Voice therapy in the context of Telespeech therapy in dysphonics patients: an integrative review

The research was based on the PCC method (Population/Concept/Context) and involved developing the research question, finding and selecting the studies, extracting the data, and clinically assessing the papers, based on Joanna Briggs protocol. The studies were searched in VHL, PubMed/MEDLINE, Web of Science, Scopus, and EMBASE in English, Portuguese, and Spanish, with descriptors from DeCS, MeSH, and Emtree and using the Boolean operators.

Selection criteria

Original studies addressing telespeech therapy for the dysphonic population were included, with no restriction of publication year. Duplicate publications in the databases were excluded.

Results

A total of 5,740 studies were found, of which only four were included based on the eligibility criteria. The studies were published between 2015 and 2020, and most of them were from the United States. Most studies were carried out with older women. The intervention had a variety of functioning methods, data safety, number, frequency, and duration of the sessions, and therapeutic exercises. There were improvements in various voice parameters assessed in the studies.

Conclusion

Telespeech therapy for dysphonic patients is aimed at different audiences with different voice problem etiologies. Various methodologies were employed in remote voice healthcare with positive voice parameter results and the patients’ satisfaction with the treatment they received in this format.

Keywords:
Voice; Dysphonia; Voice disorders; Voice training; Telerehabilitation

Databases	Search strategies
PubMed	((dysphonia OR “voice disorder”) AND “voice training” AND telerehabilitation AND voice))
BVS	((dysphonia OR “voice disorder”) AND “voice training” AND telerehabilitation AND voice))
BVS	disfonía OR “Trastornos de la Voz” AND “Entrenamiento de la Voz” AND Telerehabilitación AND voz
BVS	disfonia OR “Distúrbios da Voz” AND “Treinamento da Voz” AND Telerreabilitação AND voz
Scopus	dysphonia OR “voice disorder” AND “voice training ” AND telerehabilitation AND voice
Embase	dysphonia OR voice disorder AND voice training AND telerehabilitation AND voice
Web of Science	dysphon* OR voice disord* AND voice training AND tele* AND voice

Author	Place	Type of study	Objective	Sample
Lin et al.⁽²¹21 Lin FC, Chien HY, Chen SH, Kao YC, Cheng PW, Wang CT. Voice therapy for benign voice disorders in the elderly: a randomized controlled trial comparing telepractice and conventional face-to-face therapy. J Speech Lang Hear Res. 2020;63(7):2132-40. http://dx.doi.org/10.1044/2020_JSLHR-19-00364. PMid:32579859. http://dx.doi.org/10.1044/2020_JSLHR-19-... ⁾	China	Randomized Clinical Trial	To examine the hypothesis that voice therapy via telepractice is not inferior to traditional voice therapy.	69 subjects distributed into two groups: telepractice (33 participants – 14 women and 19 men – aged 57 to 82 years and mean of 66 years) and conventional therapy (36 participants – 19 women and 17 men – aged 58 to 81 years and mean of 69 years).
Quinn et al.⁽¹¹11 Quinn R, Park S, Theodoros D, Hill AJ. Delivering group speech maintenance therapy via telerehabilitation to people with Parkinson’s disease: A pilot study. Int J Speech Lang Pathol. 2019;21(4):385-94. http://dx.doi.org/10.1080/17549507.2018.1476918. PMid:29879854. http://dx.doi.org/10.1080/17549507.2018.... ⁾	Australia	Quasi-experimental	To establish the feasibility of a speech maintenance program for people with Parkinson’s disease, via telerehabilitation.	8 subjects with Parkinson’s disease – 2 women and 6 men – aged 61 to 81 years and mean of 69 years.
Nguyen-Feng et al.⁽²⁰20 Nguyen-Feng VN, Frazier PA, Stockness A, Narayanan A, Merians AN, Misono S. Web-based perceived present control intervention for voice disorders: a pilot study. J Voice. 2020 Mar;34(2):300.e1-9. http://dx.doi.org/10.1016/j.jvoice.2018.08.006. PMid:30227981. http://dx.doi.org/10.1016/j.jvoice.2018.... ⁾	USA	Quasi-experimental	To establish the feasibility, usability, and acceptability of an online perceived-control intervention for individuals with voice disorders and collect preliminary data on the effectiveness of the intervention.	20 dysphonic patients distributed into two groups: 10 university students with muscle tension dysphonia and 10 subjects who self-reported as dysphonic; 12 women and 8 men, 18 to 80 years old.
Rangarathnam et al.⁽²²22 Rangarathnam B, McCullough GH, Pickett H, Zraick RI, Tulunay-Ugur O, McCullough KC. Telepractice versus in-person delivery of voice therapy for primary muscle tension dysphonia. Am J Speech Lang Pathol. 2015 Ago;24(3):386-99. http://dx.doi.org/10.1044/2015_AJSLP-14-0017. PMid:25836732. http://dx.doi.org/10.1044/2015_AJSLP-14-... ⁾	USA	Prospective Randomized	To establish the usefulness of telepractice to conduct flow phonation exercises for people with primary muscle tension dysphonia.	14 individuals with muscle tension dysphonia, divided into two groups: telepractice (7) and conventional therapy (7); 11 women and 3 men, 16 to 81 years old and mean age of 50 years.

Author	Assessment	Intervention	Therapeutic Data	Functioning Method	Data Security	Resources	Main Results
Lin et al.⁽²¹21 Lin FC, Chien HY, Chen SH, Kao YC, Cheng PW, Wang CT. Voice therapy for benign voice disorders in the elderly: a randomized controlled trial comparing telepractice and conventional face-to-face therapy. J Speech Lang Hear Res. 2020;63(7):2132-40. http://dx.doi.org/10.1044/2020_JSLHR-19-00364. PMid:32579859. http://dx.doi.org/10.1044/2020_JSLHR-19-... ⁾	(Before and after): VHI-10; GRBAS; Acoustic; MPT and VLS.	Vocal Hygiene,	8 sessions,	Synchronous	Not Informed	The telepractice group used the App Line, besides the therapist’s equipment (video camera, lapel microphone, and earphones), and the patient used a mobile phone.	Improved variables in both groups (VHI-10, MPT, GRBAS, and acoustics).
		SOVTE,	once a week,				In stroboscopy, both groups had a variation in mucous wave mobility and decreased glottal area.
		VFE, and RVT.	30 to 45 minutes.




Quinn et al.⁽¹¹11 Quinn R, Park S, Theodoros D, Hill AJ. Delivering group speech maintenance therapy via telerehabilitation to people with Parkinson’s disease: A pilot study. Int J Speech Lang Pathol. 2019;21(4):385-94. http://dx.doi.org/10.1080/17549507.2018.1476918. PMid:29879854. http://dx.doi.org/10.1080/17549507.2018.... ⁾	(Before, immediately after, and 3 months after the treatment): Acoustics; Psychosocial assessment and telerehabilitation satisfaction questionnaire.	LSVT	8 sessions, twice a week, 90 minutes.	Synchronous	Adobe Connect for data security.	-Software: Adobe Connect -Therapist’s and patient’s equipment: webcam, microphone, and speaker.	Differences between the assessment moments only in sustained phonation, reading, and SPL monologue. Psychosocial assessment: No significant differences between the assessment moments. Satisfaction questionnaire: High satisfaction level with the treatment effectiveness, usability, and overall satisfaction.

						This software was installed by the therapist on the patient’s computer.



Nguyen-Feng et al.⁽²⁰20 Nguyen-Feng VN, Frazier PA, Stockness A, Narayanan A, Merians AN, Misono S. Web-based perceived present control intervention for voice disorders: a pilot study. J Voice. 2020 Mar;34(2):300.e1-9. http://dx.doi.org/10.1016/j.jvoice.2018.08.006. PMid:30227981. http://dx.doi.org/10.1016/j.jvoice.2018.... ⁾	(Before and after): Administering voice handicap questionnaires (VHI-10); perceived control (Scale of stressful events for perceived control adapted to perceived control of the voice problems); Psychosocial anguish (Inventory of psychopathological symptoms - BSI-18); Perceived stress (Scale of perceived stress -PSS4); Feasibility, Usability, and Acceptability of the program (Usability and acceptability measures).	Initial and final modules (description of the perceived control experiences) and Perceived Control Exercises (description of the actions to control the voice problems; presentation of strategies to improve vocal hygiene and deal with physical and emotional symptoms and opinions).	8 sessions, twice a week. The duration was not informed.	Asynchronous	SSL System	-Software: Red Hat Enter- Premium Linux Server Version 6.9 -Schedule -Reminder via email -Milestone conclusion	VHI-10 had a significant decrease between the moments before and after the treatment. However, the other variables (perceived control, psychosocial anguish, and perceived stress) showed no differences.


Rangarathnam et al.⁽²²22 Rangarathnam B, McCullough GH, Pickett H, Zraick RI, Tulunay-Ugur O, McCullough KC. Telepractice versus in-person delivery of voice therapy for primary muscle tension dysphonia. Am J Speech Lang Pathol. 2015 Ago;24(3):386-99. http://dx.doi.org/10.1044/2015_AJSLP-14-0017. PMid:25836732. http://dx.doi.org/10.1044/2015_AJSLP-14-... ⁾	(Before and after): Laryngeal; APA (CAPE-V); Acoustics; Aerodynamics and elf-perception (VHI).	Vocal hygiene and airflow exercises.	12 sessions, twice a week. Total duration of 45 min (vocal hygiene + intervention). The exercises lasted from 20 to 25 minutes.	Synchronous	Not informed	Tandberg videoconference platform with audio and video unit.
							Telepractice versus in-person: No differences between the groups in the variables (APA, acoustics, aerodynamics, and self-perception).

							Analysis before and after: Significant differences in the CAPE-V, comfortably sustained phonation, maximum sustained phonation, and VHI.

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[1] Conflict of interests: No.