Voice Therapy via Telepractice & App for Voice Disorders

Overseen By Elizabeth U Grillo, Ph.D.

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: West Chester University of Pennsylvania

Disqualifiers: Not a teacher, No smartphone

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 15 weeks

32 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve voice therapy through a new app and web portal that allows users to practice anytime, anywhere. It will test various methods of delivering voice therapy to determine their effectiveness in preventing and treating voice problems, particularly for teachers. Participants will be divided into four groups, each trying a different voice therapy approach, including Conversation Training Therapy. Ideal candidates are teachers or student teachers with voice complaints, especially those with smartphones. The trial seeks to make voice therapy more effective and accessible through technology. As an unphased trial, this study offers participants the chance to contribute to innovative research that could enhance the accessibility and effectiveness of voice therapy.

Do I need to stop my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What prior data suggests that this voice therapy method is safe for use in telepractice?

Research shows that the treatments in this clinical trial, including Conversation Training Therapy and the Global Voice Prevention and Therapy Model, have been studied for safety and effectiveness.

For Conversation Training Therapy, research has found it to be a well-tolerated method for treating voice disorders. This therapy uses conversation to improve voice quality, and previous studies have not reported any significant side effects.

The Global Voice Prevention and Therapy Model has also been researched. Studies have examined its effect on voice quality and found it safe to use. Participants generally accepted the model and did not report major side effects.

These therapies' modified versions build on these well-tolerated models and aim to enhance their effectiveness. Since these therapies are non-invasive and focus on voice training, they are generally considered safe. Previous studies have not shown any serious safety concerns. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores innovative ways to deliver voice therapy via telepractice and a mobile app, potentially making treatment for voice disorders more accessible. Unlike traditional in-person therapy sessions, this approach offers flexibility and convenience, allowing patients to receive therapy from the comfort of their own homes. Additionally, the trial investigates four distinct therapy models, including modified versions of existing treatments, which may offer new insights into optimizing voice therapy techniques. This could lead to more personalized and effective treatment plans for individuals with voice disorders.

What evidence suggests that this trial's voice therapy treatments could be effective for voice disorders?

This trial will compare different voice therapy methods, including Conversation Training Therapy (CTT) and the Global Voice Prevention and Therapy Model (GVPTM). Studies have shown that CTT effectively improves voice quality, with participants often reporting better scores on the Voice Handicap Index-10, which measures the impact of voice problems on daily life. GVPTM has also improved voice outcomes, including voice sound and perception. Both approaches focus on patient-driven conversations and training various voice skills to meet vocal needs. These methods aim to help individuals become their own voice experts by understanding and managing their voice issues. While these findings are promising, they rely on previous research, and further studies will help confirm their effectiveness. ^{1 2 6 7 8}

Who Is on the Research Team?

Elizabeth U Grillo, Ph.D.

Principal Investigator

West Chester University

Are You a Good Fit for This Trial?

This trial is for student teachers planning to teach in the spring and professional teachers currently working with voice complaints. Participants must own an Android or iOS smartphone or tablet but haven't sought help for their voice issues.

Inclusion Criteria

Owner of either an android or iOS smartphone or tablet.

I am a working teacher with voice issues but haven't sought help.

I am a healthy education student planning to teach this spring.

Exclusion Criteria

This criterion means that people who are not professional teachers are eligible for the study.

Not a student teacher

Does not own a smartphone.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo voice therapy through telepractice, utilizing both synchronous and asynchronous methods, including ecological momentary intervention via a daily voice therapy practice app.

15 weeks

Weekly sessions via telepractice

Follow-up

Participants are monitored for changes in voice quality and therapy satisfaction after treatment.

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Conversation Training Therapy
• Global Voice Prevention and Therapy Model
• Modified Conversation Training Therapy
• Modified Global Voice Prevention and Therapy Model

Trial Overview The study tests four different voice therapy methods delivered via telepractice, focusing on preventing and treating voice disorders in teachers. It uses a daily practice app for feedback and tracks progress over time.

How Is the Trial Designed?

Group I: Modified Global Voice Prevention and Therapy Model Experimental Treatment 1 Intervention

Group II: Modified Conversation Training Therapy Experimental Treatment 1 Intervention

Group III: Global Voice Prevention and Therapy Model Experimental Treatment 1 Intervention

Group IV: Conversation Training Therapy Experimental Treatment 1 Intervention

Who Is Running the Clinical Trial?

West Chester University of Pennsylvania

Lead Sponsor

Trials

6

Recruited

1,300+

Published Research Related to This Trial

A survey of 55 Speech Language Pathologists (SLPs) in India revealed that most have advanced degrees and primarily work in medical settings, indicating a strong educational background and professional environment for treating voice disorders.

There is a lack of uniformity in voice therapy methods among SLPs, with many modifying their approaches based on client needs, highlighting the necessity for developing standardized, indigenous protocols for voice therapy in India.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An E-Survey of Current Voice Therapy Practices Amongst Speech Language Pathologists (SLPs) in India. Venkatraman, Y., Ganesan, S., Mahalingam, S., et al.[2023]

The Global Voice Therapy Model (GVTM) was effective in improving voice quality, as evidenced by significant changes in acoustic, aerodynamic, and perceptual voice measures in four adults with voice disorders.

Participants showed measurable improvements in their voice measures after therapy, indicating that GVTM can be a beneficial approach for individuals seeking voice therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical investigation of the Global Voice Therapy Model. Grillo, EU.[2022]

Conversation training therapy (CTT) significantly improved voice handicap perception (measured by the VHI-10) more than standard voice therapy approaches, with notable improvements observed after just 2 sessions compared to 4-8 sessions for traditional methods.

CTT also led to significant enhancements in various acoustic and aerodynamic voice measures, indicating that using spontaneous conversation as a therapeutic approach can effectively address voice disorders in adults with dysphonia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of Conversation Training Therapy for Patients With Benign Vocal Fold Lesions and Muscle Tension Dysphonia Compared to Historical Matched Control Patients. Gillespie, AI., Yabes, J., Rosen, CA., et al.[2020]

In a pilot study involving 10 transgender women, intensive voice feminization therapy delivered via telepractice resulted in significant improvements in voice characteristics and self-perceived femininity after 12 sessions over 4 weeks.

Participants showed enhanced acoustic measures and better scores on the Trans Woman Voice Questionnaire, indicating that telepractice can be an effective method for voice therapy, although further research with larger groups and control comparisons is needed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Voice Outcomes of Intensive Voice Feminization Therapy for Transgender Women Delivered via Telepractice: Pilot Study. Lin, CA., Chen, CH., Tsai, MJ., et al.[2023]

The Comprehensive Voice Habilitation Program (CVHP) was developed specifically for individuals with hyperfunctional voice disorder (HFVD) in India, incorporating culturally adapted exercises and verified by voice experts, leading to significant improvements in voice quality and function.

Participants in the 6-week program showed notable changes in vocal fold movement and reductions in voice quality issues, demonstrating the efficacy of the tailored therapy approach for HFVD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An eclectic Voice Therapy Program for the Treatment of Hyperfunctional Voice Disorders (HFVD). Boominathan, P., Mahalingam, S., Arunachalam, R., et al.[2023]

Meta-therapy is a structured approach to voice therapy that uses a standardized framework (Rehabilitation Treatment Specification System) to improve the understanding and delivery of vocal rehabilitation techniques.

The focus of meta-therapy is on changing patients' cognitions and beliefs about their voice, using clinician actions like verbal cues and analogies to shape their mental representations, which can enhance the effectiveness of voice treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mapping Meta-Therapy in Voice Interventions onto the Rehabilitation Treatment Specification System. Helou, LB., Gartner-Schmidt, JL., Hapner, ER., et al.[2022]

Patients receiving individual short-term intensive voice therapy (IVT-I) and long-term traditional voice therapy (TVT) reported similar satisfaction and perceived progress in their vocal quality, indicating that both approaches can be effective.

However, patients in the IVT-I and TVT groups were more satisfied than those in the group therapy (IVT-G), suggesting that individual therapy may be preferred for better patient experience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Patient's Opinion Regarding Different Service Delivery Models for Voice Therapy. Meerschman, I., Van Lierde, K., Claeys, S., et al.[2021]

Conversation Training Therapy (CTT) is a novel voice therapy approach that emphasizes voice awareness and efficient voice production through patient-driven conversational narratives, rather than following a traditional therapeutic hierarchy.

Developed with input from both expert speech-language pathologists and patients, CTT is grounded in motor learning theory and incorporates six key tenets to enhance spontaneous speech from the very first session.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Development of Conversation Training Therapy: A Concept Paper. Gartner-Schmidt, J., Gherson, S., Hapner, ER., et al.[2017]

A consensus protocol for telerehabilitation in speech therapy for voice disorders was established by experts from the French Society of Phoniatrics and Laryngology, validating 10 key statements on best practices after multiple voting rounds.

The protocol includes recommendations for various aspects of voice therapy and suggests a combination of telerehabilitation and in-office sessions, particularly beneficial for patients in rural areas, especially during or after pandemic conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tele-rehabilitation in voice disorders during the pandemic: a consensus paper from the French Society of Phoniatrics and Laryngology. Baudouin, R., Hans, S., Guiche, M., et al.[2023]

In a study of 56 patients with voice disorders, the Verbal Instructions Model voice therapy led to significantly greater long-term improvements in voice function, particularly in the physical and emotional aspects, compared to the Imitation Model.

Both therapy models improved voice function overall, but the Verbal Instructions Model showed better outcomes in self-rated Voice Handicap Index scores and voice quality at the end of therapy, indicating it may be more effective for patient learning and adaptation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Voice Therapy Outcome: A Comparison Between Imitation Model Voice Therapy and Verbal Instructions Model Voice Therapy. Ohlsson, AC., Li, Y., Gustavsson, I., et al.[2022]

A pilot randomized controlled trial involving 34 participants demonstrated that smartphone-based ecological momentary assessment and intervention (EMA/I) is feasible and acceptable for individuals experiencing distressing voice-hearing, showing good engagement and satisfaction rates.

The study suggests that integrating EMA/I with traditional therapy may improve coping strategies and reduce the severity and negative impact of voice-hearing experiences, indicating potential clinical utility for these digital tools.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pilot randomised controlled trial of a brief coping-focused intervention for hearing voices blended with smartphone-based ecological momentary assessment and intervention (SAVVy): Feasibility, acceptability and preliminary clinical outcomes. Bell, IH., Rossell, SL., Farhall, J., et al.[2021]

The Global Voice Prevention Model (GVPM) was tested with 21 student teachers over 4 weeks, focusing on vocal education and training, and showed promise in improving voice measures using the VoiceEvalU8 app.

Preliminary results indicated changes in fundamental frequency and jitter%, suggesting that both in-person and telepractice conditions may effectively enhance vocal health compared to a control group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Online Telepractice Model for the Prevention of Voice Disorders in Vocally Healthy Student Teachers Evaluated by a Smartphone Application. Grillo, EU.[2022]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/31619107/

Efficacy of Conversation Training Therapy for Patients With ... The primary outcome was change in Voice Handicap Index-10 (VHI-10); secondary outcomes included acoustic, aerodynamic, and auditory-perceptual ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7203518/

Efficacy of Conversation Training Therapy for Patients With ... A prospective study of CTT treatment outcomes in adults with dysphonia due to primary muscle tension dysphonia or benign vocal fold lesions

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0892199723000449

Assessing Candidacy for Conversation Training Therapy On average, VHI-10 scores improved for all participants following CTT treatment. All participants heard a change in the sound of voice with stimulability ...

4. pubs.asha.org pubs.asha.org/doi/abs/10.1044/2019_JSLHR-S-19-0136

Efficacy of Conversation Training Therapy for Patients With ... The primary outcome was change in Voice Handicap Index–10 (VHI-10); secondary outcomes included acoustic, aerodynamic, and auditory-perceptual outcomes. Data ...

5. clinicaltrials.gov clinicaltrials.gov/study/NCT07176988

Deconstructing Voice Therapy: Towards Enhanced ... This research study aims to evaluate the effect of treatment delivery method on voice outcomes over 12 months in people with a primary ...

6. theadultspeechtherapyworkbook.com theadultspeechtherapyworkbook.com/conversation-training-therapy/

How To Do Conversation Training Therapy Conversation Training Therapy (CTT) is a voice therapy approach that uses conversation to treat voice disorders. It was developed by Jackie Gartner-Schmidt ...

7. pubs.asha.org pubs.asha.org/doi/10.1044/2023_JSLHR-23-00258

Gender-Affirming Voice Training for Trans Women Our study aimed to redress limitations of earlier studies and evaluate voice training effects on outcomes important to trans women.

8. 2024.sci-hub.se 2024.sci-hub.se/8573/e7fba7180afa7ed9c30a88a2b0306841/gartner-schmidt2021.pdf

Conversation Training Therapy: Let's Talk It Through This article introduces a novel approach to voice therapy called conversation training therapy (CTT). CTT is the first voice therapy.