Lowell Soren Y, Edwards Hannah R, Freedman-Doan Anya, Mercado Mariela, Maldonado Lisandra Pereyra, Thai Joanne, Kelley Richard T, Colton Raymond H
Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York.
Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York.
J Voice. 2024 Mar 26. doi: 10.1016/j.jvoice.2024.02.024.
The purpose of this study was to describe the theoretical and procedural framework of a novel intervention, Respiratory Lung Volume Training (RLVT), and to implement a standardized treatment taxonomy to operationalize the RLVT treatment paradigm.
This study involved a prospective design with a consensus treatment classification process.
The RLVT paradigm was developed based on biomechanical constructs governing the interactions of the respiratory and phonatory systems in voice production and principles of motor learning theory. In RLVT, higher levels of lung volume (LV) during speech are trained using multiple speech breathing strategies while providing real-time visual biofeedback with superimposed guidelines for desired LV initiation and termination levels. For people with primary muscle tension dysphonia (MTD), RLVT can capitalize on nonmuscular respiratory forces to increase efficiency of voice production with reduced speaking effort. To define and operationalize the treatment components of RLVT, six investigators with training in RLVT used the Rehabilitation Treatment Specification System to delineate the treatment targets, mechanisms of action, ingredients and dosing through a multistage, consensus decision-making process.
The finalized taxonomy for RLVT included four treatment targets, with three addressing the area of Respiratory Function and one addressing Somatosensory Function. For each treatment target, three categories of ingredients were defined: (1) provide opportunities to practice breathing during voicing/speech, (2) provide feedback, and (3) provide volition ingredients. Within each ingredient category, three to seven specific ingredients were ultimately defined to further operationalize RLVT.
The RLVT paradigm is a theoretically driven approach for optimizing speech breathing patterns to increase efficient voice production in people with primary MTD. By applying a standardized, systematic treatment taxonomy system to specify the components of RLVT, future researchers and clinicians can implement RLVT with improved fidelity and consistency to optimize treatment outcomes.
本研究旨在描述一种新型干预措施——呼吸肺容量训练（RLVT）的理论和程序框架，并实施标准化治疗分类法以将RLVT治疗模式操作化。
本研究采用前瞻性设计和共识治疗分类过程。
RLVT模式是基于语音产生过程中控制呼吸和发声系统相互作用的生物力学结构以及运动学习理论原理而开发的。在RLVT中，使用多种言语呼吸策略训练言语期间更高水平的肺容量（LV），同时提供实时视觉生物反馈以及关于期望LV起始和终止水平的叠加指导。对于原发性肌肉紧张性发声障碍（MTD）患者，RLVT可利用非肌肉呼吸力量提高发声效率并减少说话用力。为了定义和操作化RLVT的治疗成分，六名接受过RLVT培训的研究人员通过多阶段共识决策过程，使用康复治疗规范系统来描述治疗目标、作用机制、成分和剂量。
最终确定的RLVT分类法包括四个治疗目标，其中三个针对呼吸功能领域，一个针对躯体感觉功能。对于每个治疗目标，定义了三类成分：（1）提供在发声/言语期间练习呼吸的机会，（2）提供反馈，（3）提供意志成分。在每个成分类别中，最终定义了三到七个具体成分以进一步将RLVT操作化。
RLVT模式是一种理论驱动的方法，用于优化言语呼吸模式，以提高原发性MTD患者的发声效率。通过应用标准化、系统的治疗分类系统来明确RLVT的成分，未来的研究人员和临床医生可以更准确、一致地实施RLVT，以优化治疗效果。
