Telepractice Versus In-Person Delivery of Voice Therapy for Primary Muscle Tension Dysphonia

Purpose: The purpose of this study was to investigate the utility of telepractice for delivering flow phonation exercises to persons with primary muscle tension dysphonia (MTD). Method: Fourteen participants with a diagnosis of primary MTD participated, 7 on site and 7 at remote locations. Each participant received 12 treatment sessions across 6 weeks. Treatment consisted of flow phonation voice therapy exercises. Auditory–perceptual, acoustic, aerodynamic, and quality-of-life measures were taken before and after treatment. Results: Perceptual and quality-of-life measures were significantly better posttreatment and were statistically equivalent across groups. Acoustic and aerodynamic measures improved in both groups, but changes did not reach statistical significance. Results for the 2 service delivery groups were comparable, with no significant differences observed for perceptual and quality-of-life measures.Conclusions: Although the American Speech-Language-Hearing Association supports the use of telepractice for speech-language pathology services, evidence for the use of telepractice for providing behavioral treatment to patients with MTD has been lacking. The results of this study indicate that flow phonation exercises can be successfully used for patients with MTD using telepractice

Utility Of Clinical Swallowing Examination Measures For Detecting Aspiration Post-Stroke

The purpose of this investigation was to determine the utility of clinical swallowing examination (CSE) measures for detecting aspiration as defined by videofluoroscopic swallowing examination (VFSE). This study, involving 165 participants, is a follow-up to a previously published investigation of 60 participants. Findings are compared with that investigation as well as with other research on CSEs. The results suggest that clinicians can make an accurate judgment of the occurrence of aspiration in most poststroke patients. However, ruling out aspiration when it is absent appears more problematic. More work needs to be done if data collected from noninstrumented examinations are to be strongly predictive of the presence and absence of aspiration on VFSE. At present, there are no data to suggest that CSEs can be used to quantify aspiration or make adequate recommendations regarding patient care

The Association Between Oral Microorgansims And Aspiration Pneumonia In The Institutionalized Elderly: Review And Recommendations

Aspiration pneumonia is a leading cause of illness and death in persons who reside in long-term-care facilities and, combined with the lack of proper oral health care and services, the risk of aspiration pneumonia rises. The purpose of this article is to review recent literature on oral hygiene and oral care in long-term-care facilities and report new findings regarding associated risks for aspiration pneumonia, as well as research on oral care and health outcomes. The PubMed MeSH database was utilized to direct a specific search by entering terms ‘‘aspiration pneumonia’’ and ‘‘oral hygiene’’ from 1970 to 2009, which yielded 34 articles. The Ovid and Google Scholar databases were utilized as well and provided no additional references for the two terms. A manual search of references from other articles, including three systematic reviews published over the past decade, provided additional information regarding oral microorganisms and respiratory pathogens, as well as investigations of oral care. Finally, a brief but comprehensive introductory review was organized regarding oral microorganisms, biofilm, periodontal disease, and pneumonia to establish a framework for discussion. Over- all, studies suggest (1) an association between poor oral hygiene and respiratory pathogens, (2) a decrease in the incidence of respiratory complications when patients are provided chemical or mechanical interventions for improved oral care, (3) the complex nature of periodontal disease and aspiration pneumonia make direct connections between the two challenging, and (4) additional studies are warranted to determine adequate oral hygiene protocols for nursing home patients to further reduce the incidence of aspiration pneumonia

Effects Of Mendelsohn Maneuver On Measures Of Swallowing Duration Post-Stroke

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Effects Of Topical Nasal Anesthetic On Fiberoptic Endoscopic Examination Of Swallowing With Sensory Testing (FEESST)

Objections to the use of topical nasal anesthesia (TNA) during fiberoptic endoscopic evaluation of swallowing (FEES) with sensory testing (FEESST) have been raised, primarily because of the possibility of desensitizing the pharyngeal and laryngeal mucosa and affecting both the sensory and motor aspects of the swallow. Furthermore, it has been suggested that TNA is not necessary during FEES as it does not improve patient comfort or make the procedure easier for the endoscopist. The purpose of this double-blind, randomized, controlled, crossover clinical trial was to determine how gel TNA during flexible endoscopic evalu- ation of swallowing with sensory testing affects sensation, swallowing, and comfort rating scores in healthy nondys- phagic participants. Laryngopharyngeal sensory thresholds and swallowing durations were compared between two conditions: TNA and sham. Transition duration decreased statistically significantly during the TNA condition com- pared to the sham for 10 ml only (p \ 0.05). All other swallowing measures did not change between the conditions. Laryngopharyngeal sensory thresholds and perceptions did not change between conditions. No change was observed for subject comfort scores, ease of exam, or quality of view. Future studies should evaluate TNA administration vari- ables, including concentration, dosage amount, and method of application, to determine the optimal strategy for pro- viding comfort while avoiding altered swallowing

Do Patients Treated For Voice Therapy With Telepractice Show Similar Changes In Voice Outcome Measures As Patients Treated Face To Face?

Clinical Question: Do patients treated for voice therapy with telepractice show similar changes in voice outcome measures as patients treated face-to-face? Method: Systematic Review. Study Sources: MEDLINE, PubMed, Google Scholar, ASHA journals. Search Terms: Voice therapy OR telepractice OR telehealth OR telerehabilitation. Number of Included Studies: 6. Primary Results: Delivery of voice therapy by telepractice provided positive outcomes comparable to face-to-face delivery. Number of studies employing quantitative data is relatively limited, restricting generalization of results. Conclusions: The goal of the speech-language pathologist is to maximize functional outcomes for individuals with communication disorders. Evidence found in this literaturereview for the effectiveness of telepractice delivery for the treatment of voice disorders indicates that treatment outcomes are comparable to face-to-face therapy and shows promising scope for this mode of service delivery

Effects Of The Mendelsohn Maneuver On Extent Of Hyoid Movement And UES Opening Post-Stroke

The Mendelsohn maneuver, voluntary prolon- gation of laryngeal elevation during the swallow, has been widely used as a compensatory strategy to improve upper esophageal sphincter (UES) opening and bolus flow. Recent research suggests that when used as a rehabilitative exercise, it significantly improves duration of hyoid movement and positively impacts duration of UES opening (DOUESO). The data presented here were derived from that same prospective crossover study of 18 participants with dysphagia post-stroke evaluated with videofluoroscopy after treatment using the Mendelsohn maneuver versus no treatment. Results demon- strate gains in the extent of hyoid movement and UES opening and improvements in coordination of structural movements with each other as well as with bolus flow

Bolus Consistency And Swallowing In Children And Adults

Research has shown that swallowing in adults is affected by bolus consistency. Little is known, however, regarding the effect of bolus con- sistency on swallowing in children. Electromyo- graphic (EMG) data from typically developing five- and eight-year-old-children and adults were obtained from the following muscles as they swallowed boluses of different consistencies: (1) right upper lip, (2) right lower lip, (3) submental, and (4) laryngeal strap. Signal analyses included calculating EMG onset and offset and average EMG amplitude of muscle activity during swallowing. Findings revealed that by five years of age, children employ adult-like control strategies during swallowing: significant differences in duration and magnitude of muscle activity resulted as a function of bolus consistency. General observations revealed, however, that swallowing in children is characterized by muscle activity that is shorter in duration. Similarities and differences in the biomechanics of swallowing between children and adults are important to consider during clinical evaluations and treatment of children with dysphagia

Improvement In Arousal, Visual Neglect, And Perception Of Stimulus Intensity Following Cold Pressor Stimulation

The relationship between arousal, perception, and visual neglect was examined in this case study. Cold pressor stimulation (CPS: immersing the foot in iced water) was used to manipulate arousal and to determine its effects on contralesional neglect, perception of stimulus intensity (magnitude estimation), reaction time, and an electrophysiological correlate of ascending reticular activating system activity (i.e., the P50 potential). Measures that normalized from baseline following CPS included contralesional neglect on a clock drawing test, perception of stimulus magnitude, and P50 amplitude. The P50 amplitude returned to its abnormally low baseline level 20 minutes after CPS ended, indicating that CPS increased arousal

"Prologues To A Bad Voice": Effect Of Vocal Hygiene Knowledge And Training On Voice Quality Following Stage Performance

The purpose of this investigation was to determine the effects of intensive stage rehearsal and performance on perceptual, acoustic, and aerodynamic measures of voice, and to determine the impact of knowledge and practice of vocal hygiene on measures of voice during intensive vocal performance. Nineteen stage actors who were participating in the Arkansas Shakespeare Theatre festival took part in the study. Each participant completed auditory-perceptual, acoustic, aerodynamic, and quality of life measures before and after 1 month of intensive rehearsals and stage performances. They also completed a questionnaire documenting their vocal use, vocal hygiene, and previous vocal training, if any. Subjects demonstrated statistically significant deterioration in auditory-perceptual measures and mean expiratory airflow. Other acoustic measures trended toward poorer outcomes after the performances; however, these were not statistically significant. Knowledge of vocal hygiene and vocal training did not have an impact on the change in vocal measures. Conclusions: Stage performances do impact vocal outcomes with reduction in quality and efficient use of airflow for voice production. Knowledge and practice of vocal hygiene have some impact on these changes; however, vocal hygiene may not be the best preventive strategy of potential phonotrauma in this subject population