Development of an Electronic Documentation System for Voice Therapy A New Teaching and Clinical Research Tool Elizabeth Heller Murray, Katherine Girouard, Meredith Cler, Cara Stepp

Disclosures Financial: This work was supported by grant DC012651 from the National Institute on Deafness and Other Communication Disorders (NIDCD). Cara E. Stepp is an assistant professor at Boston University. Elizabeth S. Heller Murray, Katherine L. Girouard, and Meredith J. Cler have no relevant financial interests to disclose. Nonfinancial: Elizabeth S. Heller Murray, Katherine Girouard, Meredith J. Cler, and Cara E. Stepp are the developers of the VoiceTx application. Heller Murray, E. S., Girouard, K. L., Cler, M. J., & Stepp, C. E. (2016). Development of an Electronic Documentation System for Voice Therapy: A New Teaching and Clinical Research Tool. Perspectives of the ASHA Special Interest Groups, 1(3), 63-73.

Motivation Research frequently focuses on the outcomes of voice therapy Often don’t know the elements that go into the therapy sessions Research: difficult to repeat or expand on a study Clinical: difficult to understand what aspects of voice therapy contributed to outcomes

Aim of Current Project Develop a flexible and easy-to-use documentation system Documents all aspects of therapy Compiles all the information in one central location Provides enough detail to use as a teaching tool Allow the clinician to document everything they do, without putting any limitations on their clinical care

Development and Suggested Use Structure developed from research articles, textbooks, and knowledge of clinical practice Amended terminology A Taxonomy of Voice Therapy (Van Stan, et al., 2015) All definitions of terms provided in application Suggested use Teaching tool Clinical research Noted limitation in integrating into expert clinical practice

Structure of Documentation System Change this figure Heller Murray et al., 2016

Indirect Intervention Change this figure Heller Murray et al., 2016

Indirect Intervention Change this figure Heller Murray et al., 2016

Structure of Documentation System Change this figure Heller Murray et al., 2016

Direct Intervention Change this figure Heller Murray et al., 2016

Direct Intervention Change this figure Heller Murray et al., 2016

Direct Intervention Change this figure Heller Murray et al., 2016

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Teaching Tool: Student Competencies Checklist of assessing graduate student competencies in voice disorders (Teten et al., 2013) Plans and implements a treatment program to address the individual needs of the patient and communication styles of family members based on the results of a comprehensive assessment and patient and/or family consultation Assists patient with developing and adhering to a plan for managing vocal hygiene Displays flexibility in selecting appropriate facilitating voice techniques when assessing the patient’s stimulability for improved voice quality at the time of the initial evaluation and during ongoing treatment Writes evaluation, therapy, and referral reports that adequately explain the nature of the patient’s voice disorder and treatment for the patient and the family

Teaching Tool: Student Competencies Planning and implementing a treatment program Student can document the choices of an expert clinician to began to understand a training program Development of goals Document goals based on voice evaluation Expert clinician can put in goals as a model All decisions moving through therapy are documented, allowing concrete points for feedback Vocal Hygiene: Vocal hygiene hierarchy (Stemple et al., 2000) Identify the behavior Describe the effects Define specific occurrences Plan for modifying behavior

Teaching Tool: Student Competencies Flexibility in selecting appropriate therapy techniques Structure allows for guidance on selecting therapy technique: cannot select a tool in isolation Provides way to document success to assist with decision making Writing reports Documentation of tasks and data regarding success are saved Summary printed at the end of each session

Clinical Research Large dataset of information compiled in one location Everything is linked to a patient and goal Download entire database in SQL For example, allows examination of: Effectiveness of interventions for certain presentations Trends in a large sample Relationship between success in different interventions Sql = structured query language: used to communicate with a database

Summary and Future Directions New tool for teaching and clinical research Allow all aspects of voice therapy to be documented Future directions Expanding beyond voice Continuing to improve usability Make application publically available (soon!) Interested in testing Voicetx? ehmurray@bu.edu cstepp@bu.edu

Speech, Language, & Hearing Sciences Acknowledgements: Stepp Lab, Boston University: Speech, Language, & Hearing Sciences Grace O’Donnell Jessica Silfen Jordan Piel Edie Hapner Brienne Ruel Jackie Gartner-Schmidt Ali Lewandowski Jarrad Van Stan Robert Hillman Elizabeth Gavett Adrianna Shembel Biomedical Engineering Computational Neuroscience

References Heller Murray, E. S., Girouard, K. L., Cler, M. J., & Stepp, C. E. (2016). Development of an Electronic Documentation System for Voice Therapy: A New Teaching and Clinical Research Tool. Perspectives of the ASHA Special Interest Groups, 1(3), 63-73. Stemple, J. C., Glaze, L. E., & Gerdeman, B. K. (2000). Clinical voice pathology: Theory and management (3rd ed.). San Diego, CA: Cengage Learning. Teten, A. F., DeVeney, S. L., & Friehe, M. J. (2013). Checklist for assessing graduate student competencies in voice disorders. Perspectives on Voice and Voice Disorders, 23, 95–100. Van Stan, J. H., Roy, N., Awan, S., Stemple, J., & Hillman, R. E. (2015). A taxonomy of voice therapy. American Journal of Speech-Language Pathology, 24, 101–125.