The Influence of Ambulatory Biofeedback Schedules on the Retention of a Vocal Motor behavior

描述（由申请人提供）：语音动态生物反馈有可能通过针对康复中最困难的方面来显著提高语音治疗的有效性 - 治疗期外的遗留（也称为保留或学习）。虽然有初步证据表明当存在生物反馈时（即，生物反馈效应），但是还没有精心设计的研究证明一旦生物反馈被关闭，发声行为改变的持续性。这意味着动态生物反馈已经证明了仅暂时改变受试者的发声行为的能力，而不是制定更长期的改变或保持/学习。根据运动控制和学习文献，生物反馈传递的两个方面将改善发声运动学习：（i）减少提示频率（例如，每第二次超过阈值而不是每次提供反馈）和（i i）平均概括反馈（例如，提供一段时间内的正确百分比）。此外，如果受试者收到高百分比的反馈，平均概括反馈有可能提供积极的反馈-这也是众所周知的加强保留。为了以流动方式应用（i）和（ii），需要比目前可用的更先进的监测和生物反馈平台。我们最近开发了一种基于智能手机的语音动态监测器（命名为语音健康监测器-VHM），用于另一项NIH资助的研究，该研究也具有生物反馈功能。VHM将用于拟议项目中，以提供三种不同的动态生物反馈结构，从而降低受试者全天的声音响度。对照组（组1）将在每次他们的声音大于生物反馈阈值时提供动态生物反馈，第二组（组2）将在他们的声音大于生物反馈阈值时每四次提供动态生物反馈，第三组（组3）将每20分钟提供关于他们的顺应性低于生物反馈阈值的汇总平均统计。假设与对照组相比，当生物反馈关闭时，降低的频率（组2）和汇总平均反馈（组3）将导致更好地保留所需的较柔和发声。

DESCRIPTION (provided by applicant): Voice ambulatory biofeedback has the potential to significantly improve voice therapy effectiveness by targeting the hardest aspect of rehabilitation - carryover outside the therapy session (also known as retention or learning). While there is initial evidence that ambulatory biofeedback can alter vocal behavior (using simple pitch and loudness thresholds) when the biofeedback is present (i.e., a biofeedback effect), there have been no well-designed studies demonstrating the persistence of a vocal behavior change once the biofeedback was turned off. Meaning ambulatory biofeedback has demonstrated the ability to only temporarily modify a subject's vocal behavior, not enact a longer term change or retention/learning. According to motor control and learning literature, two aspects of biofeedback delivery will improve vocal motor learning: (i) decreased frequency of cueing (e.g., providing feedback every 2nd time exceeding threshold instead of every time) and (ii) average summary feedback (e.g., providing the percent correct over a time period). Furthermore, average summary feedback has the potential to provide positive feedback if the subject receives a high percentage - which is also known to strengthen retention. In order to apply (i) and (ii) in an ambulatory manner, more advanced platforms for monitoring and biofeedback are needed than are currently available. We recently developed a smartphone-based voice ambulatory monitor (named the Voice Health Monitor -VHM) for use in another NIH-funded study that also has biofeedback capabilities. The VHM will be used in the proposed project to provide three different structures of ambulatory biofeedback in order to decrease a subject's vocal loudness throughout the day. A control group (group 1) will be provided ambulatory biofeedback every time they voice louder than a biofeedback threshold, a second group (group 2) will be provided ambulatory biofeedback every fourth time they voice louder than a biofeedback threshold, and a third group (group 3) will be provided summary average statistics regarding their compliance below a biofeedback threshold every 20 minutes. It is hypothesized that decreased frequency (group 2) and summary average feedback (group 3) will result in better retention of the desired softer phonation when biofeedback is turned off compared to the control group.