Voice Therapy with Semi-Occluded Vocal Tracts

描述(由申请者提供)：这项研究的中心目标是统一目前世界各地使用的不同的声音治疗方法组。它们有着不同的名字、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，它们都使用声道半闭塞的练习。这些半闭塞的形式是浊音摩擦、嘴唇和舌头颤动、鼻辅音、紧元音/u/和/o/以及插入口腔的阻力管。最近，科学证明了使用半闭塞声道锻炼的益处。其中一个好处是稳定的声门上压力，可以抵消在说话时过度收拢或“挤压”声带的趋势。另一个好处是声门以上的良好声阻抗，可以降低发声门槛压力和“发声容易”。为了控制半闭塞的压力-流量特性，将研究一系列管状和非管状关节手势，并针对治疗方案进行优化。具体目的是(1)根据前部压力与声门下压力的比率来描述和排序声道半闭塞(嘴唇颤动、舌头、颤音、哼唱、浊音、喉管发声)，主要方法是口腔压力测压和电声门图(EGG)，(2)确定选定的不同直径和长度的管子的稳定压力-流量特性和声学输入阻抗，(3)评估管子发声实现混合音域(具有中等声带接触)的程度，并确定混合音域是否具有最低的发声阈值压力；结果将通过比较测量的EGG和计算机模拟的接触面积和声道的最大功率转移来实现，(4)使用磁共振成像(MRI)对一组选定的受试者进行口腔半闭塞治疗，以量化咽周围的变化，(5)进行一项非语音半闭塞练习(管状发声)和渐进式Lessac-Madsen共振发声疗法(LMRVT)之间在临床经济性和患者依从性方面的优势试验。

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.