Voice Therapy with Semi-Occluded Vocal Tracts

描述（由申请人提供）：本研究的中心目标是统一目前世界各地使用的多种语音治疗方法。它们有着不同的名称、不同的起源和不同的协议，乍一看似乎没有什么共同之处。然而，仔细观察发现，他们都使用了半封闭声道的练习。这些半咬合以浊音摩擦音、唇和舌颤音、鼻辅音、紧张的元音/u/和/o/以及插入口腔的抗流管的形式出现。半封闭声道运动的好处最近已得到科学证明。一个好处是稳定的声门上压力，以抵消过度加合或“压”声带的倾向，以提高说话的音量和口音。另一个好处是声门上方有利的声阻抗，可以降低发声门槛压力和“轻松发声”。为了控制半闭塞的压力-血流特性，我们将研究一系列的管状和非管状发音手势，并优化治疗方案。具体目的是：(1)根据口腔压力与声门下压力比来表征和排序声道半封闭（唇颤音、舌颤音、哼音、浊音、管发音），主要方法是口腔压力测压和声门电图（EGG），(2)确定选定的不同直径和长度的管道的稳定压力-流动特性和声输入阻抗。(3)评估管音发声时混音区（与声带适度接触）可达到的程度，判断混音区是否具有最低的发声阈值压力；结果将通过比较测量的EGG与计算机模拟的接触面积和最大功率转移到声道来获得，(4)量化作为口腔半闭塞的功能的epilar咽变化，主要仪器是与选定的一组受试者进行磁共振成像（MRI）。(5)对非言语半闭塞练习（管式发声）与渐进式Lessac-Madsen共振语音疗法（LMRVT）在临床经济性和患者依从性方面的优势进行试验。

DESCRIPTION (provided by applicant): This study has a central goal of unifying a currently diverse group of voice therapy approaches used around the world. With different names, different origins, and different protocols, they appear at first glance to have little in common. Close scrutiny, however, reveals that all of them utilize exercises with a semi-occluded vocal tract. These semi-occlusions are in the form of voiced fricatives, lip and tongue trills, nasal consonants, tense vowels /u/ and /o/, and flow-resistant tubes inserted into the mouth. The benefits derived from exercising with a semi-occluded vocal tract have recently been demonstrated scientifically. One benefit is a steady supraglottal pressure to counteract a tendency to hyper-adduct or "press" the vocal folds for loudness and accent in speech. Another benefit is favorable acoustic impedance above the glottis for low phonation threshold pressure and "ease of phonation." To gain control over the pressure-flow characteristics of the semi- occlusions, a series of tubes and non-tube articulatory gestures will be studied and optimized for a therapy protocol. Specific aims are to (1) characterize and rank-order vocal tract semi-occlusions (lip trills, tongue, trills, humming, voiced fricatives, tube phonation) in terms of an ral pressure to subglottal pressure ratio, primary methodologies being oral pressure manometry and electroglottography (EGG), (2) to determine the steady pressure-flow characteristics and acoustic input impedance of selected tubes with different diameters and lengths, (3) to assess the degree to which mixed register (with moderate vocal fold contact) is achievable with tube phonation, and to determine if mixed register has the lowest phonation threshold pressure; results will be achieved by comparing measured EGG to computer simulated contact area and maximum power transfer to the vocal tract, (4) to quantify epilaryngeal changes as a function of oral semi-occlusion with the primary instrumentation being magnetic resonance imaging (MRI) with a select group of subjects, (5) to conduct a superiority trial between non-speech semi-occluded exercises (tube phonation) and progressive Lessac-Madsen Resonant Voice Therapy (LMRVT) in terms of clinical economy and patient adherence.