Some Guiding Principles in Emerging Models of Voice Therapy for Children

Abstract

Voice disorders are the most common communication disorder across the life span, affecting more than five million school-aged children annually in the United States alone. Although such disorders are commonly associated with benign pathology, medically malicious conditions cannot be ruled out without proper medical examination by an otolaryngologist. Many children with voice disorders are otherwise healthy. However, some are not. Moreover, children with voice problems of any origin often experience distinctly negative consequences in quality of life and academic participation as a result of them. Regrettably, this population is badly underserved by speech-language pathology. In this article, possible reasons are suggested, among them the relative unattractiveness of traditional therapy that emphasizes voice conservation using a Skinnerian paradigm. Alternatives are presented in terms of foundational principles of biomechanics, biology, and learning and factors affecting children's compliance with health care directives, which may help to shape the next generation of pediatric voice therapies. The article concludes with discussion of challenges surrounding voice therapy in the school setting and possible solutions.

Liuzijue Qigong: A Voice Training Method For Unilateral Vocal Fold Paralysis Patients

“…Some studies have shown that glottal width could be related to the type or mode of phonation: When an individual speaks with "glottal attack," the glottal width can be less than 0; when SOVT or SAT is used, the glottal width is approximately 0 mm to 0.5 mm; when yawn-sigh is used, the glottal width is 1 mm to 2 mm; and the glottal width is more than 3 mm in cases of breathy voice. 20 There were no significant differences in the changes of jitter, shimmer, and NNE between the 2 groups posttreatment (P > .004). UVFP patients with poor glottal closure often overcompensate, resulting in a lower output-cost ratio (OCR) for phonation 21 and hoarseness.…”

Liuzijue Qigong: A Voice Training Method For Unilateral Vocal Fold Paralysis Patients

“…Some studies have shown that glottal width could be related to the type or mode of phonation: When an individual speaks with "glottal attack," the glottal width can be less than 0; when SOVT or SAT is used, the glottal width is approximately 0 mm to 0.5 mm; when yawn-sigh is used, the glottal width is 1 mm to 2 mm; and the glottal width is more than 3 mm in cases of breathy voice. 20 There were no significant differences in the changes of jitter, shimmer, and NNE between the 2 groups posttreatment (P > .004). UVFP patients with poor glottal closure often overcompensate, resulting in a lower output-cost ratio (OCR) for phonation 21 and hoarseness.…”

Socioeconomic Status, Voice Disorder Risk, and Voice-Related Handicap Across Childhood

“…In addition, P-VHI scores were elevated in children with voice disorders, suggesting that pediatric populations experience the functional, physical, and emotional outcomes of voice problems . These findings highlight the need for efficient and effective voice treatment across childhood …”

“…59,60 These findings highlight the need for efficient and effective voice treatment across childhood. [61][62][63][64] In those with voice disorders, household income was inversely associated with voice-related handicap as measured by the VHI and P-VHI. This suggests that impacts of voice symptoms in a child's life may vary according to SES.…”

“… 59 , 60 These findings highlight the need for efficient and effective voice treatment across childhood. 61 – 64 …”

Are Children with Cleft Palate at Increased Risk for Laryngeal Pathology?

“…72,73 Although dysphonia in CP ± L may often be eclipsed by other medical needs, diagnosis of laryngeal pathology remains important. Voice therapy has been shown to effectively treat pediatric voice disorders in children with and without CP ± L. 53,[74][75][76] As such, viable treatment options are available for these children if dysphonia interferes with quality of life. 77 The findings of the current study emphasize the importance of laryngeal visualization/diagnosis in ruling out medically urgent diagnoses such as cancer or papilloma.…”

Liuzijue Qigong: A Voice Training Method For Unilateral Vocal Fold Paralysis Patients

“…Some studies have shown that glottal width could be related to the type or mode of phonation: When an individual speaks with "glottal attack," the glottal width can be less than 0; when SOVT or SAT is used, the glottal width is approximately 0 mm to 0.5 mm; when yawn-sigh is used, the glottal width is 1 mm to 2 mm; and the glottal width is more than 3 mm in cases of breathy voice. 20 There were no significant differences in the changes of jitter, shimmer, and NNE between the 2 groups posttreatment (P > .004). UVFP patients with poor glottal closure often overcompensate, resulting in a lower output-cost ratio (OCR) for phonation 21 and hoarseness.…”

Socioeconomic Status, Voice Disorder Risk, and Voice-Related Handicap Across Childhood

“…In addition, P-VHI scores were elevated in children with voice disorders, suggesting that pediatric populations experience the functional, physical, and emotional outcomes of voice problems . These findings highlight the need for efficient and effective voice treatment across childhood …”

“…59,60 These findings highlight the need for efficient and effective voice treatment across childhood. [61][62][63][64] In those with voice disorders, household income was inversely associated with voice-related handicap as measured by the VHI and P-VHI. This suggests that impacts of voice symptoms in a child's life may vary according to SES.…”

“… 59 , 60 These findings highlight the need for efficient and effective voice treatment across childhood. 61 – 64 …”

Are Children with Cleft Palate at Increased Risk for Laryngeal Pathology?

“…72,73 Although dysphonia in CP ± L may often be eclipsed by other medical needs, diagnosis of laryngeal pathology remains important. Voice therapy has been shown to effectively treat pediatric voice disorders in children with and without CP ± L. 53,[74][75][76] As such, viable treatment options are available for these children if dysphonia interferes with quality of life. 77 The findings of the current study emphasize the importance of laryngeal visualization/diagnosis in ruling out medically urgent diagnoses such as cancer or papilloma.…”

Liuzijue Qigong: A Voice Training Method For Unilateral Vocal Fold Paralysis Patients

“…Some studies have shown that glottal width could be related to the type or mode of phonation: When an individual speaks with "glottal attack," the glottal width can be less than 0; when SOVT or SAT is used, the glottal width is approximately 0 mm to 0.5 mm; when yawn-sigh is used, the glottal width is 1 mm to 2 mm; and the glottal width is more than 3 mm in cases of breathy voice. 20 There were no significant differences in the changes of jitter, shimmer, and NNE between the 2 groups posttreatment (P > .004). UVFP patients with poor glottal closure often overcompensate, resulting in a lower output-cost ratio (OCR) for phonation 21 and hoarseness.…”

Socioeconomic Status, Voice Disorder Risk, and Voice-Related Handicap Across Childhood

“…In addition, P-VHI scores were elevated in children with voice disorders, suggesting that pediatric populations experience the functional, physical, and emotional outcomes of voice problems . These findings highlight the need for efficient and effective voice treatment across childhood …”

“…59,60 These findings highlight the need for efficient and effective voice treatment across childhood. [61][62][63][64] In those with voice disorders, household income was inversely associated with voice-related handicap as measured by the VHI and P-VHI. This suggests that impacts of voice symptoms in a child's life may vary according to SES.…”

“… 59 , 60 These findings highlight the need for efficient and effective voice treatment across childhood. 61 – 64 …”

Are Children with Cleft Palate at Increased Risk for Laryngeal Pathology?

“…72,73 Although dysphonia in CP ± L may often be eclipsed by other medical needs, diagnosis of laryngeal pathology remains important. Voice therapy has been shown to effectively treat pediatric voice disorders in children with and without CP ± L. 53,[74][75][76] As such, viable treatment options are available for these children if dysphonia interferes with quality of life. 77 The findings of the current study emphasize the importance of laryngeal visualization/diagnosis in ruling out medically urgent diagnoses such as cancer or papilloma.…”