To assess the clinical effectiveness of two speech and language therapy approaches versus no speech and language therapy for dysarthria in people with Parkinson\'s disease.
Pragmatic, UK based, multicentre, three arm, parallel group, unblinded, randomised controlled trial.
The speech and language therapy interventions were delivered in outpatient or home settings between 26 September 2016 and 16 March 2020.
388 people with Parkinson\'s disease and dysarthria.
Participants were randomly assigned to one of three groups (1:1:1): 130 to Lee Silverman voice treatment (LSVT LOUD), 129 to NHS speech and language therapy, and 129 to no speech and language therapy. LSVT LOUD consisted of four, face-to-face or remote, 50 min sessions each week delivered over four weeks. Home based practice activities were set for up to 5-10 mins daily on treatment days and 15 mins twice daily on non-treatment days. Dosage for the NHS speech and language therapy was determined by the local therapist in response to the participants\' needs (estimated from prior research that NHS speech and language therapy participants would receive an average of one session per week over six to eight weeks). Local practices for NHS speech and language therapy were accepted, except for those within the LSVT LOUD protocol. Analyses were based on the intention to treat principle.
The primary outcome was total score at three months of self-reported voice handicap index.
People who received LSVT LOUD reported lower voice handicap index scores at three months after randomisation than those who did not receive speech and language therapy (-8.0 points (99% confidence interval -13.3 to -2.6); P<0.001). No evidence suggests a difference in voice handicap index scores between NHS speech and language therapy and no speech and language therapy (1.7 points (-3.8 to 7.1); P=0.43). Patients in the LSVT LOUD group also reported lower voice handicap index scores than did those randomised to NHS speech and language therapy (-9.6 points (-14.9 to -4.4); P<0.001). 93 adverse events (predominately vocal strain) were reported in the LSVT LOUD group, 46 in the NHS speech and language therapy group, and none in the no speech and language therapy group. No serious adverse events were recorded.
LSVT LOUD was more effective at reducing the participant reported impact of voice problems than was no speech and language therapy and NHS speech and language therapy. NHS speech and language therapy showed no evidence of benefit compared with no speech and language therapy.
ISRCTN registry ISRCTN12421382.

UNASSIGNED: Systematically improving voice therapy outcomes is challenging as the clinician actions (i.e., active ingredients) responsible for improved patient functioning (i.e., targets) are relatively unknown. The theory-driven Rehabilitation Treatment Specification System (RTSS) and standard, voice-specific terminology based on the RTSS (RTSS-Voice) may help address this problem. This qualitative study evaluated if the RTSS and RTSS-Voice can describe four evidence-based voice therapies for muscle tension dysphonia without missing critical aspects (content validity) and identify commonalities and differences across them (criterion validity).
UNASSIGNED: Qualitative interviews were completed between the clinicians (protocol experts) who developed and/or popularized the vocal function exercises, laryngeal reposturing, circumlaryngeal massage, and conversation training therapies as well as RTSS experts to produce RTSS specifications that met two consensus criteria: (a) The protocol expert agreed that the specification represented their treatment theory, and (b) the RTSS experts agreed that the specifications correctly adhered to both the RTSS framework and the RTSS-Voice\'s standard terminology.
UNASSIGNED: The RTSS and RTSS-Voice comprehensively described voice therapy variations across and within the four diverse treatment programs, needing only the addition of one new target: overall auditory-perceptual severity.
UNASSIGNED: The RTSS and RTSS-Voice exhibited strong content validity. The standard RTSS-Voice terminology helped identify, for the first time, commonalities and differences in treatment ingredients, targets, and mechanisms of action across four treatments developed for the same patient population. In the long term, the RTSS and RTSS-Voice could provide the framework for an ever-growing collection of clinically meaningful and evidence-based therapy algorithms with potential to improve research, education, and clinical care.
UNASSIGNED: https://doi.org/10.23641/asha.25537624.

Dysarthria is disabling in persons with degenerative ataxia. There is limited evidence for speech therapy interventions. In this pilot study, we used the Voice trainer app, which was originally developed for patients with Parkinson\'s disease, as a feedback tool for vocal control. We hypothesized that patients with ataxic dysarthria would benefit from the Voice trainer app to better control their loudness and pitch, resulting in a lower speaking rate and better intelligibility. This intervention study consisted of five therapy sessions of 30 min within 3 weeks using the principles of the Pitch Limiting Voice Treatment. Patients received real-time visual feedback on loudness and pitch during the exercises. Besides, they were encouraged to practice at home or to use the Voice trainer in daily life. We used observer-rated and patient-rated outcome measures. The primary outcome measure was intelligibility, as measured by the Dutch sentence intelligibility test. Twenty-one out of 25 included patients with degenerative ataxia completed the therapy. We found no statistically significant improvements in intelligibility (p = .56). However, after the intervention, patients were speaking slower (p = .03) and the pause durations were longer (p < .001). The patients were satisfied about using the app. At the group level, we found no evidence for an effect of the Voice trainer app on intelligibility in degenerative ataxia. Because of the heterogeneity of ataxic dysarthria, a more tailor-made rather than generic intervention seems warranted.

Pediatric vocal ford paralysis is a vocal cord movement disorder caused by damage to the pediatric laryngeal motor nerves.It is mainly characterized by voice, breathing,and swallowing difficulties,and in severe cases,it can lead to choking in affected children. Currently, the diagnosis and treatment of this condition pose a significant challenge for pediatric otolaryngologists, as the goal is to minimize damage to the vocal folds and laryngeal framework.In order to standardize the diagnosis and treatment of pediatric vocal cord paralysis, the Pediatric Otolaryngology Committee of the Chinese Medical Association,in collaboration with multiple children\'s medical centers nationwide, have formulated this consensus document.
摘要: 儿童声带麻痹是小儿喉运动神经损伤导致的声带运动障碍，主要表现为发声、呼吸和吞咽功能障碍，严重可导致患儿窒息。目前对该疾病采取何种诊治方式，最大程度地减少对声门和喉框架结构的破坏，是小儿耳鼻喉科医师面临最棘手的问题。因此，为规范儿童声带麻痹的诊治，中国医师协会儿科医师分会儿童耳鼻咽喉专业委员会联合全国多家儿童医疗中心特制定本共识。.

OBJECTIVE: Dysphonia is a common symptom due to the coronavirus disease of the 2019 (COVID-19) infection. Nonetheless, it is often underestimated for its impact on human\'s health. We conducted this first study to investigate the global prevalence of COVID-related dysphonia as well as related clinical factors during acute COVID-19 infection, and after a mid- to long-term follow-up following the recovery.
METHODS: Five electronic databases including PubMed, Embase, ScienceDirect, the Cochrane Library, and Web of Science were systematically searched for relevant articles until Dec, 2022, and the reference of the enrolled studies were also reviewed. Dysphonia prevalence during and after COVID-19 infection, and voice-related clinical factors were analyzed; the random-effects model was adopted for meta-analysis. The one-study-removal method was used for sensitivity analysis. Publication bias was determined with funnel plots and Egger\'s tests.
RESULTS: Twenty-one articles comprising 13,948 patients were identified. The weighted prevalence of COVID-related dysphonia during infection was 25.1 % (95 % CI: 14.9 to 39.0 %), and male was significantly associated with lower dysphonia prevalence (coefficients: -0.116, 95 % CI: -0.196 to -0.036; P = .004) during this period. Besides, after recovery, the weighted prevalence of COVID-related dysphonia declined to 17.1 % (95 % CI: 11.0 to 25.8 %). 20.1 % (95 % CI: 8.6 to 40.2 %) of the total patients experienced long-COVID dysphonia.
CONCLUSIONS: A quarter of the COVID-19 patients, especially female, suffered from voice impairment during infection, and approximately 70 % of these dysphonic patients kept experiencing long-lasting voice sequelae, which should be noticed by global physicians.

UNASSIGNED: This investigation aimed to propose a new rehabilitation technique that combines voice exercises and instrumental postural rehabilitation for patients with muscle tension dysphonia (MTD).
UNASSIGNED: We enrolled nine dysphonic patients (8 women and 1 man, aged 22-55 years). Voice assessment included strobovideolaryngoscopy, Maximum Phonation Time (MPT), perceptual evaluation by GRBAS scale and patient\'s self-rating by Italian version of the Voice Handicap Index (VHI). Vestibular function was evaluated by the Bed Side Examination and Video Head Impulse test (VHIT). Postural control was evaluated by Dynamic Posturography (DP) using the Sensory Organization Test (SOT) and analysing the Equilibrium Score (ES) and balance subsystems (somatosensorial, visual, vestibular).
UNASSIGNED: All cases underwent different types of voice exercises combined with balance training based on NeuroCom Balance Master Protocols, once a week for six 35-minutes sessions. After therapy, an improvement in MPT, VHI, GRBAS scores and endoscopic laryngeal features was obtained. DP results at baseline were normal and after therapy we showed a slight improvement of ES (somatosensorial and visual components).
UNASSIGNED: A combined rehabilitation technique for MTD, by improving the attention to postural control, allows for significant improvement in vocal symptoms.
Trattamento combinato della disfonia muscolo tensiva: terapia logopedica e riabilitazione posturale strumentale.
UNASSIGNED: Scopo di questo lavoro era proporre una tecnica riabilitativa che combinasse esercizi vocali e riabilitazione posturale strumentale per pazienti con disfonia muscolo tensiva (MTD).
UNASSIGNED: Abbiamo arruolato nove pazienti disfonici (8F e 1M, età 22-55 anni). La valutazione includeva: videostroboscopia, tempo massimo fonatorio (TMF), valutazione percettiva (GRBAS) e autovalutazione del paziente mediante Voice Handicap Index (VHI) per la voce; Bed Side Examination e Video Head Impulse Test (VHIT) per la funzione vestibolare; Posturografia Dinamica (DP) con Test di Organizzazione Sensoriale (SOT), analizzando l’Equilibrium Score (ES) e i sottosistemi di equilibrio (Somatosensoriale, Visivo, Vestibolare) per il controllo posturale. Tutti i casi sono stati sottoposti a esercizi vocali associati a un training sull’equilibrio basato sui protocolli NeuroCom Balance Master, una volta alla settimana per sei sedute da 35 minuti.
UNASSIGNED: Dopo la terapia è stato riscontrato un miglioramento nel TMF, nei punteggi al VHI e alla GRBAS e nel quadro endoscopico laringeo. Dopo la terapia è stato riscontrato un lieve miglioramento della componente ES, somatosensoriale e visiva.
UNASSIGNED: Un trattamento combinato per la MTD, migliorando l’attenzione sul controllo posturale, permette di ottenere un miglioramento significativo dei sintomi vocali.

Limited research has examined the suitability of crowdsourced ratings to measure treatment effects in speakers with Parkinson\'s disease (PD), particularly for constructs such as voice quality. This study obtained measures of reliability and validity for crowdsourced listeners\' ratings of voice quality in speech samples from a published study. We also investigated whether aggregated listener ratings would replicate the original study\'s findings of treatment effects based on the Acoustic Voice Quality Index (AVQI) measure.
This study reports a secondary outcome measure of a randomized controlled trial with speakers with dysarthria associated with PD, including two active comparators (Lee Silverman Voice Treatment [LSVT LOUD] and LSVT ARTIC), an inactive comparator (untreated PD), and a healthy control group. Speech samples from three time points (pretreatment, posttreatment, and 6-month follow-up) were presented in random order for rating as \"typical\" or \"atypical\" with respect to voice quality. Untrained listeners were recruited through the Amazon Mechanical Turk crowdsourcing platform until each sample had at least 25 ratings.
Intrarater reliability for tokens presented repeatedly was substantial (Cohen\'s κ = .65-.70), and interrater agreement significantly exceeded chance level. There was a significant correlation of moderate magnitude between the AVQI and the proportion of listeners classifying a given sample as \"typical.\" Consistent with the original study, we found a significant interaction between group and time point, with the LSVT LOUD group alone showing significantly higher perceptually rated voice quality at posttreatment and follow-up relative to the pretreatment time point.
These results suggest that crowdsourcing can be a valid means to evaluate clinical speech samples, even for less familiar constructs such as voice quality. The findings also replicate the results of the study by Moya-Galé et al. (2022) and support their functional relevance by demonstrating that the effects of treatment measured acoustically in that study are perceptually apparent to everyday listeners.

暂无摘要。

OBJECTIVE: Understanding speech in real life can be challenging and effortful, such as in multiple-talker listening conditions. Fundamental frequency ( fo ) and vocal-tract length ( vtl ) voice cues can help listeners segregate between talkers, enhancing speech perception in adverse listening conditions. Previous research showed lower sensitivity to fo and vtl voice cues when speech signal was degraded, such as in cochlear implant hearing and vocoder-listening compared to normal hearing, likely contributing to difficulties in understanding speech in adverse listening. Nevertheless, when multiple talkers are present, familiarity with a talker\'s voice, via training or exposure, could provide a speech intelligibility benefit. In this study, the objective was to assess how an implicit short-term voice training could affect perceptual discrimination of voice cues ( fo+vtl ), measured in sensitivity and listening effort, with or without vocoder degradations.
METHODS: Voice training was provided via listening to a recording of a book segment for approximately 30 min, and answering text-related questions, to ensure engagement. Just-noticeable differences (JNDs) for fo+vtl were measured with an odd-one-out task implemented as a 3-alternative forced-choice adaptive paradigm, while simultaneously collecting pupil data. The reference voice either belonged to the trained voice or an untrained voice. Effects of voice training (trained and untrained voice), vocoding (non-vocoded and vocoded), and item variability (fixed or variable consonant-vowel triplets presented across three items) on voice cue sensitivity ( fo+vtl JNDs) and listening effort (pupillometry measurements) were analyzed.
RESULTS: Results showed that voice training did not have a significant effect on voice cue discrimination. As expected, fo+vtl JNDs were significantly larger for vocoded conditions than for non-vocoded conditions and with variable item presentations than fixed item presentations. Generalized additive mixed models analysis of pupil dilation over the time course of stimulus presentation showed that pupil dilation was significantly larger during fo+vtl discrimination while listening to untrained voices compared to trained voices, but only for vocoder-degraded speech. Peak pupil dilation was significantly larger for vocoded conditions compared to non-vocoded conditions and variable items increased the pupil baseline relative to fixed items, which could suggest a higher anticipated task difficulty.
CONCLUSIONS: In this study, even though short voice training did not lead to improved sensitivity to small fo+vtl voice cue differences at the discrimination threshold level, voice training still resulted in reduced listening effort for discrimination among vocoded voice cues.

The purpose of the study was to investigate the effects of flow phonation voice therapy on laryngeal physiology and vocal quality in persons with primary Muscle Tension Dysphonia (MTD1).
Seventeen participants with a diagnosis of MTD1 completed the study. Participants were randomized to two groups. Group 1 (9 participants) received flow phonation treatment and individualized vocal hygiene education for 12 sessions over six weeks. Group 2 (8 participants) received vocal hygiene education only for three weeks (6 sessions), followed by another three weeks (6 sessions) of both vocal hygiene instruction and flow phonation therapy. Treatment consisted of cup-bubble blowing, gargling, and stretch and flow exercises. Visual-perceptual. auditory-perceptual, acoustic, aerodynamic and voice-related quality-of-life measures were obtained at three time points: before treatment, three weeks after initiation of treatment and after completion of treatment.
Voice quality was perceived to be significantly improved in both groups. Voice related quality-of-life trended toward improvement for both groups across time points. Changes in aerodynamic and acoustic measures did not reach statistical significance compared to baseline for both groups. Visual comparisons of laryngeal closure patterns demonstrated comparably better outcomes for Group 1.
Results of this study indicate flow phonation exercises can potentially be favorably employed for individuals with MTD1. In particular, it appears that the exercises aid in alleviating vocal hyperfunction, as evidenced by visual perceptual stroboscopic analysis, and clinically improved auditory-perceptual measures.