title: The effect of stretch-and-flow voice therapy on measures of vocal function and handicap.
abstract: OBJECTIVE
  To investigate the efficacy of stretch-and-flow voice therapy as a primary physiological treatment for patients with hyperfunctional voice disorders.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Participants with a diagnosis of primary muscle tension dysphonia or phonotraumatic lesions due to hyperfunctional vocal behaviors were included. Participants received stretch-and-flow voice therapy structured once weekly for 6 weeks. Outcome variables consisted of two physiologic measures (s/z ratio and maximum phonation time), an acoustic measure (cepstral peak prominence [CPP]), and a measure of vocal handicap (voice handicap index [VHI]). All measures were obtained at baseline before treatment and within 2 weeks posttreatment.
  
  
  RESULTS
  The s/z ratio, maximum phonation time, sentence CPP, and VHI showed statistically significant (P < 0.05) improvement through therapy. Effect sizes reflecting the magnitude of change were large for s/z ratio and VHI (d = 1.25 and 1.96 respectively), and moderate for maximum phonation time and sentence CPP (d = 0.79 and 0.74, respectively).
  
  
  CONCLUSIONS
  This study provides supporting evidence for preliminary efficacy of stretch-and-flow voice therapy in a small sample of patients. The treatment effect was large or moderate for multiple outcome measures. The data provide justification for larger, controlled clinical trials on the application of stretch-and-flow voice therapy in the treatment of hyperfunctional voice disorders.
authors.affiliation: Department of Communication Sciences and Disorders, Texas Christian University, Fort Worth, Texas. Electronic address: c.watts@tcu.edu.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Watts
authors.affiliation: Department of Communication Sciences and Disorders, Texas Christian University, Fort Worth, Texas.
authors.forename: Shelby S
authors.initials: SS
authors.lastname: Diviney
authors.affiliation: Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Amy
authors.initials: A
authors.lastname: Hamilton
authors.affiliation: Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Laura
authors.initials: L
authors.lastname: Toles
authors.affiliation: Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Lesley
authors.initials: L
authors.lastname: Childs
authors.affiliation: Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Ted
authors.initials: T
authors.lastname: Mau
mesh_terms: D000328:Adult; D000368:Aged; D006233:Persons with Disabilities / Q000534:rehabilitation*; D055154:Dysphonia / Q000503:physiopathology* / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010699:Phonation / Q000502:physiology*; D011446:Prospective Studies; D013061:Speech Acoustics; D014831:Voice / Q000502:physiology*; D014833:Voice Quality; D014834:Voice Training; D055815:Young Adult
keywords: Dysphonia; Flow phonation; Speech therapy; Stretch-and-flow; Vocal handicap; Voice therapy