Effects of Vocal Exercises for Spasmodic Dysphonia
Condition: Adductor Spasmodic Dysphonia
MeSH terms: Dysphonia; Hoarseness
Study type: Interventional

Summary: 
      The purpose of this study is to assess the effect of voice exercise and voice rest on
      subject's perception of vocal handicap and communicative participation following Botox
      injections for adductor spasmodic dysphonia.
    

Detailed description: 
      Spasmodic dysphonia (SD) is a neurological disorder characterized by involuntary spasms of
      the vocal folds resulting in a strained and strangled voice quality. This disorder is quite
      disabling to patients who suffer from it, particularly affecting patients' quality of life.
      Botulinum toxin (Botox) has been found to be the most effective treatment for SD. The Botox
      is injected into the affected muscle resulting in temporary weakening of the muscle. The
      patients return for injections on average every 3 - 6 months.

      There is a suggestion in the literature that increased diffusion of the Botox injectate could
      improve the effects of the injection. Furthermore, there is literature supporting the use of
      exercise to increase the diffusion of the Botox. Previous research examined the use of
      voluntary muscle activity vs. rest immediately following Botox injection for writer's cramp.
      It was found that the active condition resulted in greater reduction of muscle strength in
      the injected muscle. Another small study of 9 patients implemented intense exercise comprised
      of loud reading for one hour and a rest condition of total voice rest for 24 hours. They
      found that the exercise condition resulted in improved scores on the voice related-quality of
      life (V-RQOL) measure and concluded that improvement in results of Botox injections may be
      achieved more consistently with the implementation of exercise following the injection. The
      exercise used in this study was intense and may be contrary to the overall benefit as the
      subjects may experience phonotrauma. Timing of the exercise post-injection may also be a
      factor. Previous literature review revealed combined modality treatment of Botox injection
      only, Botox with therapy and Botox with sham treatment. They found no significant differences
      in acoustic stability, V-RQOL, or duration of injection benefit. However, the exercise was
      initiated 3 weeks post-injection and completed once per week for 5 weeks. Investigators aim
      to identify what might improve or extend the duration of botox injections for adductor
      Spasmodic dysphonia.
    

Intervention name(s): Voice Exercise
Intervention type(s): Behavioral
Intervention description(s): Voice exercise will consist of sustained pitches and pitch glides on a variety of different vocal facilitators.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants will undergo one of two study conditions immediately following a standard of care Botox injections. One condition is a 45 minute voice rest condition and the other condition is a 45 minute voice exercise condition.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Botox Injection; Spasmodic; Dysphonia; Voice Therapy; Speech Therapy; Voice Rest