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Therapeutic intervention
Published in Stephanie Martin, Working with Voice Disorders, 2020
The approach allows patients to self-monitor the effort level required to generalise the new patterns of speaking. The effectiveness of this approach is reported in Ramig et al. (1996, 2001) and Pannbacker (1998). The intensive approach allows people with Parkinson’s disease to ‘recalibrate’ sensory feedback so that they can recognise that their louder voice in fact falls within normal range. It may be difficult for individuals to equate the amount of vocal effort they need to put into speaking with the vocal loudness they achieve.
Cognitive influences on perceived phonatory exertion using the Borg CR10
Published in Logopedics Phoniatrics Vocology, 2020
Miriam van Mersbergen, Lisa A. Vinney, Alexis E. Payne
Because increased vocal effort is a common symptom observed in the voice clinic, reduction of vocal effort is a frequent target in voice therapy. In the literature and in clinical settings, vocal effort may be characterized as an auditory-perceptual phenomena observed by the listener or perceived phonatory exertion experienced by the speaker. Physical symptoms are often correlated with the auditory-perceptual feature of vocal strain [7,8]. In a sense, vocal effort may be heard in an individual’s voice, which may in turn, interfere with effective communication. Additionally, physical symptoms are also translated into the impression of physical work when producing voice [1–3]. Thus, reductions in a voice patient’s perceived exertion and a listener’s impression of strain are two, separate but related, targets in voice therapy [7,8]. In this study, vocal effort is defined as speaker-perceived phonatory exertion or the speaker’s impression of physical exertion during voice production.
Long-term effects of Lee Silverman Voice Treatment on daily voice use in Parkinson’s disease as measured with a portable voice accumulator
Published in Logopedics Phoniatrics Vocology, 2019
Joakim Körner Gustafsson, Maria Södersten, Sten Ternström, Ellika Schalling
Even though there are diverse pharmacological and surgical treatment options available to alleviate motor symptoms in PD, their effect on the dysarthria is limited and variable (7–14). The leading treatment option for speech and voice symptoms in PD today is the LSVT LOUD® Lee Silverman Voice Treatment (LSVT Global, Tucson, AZ) (15). It is an intensive treatment program focusing on increased effort to increase voice intensity with the goal to achieve normal levels. It includes 16 h-long individual treatment sessions four times per week over 4 weeks together with a speech and language pathologist as well as daily exercises performed by the patient at home. Each session includes daily tasks that are consistent during the program as well hierarchically structured exercises that increases in difficulty from session to session. Tasks solely focus on increasing the voice intensity as the single motor control parameter trained during treatment to promote activity-driven neural plasticity (16). The treatment program also aims to ‘recalibrate’ the patient’s perception of speech production enabling them to compensate for deficits in internal cueing and self-regulation of vocal effort during speech. Positive outcomes lasting for up to 2 years after treatment have been reported in a clinical setting (17).
The effect of a prolonged and demanding vocal activity (Divya Prabhandam recitation) on subjective and objective measures of voice among Indian Hindu priests
Published in Speech, Language and Hearing, 2022
S. Y. Aishwarya, S. V. Narasimhan
The present study aimed at investigating the subjective (VFI) and objective parameters (acoustic and cepstral parameters) of voice before and after a vocally demanding task among Hindu priests. The first null hypothesis tested in the present study was that there will be no statistically significant differences in the scores of vocal fatigue index before and after recitation of Dravida prabhanda. The results showed that there were significant differences in the scores of VFI between the two conditions. All the participants reported significantly higher VFI scores in condition 2 compared to condition 1. In condition 1, most of the participants rated the frequency of vocal fatigue symptoms as ‘never’ or ‘almost never’. Whereas, the frequency of vocal fatigue symptoms rated as ‘never’ or ‘almost never’ reduced in condition 2. Hence, the first null hypothesis stating that there will be no statistically significant differences in the scores of vocal fatigue index before and after recitation of Dravida prabhandam was rejected. It was inferred that the loud and continuous recitation of Divya prabhandam for two hours resulted in vocal fatigue. Loud, continuous or excessive voice use can cause neuromuscular and biomechanical changes that increase vocal effort leading the voice user to make compensatory changes in vocal function. These compensatory functions or laryngeal adjustments can lead to tissue change in the lamina propria of the vocal folds and possibly resulting in symptoms of vocal fatigue (McCabe & Titze, 2002). Therefore, the present study supports the notion that the scales using subjective assessment of symptoms as VFI could be used as the reliable indicator of vocal fatigue in Divya prabhandam reciters.