title: Integration of Motor Learning Principles Into Real-Time Ambulatory Voice Biofeedback and Example Implementation Via a Clinical Case Study With Vocal Fold Nodules.
abstract: OBJECTIVE
  Ambulatory voice biofeedback (AVB) has the potential to significantly improve voice therapy effectiveness by targeting one of the most challenging aspects of rehabilitation: carryover of desired behaviors outside of the therapy session. Although initial evidence indicates that AVB can alter vocal behavior in daily life, retention of the new behavior after biofeedback has not been demonstrated. Motor learning studies repeatedly have shown retention-related benefits when reducing feedback frequency or providing summary statistics. Therefore, novel AVB settings that are based on these concepts are developed and implemented.
  
  
  METHODS
  The underlying theoretical framework and resultant implementation of innovative AVB settings on a smartphone-based voice monitor are described. A clinical case study demonstrates the functionality of the new relative frequency feedback capabilities.
  
  
  RESULTS
  With new technical capabilities, 2 aspects of feedback are directly modifiable for AVB: relative frequency and summary feedback. Although reduced-frequency AVB was associated with improved carryover of a therapeutic vocal behavior (i.e., reduced vocal intensity) in a patient post-excision of vocal fold nodules, causation cannot be assumed.
  
  
  CONCLUSIONS
  Timing and frequency of AVB schedules can be manipulated to empirically assess generalization of motor learning principles to vocal behavior modification and test the clinical effectiveness of AVB with various feedback schedules.
authors.affiliation: Massachusetts General Hospital, BostonMGH Institute of Health Professions, Boston, MA.
authors.forename: Jarrad H
authors.initials: JH
authors.lastname: Van Stan
authors.affiliation: Massachusetts General Hospital, BostonMGH Institute of Health Professions, Boston, MAHarvard Medical School, Boston, MA.
authors.forename: Daryush D
authors.initials: DD
authors.lastname: Mehta
authors.affiliation: Independent Scholar, Boston, MA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Petit
authors.affiliation: Northeastern University, Boston, MA.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Sternad
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: Jason
authors.initials: J
authors.lastname: Muise
authors.affiliation: Massachusetts General Hospital, BostonHarvard Medical School, Boston, MA.
authors.forename: James A
authors.initials: JA
authors.lastname: Burns
authors.affiliation: Massachusetts General Hospital, BostonMGH Institute of Health Professions, Boston, MAHarvard Medical School, Boston, MA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Hillman
mesh_terms: D061725:Accelerometry / Q000295:instrumentation; D000328:Adult; D000553:Ambulatory Care; D001676:Biofeedback, Psychology / Q000295:instrumentation*; D055154:Dysphonia / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007818:Laryngeal Diseases / Q000628:therapy*; D063731:Mobile Applications; D011127:Polyps / Q000628:therapy*; D000068997:Smartphone; D013018:Sound Spectrography; D013813:Therapy, Computer-Assisted / Q000295:instrumentation*; D014584:User-Computer Interface; D014833:Voice Quality; D014834:Voice Training