The Development of Conversation Training Therapy: A Concept Paper.
OBJECTIVE
To introduce the conceptual, theoretical, and practical foundations of a novel approach to voice therapy, called conversation training therapy (CTT), which focuses exclusively on voice awareness and efficient voice production in patient-driven conversational narrative, without the use of a traditional therapeutic hierarchy. CTT is grounded in motor learning theory, focused on training target voice goals in spontaneous, conversational speech in the first session and throughout. CTT was developed by a consensus panel of expert clinical voice-specialized speech-language pathologists (SLPs) and patients with voice problems.


METHODS
This is a prospective, clinical consensus design.


METHODS
A preliminary CTT approach to voice therapy was developed by the first and last authors (J.G-S. and A.I.G.) and incorporated six interchangeable tenets: clear speech, auditory/kinesthetic awareness, rapport building, negative practice, basic training gestures, and prosody. Five expert voice-specialized clinical SLPs (consensus group) were then presented CTT and a discussion ensued. Later, an informal interview by a neutral third party person occurred for further recommendations for CTT.


RESULTS
The CTT approach was modified to reflect all the consensus groups' recommendations, which included the need for more detail and rationale in the program, troubleshooting suggestions, and the concern for potential challenges for novice clinicians.


CONCLUSIONS
CTT is a new therapy approach based on motor learning theory, which exclusively uses patient-driven conversational narrative as the sole therapeutic stimuli. CTT is conceptually innovative because it represents an approach to voice therapy developed without the use of a traditional therapeutic hierarchy. It is also developed using input from patients with voice disorders and expert clinical providers.
Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: jgs@pitt.edu.
Jackie
J
Gartner-Schmidt
Department of Otolaryngology Rehabilitation Medicine, Rusk Rehabilitation, New York City Medical Center, New York, New York.
Shirley
S
Gherson
Department of Otolaryngology Head and Neck Surgery, Emory Voice Center, Emory University School of Medicine, Atlanta, Georgia.
Edie R
ER
Hapner
Department of Otolaryngology, Vanderbilt Bill Wilkerson Center, Vanderbilt Voice Center, Nashville, Tennessee.
Jennifer
J
Muckala
Department of Otolaryngology, Tufts Voice and Swallowing Center, Tufts University School of Medicine, Boston, Massachusetts.
Douglas
D
Roth
Department of Otolaryngology-Head and Neck Surgery, Voice and Swallowing Center, University of California San Francisco, San Francisco, California.
Sarah
S
Schneider
Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Amanda I
AI
Gillespie
D001364:Awareness; D003142:Communication; D032921:Consensus; D006801:Humans; D010699:Phonation; D011446:Prospective Studies; D020127:Recovery of Function; D012649:Self Concept; D013061:Speech Acoustics; D013065:Speech Intelligibility; D013067:Speech Perception; D013997:Time Factors; D016896:Treatment Outcome; D014832:Voice Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014833:Voice Quality; D014834:Voice Training
Adherence; Motor learning; Voice disorders; Voice therapy