1. Practice Makes Perfect – But Which Practice? Enhancing Motor Learning Of New Vocal Techniques

2. Forming our Question Questions – How effective are current Tx regimes? – Is there a way to ensure both acquisition and retention of skills? – Current service delivery models in voice? Motor learning literature – Motor learning Promoting brain reorganisation Acquisition, retention and transfer of a motor skill – Voice Tx is motor re-learning – Therefore…Topical & Relevant

3. Clinical Question

4. Where did we look? Search terms – Motor learning, voice, voice therapy, feedback, practice Minimal motor learning research related to voice – Non speech literature – Motor speech (Apraxia, LSVT)

5. Principles of Motor Learning Structure of practice – Amount – Distribution – Variability – Schedule – Focus of attention Movement complexity Structure of feedback – Type – Frequency and timing

6. Maas et al (2008). Principles of Motor Learning in Treatment of Motor Speech Disorders. Journal of Speech-Language Pathology, Vol 17, 277-298 Practice performance doesn’t predict retention. Relative and absolute parameters respond differently to different treatment variables May need to consider instrumental measures to better understand underlying motor control and impairment Conditions of feedback and practice interact in complex ways CAP 1

7. CAP 2 Steinhauer,K. & Grayhack, J. (2000). The role of knowledge of results in performance and learning of a voice motor task. Journal of voice, Vol 14 (2), 137-145 100% knowledge of results feedback is detrimental to acquisition, retention and transfer of learning nasalance Feedback provided every 2 nd time or not at all during acquisition phase = better learning

8. CAP 3 Yiu, Verdolini & Chow (2005). Electromyographic study of motor learning for a voice production task. Journal of Speech, Language and Hearing Research. 48, 1254-1268 Neither terminal nor concurrent biofeedback facilitated learning of “relaxed voice production” ? Validity ? Timing of feedback in voice tx

9. CAP 4 Austermann et al (2008). Effects of Feedback Frequency and Timing on Acquisition, Retention and Transfer of Speech Skills in Acquired Apraxia of Speech. Journal of Speech, Language and Hearing Research. Vol 51, 1088-1113. Low frequency feedback may best promote learning (retention and transfer) Delayed feedback may enhance longer-term retention and transfer Acquisition performance does not predict true learning People respond differently to various frequency and timing feedback regimes

10. CAP 5 Spielman et al (2007). Effects of an extended version of the Lee Silverman Voice Treatment on Voice and Speech in Parkinson’s Disease. Journal of Speech-Language Pathology, Vol 16. 95-107. Administering LSVT using an alternative service delivery may result in comparable SPL and VHI measures

11. Critically Appraised Topic Unclear if principles of motor learning apply to the treatment of voice disorders Can we assume and at least consider principles to guide our tx? Delayed and reduced feedback may enhance learning of voice skills

12. Potential Clinical Application Feedback – Type? – Frequency? – Timing? Consider performance vs retention Complexity of task Attention – external Service delivery

13. Case Study 37 year old female with early vocal nodules 1 st session : Assessment & teach clear & effortless voicing (using WTW™*) Target movement acquisition = ↑vocal clarity & ↑perception of ease of phonation on /m/ Achieved by end of first session * WTW™ = Whatever Technique Works (Madill, 2009) ©

14. Case Study 1 st session Homework Practice clear & effortless /m/: 1)10 x an hour for 5-10 secs each time 2)Spread approx evenly across the hour 3)In whatever environment you are in (car, workplace, on the phone, in the toilet, etc)

15. Case Study 3 rd session Homework Practice 3 exercises : Clear & effortless /m/, /m/ + vowel, /m/+ 2-3 word voiced sound only phrases: 1)10 x an hour for 30 secs each time 2)Exercises in different & random order each time 3)Spread approx evenly across the hour 4)In whatever environment you are in (car, workplace, on the phone, in the toilet, etc)

16. Where to from here? Consider possible clinical applications Investigate upcoming research in the motor learning area Explore other areas of voice therapy in 2010

17. Methodology (or I don’t know anything about statistics!!!) 1)Can you reproduce/replicate the study with info provided? 2)Is the method design appropriate to answer the research question? 3)Are the measures used valid & reliable? 4)Do they test the reliability of their measurement process in the study? 5)Are the statistics used appropriate for the data/to answer the research qu.?

18. Voice EBP Group Katrina Blyth Katherine Kelly Cate Madill Judy Rough Danielle Stone