Behavioral intervention for voice disorders - Voice therapy by the SLHT

Abstract

This review considers the framework of voice therapy by the SLHT (speech-language-hearing therapist) to otolarngologists using the 5-R concept. The 5-R concept is "Right" client, voice therapy, time, dose, and route. "Right" is used in the sense of "most appropriate". First, Right client means that the right voice client with " functional" (no visible structural or neuro-logical laryngeal pathology) voice problems must be selected because voice therapy by the SLHT is most effective for functional voice disorders. If the client does not have a functional problem with phonation, voice therapy might not be effective. Second, Right voice therapy means that the SLHT should carefully choose the right therapeutic technique to treat the client's voice symptom. In this review, I will introduce a tube-phonation exercise and vocal hygienic advice, which are evidence-based. Third, Right time refers to when the SLHT should start and stop voice therapy. Voice therapy should be begun as soon as possible after the client is diagnosed with a functional voice disorder. The SLHT must also know when to terminate a series of voice therapy sessions. Fourth, Right dose refers to how many sessions of voice therapy and number of phonatory repetitions are effective. Unfortunately, there is a lack of research data in this area. My recent study shows that more than 1500 phonatory repetitions (50-repetitions per day) may be needed to retain the effect 1-month post-therapy. Fifth, Right route indicates that the SLHT should have extensive knowledge of the motor-learning system because voice therapy is a behavioral modification, which is based on motor-learning theory. Some previous research in speech therapy, which is based on motor-learning therapy has shown that summaryfeedback and randomized task exercises are effective to promote retention of new motor behaviors.