Practice Makes Perfect – But Which Practice?

Enhancing Motor Learning Of New Vocal Techniques

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

Clinical Question

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)

Principles of Motor Learning• Structure of practice

– Amount– Distribution– Variability– Schedule– Focus of attention

• Movement complexity

• Structure of feedback– Type– Frequency and timing

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

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 2nd time or not at all during acquisition phase = better learning

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

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

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

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

Potential Clinical Application• Feedback– Type?– Frequency?– Timing?

• Consider performance vs retention• Complexity of task• Attention – external• Service delivery

Case Study• 37 year old female with early vocal

nodules • 1st 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) ©

Case Study1st session Homework

Practice clear & effortless /m/:1) 10 x an hour for 5-10 secs each

time2) Spread approx evenly across the

hour3) In whatever environment you are in

(car, workplace, on the phone, in the toilet, etc)

Case Study3rd 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 time2) Exercises in different & random order

each time3) Spread approx evenly across the hour4) In whatever environment you are in (car,

workplace, on the phone, in the toilet, etc)

Where to from here?

• Consider possible clinical applications

• Investigate upcoming research in the motor learning area

• Explore other areas of voice therapy in 2010

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.?

Voice EBP Group

Katrina BlythKatherine Kelly

Cate MadillJudy Rough

Danielle Stone