title: Manual therapy and exercise to improve outcomes in patients with muscle tension dysphonia: a case series.
abstract: OBJECTIVE
  Muscle tension dysphonia (MTD), a common voice disorder that is not commonly referred for physical therapy intervention, is characterized by excessive muscle recruitment, resulting in incorrect vibratory patterns of vocal folds and an alteration in voice production. This case series was conducted to determine whether physical therapy including manual therapy, exercise, and stress management education would be beneficial to this population by reducing excess muscle tension.
  
  
  METHODS
  Nine patients with MTD completed a minimum of 9 sessions of the intervention. Patient-reported outcomes of pain, function, and quality of life were assessed at baseline and the conclusion of treatment. The outcome measures were the numeric rating scale (NRS), Patient-Specific Functional Scale (PSFS), and Voice Handicap Index (VHI). Cervical and jaw range of motion also were assessed at baseline and postintervention using standard goniometric measurements.
  
  
  RESULTS
  Eight of the patients had no pain after treatment. All 9 of the patients demonstrated an improvement in PSFS score, with 7 patients exceeding a clinically meaningful improvement at the conclusion of the intervention. Three of the patients also had a clinically meaningful change in VHI scores. All 9 of the patients demonstrated improvement in cervical flexion and lateral flexion and jaw opening, whereas 8 patients improved in cervical extension and rotation postintervention.
  
  
  CONCLUSIONS
  The findings suggest that physical therapists can feasibly implement an intervention to improve outcomes in patients with MTD. However, a randomized clinical trial is needed to confirm the results of this case series and the efficacy of the intervention. A clinical implication is the expansion of physical therapy to include referrals from voice centers for the treatment of MTD.
authors.affiliation: C.A. Tomlinson, PT, MPT, Vanderbilt Dayani Center, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 1500 Medical Center Dr, Nashville, TN 37232 (USA). carey.a.tomlinson@vanderbilt.edu.
authors.forename: Carey A
authors.initials: CA
authors.lastname: Tomlinson
authors.affiliation: K.R. Archer, PT, DPT, PhD, Department of Orthopaedic Surgery and Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center.
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D055154:Dysphonia / Q000503:physiopathology / Q000628:therapy*; D006804:Ergonomics; D005081:Exercise Therapy; D005240:Feasibility Studies; D006801:Humans; D007821:Laryngeal Muscles / Q000503:physiopathology*; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D009129:Muscle Tonus / Q000502:physiology*; D026201:Musculoskeletal Manipulations; D009334:Neck Muscles / Q000503:physiopathology; D010147:Pain Measurement; D011187:Posture / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology; D013315:Stress, Psychological / Q000517:prevention & control