces from an electrolaryngograph and an auditory evaluation using a phonation profile. Two personality questionnaires were administered and the subjects' self‐rating of voice was recorded. The duration of treatment was noted. Subjects were matched into groups receiving either laryngeal EMG biofeedback or progressive relaxation, both within a graded voice training programme. A significant improvement in all measures occurred for both programmes, which was maintained at follow‐up. No significant difference between the two approaches emerged. Implications for the assessment and treatment of hyperfunctional dysphonia are discussed.

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A combination of practitioner, consumer and government pressure has resulted in a radical reappraisal of the role of the midwife over the last decade, expanding their sphere of practice into new responsibilities. This article will examine the effect this has had on managing midwifery services. It will start with background material by outlining the core role of the midwife, the position of midwifery management within trusts and the causes and origins of the expansion of midwives’ sphere of practice. This will be followed with an assessment of the managerial implications, problems and advantages of the changes in the role of the midwife.