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Disability and Rehabilitation Jun 2022This review aimed to evaluate the evidence for group therapy in improving speech production in adults with acquired dysarthria. Secondary outcomes included communication...
PURPOSE
This review aimed to evaluate the evidence for group therapy in improving speech production in adults with acquired dysarthria. Secondary outcomes included communication effectiveness and/or wellbeing.
MATERIALS AND METHODS
A review protocol was prospectively published on PROSPERO. Fourteen electronic databases were searched to identify experimental studies investigating adults with acquired dysarthria participating in group intervention with outcomes related to communication and/or wellbeing. The quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT) or the McMaster University's Critical Review Form, and the TIDieR template for intervention description and replication.
RESULTS
21 studies were identified involving 330 individuals with dysarthria, from mostly Parkinson's disease (PD) (97%; 321). Treatment approaches included singing therapy ( = 10), loudness therapy ( = 5) and multi-components therapy (including a combination of impairment and/or compensatory approaches) ( = 4). Studies varied in intensity and outcome measures used. Statistically significant improvements to speech production and/or wellbeing were reported following most approaches.
CONCLUSION
There is some preliminary moderate-quality evidence to suggest that group therapy may improve speech production and in some cases communication effectiveness or wellbeing in people with dysarthria following PD, with more consistent improvements being found for loudness approaches. Singing approaches were frequently studied in PD with some improvements to intelligibility evident. Further well-designed controlled studies including individuals with non-progressive aetiologies is warranted to establish the effectiveness of group treatment.IMPLICATIONS FOR REHABILITATIONGroup therapy may be an effective means of improving speech production and/or wellbeing in individuals with dysarthria following Parkinson's disease.Studies' employing loudness-based group therapy for PD demonstrated more consistent improvements to intensity measures.Some controlled studies utilising singing group therapy resulted in improved intelligibility in PD. CRD42015029374.
Topics: Adult; Dysarthria; Humans; Language Therapy; Parkinson Disease; Singing; Speech Therapy
PubMed: 33356634
DOI: 10.1080/09638288.2020.1859629 -
Journal of Voice : Official Journal of... Jan 2017The study systematically reviews evidence-based frameworks for teaching and learning of classical singing training. (Review)
Review
OBJECTIVES/HYPOTHESIS
The study systematically reviews evidence-based frameworks for teaching and learning of classical singing training.
STUDY DESIGN
This is a systematic review.
METHODS
A systematic literature search of 15 electronic databases following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines was conducted. Eligibility criteria included type of publication, participant characteristics, intervention, and report of outcomes. Quality rating scales were applied to support assessment of the included literature. Data analysis was conducted using meta-aggregation.
RESULTS
Nine papers met the inclusion criteria. No complete evidence-based teaching and learning framework was found. Thematic content analysis showed that studies either (1) identified teaching practices in one-to-one lessons, (2) identified student learning strategies in one-to-one lessons or personal practice sessions, and (3) implemented a tool to enhance one specific area of teaching and learning in lessons. The included studies showed that research in music education is not always specific to musical genre or instrumental group, with four of the nine studies including participant teachers and students of classical voice training only. The overall methodological quality ratings were low.
CONCLUSIONS
Research in classical singing training has not yet developed an evidence-based framework for classical singing training. This review has found that introductory information on teaching and learning practices has been provided, and tools have been suggested for use in the evaluation of the teaching-learning process. High-quality methodological research designs are needed.
Topics: Curriculum; Humans; Learning; Models, Educational; Singing; Students; Teaching
PubMed: 26804784
DOI: 10.1016/j.jvoice.2015.12.001 -
The Journal of Craniofacial Surgery Jul 2019Nonsurgical and surgical options are available for transgender vocal feminization. This systematic review explores the efficacy of feminizing voice therapy and...
OBJECTIVE
Nonsurgical and surgical options are available for transgender vocal feminization. This systematic review explores the efficacy of feminizing voice therapy and phonosurgery.
METHODS
A systematic review was performed using PubMed, Cinahl Plus, Ovid SP, Web of Science, Science Direct, and Google Scholar with terms related to transgender phonosurgery and voice therapy. Included studies were outcomes-based vocal feminization interventions for transgender women. Data were collected on pre- and postintervention fundamental frequency (F0), externally measured vocal femininity, patient satisfaction, and complications.
RESULTS
Two hundred twelve studies were identified and 20 met inclusion criteria. Postintervention patient satisfaction was approximately 80% to 85% for voice therapy, endoscopic shortening, and cricothyroid approximation. Complications were reported for each phonosurgery technique, most commonly decreased mean phonation time and loudness. Of the 20 studies, 17 were used for meta-analysis of F0 change. F0 increased by 31 Hz with voice therapy alone, 26 Hz with laser reduction glottoplasty, 39 Hz with cricothyroid approximation, and 72 Hz with endoscopic shortening.
CONCLUSION
The literature supports both voice therapy and phonosurgery, depending on a patient's magnitude of desired pitch change and tolerance for cost and potential complications. Most will likely benefit from voice therapy, as it is highly satisfactory, raises vocal pitch, and is noninvasive. However, endoscopic shortening is also highly satisfactory and provides the greatest absolute increase in vocal pitch. If surgery is chosen, postoperative voice therapy may additionally increase F0, stabilize the voice, and create a more female timbre. However, further studies will be necessary to provide definitive clinical recommendations.
Topics: Female; Feminization; Humans; Male; Patient Satisfaction; Transgender Persons; Vocal Cords; Voice; Voice Quality
PubMed: 31299724
DOI: 10.1097/SCS.0000000000005132 -
The Cochrane Database of Systematic... Dec 2017Singing is a complex physical activity dependent on the use of the lungs for air supply to regulate airflow and create large lung volumes. In singing, exhalation is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Singing is a complex physical activity dependent on the use of the lungs for air supply to regulate airflow and create large lung volumes. In singing, exhalation is active and requires active diaphragm contraction and good posture. Chronic obstructive pulmonary disease (COPD) is a progressive, chronic lung disease characterised by airflow obstruction. Singing is an activity with potential to improve health outcomes in people with COPD.
OBJECTIVES
To determine the effect of singing on health-related quality of life and dyspnoea in people with COPD.
SEARCH METHODS
We identified trials from the Cochrane Airways Specialised Register, ClinicalTrials.gov, the World Health Organization trials portal and PEDro, from their inception to August 2017. We also reviewed reference lists of all primary studies and review articles for additional references.
SELECTION CRITERIA
We included randomised controlled trials in people with stable COPD, in which structured supervised singing training of at least four sessions over four weeks' total duration was performed. The singing could be performed individually or as part of a group (choir) facilitated by a singing leader. Studies were included if they compared: 1) singing versus no intervention (usual care) or another control intervention; or 2) singing plus pulmonary rehabilitation versus pulmonary rehabilitation alone.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened and selected trials for inclusion, extracted outcome data and assessed risk of bias. We contacted authors of trials for missing data. We calculated mean differences (MDs) using a random-effects model. We were only able to analyse data for the comparison of singing versus no intervention or a control group.
MAIN RESULTS
Three studies (a total of 112 participants) were included. All studies randomised participants to a singing group or a control group. The comparison groups included a film workshop, handcraft work, and no intervention. The frequency of the singing intervention in the studies ranged from 1 to 2 times a week over a 6 to 24 week period. The duration of each singing session was 60 minutes.All studies included participants diagnosed with COPD with a mean age ranging from 67 to 72 years and a mean forced expiratory volume in one second (FEV) ranging from 37% to 64% of predicted values. The sample size of included studies was small (33 to 43 participants) and overall study quality was low to very low. Blinding of personnel and participants was not possible due to the physical nature of the intervention, and selection and reporting bias was present in two studies.For the primary outcome of health-related quality of life, there was no statistically significant improvement in the St George's Respiratory Questionnaire total score (mean difference (MD) -0.82, 95% confidence interval (CI) -4.67 to 3.02, 2 studies, n = 58, low-quality evidence). However, there was a statistically significant improvement in the SF-36 Physical Component Summary (PCS) score favouring the singing group (MD 12.64, 95% CI 5.50 to 19.77, 2 studies, n = 52, low-quality evidence). Only one study reported results for the other primary outcome of dyspnoea, in which the mean improvement in Baseline Dyspnoea Index (BDI) score favouring the singing group was not statistically significant (MD 0.40, 95% CI -0.65 to 1.45, 1 study, n = 30, very low-quality evidence).No studies examined any long-term outcomes and no adverse events or side effects were reported.
AUTHORS' CONCLUSIONS
There is low to very low-quality evidence that singing is safe for people with COPD and improves physical health (as measured by the SF-36 physical component score), but not dyspnoea or respiratory-specific quality of life. The evidence is limited due to the low number of studies and the small sample size of each study. No evidence exists examining the long-term effect of singing for people with COPD. The absence of studies examining singing performed in conjunction with pulmonary rehabilitation precludes the formulation of conclusions about the effects of singing in this context. More randomised controlled trials with larger sample sizes and long-term follow-up, and trials examining the effect of singing in addition to pulmonary rehabilitation, are required to determine the effect of singing on health-related quality of life and dyspnoea in people with COPD.
Topics: Aged; Dyspnea; Humans; Pulmonary Disease, Chronic Obstructive; Quality of Life; Singing; Time Factors
PubMed: 29253921
DOI: 10.1002/14651858.CD012296.pub2 -
Folia Phoniatrica Et Logopaedica :... 2024Diabetes mellitus type 2 is a growing health concern that affects several systems in the body, among which is the phonatory apparatus. Voice may be affected in view of... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Diabetes mellitus type 2 is a growing health concern that affects several systems in the body, among which is the phonatory apparatus. Voice may be affected in view of the high prevalence of myopathy and neuropathy in diseased subjects. The authors aimed to answer the following question: does type 2 diabetes have an effect on voice?
METHODS
The systematic review included search terms such as "speech, voice, larynx, glucose, diabetes, and hyperglycemia." The search strategy yielded 221 articles, only five of which satisfied the inclusion criteria. Articles were considered for inclusion using the PRISMA method. Analysis included 321 patients with type 2 diabetes mellitus and 171 controls. All studies included were case-control studies except for one study which was an observational cohort. Six parameters were chosen as endpoints for the systematic review and meta-analysis: the presence/absence of voice complaints, fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time.
RESULTS
There was no significant difference in the prevalence of voice complaints (i.e., hoarseness) between diabetic patients and control groups. There was also no significant difference in any of the acoustic and aerodynamic measures between patients with type 2 diabetes and controls. These findings can be ascribed to the high resilience of the laryngeal muscles to the adverse effect of systemic diseases.
CONCLUSION
There is no consensus in the literature that the prevalence of voice symptoms in diabetic patients is significantly higher than that reported in healthy subjects.
Topics: Diabetes Mellitus, Type 2; Humans; Voice Disorders; Phonation; Voice Quality; Case-Control Studies
PubMed: 37757764
DOI: 10.1159/000534271 -
The Cochrane Database of Systematic... Nov 2018The reading skills of 16% of children fall below the mean range for their age, and 5% of children have significant and severe reading problems. Phonics training is one... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The reading skills of 16% of children fall below the mean range for their age, and 5% of children have significant and severe reading problems. Phonics training is one of the most common reading treatments used with poor readers, particularly children.
OBJECTIVES
To measure the effect of phonics training and explore the impact of various factors, such as training duration and training group size, that might moderate the effect of phonics training on literacy-related skills in English-speaking poor readers.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, 12 other databases, and three trials registers up to May 2018. We also searched reference lists of included studies and contacted experts in the field to identify additional studies.
SELECTION CRITERIA
We included studies that used randomisation, quasi-randomisation, or minimisation to allocate participants to a phonics intervention group (phonics training only or phonics training plus one other literacy-related skill) or a control group (no training or non-literacy training). Participants were English-speaking poor readers with word reading one standard deviation below the appropriate level for their age (children, adolescents, and adults) or one grade or year below the appropriate level (children only), for no known reason. Participants had no known comorbid developmental disorder, or physical, neurological, or emotional problem.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane.
MAIN RESULTS
We included 14 studies with 923 participants in this review. Studies took place in Australia, Canada, the UK, and the USA. Six of the 14 included studies were funded by government agencies and one was funded by a university grant. The rest were funded by charitable foundations or trusts. Each study compared phonics training alone, or in conjunction with one other reading-related skill, to either no training (i.e. treatment as usual) or alterative training (e.g. maths). Participants were English-speaking children or adolescents, of low and middle socioeconomic status, whose reading was one year, one grade, or one standard deviation below the level expected for their age or grade for no known reason. Phonics training varied between studies in intensity (up to four hours per week), duration (up to seven months), training group size (individual and small groups), and delivery (human and computer). We measured the effect of phonics training on seven primary outcomes (mixed/regular word reading accuracy, non-word reading accuracy, irregular word reading accuracy, mixed/regular word reading fluency, non-word reading fluency, reading comprehension, and spelling). We judged all studies to be at low risk of bias for most risk criteria, and used the GRADE approach to assess the quality of the evidence.There was low-quality evidence that phonics training may have improved poor readers' accuracy for reading real and novel words that follow the letter-sound rules (standardised mean difference (SMD) 0.51, 95% confidence interval (CI) 0.13 to 0.90; 11 studies, 701 participants), and their accuracy for reading words that did not follow these rules (SMD 0.67, 95% CI 0.26 to 1.07; 10 studies, 682 participants). There was moderate-quality evidence that phonics training probably improved English-speaking poor readers' fluency for reading words that followed the letter-sounds rules (SMD 0.45, 95% CI 0.19 to 0.72; 4 studies, 224 participants), and non-word reading fluency (SMD 0.39, 95% CI 0.10 to 0.68; 3 studies, 188 participants), as well as their accuracy for reading words that did not follow these rules (SMD 0.84, 95% CI 0.30 to 1.39; 4 studies, 294 participants). In addition, there was low-quality evidence that phonics training may have improved poor readers' spelling (SMD 0.47, 95% CI -0.07 to 1.01; 3 studies, 158 participants), but only slightly improve their reading comprehension (SMD 0.28, 95% CI -0.07 to 0.62; 5 studies, 343 participants).
AUTHORS' CONCLUSIONS
Phonics training appears to be effective for improving literacy-related skills, particularly reading fluency of words and non-words, and accuracy of reading irregular words. More studies are needed to improve the precision of outcomes, including word and non-word reading accuracy, reading comprehension, spelling, letter-sound knowledge, and phonological output. More data are also needed to determine if phonics training in English-speaking poor readers is moderated by factors such as training type, intensity, duration, group size, or administrator.
Topics: Adolescent; Adult; Australia; Canada; Child; Comprehension; Dyslexia; Female; Humans; Language; Male; Phonation; Phonetics; Randomized Controlled Trials as Topic; Reading; Socioeconomic Factors; United Kingdom; United States
PubMed: 30480759
DOI: 10.1002/14651858.CD009115.pub3 -
Journal of Parkinson's Disease Jun 2016There is evidence that participation in performing arts brings psychosocial benefits in the general population and in recent years there has been substantial interest in... (Review)
Review
BACKGROUND
There is evidence that participation in performing arts brings psychosocial benefits in the general population and in recent years there has been substantial interest in the potential therapeutic benefit of performing arts, including singing, for people with chronic medical conditions including those of neurological aetiology.
OBJECTIVE
To systematically review the existing body of evidence regarding the potential benefit of singing on clinical outcomes of people with PD.
METHODS
Seven online bibliographic databases were systematically searched in January 2016 and supplementary searches were conducted. Full-text original peer-reviewed scientific papers that investigated the potential benefit of singing on at least one of speech, functional communication, cognitive status, motor function and quality of life in human participants with PD were eligible for inclusion.
RESULTS
449 unique records were identified, 25 full-text articles were screened and seven studies included in the review. All seven studies assessed the impact of singing on speech, five found partial evidence of benefit and two found no evidence of benefit. One study assessed each of functional communication and quality of life and no significant benefit was found. No included study assessed the impact of singing on motor function or cognitive status.
CONCLUSIONS
Singing may benefit the speech of people with PD, although evidence is not unequivocal. Further research is required to assess wider benefits including on functional communication, cognitive status, motor function and quality of life. Substantial methodological limitations were identified in the existing literature. Recommendations are made for advancing the state of the literature.
Topics: Humans; Music Therapy; Parkinson Disease; Singing
PubMed: 27258698
DOI: 10.3233/JPD-160837 -
Journal of Voice : Official Journal of... Jan 2023The voice is an important marker of the transition process to the new gender identity of the transgender person. For 20% of patients seeking voice feminization, voice... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The voice is an important marker of the transition process to the new gender identity of the transgender person. For 20% of patients seeking voice feminization, voice therapy is not completely satisfactory, and surgery should be considered, with endoscopic glottoplasty being the current practice. While the increase in fundamental frequency (F0) after glottoplasty has been well described, no systematic review of the literature or meta-analysis regarding other acoustic parameters and quality of voice has been performed yet.
OBJECTIVE
To define the effect of endoscopic glottoplasty on acoustic measures and quality of voice by assessing F0, maximum phonation time (MPT), frequency range, and grade of dysphonia.
METHODS
A literature review was performed in Medline/PubMed, Cochrane, Science Direct, LILACS, and Google Scholar, following PRISMA guidelines, with no constraints on publication date. We included studies in English, Portuguese or Spanish that assessed transgender women who underwent endoscopic glottoplasty. All the included articles were measured in terms of their methodological quality.
RESULTS
The PRISMA approach yielded 14 studies, totaling 566 patients. There was significant heterogeneity between studies regarding follow-up time, surgical technique and perioperative care. Thirteen studies were submitted to meta-analysis. The results showed significant changes in pre- to postglottoplasty mean differences of F0 = 78.49 Hz (95%CI: 75.69-81.30), MPT = -1.11 seconds (95%CI -1.67 to -0.54), frequency range = -3.55 semitones (95%CI -5.74 to -1.36) and grade of dysphonia on the GRBAS scale = 0.44 (95%CI 0.27-0.61).
CONCLUSION
Glottoplasty is effective in significantly increasing fundamental frequency, but slightly decreases MPT, frequency range and vocal quality measured by the grade of dysphonia on the GRBAS scale.
Topics: Female; Humans; Male; Acoustics; Dysphonia; Gender Identity; Transsexualism; Voice; Larynx
PubMed: 33277130
DOI: 10.1016/j.jvoice.2020.11.005 -
Cells Nov 2020Unilateral vocal fold paralysis (UVFP) is a common disorder that may cause glottal closure insufficiency and then hoarseness of voice and aspiration during swallowing.... (Meta-Analysis)
Meta-Analysis
Unilateral vocal fold paralysis (UVFP) is a common disorder that may cause glottal closure insufficiency and then hoarseness of voice and aspiration during swallowing. We conducted a systematic review and meta-analysis to evaluate whether hyaluronic acid (HA) injection laryngoplasty (IL) is an effective treatment for patients with UVFP. Comprehensive systematic searches were undertaken using PubMed, EBSCO Medline, and Cochrane Library databases. We appraised the quality of studies according to preset inclusion and exclusion criteria. The lengths of follow-up were divided into "short-term" (3 months or shorter), "medium-term" (6 months), and "long-term" (12 months or longer). We performed random-effect meta-analysis to estimate the changes in voice-related quality of life, perceptual evaluation by grading systems, voice lab analysis of maximal phonation time, and normalized glottal gap area, before and after HA IL. Fourteen studies were eligible for the final analysis. The results showed that patients' glottal closure insufficiency could be improved; maximal phonation time could be prolonged; perceptual evaluations of the voice and quality of life were better after HA IL, but the duration of treatment effect varied among different studies. In conclusion, HA IL is an effective treatment for UVFP, which may achieve a long-term effect and therefore reduce the likelihood of requiring permanent medialization thyroplasty.
Topics: Humans; Hyaluronic Acid; Injections; Laryngoplasty; Surveys and Questionnaires; Vocal Cord Paralysis; Vocal Cords
PubMed: 33167303
DOI: 10.3390/cells9112417 -
International Journal of Pediatric... Feb 2021To evaluate outcomes of injection laryngoplasty (IL) and laryngeal reinnervation for the treatment of pediatric Unilateral Vocal Fold Paralysis (UVFP), especially on... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate outcomes of injection laryngoplasty (IL) and laryngeal reinnervation for the treatment of pediatric Unilateral Vocal Fold Paralysis (UVFP), especially on swallowing and quality of voice.
METHODS
A literature review was performed in Medline/PubMed and Cochrane Library, following PRISMA guidelines, with no constraints on publication date. We included studies in English, Portuguese or Spanish about surgical treatment for UVFP on the pediatric population (0-21 years) that documented outcomes for one of the following techniques: IL or laryngeal reinnervation. Study characteristics, patient demographics, technical aspects of each procedure, complications, and outcomes for voice and swallowing were extracted. A meta-analysis with inverse variance, random-effects model was performed.
RESULTS
The PRISMA approach yielded 22 studies, totaling 267 patients. Seven reinnervation articles were included in meta-analysis for maximum phonation time (MPT) and quality of voice measured by Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Cardiac surgery had caused UVFP in 62.8% (142/226) of the cases. The main indication for IL was aspiration and for reinnervation was dysphonia. For IL, there was an improvement of 84.5% (confidence interval [CI] 82.6-88.4%) in swallowing and 81.4% (CI 74.6-88.1%) in voice. For reinnervation, there was an improvement of 91.6% (CI 88.2-94.9%) in swallowing and 96.8% (CI 95.5-98.0%) in voice. We found an increase of 6.19 s (CI 1.00 to 11.38) in MPT and a mean difference in GRBAS sum of -3.53 points (CI -6.15 to -0.91) after reinnervation.
CONCLUSION
Retrospective cohort studies suggest that injection laryngoplasty and reinnervation are both effective in improving swallowing and voice in children with UVFP. There was clinical evidence of improvement in the MPT and GRBAS scale meta-analysis in patients undergoing reinnervation.
Topics: Child; Dysphonia; Humans; Laryngoplasty; Retrospective Studies; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords
PubMed: 33333340
DOI: 10.1016/j.ijporl.2020.110553