A Conceptual Framework and Treatment Taxonomy for Respiratory Lung Volume Training (RLVT)

Soren Y Lowell; Hannah R Edwards; Anya Freedman-Doan; Mariela Mercado; Lisandra Pereyra Maldonado; Joanne Thai; Richard T Kelley; Raymond H Colton

doi:10.1016/j.jvoice.2024.02.024

A Conceptual Framework and Treatment Taxonomy for Respiratory Lung Volume Training (RLVT)

J Voice. 2024 Mar 26:S0892-1997(24)00063-8. doi: 10.1016/j.jvoice.2024.02.024. Online ahead of print.

Authors

Soren Y Lowell¹, Hannah R Edwards², Anya Freedman-Doan², Mariela Mercado², Lisandra Pereyra Maldonado², Joanne Thai², Richard T Kelley³, Raymond H Colton²

Affiliations

¹ Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York. Electronic address: slowell@syr.edu.
² Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York.
³ Department of Otolaryngology & Communication Sciences, SUNY Upstate Medical University, Syracuse, New York.

PMID: 38538410
DOI: 10.1016/j.jvoice.2024.02.024

Abstract

Objectives: The purpose of this study was to describe the theoretical and procedural framework of a novel intervention, Respiratory Lung Volume Training (RLVT), and to implement a standardized treatment taxonomy to operationalize the RLVT treatment paradigm.

Study design: This study involved a prospective design with a consensus treatment classification process.

Methods: The RLVT paradigm was developed based on biomechanical constructs governing the interactions of the respiratory and phonatory systems in voice production and principles of motor learning theory. In RLVT, higher levels of lung volume (LV) during speech are trained using multiple speech breathing strategies while providing real-time visual biofeedback with superimposed guidelines for desired LV initiation and termination levels. For people with primary muscle tension dysphonia (MTD), RLVT can capitalize on nonmuscular respiratory forces to increase efficiency of voice production with reduced speaking effort. To define and operationalize the treatment components of RLVT, six investigators with training in RLVT used the Rehabilitation Treatment Specification System to delineate the treatment targets, mechanisms of action, ingredients and dosing through a multistage, consensus decision-making process.

Results: The finalized taxonomy for RLVT included four treatment targets, with three addressing the area of Respiratory Function and one addressing Somatosensory Function. For each treatment target, three categories of ingredients were defined: (1) provide opportunities to practice breathing during voicing/speech, (2) provide feedback, and (3) provide volition ingredients. Within each ingredient category, three to seven specific ingredients were ultimately defined to further operationalize RLVT.

Conclusions: The RLVT paradigm is a theoretically driven approach for optimizing speech breathing patterns to increase efficient voice production in people with primary MTD. By applying a standardized, systematic treatment taxonomy system to specify the components of RLVT, future researchers and clinicians can implement RLVT with improved fidelity and consistency to optimize treatment outcomes.

Keywords: Classification; Disorder; Muscle tension dysphonia; Respiratory; Treatment; Voice.