Integration of Motor Learning Principles Into Real-Time Ambulatory Voice Biofeedback and Example Implementation Via a Clinical Case Study With Vocal Fold Nodules Purpose Ambulatory voice biofeedback (AVB) has the potential to significantly improve voice therapy effectiveness by targeting one of the most challenging aspects of rehabilitation: carryover of desired behaviors outside of the therapy session. Although initial evidence indicates that AVB can alter vocal behavior in daily life, retention of the new ... Clinical Focus
Clinical Focus  |   February 01, 2017
Integration of Motor Learning Principles Into Real-Time Ambulatory Voice Biofeedback and Example Implementation Via a Clinical Case Study With Vocal Fold Nodules
 
Author Affiliations & Notes
  • Jarrad H. Van Stan
    Massachusetts General Hospital, Boston
    MGH Institute of Health Professions, Boston, MA
  • Daryush D. Mehta
    Massachusetts General Hospital, Boston
    MGH Institute of Health Professions, Boston, MA
    Harvard Medical School, Boston, MA
  • Robert J. Petit
    Independent Scholar, Boston, MA
  • Dagmar Sternad
    Northeastern University, Boston, MA
  • Jason Muise
    Massachusetts General Hospital, Boston
  • James A. Burns
    Massachusetts General Hospital, Boston
    Harvard Medical School, Boston, MA
  • Robert E. Hillman
    Massachusetts General Hospital, Boston
    MGH Institute of Health Professions, Boston, MA
    Harvard Medical School, Boston, MA
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Jarrad Van Stan: jvanstan@mghihp.edu
  • Editor: Krista Wilkinson
    Editor: Krista Wilkinson×
  • Associate Editor: Preeti Sivasankar
    Associate Editor: Preeti Sivasankar×
Article Information
Speech, Voice & Prosodic Disorders / Voice Disorders / Speech, Voice & Prosody / Clinical Focus
Clinical Focus   |   February 01, 2017
Integration of Motor Learning Principles Into Real-Time Ambulatory Voice Biofeedback and Example Implementation Via a Clinical Case Study With Vocal Fold Nodules
American Journal of Speech-Language Pathology, February 2017, Vol. 26, 1-10. doi:10.1044/2016_AJSLP-15-0187
History: Received December 2, 2015 , Revised March 18, 2016 , Accepted June 1, 2016
 
American Journal of Speech-Language Pathology, February 2017, Vol. 26, 1-10. doi:10.1044/2016_AJSLP-15-0187
History: Received December 2, 2015; Revised March 18, 2016; Accepted June 1, 2016
Web of Science® Times Cited: 1

Purpose Ambulatory voice biofeedback (AVB) has the potential to significantly improve voice therapy effectiveness by targeting one of the most challenging aspects of rehabilitation: carryover of desired behaviors outside of the therapy session. Although initial evidence indicates that AVB can alter vocal behavior in daily life, retention of the new behavior after biofeedback has not been demonstrated. Motor learning studies repeatedly have shown retention-related benefits when reducing feedback frequency or providing summary statistics. Therefore, novel AVB settings that are based on these concepts are developed and implemented.

Method The underlying theoretical framework and resultant implementation of innovative AVB settings on a smartphone-based voice monitor are described. A clinical case study demonstrates the functionality of the new relative frequency feedback capabilities.

Results With new technical capabilities, 2 aspects of feedback are directly modifiable for AVB: relative frequency and summary feedback. Although reduced-frequency AVB was associated with improved carryover of a therapeutic vocal behavior (i.e., reduced vocal intensity) in a patient post-excision of vocal fold nodules, causation cannot be assumed.

Conclusions Timing and frequency of AVB schedules can be manipulated to empirically assess generalization of motor learning principles to vocal behavior modification and test the clinical effectiveness of AVB with various feedback schedules.

Acknowledgments
This work was supported by Voice Health Institute and National Institute on Deafness and Other Communication Disorders Grants R33 DC011588 and F31 DC014412. The contents of this clinical focus article are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.
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