title: [Laryngeal electromyography in diagnosis and treatment of voice disorders]. Voice disorders in the general population: prevalence, risk factors, and occupational impact. Differentiation of adductor-type spasmodic dysphonia from muscle tension dysphonia by spectral analysis Revision of a method quality rating scale for single-case experimental designs and n-of-1 trials: The 15-item Risk of Bias in N-of-1 Trials (RoBiNT) Scale A comparison of two treatments for childhood apraxia of speech: methods and treatment protocol for a parallel group randomised control trial Laryngeal manual therapy: a preliminary study to examine its treatment effects in the management of muscle tension dysphonia. Single‐subject research design: recommendations for levels of evidence and quality rating The reliability of methodological ratings for speechBITE using the PEDro-P scale. Neurovegetative symptoms and complaints before and after voice therapy for nonorganic habitual dysphonia. Rating the methodological quality of single-subject designs and n-of-1 trials: Introducing the Single-Case Experimental Design (SCED) Scale Evaluation of functional outcomes (speech, swallowing and voice) in patients attending speech pathology after head and neck cancer treatment(s): development of a multi-centre database. Quantifying component parts of indirect and direct voice therapy related to different voice disorders. Evaluating the effectiveness and efficiency of voice therapy using transnasal flexible laryngoscopy: a randomized controlled trial. Randomized controlled trial of vocal function exercises on muscle tension dysphonia in Vietnamese female teachers. The relationship between tongue trill performance duration and vocal changes in dysphonic women. Preliminary data on prevention and treatment of voice problems in student teachers. The effectiveness of voice therapy for patients with non-organic dysphonia. Completeness of reporting of trials published in languages other than English: implications for conduct and reporting of systematic reviews Differential effects of voice therapies on neurovegetative symptoms and complaints. Efficacy of the Accent Method of Voice Therapy
abstract: INTRODUCTION AND OBJECTIVES Laryngeal electromyography , together with clinical evaluation , is a valuable tool in voice disorder management . It assesses the integrity of laryngeal nerves and muscles , contributing to the diagnosis of many diseases , especially laryngeal movement disorders . Our purpose was to describe the experience of the first Spanish series with laryngeal electromyography in evaluating  voice disorders .  METHODS A prospect i ve study was design ed to evaluate laryngeal movement disorders with laryngeal electromyography . Both the cricothyroid and thyroarytenoid muscles were tested routinely and , in some cases , the posterior cricoarytenoid muscle . The laryngeal electromyography technique and result interpretation were performed by a laryngologist and a neurophysiologist . RESULTS We included 110 patients , with the most common symptom being dysphonia .  Laryngeal electromyography was performed in 85 % of cases . Primary diagnosis before electromyography was laryngeal immobility . Positive predictive value for diagnosis in cases of paralysis was 88 % . CONCLUSIONS Laryngeal electromyography is a useful adjunct , together with clinical evaluation , for diagnosis and management of motion abnormalities in the larynx in patients who present with dysphonia OBJECTIVES Epidemiologic studies of the prevalence and risk factors of voice disorders in the general adult population are rare . The purpose of this investigation was to 1 ) determine the prevalence of voice disorders , 2 ) identify variables associated with increased risk of voice disorders , and 3 ) establish the functional impact of voice disorders on the general population . STUDY DESIGN Cross-sectional telephone survey . METHODS A r and om sample ( n = 1,326 ) of adults in Iowa and Utah was interviewed using a question naire that addressed three areas related to voice disorders : prevalence , potential risk factors , and occupational consequences/effects . RESULTS The lifetime prevalence of a voice disorder was 29.9 % , with 6.6 % of participants reporting a current voice disorder . Stepwise logistic regression identified specific factors that uniquely contributed to increased odds of reporting a chronic voice disorder including sex ( women ) , age ( 40 - 59 years ) , voice use patterns and dem and s , esophageal reflux , chemical exposures , and frequent cold/sinus infections . However , tobacco or alcohol use did not independently increase the odds of reporting of a chronic voice disorder . Voice disorders adversely impacted job performance and attendance , with 4.3 % of participants indicating that their voice had limited or rendered them unable to do certain tasks in their current job . Furthermore , 7.2 % of employed respondents reported that they were absent from work 1 or more days in the past year because of their voice , and 2 % reported more than 4 days of voice-related absence . CONCLUSIONS The results of this large epidemiologic study provide valuable information regarding the prevalence of voice disorders , factors that contribute to voice disorder vulnerability , and the functional impact of voice problems on the general population Objectives To determine the utility of spectral analysis in the differentiation of adductor-type spasmodic dysphonia ( AdSD ) from muscle tension dysphonia ( MTD ) . Study Design Prospect i ve blinded study . Methods Forty-seven sample s of AdSD-connected speech spectrograms from 27 subjects and 17 sample s of MTD-connected speech spectrograms from 15 subjects were selected from clinical charts and de-identified . These spectrograms were review ed independently and blindly by two speech language pathologists experienced in spectrography . The speech language pathologists design ated the spectrogram as consistent with AdSD and MTD , and these design ations were compared with actual clinical diagnoses . Results The ability to differentiate AdSD from MTD with spectral analysis was 94 % for rater # 1 and 98 % for rater # 2 . No MTD subjects were incorrectly diagnosed as having SD ( 100 % specificity ) . Conclusions This study suggests that experienced speech language pathologists can distinguish AdSD from MTD with a high degree of sensitivity and specificity based on spectral analysis . Spectral analysis is especially useful in cases where perceptual analysis and clinical evaluation alone are insufficient Recent literature suggests a revival of interest in  single-case methodology  ( e.g. , the r and omised n-of-1 trial is now considered Level 1 evidence for treatment decision purpose s by the Oxford Centre for Evidence -Based Medicine ) . Consequently , the availability of tools to critically appraise single-case reports is of great importance . We report on a major revision of our method quality instrument , the Single-Case Experimental Design Scale . Three changes result ed in a radically revised instrument , now entitled the Risk of Bias in N-of-1 Trials ( RoBiNT ) Scale : ( i ) item content was revised and increased to 15 items , ( ii ) two subscales were developed for internal validity ( IV ; 7 items ) and external validity and interpretation ( EVI ; 8 items ) , and ( iii ) the scoring system was changed from a 2-point to 3-point scale to accommo date currently accepted st and ards . Psychometric evaluation indicated that the RoBiNT Scale showed evidence of construct ( discriminative ) validity . Inter-rater reliability was excellent , for pairs of both experienced and trained novice raters . Intraclass correlation coefficients of summary scores for individual ( experienced ) raters : ICCTotalScore = .90 , ICCIVSubscale = .88 , ICCEVISubscale = .87 ; individual ( novice ) raters : ICCTotalScore = .88 , ICCIVSubscale = .87 , ICCEVISubscale = .93 ; consensus ratings between experienced and novice raters ( ICCTotalScore = .95 , ICCIVSubscale = .93 , ICCEVISubscale = .93 . The RoBiNT Scale thus shows sound psychometric properties and provides a comprehensive yet efficient examination of important features of single-case methodology Background Childhood Apraxia of Speech is an impairment of speech motor planning that manifests as difficulty producing the sounds ( articulation ) and melody ( prosody ) of speech . These difficulties may persist through life and are detrimental to academic , social , and vocational development . A number of published single subject and case series studies of speech treatments are available . There are currently no r and omised control trials or other well design ed group trials available to guide clinical practice . Methods / Design A parallel group , fixed size r and omised control trial will be conducted in Sydney , Australia to determine the efficacy of two treatments for Childhood Apraxia of Speech : 1 ) Rapid Syllable Transition Treatment and the 2 ) Nuffield Dyspraxia Programme – Third edition .  Eligible children will be English speaking , aged 4–12 years with a diagnosis of suspected CAS , normal or adjusted hearing and vision , and no comprehension difficulties or other developmental diagnoses . At least 20 children will be r and omised to receive one of the two treatments in parallel . Treatments will be delivered by trained and supervised speech pathology clinicians using operationalised manuals . Treatment will be administered in 1-hour sessions , 4 times per week for 3 weeks . The primary outcomes are speech sound and prosodic accuracy on a customised 292 item probe and the Diagnostic Evaluation of Articulation and Phonology inconsistency subtest administered prior to treatment and 1 week , 1 month and 4 months post-treatment . All post assessment s will be completed by blinded assessors . Our hypotheses are : 1 ) treatment effects at 1 week post will be similar for both treatments , 2 ) maintenance of treatment effects at 1 and 4 months post will be greater for Rapid Syllable Transition Treatment than Nuffield Dyspraxia Programme treatment , and 3 ) generalisation of treatment effects to untrained related speech behaviours will be greater for Rapid Syllable Transition Treatment than Nuffield Dyspraxia Programme treatment . This protocol was approved by the Human Research Ethics Committee , University of Sydney ( # 12924 ) . Discussion This will be the first r and omised control trial to test treatment for CAS . It will be valuable for clinical decision-making and providing evidence -based services for children with CAS.Trial Registration Australian New Zeal and Clinical Trials Registry : The objectives of this study were to determine appropriate acoustic and outcome measures for the evaluation of a method of laryngeal manual therapy ( LMT ) used in the treatment of patients with muscle tension dysphonia ( MTD ) . The effects of this technique were also investigated . The study was based on the hypotheses that the vertical position of the larynx in the vocal tract would lower , that the quality of the voice would normalize , and that a reduction in any vocal tract discomfort ( VTD ) would occur after LMT . This was a small , prospect i ve , repeated measures pilot study in which each member of the research team was " blinded " to all other stages of the study and during which all data were anonymized until the final stage of data analysis . Ten subjects presenting with MTD completed outcome measures and provided audiorecordings immediately before , immediately after , and 1 week after LMT . The Kay CSL 4150 was used for signal acquisition and for some acoustic measurements . Spectrographic evaluation was accomplished with Praat . A new perceptual , self-rating scale , the VTD scale , and a new proforma for use by the clinician for palpatory evaluation , were developed for the study . Relative average perturbation during connected speech was significantly reduced after LMT , indicating a reduction in abnormal vocal function . The severity and frequency of VTD was shown to have reduced after LMT . This pilot study showed positive evidence for LMT as a method of therapy in the treatment of hyperfunctional voice disorders . Its effects were shown to be measurable with both acoustical analysis and the VTD scale The aim of this article is to present a set of evidence levels , accompanied by 14 quality or rigor questions , to foster a critical review of published single‐subject research articles . In developing these guidelines , we review ed levels of evidence and quality /rigor criteria that are in wide use for group research design s , e.g. r and omized controlled trials , such as those developed by the Treatment Outcomes Committee of the American Academy for Cerebral Palsy and Developmental Medicine . We also review ed method ological articles on how to conduct and critically evaluate single‐subject research design s ( SSRDs ) . We then subjected the quality questions to interrater agreement testing and refined them until acceptable agreement was reached . We recommend that these guidelines be implemented by clinical research ers who plan to conduct single‐subject research or who incorporate SSRD studies into systematic review s , and by clinicians who aim to practise evidence ‐based medicine and who wish to critically review pediatric single‐subject research BACKGROUND speechBITE ( http://www.speechbite.com ) is an online data base established in order to help speech and language therapists gain faster access to relevant research that can used in clinical decision-making . In addition to containing more than 3000 journal references , the data base also provides method ological ratings on the PEDro-P ( an adapted version of the PEDro ) scale to assist clinicians in identifying the scientific quality of r and omized ( RCTs ) and non-r and omized control trials ( N RCTs ) . While reliability of the PEDro scale has been established by similar allied health data bases , the reliability of the PEDro-P scale has yet to be reported . AIMS To examine the reliability of PEDro-P scale ratings undertaken by raters on the speechBITE data base and benchmark these results to the published reliability for the original PEDro scale . Both the total score ( out of ten ) as well as each of the 11 scale items were included in this analysis . METHODS & PROCEDURES  speechBITE 's volunteer rater network of 17 members rated the first 100 RCTs and N RCTs on the website . The criterion and overall scores for these ratings were compared with previously published reliability studies using the PEDro scale . Intra-class correlations and per cent agreement measures were used to establish and benchmark reliability . OUTCOMES & RESULTS The speechBITE PEDro-P ratings ranged from fair to excellent for both the total score and for each of the 11 scale items . Furthermore , reliability was equal to that of other data bases . CONCLUSIONS & IMPLICATION S speechBITE users can be confident of the reliability of ratings published on the website . Further analysis of differences between this study and previous PEDro scale reliability studies are discussed In a previous study , female patients in all age categories with a nonorganic dysphonia were found to report significantly more autonomic symptoms and complaints than healthy controls . This could not be confirmed for the male subgroup . The present study is to corroborate and nuance this observation by investigating larger groups , and to determine if , after voice therapy , the number of autonomic symptoms and complaints-particularly those ones that have no obvious relation to voice function-decreases . It is a prospect i ve study with a matched control group ; 184 patients with nonorganic dysphonia and 126 normal controls answered a question naire of 46 questions with 3 subsets and a consistency control . One hundred and one patients received functional voice therapy  and completed the question naire before and after treatment . A matched control group of 42 normal subjects also filled in the question naire two times , with an interval of about 6 months . Neurovegetative symptoms and complaints-voice related and not related-are reported in highly significant excess by patients ( especially but not exclusively females ) with habitual nonorganic voice disorder . After therapy , there is a highly significant reduction in the number of autonomic symptoms and complaints ( related or not related to voice ) , to such an extent that patients report on average no more general neurovegetative symptoms and complaints than healthy controls ( even less ) . The number of neurovegetative symptoms and complaints connected with voice function is also strongly reduced in patients after therapy , but remains in significant excess when compared with controls Rating scales that assess method ological quality of clinical trials provide a means to critically appraise the literature . Scales are currently available to rate r and omised and non-r and omised controlled trials , but there are none that assess single-subject design s. The Single-Case Experimental Design ( SCED ) Scale was developed for this purpose and evaluated for reliability . Six clinical research ers who were trained and experienced in rating method ological quality of clinical trials developed the scale and participated in reliability studies . The SCED Scale  is an 11-item rating scale for single-subject design s , of which 10 items are used to assess method ological quality and use of statistical analysis . The scale was developed and refined over a 3-year period . Content validity was addressed by identifying items to reduce the main sources of bias in single-case methodology as stipulated by authorities in the field , which were empirically tested against 85 published reports . Inter-rater reliability was assessed using a r and om sample of 20/312 single-subject reports archived in the Psychological Data base of Brain Impairment Treatment Efficacy ( PsycBITETM ) . Inter-rater reliability for the total score was excellent , both for individual raters ( overall ICC = 0.84 ; 95 % confidence interval 0.73–0.92 ) and for consensus ratings between pairs of raters ( overall ICC = 0.88 ; 95 % confidence interval 0.78–0.95 ) . Item reliability was fair to excellent for consensus ratings between pairs of raters ( range k = 0.48 to 1.00 ) . The results were replicated with two independent novice raters who were trained in the use of the scale ( ICC = 0.88 , 95 % confidence interval 0.73–0.95 ) . The SCED Scale thus provides a brief and valid evaluation of method ological quality of single-subject design s , with the total score demonstrating excellent inter-rater reliability using both individual and consensus ratings . Items from the scale can also be used as a checklist in the design , reporting and critical appraisal of single-subject design s , thereby assisting to improve st and ards of single-case methodology Since April 1997 , in Melbourne , Australia ,  speech pathologists have collaborated to establish a prospect i ve data base of functional outcomes of speech , swallowing and voice for patients undergoing head and neck cancer treatments . Staff at eight acute care hospitals , all of which offer speech pathology for head and neck cancer services in Victoria , are contributing data , collated central ly , in an agreed pro forma . Early results are given ( after 12 months ' data collection ) . The implication s for clinical ly-based research , and the future potential for benchmarking outcomes --by expansion of the rehabilitation data base beyond the current participating sites -- is discussed . This paper outlines the rationale of establishing the data base is multicentered , and explores some of the complexities involved , including the challenges inherent in long-term accurate data collection in the head and neck cancer patient population . This work represents the development of an appropriate , usable tool for data collection on functional outcomes Voice therapy changes how people use and care for their voices .  Speech- language pathologists ( SLPs ) have a multitude of choices from which to modify patient 's vocal behaviors . Six SLPs performed 1461 voice therapy sessions and quantified the percentage of time spent in eight component parts of indirect and four component parts of direct voice therapy across five common voice disorders . Voice therapy data collection forms were prospect ively completed immediately following each therapy visit . The SLPs were free to choose the component parts of voice therapy best suited for their respective patients . Results showed that  direct voice therapy  represented more than 75 % of the treatment time across all voice therapy sessions . In the components of direct voice therapy , there was no statistical difference between percentages of time spent in resonant voice and flow phonation across all voice disorders . However , a significant difference was found for the time spent addressing transfer to conversational speech for muscle tension dysphonia , lesions , and scar than for vocal immobility and atrophy . Interestingly , while SLPs used a more common approach to direct voice therapy across voice disorders , they tended to vary the use of indirect components of therapy across voice disorders with certain components being addressed in greater length for specific voice disorders . Collectively , these results indicate that although SLPs may individualize their approach to indirect voice therapy , when it comes to direct voice therapy , SLPs have a common approach to voice therapy regardless of voice disorder Transnasal flexible laryngoscopy ( TFL ) is an examination of laryngeal anatomy and physiology using continuous light . TFL is being used increasingly by voice pathologists in treatment but with little scientific evidence to support it . The purpose of this study was to evaluate the effectiveness and efficiency of TFL as a therapeutic tool . The study used a prospect i ve r and omized controlled trial . Fifty dysphonic subjects were recruited and r and omly assigned to either a traditional treatment group or a TFL-assisted treatment group . The effectiveness of voice therapy in both treatment groups was measured with a package of voice outcome measures . Subjects in both treatment groups demonstrated statistically significant improvements after voice therapy ( perceptual auditory rating of voice quality measurement p < 0.01 ; instrumental electroglottographic measurement p < 0.01 ; patient question naire measurement p < 0.01 ) . The time taken to complete treatment in both groups was recorded . The average ( median ) time taken to complete voice therapy in the TFL-assisted treatment group was 2 hours less than in the traditional treatment group ( p < 0.01 ) . Voice therapy with TFL  as a therapy tool was effective and more efficient than traditional voice therapy OBJECTIVE This study evaluated the treatment effects of vocal function exercises on muscle tension dysphonia ( MTD ) in tonal language speakers . DESIGN Single-blinded , r and omized , controlled , clinical trial . METHODS Forty female primary school teachers from Northern Vietnam , diagnosed with MTD , were r and omly allocated into a treatment group ( n = 22 ) , which used a full vocal exercise protocol ( FE ) ( modified for use with Vietnamese speakers ) , and a control group ( n = 18 ) which was treated with a partial vocal exercise protocol ( PE ) . The treatment duration was 4 weeks for both groups . MAIN OUTCOME MEASURES Acoustic and perceptual data were used as primary outcome measures . Acoustic parameters included frequency and amplitude perturbation , harmonics-to-noise ratio ( HNR ) , mean fundamental frequency of the broken and rising tones , and parameters representing pitch movement in the rising tone . Perceptual analyses were performed on pre- and posttreatment sample s of the sustained /a/ sound using anchor vocal sample s. Self-report data , collected via a posttreatment question naire , comprised the secondary outcome measure . RESULTS Significant changes in perturbation , HNR , and perceptual data were observed in the FE group but not in the PE group . The FE group showed increased size and speed of pitch change . Participants from both groups showed positive changes in some tonal parameters after treatment . However , the magnitude of change and the number of participants with positive changes were larger in the FE group . CONCLUSION The data showed that vocal function exercises may be a cost-effective treatment for MTD OBJECTIVE To assess the relationship between tongue trill performance duration and auditory perception and acoustic changes in dysphonic women . STUDY DESIGN Prospect i ve clinical study , with intrasubject comparison . METHODS Twenty-seven women who had vocal nodules were in the experimental group ( EG ) ( tongue trills ) , and 10 were also in the control group ( CG ) ( placebo exercises ) . The voices were recorded before and after experimental and placebo exercises at the first ( m1 ) , third ( m3 ) , fifth ( m5 ) , and seventh ( m7 ) minutes of performance . These recordings were r and omized , and the auditory perception analysis was carried out by three judges trained in voice analysis . Individual recordings were analyzed using the Consensus Auditory-Perceptual Evaluation of Voice ( CAPE-V ) protocol , the r and omized pairs of recordings were compared , and the better voice was chosen . VoxMetria software ( CTS , Parana , Brazil , www.ctsinformatica.com.br ) was used to assess the acoustic . RESULTS In the EG , the CAPE-V results showed a predominance of vocal improvement , statistically proven , at m5 of tongue trill exercise , with the best overall rating , the least roughness and breathiness , and increase in pitch level . At m7 , strain was significantly higher . In the paired comparison analysis , voices at m5 were considered the best of all moments . There was an increase of the F(0 ) and glottal-to-noise excitation after m3 and a decrease in noise as in m1 . In the CG , vocal changes were discrete compared with those in the EG . CONCLUSION Tongue trill performance duration interfered with the vocal response of dysphonic women , with positive response predominance at m5 . At m7 , there was an increase of vocal tension and a drop in vocal quality OBJECTIVES /HYPOTHESES To assess the utility of a targeted voice hygiene ( VH ) program compared to VH plus voice training intervention ( VH+VT ) for the prevention and treatment of  voice problems in student teachers . STUDY DESIGN Prospect i ve , r and omized . METHODS Thirty-one student teachers with low ( good ) and high ( poor ) voice h and icap index ( VHI ) scores in Pittsburgh and Hong Kong were r and omly assigned to ( 1 ) a targeted , individually tailored VH program , ( 2 ) the VH program plus resonant VT ( VH+VT ) , or ( c ) a control group . Participants assigned to intervention groups were monitored for their adherence to their programs for their first 4 weeks of student teaching . VHI data were collected again 4 weeks postintervention ( both sites ) and 8 weeks postintervention , following a no-contact washout period ( Pittsburgh ) . RESULTS Descriptive data analysis indicated that across both sites , for initially healthy participants , the VH program was sufficient to prevent worsening of VHI scores that occurred in all control participants over the first 4 - 8 weeks of student teaching . The addition of VT did not consistently enhance protective benefits over VH alone . In contrast , for participants with initially poor VHI scores , the VH program failed to produce VHI benefits over the control condition . The addition of VT was required to optimize results for that cohort . CONCLUSIONS Preliminary data suggest that a minimalist , individually tailored VH program may be sufficient to prevent voice problems from teaching in healthy student teachers . However , for student teachers with existing voice problems , VT may be required to optimize results of intervention Forty-five patients diagnosed as having non-organic dysphonia were assigned in rotation to one of three groups . Patients in one group received no treatment and acted as a control group . Patients in the other two groups received a programme of either ' indirect ' therapy or ' direct with indirect ' therapy , respectively . A self-report question naire of vocal performance , observed ratings of voice quality , and computer-derived acoustic measurements ( signal-to-noise ratio , pitch perturbation and amplitude perturbation ) were carried out on all patients before and after treatment to evaluate the changes in voice quality over time . There was a significant difference between the three groups on the self-report question naire , voice quality ratings and pitch perturbation measurements ( P = < 0.05 ) . Thirteen out of 15 control patients showed no significant change on any of the measures . Seven patients who received indirect treatment showed significant improvement in voice quality following treatment . Fourteen out of 15 patients who received direct treatment showed significant improvement in voice quality BACKGROUND Lately , the number of systematic review s published has increased substantially . Many systematic review s exclude trials published in language s other than English . However , there is little empirical evidence to support this action . We looked for differences in the completeness of reporting between trials published in other language s and those published in English , to see whether the exclusion of trials published in other language s is justified . METHODS We compared completeness of reporting , design characteristics , and analytical approaches of 133 r and omised controlled trials ( RCTs ) published in English between 1989 and 1994 and 96 published in French , German , Italian , or Spanish during the same time . RCTs were identified by h and search ing of journals ( seven in English and six in the other language s ) . FINDINGS We found no significant differences between trials published in English and other- language trials for any single item in the completeness of reporting scale ( r and omisation , double-blinding , withdrawals ) , or for the overall score ( percentage of maximum possible score 51.0 % for trials in English , 46.2 % for trials in other language s ; 95 % CI for difference -1.1 to 10.5 ) . Other- language trials were more likely than English- language trials to have adult participants , to use two or more interventions , and to compare two or more active treatments without an untreated control group . Trials in other language s were less likely to report a clearly prespecified primary outcome or any rationale for sample size estimation . INTERPRETATION These results provide evidence for inclusion of all trial reports , irrespective of the language in which they are published , in systematic review s. Their inclusion is likely to increase precision and may reduce systematic errors . We hope that our findings will prove useful to those developing guidelines and policies for the conduct of reporting of systematic review In previous studies , female patients in all age categories with a nonorganic dysphonia were found to report significantly more autonomic symptoms and complaints than healthy controls . After voice therapy , there was a highly significant reduction in the amount of autonomic symptoms and complaints ( related or not related to voice ) . The present prospect i ve study with a matched control group is design ed to test the hypothesis that a specific kind of therapy is more efficient than the usual approaches in reducing these neurovegetative symptoms and complaints .  Two matched groups of 34 patients diagnosed with nonorganic dysphonia and referred for voice therapy answered a question naire of 46 questions with 3 subsets and a consistency control . They received either " coordination therapy " (CTh)--a holistic approach addressing functional , personal and emotional aspects -- or a conventional voice therapy ( approximately 15 sessions ) . All patients again filled in a similar question naire after approximately 6 months . After therapy , there is in general a highly significant reduction in the amount of autonomic symptoms and complaints ( related or not related to voice ) , to such an extent that patients report on average no more general neurovegetative symptoms and complaints than those of healthy controls . Symptoms and complaints of other nature ( validity control ) are not influenced . When compared with patients receiving conventional therapy , those who received CTh demonstrate a significantly higher reduction for the subset " neurovegetative symptoms/complaints related to voice and speech . There is an increasing need for studies of efficacy of behavior readjustment therapy procedures in human communicative disorders . Legal , social , scientific and professional considerations point up the need for more careful documentation of the effects of treatment techniques used by phoniatricians and speech- language pathologists . This study is conducted in order to evaluate the efficacy of the accent method of voice therapy ( AM ) . The AM is one of the holistic approaches for behavior readjustment voice therapy . It tackles collectively and simultaneously the various parameters of voice such as pitch , loudness and timbre . The results of intervention utilizing the AM in this clinical trial are assessed in a relatively controlled setup . Patients with voice problems result ing from various etiologic vocal pathologies are distributed r and omly into two groups . Group 1 ( G1 ) is given the full aspect of the AM , that is , voice hygiene advice plus the accent exercises to correct the faulty vocal technique ( habit ) . Group 2 ( G2 ) receives only voice hygiene advice . The AM is administered in individual sessions 20 min each , twice a week , while the voice hygiene advice counseling is given once a week . The assessment of the vocal pathology is done following a diagnostic protocol utilizing subjective as well as quasi- objective measures of evaluation . The initial assessment presents the baseline ( pretest ) data for both groups . The follow-up evaluations are done at mid intervention ( mid-test ) , that is , 10 sessions for G1 and 5 sessions for G2 , and at the termination of intervention/therapy ( post-test ) . The difference in improvement between G1 and G2 at the end of the observation was generally significant in favor of G1 . There were significant improvements in G1 in certain items specific for the various etiologic categories . The improvement from pretest to mid-test to post-test values followed a linear tendency . The significance of the results is discussed and the conclusions are outlined and criticized
target: Specific " active ingredients " for therapeutic change were not identified .
background: PURPOSE A systematic review of behavioural intervention for the treatment of adults with muscle tension voice disorders ( MTVD ) .