PhD Student, University of Pittsburgh


This is a study of learning effects on a voice task that is used for voice disorder diagnosis.

A significant amount of literature has been devoted to studying motor learning processes in limb movements (i.e. learning to swing a bat in baseball). However, significantly less research has been devoted to vocal motor learning, which is important for speaking and singing. When people have a voice disorder (i.e. vocal nodules), speech language pathologists may ask the patient to perform a specific vocal task called phonation threshold pressure (PTP). PTP measures the smallest amount of air pressure required for a person's vocal folds to start vibrating. When it is elevated (e.g. 20 cm H2O), this may indicate damage is present on the vocal folds. PTP assists in the diagnosis of voice pathology, and may guide treatment recommendations. This measurement is also important in clinical studies evaluating treatment effectiveness. Phonation threshold pressure (PTP) is a common measure for evaluating treatment outcomes, and PTP requires patients to repeat the same task for measurement multiple times. It is unknown how this measurement changes with practice, which is important to know when evaluating measurement change after treatment. This study focuses on how much PTP changes when normal people practice the task over the course of two practice sessions, each a day apart. Eighteen normal young female participants practiced this task, and PTP was measured from the productions over time. The results showed that the PTP (amount of pressure used to start vocal fold vibration), decreased with practice. PTP decreased by approximately 2 cm H2O during the first day of practice and by 0.9 cm H20 on the second day of practice, and a t-test confirmed that these results were statistically significant (p<0.001). The pattern improvement in PTP performance is similar to patterns observed in limb motor learning research. This change with practice shows that people are able to learn vocal tasks similar to the way that we learn during limb movements like swinging a bat. It also shows that clinicians who are using this particular measurement (PTP) should be cautious of changes in the measurement due to learning, and not due to the treatment that is being studied.


Perceptions of voice therapy from patients diagnosed with primary muscle tension dysphonia and benign mid-membranous vocal fold lesions.

Abstract: Studies have established the role of behavioral therapy in treating voice problems. However, studies have also identified patient adherence as a limitation in voice therapy effectiveness. Accordingly, an understanding of patient preferences may help to improve adherence and increase voice therapy success. The primary aim of this study was to understand patient-perceived facilitators and barriers influencing voice therapy effectiveness in a group of treatment-seeking individuals with voice disorders. A secondary aim was to examine the relationship between self-reported improvement from voice therapy and the Voice Handicap Index-10 (VHI-10).Retrospective, observational study design.One hundred ten patients enrolled in voice therapy at the University of Pittsburgh Voice Center completed a self-administered Patient Perception of Voice Therapy questionnaire on discharge. Data from 45 individuals who met study criteria were analyzed.Patient-reported improvement from voice therapy was correlated with changes in VHI-10 scores. A majority of patients identified specific voice therapy exercises and transfer of techniques to conversation as the most useful aspects of treatment. Few patients rated vocal hygiene education as most useful. Generalizing new vocal behaviors was also identified as a barrier to voice therapy success for many patients.In this study, patients valued direct voice therapy in which they worked on altering vocal behaviors more than indirect voice therapy that aimed to educate patients about their voice. Study findings suggest the importance of direct voice therapy and the need to incorporate carryover activities early on in the therapy process for greater treatment satisfaction and success.

Pub.: 21 May '14, Pinned: 30 Jun '17

Aerodynamic Outcomes of Four Common Voice Disorders: Moving Toward Disorder-Specific Assessment.

Abstract: The two goals of the present study were to (1) determine the ability of commonly used aerodynamic voice measures to capture change as a function of known interventions and (2) determine if certain aerodynamic measures demonstrate better responsiveness to change in specific disorder types than others.This is a retrospective, longitudinal, single-blinded, cross-sectional study.Patients (n = 70) with a single voice disorder diagnosis of benign vocal fold lesions (lesions), unilateral vocal fold paralysis (UVFP), primary muscle tension dysphonia (MTD-1), or vocal fold atrophy (atrophy) underwent baseline testing, a single intervention (phonosurgery or voice therapy), and follow-up testing. Common aerodynamic measurements were completed in repeated syllables and an all-voiced sentence.Statistically significant improvements were observed for two outcome measures, average airflow in syllables, and average airflow in the all-voiced sentence. Patients with lesions, UVFP, and MTD-1 improved in average airflow in the all-voiced sentence. Patients with UVFP also improved in airflow in syllables.Average airflow in the all-voiced sentence changed as a function of treatment for the lesion, MTD-1, and UVFP groups, demonstrating a disorder-specific pattern. Laryngeal airway resistance, and estimates of average subglottal pressure did not show significant change. Average airflow in the all-voiced sentence measurements is recommended as a routine voice measure, and further investigation of other aerodynamic measures' sensitivity to change is warranted.

Pub.: 24 May '15, Pinned: 30 Jun '17

Phonatory aerodynamics in connected speech.

Abstract: 1) Present phonatory aerodynamic data for healthy controls (HCs) in connected speech; 2) contrast these findings between HCs and patients with nontreated unilateral vocal fold paralysis (UVFP); 3) present pre- and post-vocal fold augmentation outcomes for patients with UVFP; 4) contrast data from patients with post-operative laryngeal augmentation to HCs.Retrospective, single-blinded.For phase I, 20 HC participants were recruited. For phase II, 20 patients with UVFP were age- and gender-matched to the 20 HC participants used in phase I. For phase III, 20 patients with UVFP represented a pre- and posttreatment cohort. For phase IV, 20 of the HC participants from phase I and 20 of the postoperative UVFP patients from phase III were used for direct comparison. Aerodynamic measures captured from a sample of the Rainbow Passage included: number of breaths, mean phonatory airflow rate, total duration of passage, inspiratory airflow duration, and expiratory airflow duration. The VHI-10 was also obtained pre- and postoperative laryngeal augmentation.All phonatory aerodynamic measures were significantly increased in patients with preoperative UVFP than the HC group. Patients with laryngeal augmentation took significantly less breaths, had less mean phonatory airflow rate during voicing, and had shorter inspiratory airflow duration than the preoperative UVFP group. None of the postoperative measures returned to HC values. Significant improvement in the Voice Handicap Index-10 scores postlaryngeal augmentation was also found.Methodology described in this study improves upon existing aerodynamic voice assessment by capturing characteristics germane to UVFP patient complaints and measuring change before and after laryngeal augmentation in connected speech.4. Laryngoscope, 125:2764-2771, 2015.

Pub.: 23 Jul '15, Pinned: 30 Jun '17

Singing voice outcomes following singing voice therapy.

Abstract: The objectives of this study were to describe singing voice therapy (SVT), describe referred patient characteristics, and document the outcomes of SVT.Retrospective.Records of patients receiving SVT between June 2008 and June 2013 were reviewed (n = 51). All diagnoses were included. Demographic information, number of SVT sessions, and symptom severity were retrieved from the medical record. Symptom severity was measured via the 10-item Singing Voice Handicap Index (SVHI-10). Treatment outcome was analyzed by diagnosis, history of previous training, and SVHI-10.SVHI-10 scores decreased following SVT (mean change = 11, 40% decrease) (P < .001). Approximately 18% (n = 9) of patient SVHI-10 scores decreased to normal range. The average number of sessions attended was three (± 2); patients who concurrently attended singing lessons (n = 10) also completed an average of three SVT sessions. Primary muscle tension dysphonia (MTD1) and benign vocal fold lesion (lesion) were the most common diagnoses. Most patients (60%) had previous vocal training. SVHI-10 decrease was not significantly different between MTD and lesion.This is the first outcome-based study of SVT in a disordered population. Diagnosis of MTD or lesion did not influence treatment outcomes. Duration of SVT was short (approximately three sessions). Voice care providers are encouraged to partner with a singing voice therapist to provide optimal care for the singing voice. This study supports the use of SVT as a tool for the treatment of singing voice disorders.4 Laryngoscope, 2016.

Pub.: 28 Jun '16, Pinned: 30 Jun '17