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Patient Candidacy for Voice Therapy: Stimulability Assessment

presented by Jackie Gartner-Schmidt, PhD, CCC-SLP, ASHA Fellow

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Disclosure Statement:

Financial: Jackie Gartner-Schmidt is co-director of the University of Pittsburgh Voice Center, Professor of Otolaryngology and Director of Speech-Language Pathology-Voice Division at the University of Pittsburgh Medical Center. She was the co-investigator NIH NIDCD R03 DC01530 for Efficacy of Conversation Training Therapy, for which she received grant. She is consultant for Consultant, R01 DC015906-01A1 for Optimization and Therapeutic Translation of Semi-Occluded Vocal Tract Techniques for which she receives grant. She receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Non-Financial: Jackie Gartner-Schmidt has no competing non-financial interests or relationships with regard to the content presented in this course

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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Video Runtime: 62 Minutes, Learning Assessments: 32 Minutes

Despite voice therapy being present in the literature for more than 60 years, no objective measure exists to guide voice-specialized speech-language pathologists (SLPs) on which patients are likely to succeed in voice therapy and which are not. Yet, there is a large body of evidence that shows favorable immediate effects of various voice techniques on voice production. Assessing patient candidacy for voice therapy before enrolling in treatment could save both money and time for the patient. Because most voice therapy programs necessitate that patients alter voice production to ultimately change conversational speech, engaging in stimulability probes using connected speech is advisable. Furthermore, most studies on voice therapy enroll patients based on a characteristic diagnosis. However, voice therapy treats the patient's ability to modify the voice and voice behaviors, not a diagnosis. Without evidence-based methods to guide our referrals to voice therapy, as well as inclusion criteria for studies on voice therapy, patients will continue to be referred based solely on laryngeal diagnosis and not vocal ability. This course will disentangle both qualitative and quantitative patient characteristics from patient abilities to recommend the most effective treatment of a specific patient, but also for counseling patients about therapeutic expectations.

Meet Your Instructor

Jackie Gartner-Schmidt, PhD, CCC-SLP, ASHA Fellow

Jackie Gartner-Schmidt, PhD, CCC-SLP, ASHA Fellow, is co-director of the University of Pittsburgh Voice Center, professor of otolaryngology, and director of Speech-Language Pathology-Voice Division at the University of Pittsburgh Medical Center. Dr. Gartner-Schmidt's 25-year clinical and research focus specializes on care of the professional voice, as well as clinical effectiveness of voice therapy, and respiratory…

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1. Why Is Stimulability Important?

Unlike for many other diseases, there is no standard assessment battery to determine which patients are appropriate referrals for voice therapy even though there are many studies showing favorable immediate effects of therapy probes. Quantifying a patient’s ability to get better from voice therapy before making a referral to voice therapy may improve patient adherence. Disentangling patient characteristics from their abilities will be highlighted.

2. What Is Vocal Stimulability Testing?

Stimulability refers to a person’s ability to immediately change a behavior when provided with a model or cue. A patient demonstrates good stimulability when performance on the cued task is better than the original performance of that same task. Both quantitative and qualitative stimulability testing will be outlined.

3. Who Is a Good Candidate for Voice Therapy?

Some data exists on predictive variables for voice outcome following treatment and will be presented. Much data exists on the immediate effects of different voice therapy techniques on acoustic, aerodynamic, and patient perception measures. These techniques, which will be discussed in the chapter, include semi-occluded vocal tract exercises, variably occluded face mask, resonant voice, and clear speech. Other areas, such as cognition, affective states, and frailty, will also be discussed.

4. No Voice Lab? No Problem!

The majority of SLPs do not have access to instrumental assessment for voice disorders but still require a means of assessing immediate change. Perceptual rating scales and objective measurements that SLPs can gather to support their recommendations will be discussed. The best tool clinicians have is their own ear, so auditory-perceptual nuances of a patient’s voice will be included. Hallmark features of what to listen for when deciding on appropriate therapy candidates will be discussed.

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