Use of ambulatory biofeedback to improve behavioral treatment of vocal hyperfunction

使用动态生物反馈改善发声功能亢进的行为治疗

• 批准号: 10639615
• 负责人: Jarrad Van Stan
• 金额: $ 49.83万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-15 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10639615
• 关键词: Address; Adopted; Air Movements; Ambulatory Monitoring; Auditory; Behavior; Behavior Therapy; Biofeedback; Calibration; Clinic; Clinical; Clinical Research; Clinical Trials; Clinical assessments; Control Locus; Cues; Data; Diagnosis; Dropout; Dysphonia; Excision; Feedback; Future; Informal Social Control; Language; Larynx; Lesion; Life; Loudness; Measurement; Measures; Mediating; Methods; Modeling; Monitor; Motivation; Motor Skills; Muscle; Muscle Tension; Nodule; Operative Surgical Procedures; Pathologic; Pathologist; Patient Dropouts; Patients; Personality; Phenotype; Physiological; Prevention; Process; Randomized; Recurrence; Rehabilitation therapy; Reporting; Research; Risk; Severities; Speech Disorders; Stress; Testing; Therapeutic; Time; Training; Voice; Voice Disorders; Work; clinical care; clinical practice; curative treatments; evidence base; improved; individual patient; individualized medicine; innovation; insight; novel; patient engagement; patient subsets; pressure; relapse prevention; research study; targeted treatment; treatment group; virtual; vocal cord; voice therapy

Project Summary Vocal hyperfunction (VH) is ostensibly caused by and/or associated with pathological daily voice use and involves the most commonly treated voice disorders by speech-language pathologists, e.g., vocal fold nodules, muscle tension dysphonia. Voice therapy is the primary curative option for VH. For example, even when patients undergo laryngeal surgery to remove lesions, they are still thought to be at risk for recurrence unless they successfully complete post-surgical voice therapy. However, voice therapy suffers from high rates of patient dropout. Patients and clinicians report that generalizing desired vocal behaviors from the therapy session into daily life is one of the most significant barriers to successful voice therapy. Despite this critical barrier, voice therapy remains entirely dependent upon episodic delivery within an in-clinic or virtual session. Thus, this project will test if adding Ambulatory Voice Monitoring with Biofeedback (AVM-B) significantly addresses this generalization challenge, as it can directly extend therapeutic activities into the patient’s daily life. A clinical trial will randomize patients with VH to receive an evidence-based therapy (Conversation Training Therapy; CTT) or CTT with AVM-B added. In Aim 1, it is hypothesized that, compared to patients who only received CTT, patients who receive CTT and AVM-B will demonstrate significantly better generalization during therapy which will be retained immediately after therapy and six months later. In Aim 2, we will explore patient factors that mediate the relationship between therapy and generalization, hypothesizing that stimulabilty—how easily a patient can modify their voice—and engagement—the patient’s level of effort during therapy—will be positively correlated to the amount of generalization in daily life. If successful, this work would result in multiple paradigm-shifting impacts with potential to improve the efficiency of clinical practice. AVM-B would become one of the first evidence-based voice treatment activities taking place primarily outside the therapy session. Future work could investigate how AVM-B could transition voice therapy from once-a-week sessions into a continuous process integrated into the patient’s daily life. Further inquiry could improve generalization by identifying evidence-based methods to tailor therapy based on individual patient factors such as stimulability and engagement. After discharge, AVM-B could provide a means for patients to “recalibrate” themselves and prevent relapse without having to see a clinician. Finally, implementation work could help clinicians adopt/adapt AVM-B and evaluate its effects on dropouts.

项目摘要 发声功能亢进（VH）表面上是由病理性日常发声引起和/或与病理性日常发声有关， 涉及最常由言语语言病理学家治疗的语音障碍，例如，声带小结， 肌肉紧张性发音困难语音治疗是VH的主要治疗选择。例如即使在 患者接受喉部手术切除病变，他们仍然被认为是在复发的风险，除非 他们成功地完成了术后语音治疗。然而，声音治疗遭受高比率的 患者退出。患者和临床医生报告说，从治疗中概括期望的声音行为， 日常生活中的会话是成功的声音治疗的最重要的障碍之一。尽管这一关键 然而，由于语音障碍，语音治疗仍然完全依赖于诊所内或虚拟会话内的情景递送。 因此，本项目将测试是否增加动态语音监测与生物反馈（AVM-B）显着 解决了这一普遍性挑战，因为它可以直接将治疗活动扩展到患者的日常生活中。 生活一项临床试验将随机选择VH患者接受循证治疗（对话 训练疗法; CTT）或CTT加AVM-B。在目标1中，假设与 仅接受CTT，接受CTT和AVM-B的患者将表现出明显更好的泛化能力 在治疗期间，将在治疗后立即和六个月后保留。在目标2中，我们将探索 患者因素介导的治疗和泛化之间的关系，假设， 刺激性-患者可以多么容易地修改他们的声音-和成就-患者在治疗期间的努力水平 治疗-将与日常生活中的泛化量呈正相关。如果成功，这项工作将 导致多种范式转变的影响，有可能提高临床实践的效率。AVM-B 将成为第一个以证据为基础的声音治疗活动之一，主要发生在 心理治疗未来的工作可以研究AVM-B如何将声音治疗从每周一次转变为 将治疗过程转化为一个持续的过程，融入患者的日常生活。进一步调查可以改善 通过确定基于证据的方法来进行概括，以根据患者个体因素（例如 as stimulability刺激and engagement参与.出院后，AVM-B可以为患者提供一种“重新校准”的手段 自己和防止复发，而不必看临床医生。最后，执行工作可能有所帮助， 临床医生采用/调整AVM-B，并评估其对辍学的影响。