Functional Voice Assessment and Therapy Methods Supported by Telepractice, VoiceEvalU8, and Estill Voice Training

Abstract

Functional assessment and therapy methods are necessary for a client-centered approach that addresses the client's vocal needs across all environments. The purpose of this article is to present the approach with the intent to encourage discussion and implementation among educators, clinicians, researchers, and students. The functional approach is defined and its importance is described within the context of the World Health Organization's International Classification of Functioning, Disability, and Health with support provided by synchronous and asynchronous telepractice, the VoiceEvalU8 app, server, and web portal, and a framework that defines voice qualities (e.g., resonance, twang, loud, and others) by the anatomy and physiology of the voice production system (i.e., Estill Figures for Voice). Case scenarios are presented to highlight application of the functional voice approach.

Keywords

voice - voice disorders - function - telepractice - app technology - Estill Voice Training

Financial and Nonfinancial Disclosures

Relevant financial:

1. Dr. Grillo is an employee of West Chester University; therefore, I receive a salary and benefits.

2. Dr. Grillo receives royalties from Northern Speech Services for two online continuing education courses.

3. From September 2015 to May 2020, Dr. Grillo had grant support through salary, travel, and professional development from the National Institute on Deafness and Other Communication Disorders (NIDCD) of the National Institutes of Health (NIH), R15DC014566.

4. From 2016 to 2019, I received payments from student loan service providers through the NIH Loan Repayment Program.

5. From 2019 to the present, Dr. Grillo receives subscription fees from clinicians, researchers, educators, and students for using VoiceEvalU8, LLC.

Relevant nonfinancial:

1. Dr. Grillo holds the certificate of Estill Figure Proficiency.

2. Dr. Grillo is the president and founder of VoiceEvalU8, LLC and the inventor of the Global Voice Prevention and Therapy Model (GVPTM).

Publication History

Article published online:
17 February 2021

• References

• 1 Kogan AC, Wilber K, Mosqueda L. Person-centered care for older adults with chronic conditions and functional impairment: a systematic literature review. J Am Geriatr Soc 2016; 64 (01) e1-e7
• 2 Noland D, Raj S. Academy of Nutrition and Dietetics: Revised 2019 standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in nutrition in integrative and functional medicine. J Acad Nutr Diet 2019; 119 (06) 1019-1036
• 3 High KP, Zieman S, Gurwitz J. et al. Use of functional assessment to define therapeutic goals and treatment. J Am Geriatr Soc 2019; 67 (09) 1782-1790
• 4 Angeli JM, Harpster K, Huijs L, Seid M, Sheehan A, Schwab SM. Patient-centered goal setting in developmental therapy: discordance between documented goals and caregiver-perceived goals. Pediatr Qual Saf 2019; 4 (04) e199
• 5 World Health Organization. International Classification of Functioning, Disability and Health (ICF). 2001 . Accessed December 21, 2020 at: http://www.who.int/classifications/icf/en/
• 6 Jones DS, Quinn S. Reversing the chronic disease trend: six steps to better wellness. The Institute for Functional Medicine; . July 2020. Accessed December 21, 2020 at: https://p.widencdn.net/xazlwe/Intro_Functional_Medicine
• 7 de Vreede PL, Samson MM, van Meeteren NL, van der Bom JG, Duursma SA, Verhaar HJ. Functional tasks exercise versus resistance exercise to improve daily function in older women: a feasibility study. Arch Phys Med Rehabil 2004; 85 (12) 1952-1961
• 8 de Vreede PL, Samson MM, van Meeteren NL, Duursma SA, Verhaar HJ. Functional-task exercise versus resistance strength exercise to improve daily function in older women: a randomized, controlled trial. J Am Geriatr Soc 2005; 53 (01) 2-10
• 9 Siemonsma PC, Blom JW, Hofstetter H. et al. The effectiveness of functional task exercise and physical therapy as prevention of functional decline in community dwelling older people with complex health problems. BMC Geriatr 2018; 18 (01) 164
• 10 Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet 2011; 377 (9778): 1693-1702
• 11 Steultjens EMJ, Dekker J, Bouter LM, van de Nes JCM, Cup EHC, van den Ende CHM. Occupational therapy for stroke patients: a systematic review. Stroke 2003; 34 (03) 676-687
• 12 Abu Tariah H, Aljehani AS, Alenazi DY, Alturaif DA, Alsarhani MN. Occupational therapy goal achievement for people with stroke: a retrospective study. Occup Ther Int 2020; 2020: 8587908
• 13 American Speech-Language-Hearing Association. Medical necessity for speech-language pathology and audiology. 2004 . Accessed December 21, 2020 at: www.asha.org/uploadedFiles/practice/reimbursement/mednecfifinal3.pdf
• 14 Centers for Medicare and Medicaid Services. Medicare benefit policy manual, chapter 16, section 20. 2014 r-a. Accessed December 21, 2020 at: www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c16.pdf
• 15 Centers for Medicare and Medicaid Services. Medicare program integrity manual, chapter 13, section 13.5.1. 2014 r-b. Accessed December 21, 2020 at: www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/pim83c13.pdf
• 16 Centers for Medicare and Medicaid Services. Medicare benefit policy manual, chapter 15, section 220.2B. 2014 r-c. Accessed December 21, 2020 at: www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf
• 17 The Joint Commission for Hospital Accreditation. Advancing effective communication, cultural competence and patient- and family-centered care. 2020 . Accessed December 21, 2020 at: https://www.jointcommission.org/
• 18 Commission on Accreditation of Rehabilitation Facilities. 2020 . Accessed December 21, 2020 at: https://www.accreditationnow.com/
• 19 Individuals with Disabilities Education Act. 2004 . 20 U.S.C. § 1400
• 20 Khayum B, Wynn R. Developing personally relevant goals for people with mild dementia. Semin Speech Lang 2015; 36 (03) 190-198
• 21 Wynn R, Khayum B. Developing personally relevant goals for people with moderate to severe dementia. Semin Speech Lang 2015; 36 (03) 199-208
• 22 Glickstein JK, Neustadt GK. Speech-language interventions in Alzheimer's disease. A functional communication approach. Clin Commun Disord 1993; 3 (01) 15-30
• 23 Webb PM, Glueckauf RL. The effects of direct involvement in goal setting on rehabilitation outcome for persons with traumatic brain injuries. Rehabil Psychol 1994; 39: 179-188
• 24 Ponsford JL, Downing MG, Olver J. et al. Longitudinal follow-up of patients with traumatic brain injury: outcome at two, five, and ten years post-injury. J Neurotrauma 2014; 31 (01) 64-77
• 25 Kennedy MR, Coelho C, Turkstra L. et al. Intervention for executive functions after traumatic brain injury: a systematic review, meta-analysis and clinical recommendations. Neuropsychol Rehabil 2008; 18 (03) 257-299
• 26 Hecimovic A, Powell TH, Christensen L. Supporting families in meeting their needs. In: Zager DB. ed. Autism: Identification, Education, and Treatment. 2nd ed.. Mahwah, NJ: Erlbaum; 1999: 261-299
• 27 Marshall JK, Mirenda P. Parent-professional collaboration for positive behavior support in the home. Focus Autism Other Dev Disabl 2002; 17: 216-228
• 28 Moes DR, Frea WD. Using family context to inform intervention planning for the treatment of a child with autism. J Posit Behav. 2000; 2: 40-46
• 29 Worrall L. Professionalism and functional outcomes. J Commun Disord 2006; 39 (04) 320-327
• 30 Chapey R, Duchan JF, Elman RJ. et al. Life participation approach to aphasia: a statement of values for the future. ASHA Lead 2000; 5: 4-6
• 31 Roberts MY, Kaiser AP, Wolfe CE, Bryant JD, Spidalieri AM. Effects of the teach-model-coach-review instructional approach on caregiver use of language support strategies and children's expressive language skills. J Speech Lang Hear Res 2014; 57 (05) 1851-1869
• 32 Bhat V. Family centered developmental care as early intervention for children with special needs. Inter Edu Appl Scien Res J. 2017; 2: 26-28
• 33 Titze IR, Riede T, Palaparthi A. et al. Individualized patient vocal priorities for tailored therapy. J Speech Lang Hear Res 2018; 61 (12) 2884-2894
• 34 Gartner-Schmidt J, Gherson S, Hapner ER. et al. The development of conversation training therapy: a concept paper. J Voice 2016; 30 (05) 563-573
• 35 Gillespie AI, Yabes J, Rosen CA, Gartner-Schmidt JL. Efficacy of conversation training therapy for patients with benign vocal fold lesions and muscle tension dysphonia compared to historical matched control patients. J Speech Lang Hear Res 2019; 62 (11) 4062-4079
• 36 Grillo EU. Building a successful voice telepractice program. Perspect ASHA Spec Interest Groups (SIG 3) 2019; 4 (01) 100-110
• 37 Grillo EU. An online telepractice model for the prevention of voice disorders in vocally healthy student teachers evaluated by a smartphone application. Perspect ASHA Spec Interest Groups (SIG 3) 2017; 2 (02) 63-78
• 38 Grillo EU. A nonrandomized trial for student teachers of an in-person and telepractice Global Voice Prevention and Therapy Model with Estill Voice Training assessed by the VoiceEvalU8 app. Am J Speech Lang Pathol [Epub ahead of print]
• 39 American Speech-Language-Hearing Association. Considerations when providing voice services in the absence of endoscopic evaluation during COVID-19. Accessed December 21, 2020 at: https://www.asha.org/slp/healthcare/considerations-when-providing-voice-services-in-the-absence-of-endoscopic-evaluation-during-covid-19/
• 40 Llico AF, Zañartu M, González AJ. et al. Real-time estimation of aerodynamic features for ambulatory voice biofeedback. J Acoust Soc Am 2015; 138 (01) EL14-EL19
• 41 Mehta DD, Van Stan JH, Hillman RE. Relationships between vocal function measures derived from an acoustic microphone and a subglottal neck-surface accelerometer. IEEE/ACM Trans Audio Speech Lang Process 2016; 24 (04) 659-668
• 42 Grillo EU, Brosious JN, Sorrell SL, Anand S. Influence of smartphones and software on acoustic voice measures. Int J Telerehabil 2016; 8 (02) 9-14
• 43 Bassich CJ, Ludlow CL. The use of perceptual methods by new clinicians for assessing voice quality. J Speech Hear Disord 1986; 51 (02) 125-133
• 44 Kempster GB, Kistler DJ, Hillenbrand J. Multidimensional scaling analysis of dysphonia in two speaker groups. J Speech Hear Res 1991; 34 (03) 534-543
• 45 Kent R. Hearing and believing: some limits to the auditory-perceptual assessment of speech and voice disorders. Am J Speech Lang Pathol 1996; 5 (03) 7-23
• 46 Ramig LO, Bonitati C, Lemke J, Horii Y. Voice treatment for patients with Parkinson disease: development of an approach and preliminary efficacy data. J Med Speech-Lang Pathol 1994; 2: 191-209
• 47 Fex S. Perceptual evaluation. J Voice 1992; 6 (02) 155-158
• 48 Kreiman J, Gerratt BR. Perceptual assessment of voice quality: past, present, and future. Perspect Voice and Voice Dis 2010; 20 (02) 62-67
• 49 Sonninen A, Hurme P. On the terminology of voice research. J Voice 1992; 6 (02) 188-193
• 50 Laver JDM. Voice quality and indexical information. Br J Disord Commun 1968; 3 (01) 43-54
• 51 Steinhauer K, Klimek MM, Estill J. The Estill Voice Model: Theory & Translation. Pittsburgh, PA: Estill Voice International; 2017
• 52 Lombard LE, Steinhauer KM. A novel treatment for hypophonic voice: twang therapy. J Voice 2007; 21 (03) 294-299
• 53 Tellis CM. Integrated implicit–explicit learning approach to voice therapy. Perspect ASHA Spec Interest Groups (SIG 3) 2014; 24: 111-118
• 54 Tellis C. New concepts in motor learning and training related to voice rehabilitation. Perspect ASHA Spec Interest Groups (SIG 3) 2018; 3: 56-67
• 55 Fantini M, Fussi F, Crosetti E, Succo G. Estill Voice Training and voice quality control in contemporary commercial singing: an exploratory study. Logoped Phoniatr Vocol 2017; 42 (04) 146-152
• 56 Perta K, Bae Y, Obert K. A pilot investigation of twang quality using magnetic resonance imaging. Logoped Phoniatr Vocol 2020; ; (epub ahead of print)
• 57 Saldías M, Laukkanen AM, Guzmán M. et al. The vocal tract in loud twang-like singing while producing high and low pitches. J Voice 2020; ; (epub ahead of print)
• 58 Yanagisawa E, Estill J, Mambrino L, Talkin D. Supraglottic contributions to pitch raising. Videoendoscopic study with spectroanalysis. Ann Otol Rhinol Laryngol 1991; 100 (01) 19-30
• 59 Yanagisawa E, Kmucha ST, Estill J. Role of the soft palate in laryngeal functions and selected voice qualities. Simultaneous velolaryngeal videoendoscopy. Ann Otol Rhinol Laryngol 1990; 99 (01) 18-28
• 60 Aura M, Geneid A, Bjørkøy K, Rantanen M, Laukkanen A-M. A nasoendoscopic study of “Head Resonance” and “Imposto” in classical singing. J Voice 2020; ; (epub ahead of print)
• 61 Barone NA, Ludlow CL, Tellis CM. Acoustic and aerodynamic comparisons of voice qualities produced after voice training. J Voice 2019; ; (epub ahead of print)
• 62 Grillo EU. Clinical investigation of the global voice therapy model. Int J Speech Lang Pathol 2012; 14 (02) 156-164
• 63 Verdolini Abbott K. Lessac-Madsen Resonant Voice Therapy Clinician Manual. Plural Publishing; 2008
• 64 Morsella E, Krauss RM. The role of gestures in spatial working memory and speech. Am J Psychol 2004; 117 (03) 411-424
• 65 Kelly SD, Manning SM, Rodak S. Gesture gives a hand to language and learning: Perspectives from cognitive neuroscience, developmental psychology and education. Lang Ling Comp 2008; 2 (04) 569-588
• 66 Cook SW, Mitchell Z, Goldin-Meadow S. Gesturing makes learning last. Cognition 2008; 106 (02) 1047-1058
• 67 Ping R, Goldin-Meadow S. Gesturing saves cognitive resources when talking about nonpresent objects. Cogn Sci 2010; 34 (04) 602-619