Semin Speech Lang 2021; 42(01): 032-040
DOI: 10.1055/s-0040-1722751
Review Article

Conversation Training Therapy: Let's Talk It Through

Jackie Gartner-Schmidt
1   Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
,
Amanda I. Gillespie
2   Emory Voice Center, Department of Otolaryngology, Emory University School of Medicine, Emory University Hospital Midtown, Atlanta, Georgia
› Author Affiliations

Abstract

This article introduces a novel approach to voice therapy called conversation training therapy (CTT). CTT is the first voice therapy approach to remove the therapeutic hierarchy common in most treatment programs. Rather, CTT uses patient-driven conversation as the sole stimuli in therapy to increase perceptual awareness of voice production in conversational speech. The genesis as to why CTT was developed, as well as the conceptual, theoretical, and component parts of CTT, will be explained. In addition, this article will offer examples of the language of therapy, as it applies to CTT and how to trouble-shoot if problems arise. Medical documentation relevant to CTT will also be outlined. Last, results from a recent efficacy study on CTT will be reported.

Financial Disclosure

J.G-S. and A.I.G. receive royalties from MedBridge, Inc. for an educational video offering Continuing Education Units on Conversation Training Therapy.




Publication History

Article published online:
17 February 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Gillespie AI, Yabes J, Rosen CA, Gartner-Schmidt JL. Efficacy of conversation training therapy for patients with benign vocal fold lesions and muscle tension dysphonia compared to historical matched control patients. J Speech Lang Hear Res 2019; 62 (11) 4062-4079
  • 2 Gartner-Schmidt J, Gherson S, Hapner ER. et al. The development of conversation training therapy: a concept paper. J Voice 2016; 30 (05) 563-573
  • 3 Hapner E, Portone-Maira C, Johns III MM. A study of voice therapy dropout. J Voice 2009; 23 (03) 337-340
  • 4 MacKenzie K, Millar A, Wilson JA, Sellars C, Deary IJ. Is voice therapy an effective treatment for dysphonia? A randomised controlled trial. BMJ 2001; 323 (7314): 658-661
  • 5 Roy N. Functional dysphonia. Curr Opin Otolaryngol Head Neck Surg 2003; 11 (03) 144-148
  • 6 Roy N, Bless DM, Heisey D, Ford CN. Manual circumlaryngeal therapy for functional dysphonia: an evaluation of short- and long-term treatment outcomes. J Voice 1997; 11 (03) 321-331
  • 7 Ziegler A, Dastolfo C, Hersan R, Rosen CA, Gartner-Schmidt J. Perceptions of voice therapy from patients diagnosed with primary muscle tension dysphonia and benign mid-membranous vocal fold lesions. J Voice 2014; 28 (06) 742-752
  • 8 Iwarsson J, Morris DJ, Balling LW. Cognitive load in voice therapy carry-over exercises. J Speech Lang Hear Res 2017; 60 (01) 1-12
  • 9 Iwarsson J. Facilitating behavioral learning and habit change in voice therapy---theoretic premises and practical strategies. Logoped Phoniatr Vocol 2015; 40 (04) 179-186
  • 10 Grillo EU. Clinical investigation of the Global Voice Therapy Model. Int J Speech Lang Pathol 2012; 14 (02) 156-164
  • 11 Verdolini Abbott K. Lessac-Madsen Resonant Voice Therapy. 2nd ed.. San Diego, CA: Plural Publishing Inc.; 2008
  • 12 Stemple JC, Lee L, D'Amico B, Pickup B. Efficacy of vocal function exercises as a method of improving voice production. J Voice 1994; 8 (03) 271-278
  • 13 Watts CR, Diviney SS, Hamilton A, Toles L, Childs L, Mau T. The effect of stretch-and-flow voice therapy on measures of vocal function and handicap. J Voice 2015; 29 (02) 191-199
  • 14 Titze IR, Verdolini Abbott K. Vocology: The Science and Practice of Voice Habilitation. National Center for Voice and Speech; 2012
  • 15 Schmidt R, Lee T. Motor Control and Learning: A Behavioral Emphasis. 4th ed.. Champaign, IL: Human Kinetics; 2005
  • 16 Maas E, Robin DA, Austermann Hula SN. et al. Principles of motor learning in treatment of motor speech disorders. Am J Speech Lang Pathol 2008; 17 (03) 277-298
  • 17 Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res 2008; 51 (01) S225-S239
  • 18 Helou L. Crafting the dialogue: meta-therapy in transgender voice and communication training. Perspectives ASHA Special Interest Groups (SIG 10). 2017; 2 (10) 83
  • 19 Ohlsson AC. Verbal Instruction Model (VIM) in voice therapy. Logoped Phoniatr Vocol 2016; 41 (01) 41-46
  • 20 Whitfield JA, Mehta DD. Examination of clear speech in Parkinson disease using measures of working vowel space. J Speech Lang Hear Res 2019; 62 (07) 2082-2098
  • 21 Tjaden K, Kain A, Lam J. Hybridizing conversational and clear speech to investigate the source of increased intelligibility in speakers with Parkinson's disease. J Speech Lang Hear Res 2014; 57 (04) 1191-1205
  • 22 Picheny MA, Durlach NI, Braida LD. Speaking clearly for the hard of hearing. II: acoustic characteristics of clear and conversational speech. J Speech Hear Res 1986; 29 (04) 434-446
  • 23 Krause JC, Braida LD. Acoustic properties of naturally produced clear speech at normal speaking rates. J Acoust Soc Am 2004; 115 (01) 362-378
  • 24 Goberman AM, Elmer LW. Acoustic analysis of clear versus conversational speech in individuals with Parkinson disease. J Commun Disord 2005; 38 (03) 215-230
  • 25 Gillespie AI, Gartner-Schmidt J. Immediate effect of stimulability assessment on acoustic, aerodynamic, and patient-perceptual measures of voice. J Voice 2016; 30 (04) 507.e9-507.e14
  • 26 Behrman A, Akhund A. The effect of loud voice and clear speech on the use of vocal fry in women. Folia Phoniatr Logop 2016; 68 (04) 159-166
  • 27 Timmons L, Hapner ER. The Use of Conversation Training Therapy for an Individual with Voice Fatigue and Pervasive Vocal Fry. In: Stemple JR, Hapner ER. eds. Voice Therapy Clinical Case Studies. 5th ed.. San Diego: Plural Publishing; 2019: 483-491
  • 28 Verdolini K, Druker DG, Palmer PM, Samawi H. Laryngeal adduction in resonant voice. J Voice 1998; 12 (03) 315-327
  • 29 Verdolini Abbott K. Lessac-Madsen Resonant Voice Therapy. San Diego, CA: Plural Publishing; 2008
  • 30 Gartner-Schmidt J. Flow phonation. In: Behrman A, Haskell J. eds. Exercises for Voice Therapy. 3rd ed.. San Diego, CA: Plural Publishing Inc; 2019
  • 31 Gartner-Schmidt J. Flow phonation. In: Stemple J, Hapner E. eds. Voice Therapy Clinical Case Studies. 5th ed.. San Diego, CA: Plural Publishing; 2019
  • 32 Saltuklaroglu T, Kalinowski J, Dayalu VN, Stuart A, Rastatter MP. Voluntary stuttering suppresses true stuttering: a window on the speech perception-production link. Percept Psychophys 2004; 66 (02) 249-254
  • 33 Chen Z, Wong FC, Jones JA. et al. Transfer effect of speech-sound learning on auditory-motor processing of perceived vocal pitch errors. Sci Rep 2015; 5: 13134
  • 34 Gillespie AI. The role of self-efficacy on voice therapy adherence: a case study. In: Stemple JC, Hapner E. eds. Voice Therapy: Clinical Case Studies, 4th ed. Plural Publishing; 2014
  • 35 Gillespie AI, Abbott KV. The influence of clinical terminology on self-efficacy for voice. Logoped Phoniatr Vocol 2011; 36 (03) 91-99
  • 36 van Leer E, Hapner ER, Connor NP. Transtheoretical model of health behavior change applied to voice therapy. J Voice 2008; 22 (06) 688-698
  • 37 van Leer E, Connor NP. Predicting and influencing voice therapy adherence using social-cognitive factors and mobile video. Am J Speech Lang Pathol 2015; 24 (02) 164-176
  • 38 Marques Torbes TM, Zencke da Silva K, Dalbosco Gadenz C, Cassol M. Adherence of patients with dysphonia to voice therapy: systematic review. J Voice 2020; 34 (05) 808.e15-808.e23
  • 39 Tse AC, Wong AW, Whitehill TL, Ma EP, Masters RS. Analogy instruction and speech performance under psychological stress. J Voice 2014; 28 (02) 196-202
  • 40 Verdolini KA, Lee T. Optimizing motor learning in speech interventions. In: Sapienza C, Casper JK. eds. Vocal Rehabilitation for Medical Speech Language Pathology. Austin, TX: Pro-Ed; 2004: 403-446
  • 41 Verdolini Abbott K. Some guiding principles in emerging models of voice therapy for children. Semin Speech Lang 2013; 34 (02) 80-93
  • 42 Verdolini K. Principles of skill acquisition applied to voice training. In: Acker B, Hampton M. eds. The Vocal Vision: Views of Voice. New York: Applause; 1997: 65-80
  • 43 Verdolini Abbott K. Resonant voice therapy. In: Stemple J. ed. Voice Therapy: Clinical Studies. San Diego, CA: Singular; 2000: 46-61
  • 44 Ebert KD. Parent perspectives on the clinician-client relationship in speech-language treatment for children. J Commun Disord 2018; 73: 25-33
  • 45 van Leer E, Connor NP. Patient perceptions of voice therapy adherence. J Voice 2010; 24 (04) 458-469
  • 46 Verdolini Abbott K. Clinician Manual: Casper-Stone Confidential Voice Therapy. In: Kankakee, IL: Multivoicedimensions e-Publication; 2011
  • 47 De Bodt M, Patteeuw T, Versele A. Temporal variables in voice therapy. J Voice 2015; 29 (05) 611-617
  • 48 Powell TW, Miccio AW. Stimulability: a useful clinical tool. J Commun Disord 1996; 29 (04) 237-253
  • 49 Gillespie AI, Gartner-Schmidt J. Voice-specialized speech-language pathologists' criteria for discharge from voice therapy. J Voice 2018; 32 (03) 332-339