Developmental Medicine & Child Neurology, Oct 1, 2018
ABBREVIATIONS RCT Randomized controlled trial RoBiNT Risk of Bias assessment in N-of-1 Trials SCE... more ABBREVIATIONS RCT Randomized controlled trial RoBiNT Risk of Bias assessment in N-of-1 Trials SCED Single case experimental design AIM To review the evidence for behavioural interventions to reduce drooling in children with neurodisability. METHOD A detailed search in eight databases sought studies that: (1) included participants aged 0 to 18 years with neurodisability and drooling; (2) provided behavioural interventions targeting drooling or a drooling-related behaviour; and (3) used experimental designs. Two reviewers extracted data from full-text papers independently. Results were tabulated for comparison. The Risk of Bias assessment in N-of-1 Trials scale for single case experimental designs (SCEDs) and the Cochrane risk of bias assessment tool for randomized controlled trials (RCTs) were applied. RESULTS Of an initial yield of 763, seven SCEDs and one RCT were included. Behavioural interventions included the use of reinforcement, prompting, self-management, instruction, extinction, overcorrection, and fading. Each assessed body functions or structures' outcomes (drooling frequency and severity); three included activity outcomes (mouth drying, head control, eye contact, and vocalizations) and none assessed participation or quality of life. While each study reported positive effects of intervention, risk of bias was high. INTERPRETATION Low-level evidence suggests behavioural interventions may be useful for treatment of drooling in children with neurodisability. Well-designed intervention studies are urgently needed to determine effectiveness.
Dysphonia due to unilateral vocal fold paralysis (UVFP) can be characterized by hoarseness and we... more Dysphonia due to unilateral vocal fold paralysis (UVFP) can be characterized by hoarseness and weakness, resulting in a significant impact on patients' activity and participation. Voice therapy provided by a speech-language pathologist is designed to maximize vocal function and improve quality of life. The purpose of this paper is to systematically review literature surrounding the effectiveness of speech-language pathology intervention for the management of UVFP in adults. Study Design. This is a systematic review. Methods. Electronic databases were searched using a range of key terms including dysphonia, vocal fold paralysis, and speech-language pathology. Eligible articles were extracted and reviewed by the authors for risk of bias, methodology, treatment efficacy, and clinical outcomes. Results. Of the 3311 articles identified, 12 met the inclusion criteria: seven case series and five comparative studies. All 12 studies subjectively reported positive effects following the implementation of voice therapy for UVFP; however, the heterogeneity of participant characteristics, voice therapy, and voice outcome resulted in a low level of evidence. Conclusions. There is presently a lack of methodological rigor and clinical efficacy in the speech-language pathology management of dysphonia arising from UVFP in adults. Reasons for this reduced efficacy can be attributed to the following: (1) no standardized speech-language pathology intervention; (2) no consistency of assessment battery; (3) the variable etiology and clinical presentation of UVFP; and (4) inconsistent timing, frequency, and intensity of treatment. Further research is required to develop the evidence for the management of UVFP incorporating controlled treatment protocols and more rigorous clinical methodology.
Objectives: Unilateral vocal fold paralysis (UVFP) typically results in marked changes in voice q... more Objectives: Unilateral vocal fold paralysis (UVFP) typically results in marked changes in voice quality and performance and has a significant impact on quality of life. Treatment approaches generally aim to restore glottal closure for phonation and improve vocal function. There are a wide range of voice outcome measures that are available to measure the treatment effect. Careful selection of voice outcome measures is required to ensure that they are adequate for purpose and are psychometrically sound to detect the treatment effect. This article aims to critically evaluate the literature for voice outcome measures that are used for patients with UVFP. Study Design: Systematic review. Methods: Nine databases were searched for UVFP treatment studies published since 2003 (n = 2,484 articles). These articles and their references were screened using inclusion/exclusion criteria, including population characteristics, treatment, voice outcomes, and study findings. Data from the included articles was extracted and appraised with respect to multidimensionality, timing, selection rationale, validity, reliability, and responsiveness to change of the voice outcome measures. Results: A total of 29 studies met the inclusion criteria for the systematic review. These studies showed considerable variability in the rationale, selection, and application of voice outcome measures for reporting the treatment effect for patients with UVFP. Conclusion: There is currently a significant disparity in the selection and use of voice outcome measures for patients with UVFP. A set of principles around selection rationale, validity, reliability, and responsiveness to change is proposed to enhance the judicious selection of voice outcome measures for this patient group.
Current Opinion in Otolaryngology & Head and Neck Surgery, Jun 1, 2018
Purpose of review Unilateral vocal fold paralysis (UVFP) is a common cause of neurogenic dysphoni... more Purpose of review Unilateral vocal fold paralysis (UVFP) is a common cause of neurogenic dysphonia resulting in glottal insufficiency. To restore glottal sufficiency and reduce the presenting dysphonia, treatment involving either surgical intervention, voice therapy or a combination of the two is typically provided. Currently, there is no consensus for the most effective voice treatment for UVFP. This results in an inability to compare current studies, and a lack of treatment effectiveness for the management of UVFP. This study aims to review the most recent literature for the management of dysphonia due to UVFP to establish the current evidence base for voice treatment options. Recent findings There was found to be a lack of consistency in the rationale, selection and timing of the surgical intervention and/or voice therapy being provided for patients with UVFP. Summary Further consensus is required for the rationale and selection of voice treatment prescriptions for the management of UVFP in order to improve treatment effectiveness and voice outcomes in patients with UVFP.
ObjectivesUnilateral vocal fold paralysis (UVFP) typically results in marked changes in voice qua... more ObjectivesUnilateral vocal fold paralysis (UVFP) typically results in marked changes in voice quality and performance and has a significant impact on quality of life. Treatment approaches generally aim to restore glottal closure for phonation and improve vocal function. There are a wide range of voice outcome measures that are available to measure the treatment effect. Careful selection of voice outcome measures is required to ensure that they are adequate for purpose and are psychometrically sound to detect the treatment effect. This article aims to critically evaluate the literature for voice outcome measures that are used for patients with UVFP.Study DesignSystematic review.MethodsNine databases were searched for UVFP treatment studies published since 2003 (n = 2,484 articles). These articles and their references were screened using inclusion/exclusion criteria, including population characteristics, treatment, voice outcomes, and study findings. Data from the included articles wa...
Current Opinion in Otolaryngology & Head & Neck Surgery, 2018
Purpose of review Unilateral vocal fold paralysis (UVFP) is a common cause of neurogenic dysphoni... more Purpose of review Unilateral vocal fold paralysis (UVFP) is a common cause of neurogenic dysphonia resulting in glottal insufficiency. To restore glottal sufficiency and reduce the presenting dysphonia, treatment involving either surgical intervention, voice therapy or a combination of the two is typically provided. Currently, there is no consensus for the most effective voice treatment for UVFP. This results in an inability to compare current studies, and a lack of treatment effectiveness for the management of UVFP. This study aims to review the most recent literature for the management of dysphonia due to UVFP to establish the current evidence base for voice treatment options. Recent findings There was found to be a lack of consistency in the rationale, selection and timing of the surgical intervention and/or voice therapy being provided for patients with UVFP. Summary Further consensus is required for the rationale and selection of voice treatment prescriptions for the management...
Developmental Medicine & Child Neurology, 2018
AimTo review the evidence for behavioural interventions to reduce drooling in children with neuro... more AimTo review the evidence for behavioural interventions to reduce drooling in children with neurodisability.MethodA detailed search in eight databases sought studies that: (1) included participants aged 0 to 18 years with neurodisability and drooling; (2) provided behavioural interventions targeting drooling or a drooling‐related behaviour; and (3) used experimental designs. Two reviewers extracted data from full‐text papers independently. Results were tabulated for comparison. The Risk of Bias assessment in N‐of‐1 Trials scale for single case experimental designs (SCEDs) and the Cochrane risk of bias assessment tool for randomized controlled trials (RCTs) were applied.ResultsOf an initial yield of 763, seven SCEDs and one RCT were included. Behavioural interventions included the use of reinforcement, prompting, self‐management, instruction, extinction, overcorrection, and fading. Each assessed body functions or structures’ outcomes (drooling frequency and severity); three included ...
Dysphonia due to unilateral vocal fold paralysis (UVFP) can be characterized by hoarseness and we... more Dysphonia due to unilateral vocal fold paralysis (UVFP) can be characterized by hoarseness and weakness, resulting in a significant impact on patients' activity and participation. Voice therapy provided by a speech-language pathologist is designed to maximize vocal function and improve quality of life. The purpose of this paper is to systematically review literature surrounding the effectiveness of speech-language pathology intervention for the management of UVFP in adults. Study Design. This is a systematic review. Methods. Electronic databases were searched using a range of key terms including dysphonia, vocal fold paralysis, and speech-language pathology. Eligible articles were extracted and reviewed by the authors for risk of bias, methodology, treatment efficacy, and clinical outcomes. Results. Of the 3311 articles identified, 12 met the inclusion criteria: seven case series and five comparative studies. All 12 studies subjectively reported positive effects following the implementation of voice therapy for UVFP; however, the heterogeneity of participant characteristics, voice therapy, and voice outcome resulted in a low level of evidence. Conclusions. There is presently a lack of methodological rigor and clinical efficacy in the speech-language pathology management of dysphonia arising from UVFP in adults. Reasons for this reduced efficacy can be attributed to the following: (1) no standardized speech-language pathology intervention; (2) no consistency of assessment battery; (3) the variable etiology and clinical presentation of UVFP; and (4) inconsistent timing, frequency, and intensity of treatment. Further research is required to develop the evidence for the management of UVFP incorporating controlled treatment protocols and more rigorous clinical methodology.
A functioning voice is essential for normal human communication. A good voice requires two moving... more A functioning voice is essential for normal human communication. A good voice requires two moving vocal folds; if one fold is paralysed (unilateral vocal fold paralysis (UVFP)) people suffer from a breathy, weak voice that tires easily and is unable to function normally. UVFP can also result in choking and breathlessness. Current treatment for adults with UVFP is speech therapy to stimulate recovery of vocal fold (VF) motion or function and/or injection of the paralysed VF with a material to move it into a more favourable position for the functioning VF to close against. When these therapies are unsuccessful, or only provide temporary relief, surgery is offered. Two available surgical techniques are: (1) surgical medialisation; placing an implant near the paralysed VF to move it to the middle (thyroplasty) and/or repositioning the cartilage (arytenoid adduction) or (2) restoring the nerve supply to the VF (laryngeal reinnervation). Currently there is limited evidence to determine wh...
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