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.

Public Health Relevance

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). This project will use ambulatory biofeedback structures based on motor control and learning theory to attempt to improve the retention of modified vocal behaviors (decreased vocal loudness) in subjects with normal voices. Specifically, decreased frequency of feedback and summary average feedback schedules will be empirically compared to immediate 100% feedback regarding their effects on subject performance, short term retention, and long term retention.

Agency
National Institute of Health (NIH)
Institute
National Institute on Deafness and Other Communication Disorders (NIDCD)
Type
Predoctoral Individual National Research Service Award (F31)
Project #
5F31DC014412-03
Application #
9120355
Study Section
Special Emphasis Panel (ZDC1)
Program Officer
Rivera-Rentas, Alberto L
Project Start
2014-09-02
Project End
2017-09-01
Budget Start
2016-09-02
Budget End
2017-09-01
Support Year
3
Fiscal Year
2016
Total Cost
Indirect Cost
Name
Mgh Institute of Health Professions
Department
Type
DUNS #
605122258
City
Boston
State
MA
Country
United States
Zip Code
Van Stan, Jarrad H; Mehta, Daryush D; Sternad, Dagmar et al. (2017) Ambulatory Voice Biofeedback: Relative Frequency and Summary Feedback Effects on Performance and Retention of Reduced Vocal Intensity in the Daily Lives of Participants With Normal Voices. J Speech Lang Hear Res 60:853-864
Van Stan, Jarrad H; Park, Se-Woong; Jarvis, Matthew et al. (2017) Measuring vocal motor skill with a virtual voice-controlled slingshot. J Acoust Soc Am 142:1199
Van Stan, Jarrad H; Mehta, Daryush D; Petit, Robert J et al. (2017) Integration of Motor Learning Principles Into Real-Time Ambulatory Voice Biofeedback and Example Implementation Via a Clinical Case Study With Vocal Fold Nodules. Am J Speech Lang Pathol 26:1-10
Espinoza, Víctor M; Zañartu, Matías; Van Stan, Jarrad H et al. (2017) Glottal Aerodynamic Measures in Women With Phonotraumatic and Nonphonotraumatic Vocal Hyperfunction. J Speech Lang Hear Res 60:2159-2169
Van Stan, Jarrad H; Mehta, Daryush D; Hillman, Robert E (2015) The Effect of Voice Ambulatory Biofeedback on the Daily Performance and Retention of a Modified Vocal Motor Behavior in Participants With Normal Voices. J Speech Lang Hear Res 58:713-21
Llico, Andrés F; Zañartu, Matías; González, Agustín J et al. (2015) Real-time estimation of aerodynamic features for ambulatory voice biofeedback. J Acoust Soc Am 138:EL14-9