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Across the literature it is seen that when trying to enact change in a patient’s everyday life there is always some degree of adherence risk. In the field of voice therapy this risk is particularly high. Traditional comparisons of therapy techniques focus only on change achieved as opposed to the ways in which each therapy protocol was carried out. This type of focus minimizes the amounts of adherence risk present in each therapy technique. This risk can have a fundamental impact on the success of therapy. A comparison of the types of adherence risk that exists and the ways they can be minimized is useful for the treatment of voice disorders. This report serves to address issues of adherence risk in voice by examining relevant research outside the field of speech language pathology. It contains information regarding the most commonly seen adherence risks encountered, research on how those risks were addressed in the fields of medicine and physical therapy, and how those techniques can be adapted for clinical use. A comparative analysis of the types of risks present in the most common therapy protocols and how those risks can be minimized is also included. Tables are included in order to provide the speech language pathologist (SLP) with a user-friendly guide on the possible ways to determine adherence risks present in their client and possible ways to address this risk. Sample dialogue is also provided. Adherence risk is a key component in voice therapy that is often not being considered when choosing and implementing therapy protocols. There are many factors that make up adherence risk including personality characteristics, motivation, expectations for therapy, ease of use of the technique/instructions, client understanding of implementation, and the nature of the disorder itself. It is useful to look at how such factors are addressed. We’re asking our clients to do many things that will change their daily lives: behaviorally, diet-wise, it may even impact the way they feel about themselves. How do we ask them this and expect that it’ll actually get done? / text

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Rörfonation och traditionell svensk röstbehandling är två av de vanligaste behandlingsalternativen inom svensk röstlogopedi idag. Som forskare är det viktigt att kontinuerligt utvärdera de behandlingar som erbjuds för att göra vården mer kvalitativ och kostnadseffektiv. Finns det skillnader i behandlingseffekt mellan dessa två röstbehandlingar? Är skillnaderna så tydliga att det går att fastslå att den ena behandlingen är att föredra framför den andra? Med analyser av ett patientmaterial, före och efter behandling, i form av akustisk analys, perceptuella bedömningar av en grupp erfarna logopeder samt patienternas självskattningar syftar föreliggande uppsats till att besvara vad behandlingsformerna har för effekt inom dessa områden. Patientmaterialet bestod av totalt 28 patienter varav 23 fullföljde behandling. Tolv av dessa erhöll behandling med rörfonation medan resterande elva patienter erhöll traditionell svensk röstbehandling.. Utöver röstinspelningar bestod materialet av patienternas självskattningar, i form av RHI- och Swe-VAPP-formulär. Gällande behandlingseffekt på akustiska parametrar kunde inga slutsatser dras. De perceptuella parametrarna afoni, hyperfunktion och knarr förbättrades sett till hela urvalet, oavsett typ av röstbehandling. Tydliga förbättringar sågs i patienternas självskattningar efter båda behandlingsmetoderna. Röstbehandling ger således positiva resultat, men några skillnader i behandlingseffekt mellan de två olika metoderna för röstbehandling kunde inte påvisas. / Tube phonation and traditional Swedish voice therapy are two of the most common voice therapy options in Sweden today. As a researcher, it is important to continually evaluate available therapy options to make health care more qualitative and cost effective. Are there differences in treatment effect between these two voice treatments? If so, are the differences so obvious that it is possible to conclude that one treatment should be preferred over the other? Analyses of a patient material, before and after treatment, which included acoustic analysis, perceptual analysis by a group of experienced speech-language therapists and patients' selfassessments were made aiming to answer what effect the two treatment options have in these areas. The patient material consisted of 28 patients, of whom 23 completed the therapy. Twelve of them received treatment with tube phonation while the remaining eleven patients received traditional Swedish voice therapy. Besides audio recordings, the material consisted of patients' self-assessments pre- and post-therapy, including VHI and Swe-VAPP forms. The treatment effect on acoustic parameters was inconclusive. The perceptual parameters aphonia, hyper function, and creaking improved over the entire sample, regardless of the type of voice therapy. Clear improvements were seen in the patients' self-assessments after both therapy methods. Voice therapy thus gives positive results, but no differences in treatment effect between the two different methods of voice therapy were seen.

Bakgrund Kraven på evidensbaserad vård ökar ständigt. Att jämföra patienters självskattade besvär före och efter behandling är ett sätt att utvärdera behandlingseffekten.  Rösthandikappindex (RHI) och VA-skala för röstbesvär är två verktyg för utvärdering av röstbehandling. Tidigare studier har visat att röstbehandling ger minskade självskattade röstbesvär. Syfte Syftet med denna studie var att med självskattningsformulär utvärdera effekten av logopedisk röstbehandling i Västerbottens läns landsting (VLL) och undersöka om behandlingseffekten påverkas av kön, diagnos, antal behandlingstillfällen och hur mycket tid patienten är beredd att lägga på behandling, samt att undersöka om det finns ett samband mellan självskattningsformuläret RHI och VA-skala för röstbesvär. Metod 102 patienter, 28 män och 74 kvinnor, som under perioden januari 2009 till september 2012 genomgått logopedisk röstbehandling inom VLL, deltog i studien. Deltagarna rekryterades retrospektivt. Genom dataanalys undersöktes huruvida det fanns någon signifikant skillnad i poäng på RHI efter behandling, om det fanns några signifikanta skillnader i självskattning beroende på kön, diagnos eller antal behandlingstillfällen samt om det fanns en korrelation mellan RHI-poäng och skattning på VA-skala. Resultat En signifikant minskning av RHI-poäng kunde ses för hela gruppen efter röstbehandling jämfört med före. Inga signifikanta skillnader sågs mellan könen eller mellan grupper indelade utifrån antal behandlingstillfällen. Det fanns inte heller någon skillnad mellan olika diagnoser. Däremot sågs signifikanta korrelationer mellan RHI och VA-skala för röstbesvär. Slutsats Studien visade att de självskattade besvären minskade efter behandling. Resultaten var inte beroende av kön, diagnos eller antal behandlingstillfällen. Utifrån detta dras slutsatsen att den logopediska röstbehandlingen i Västerbottens läns landsting ger effekt. Vad gäller de självskattningsverktyg som används i verksamheten sågs en korrelation mellan RHI och VA-skala för röstbesvär. Det är möjligt att dessa verktyg mäter olika aspekter av samma problem. Det är då av vikt att kombinera dessa för att få en helhetsbild av patienters upplevda röstbesvär / Background The demand for evidence based health care is increasing. One way to evaluate the effect of treatment is to compare patients’ self-assessed malaise before and after treatment. Two useful tools for evaluating voice therapy administered by a speech-language pathologist  is Voice Handicap Index (VHI) and a Visual Analogue Scale, VA-scale, for voice problems. Previous studies has found that voice therapy results in a decreased level of voice problems                                                                                        Aim The aim of this study was to evaluate the effect of voice treatment administered by speech-language pathologists in Västerbottens läns landsting (VLL) with help of the self-assessment tools VHI and VA-scale for voice problems and to investigate if there were any differences in the self-assessment due to gender, diagnosis, number of treatment sessions or the amount of time the patient was willing to spend on voice therapy. The aim was also to investigate if there was a correlation between the VHI and the VA-scale for voice problems.                                                                                                                      Method This retrospective study has analyzed self-assessment forms from 102 patients, 28 men and 74 women, who have been seeing a speech-language pathologist for voice therapy sometime between January 2009 and September 2012 in VLL. Data analysis was used to investigate if there was any significant difference in VHI points before and after voice therapy, if there was any significant differences in the self-assessment due to gender, diagnosis or number of therapy sessions and if there was a correlation between the points on VHI and self-assessed malaise on the VA-scale for voice problems.                                                                                                                      Results There was a significant decrease of VHI points for the whole group after voice therapy. No significant differences were found regarding gender, diagnosis or number of treatment sessions. There was no correlation between the VHI score and the amount of time the patient was willing to spend on voice therapy. A significant correlation was found between VHI and the VA-scale for voice problems.           Conclusion This study found that self-assessed voice problems decreased after voice treatment. The efficacy of voice therapy does not seem to be affected by gender, diagnosis, number of treatment sessions or the amount of time the patient was willing to spend on voice therapy. The conclusion is that the voice therapy administered by speech-language pathologists in VLL has an effect. There was a correlation between VHI and the VA-scale for voice disorders. It is possible that these tools are measuring different aspects of the same problem. Therefore, it is important to combine these tools to get an overall picture of the patients’ self-perceived voice problems.

This dissertation focuses on the aging voice - specifically the aging elite vocal athlete. It is comprised of four components; a series of research studies and a viewpoint piece designed to explore the awareness, struggles, and vocal compensations of aging singers dealing with age related vocal and performance problems. The overarching goal of these studies is to inform the development of a voice care protocol for the aging rock star to guide customized intervention for these elite vocal athletes that is focused on optimizing both vocal output and performance. First, the dissertation introduces and identifies characteristics of the exceptional voice. This involves a new vocal continuum that includes the normal voice, the trained voice, and the exceptional voice. The second component is a qualitative study of older contemporary commercial music (CCM) singers adjustments and accommodations associated with their aging. From this, four overarching themes are identified: modest self-perception of their vocal prowess and its relationship to performance, acute sensitivity to changes in vocal quality, recognition of the critical association of voice quality with their identity as a performer, and an array of accommodations to aging-related vocal changes. The third component of the dissertation is a randomized control trial examining the efficacy of Vocal Function Exercises as a treatment modality for presbyphonia. Analysis revealed that the experimental group improved in select outcome measures including decreased glottic gap, increased upper range, and maximum phonation time at the 6-week post-treatment re-evaluation with no such changes in the control group. The final study investigated the vocal and performing trajectories of six CCM male singers through analysis of video performances across their career. Singers were shown to make accommodations consistent with the reported findings from component two. Such accommodations include decreased total time singing for some singers, accommodations for range changes, and changes to performance. From this study, the Exceptional Voice Protocol was created to provide a customized vocal and performance blueprint for each artist that meets their unique needs for their exceptional voices. Overall, this research indicates that aging CCM singers appear to be experiencing age and performance related vocal changes and are making detectable accommodations to their performance. Additional findings show that Vocal Function Exercises appear to be an efficacious treatment modality for aging voice. Findings from these studies confirm the need for continued research on age-related vocal and performance changes for these performers and guidelines for appropriate habilitation and rehabilitation so these rock stars can continue performing for as long as they desire.