Indirect vs Direct Voice Therapy for Children With Vocal Nodules

Hartnick, Christopher J.; Ballif, Catherine; Guzman, Vanessa de; Sataloff, Robert T.; Campisi, Paolo; Kerschner, Joseph E.; Shembel, Adrianna C.; Reda, Domenic J.; Shi, Helen; Zacny, Elinore; Bunting, Glenn

doi:10.1001/jamaoto.2017.2618

Cited by 60 publications

(46 citation statements)

References 30 publications

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“…Instead, current models (i.e., [13]) suggest focusing on motor learning principles and 'direct' therapy. In a randomized clinical trial that evaluated the 'direct' versus 'indirect' voice therapy in CwVN, improvements were seen from both therapies [28]. Yet, when evaluating the difference in outcome measures for 'direct' as compared to 'indirect' therapy across age, larger effect sizes were seen in children over eight years of age.…”

Section: Clinical Implications For Voice Therapy In Cwvnmentioning

confidence: 98%

“…Consistent with this timeframe, the current study also showed differences between younger and older children in auditory discrimination abilities. Therefore, if children in the clinical trial [28] over the age of eight had adult-like discrimination abilities, this may have provided them with an increased ability to hear subtle differences in voices. This ability could subsequently allow them to benefit more from direct therapy.…”

Section: Clinical Implications For Voice Therapy In Cwvnmentioning

confidence: 99%

“…A recent study has provided a more comprehensive view of pediatric-focused voice therapy by conducting a randomized clinical trial with children with vocal fold nodules (CwVN) ages 6-10 [28]. Authors selected two therapy approaches to compare: (1) 'Indirect' therapy, focusing on vocal hygiene and discussion of desired vocal productions, and (2) 'direct' therapy, focusing on motor learning tasks.…”

Section: Introductionmentioning

confidence: 99%

“…Although no significant differences were found between the two therapy types, post hoc analyses indicated that older children (8-10 years) had a larger improvement in their PVRQOL scores for the 'direct' therapy, as compared to 'indirect' therapy. Authors suggested that these older children may be more cognitively able to learn the new motor patterns during the 'direct' therapy sessions and, thus, displayed greater improvements [28].…”

Section: Introductionmentioning

confidence: 99%

“…An alternate (or perhaps, extended) hypothesis for differences seen between older and younger children [28] may be that older children have more developed auditory-perceptual abilities, thus allowing them to better detect, learn, and implement vocal changes. Explicit examination of auditory-perceptual discrimination has not been examined in CwVN, yet previous works suggest that CwVN may have perceptual differences as compared to children without voice disorders [30,31].…”

Section: Introductionmentioning

confidence: 99%

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Vocal Pitch Discrimination in Children with and without Vocal Fold Nodules

et al. 2019

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Vocal pitch discrimination abilities were compared in sixteen children with vocal fold nodules (CwVN) and sixteen matched controls with typical voices (CwTV). Vocal pitch discrimination was also evaluated in thirty-five vocally healthy children and twenty adults to examine potential changes as a function of maturation. CwTV were categorized as either younger (N = 15, 5.6–7.7 years) or older (N = 20, 8.2–11.7 years). Participants completed two-alternative, forced choice listening tasks in which they judged whether pairs of sustained /ɑ/ tokens were different in pitch. Each pair consisted of a base token with a fundamental frequency (fo) of 216.2 Hz and a test token with a fo that was adaptively modified, according to the participant’s prior judgments. There were no significant differences in pitch discrimination abilities between CwVN and CwTV. Pitch discrimination abilities were significantly poorer in younger and older CwTV as compared to adults. Additionally, younger CwTV had significantly poorer discrimination abilities than older CwTV. Findings from this study suggest that CwVN do not have differences in pitch discrimination abilities, yet, therapies designed for CwVN should consider this developmental trend in perceptual abilities.

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Section: Clinical Implications For Voice Therapy In Cwvnmentioning

confidence: 98%

Section: Clinical Implications For Voice Therapy In Cwvnmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Vocal Pitch Discrimination in Children with and without Vocal Fold Nodules

et al. 2019

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Describing, Assessing, and Treating Voice Disorders

Morris

Harmon

2021

The Handbook of Language and Speech Disorders

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Voice Therapy Improves Acoustic and Auditory‐Perceptual Outcomes in Children

2022

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This study employed acoustic measures as well as auditory-perceptual assessments to examine the effects of voice therapy in children presenting with benign vocal fold lesions.Methods: A retrospective, observational cohort design was employed. Sustained vowels produced by 129 children diagnosed with benign vocal fold lesions were analyzed, as well as connected speech samples produced by 47 children. Treatment outcome measures included Consensus of Auditory-Perceptual Evaluation of Voice (CAPE-V), jitter, shimmer, Noise-to-Harmonic Ratio (NHR), cepstral peak prominence (CPP), and Low-to-High Ratio (LHR) on sustained vowels, and CPP and LHR on connected speech.Results: Following voice therapy, significant improvements in CAPE-V ratings (p < 0.001) were observed. Additionally, jitter (p = 0.041), NHR (p = 0.019), and CPP (p < 0.01) on sustained vowels, and CPP (p = 0.002), and LHR (p = 0.008) on connected speech significantly improved following voice therapy. CPP increased with age in males but did not change in females. CAPE-V ratings and perturbation measures indicated that dysphonia was more severe in younger children pre and posttherapy.Conclusions: Auditory-perceptual and acoustic measures demonstrated improved voice quality following voice therapy in children with dysphonia. CPP effectively quantified voice therapy gains and allowed for analysis of connected speech, in addition to sustained vowels. These findings demonstrate the value of CPP as a tool in assessing therapy outcomes and support the efficacy of voice therapy for children presenting with vocal fold lesions.

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Indirect vs Direct Voice Therapy for Children With Vocal Nodules

Abstract: clinicaltrials.gov Identifier: NCT01255735.

Cited by 60 publications

References 30 publications

Vocal Pitch Discrimination in Children with and without Vocal Fold Nodules

Vocal Pitch Discrimination in Children with and without Vocal Fold Nodules

Describing, Assessing, and Treating Voice Disorders

Voice Therapy Improves Acoustic and Auditory‐Perceptual Outcomes in Children

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