将基于谐波水平差异的动态生物反馈整合到嗓音功能亢进治疗中：两项病例研究。

文献信息

中文摘要

目的： 动态生物反馈与嗓音功能亢进（VH）患者将改良的音高或响度从诊所推广到日常生活的能力改善相关。音高和响度是听觉感知构念，许多患者易于察觉和修改。它们也与基频和声压级等客观声学测量密切相关。然而，这些构念与VH的病理生理学并无直接关联。相比之下，H1-H2——前两个谐波之间的差值——与异常声带闭合动力学和治疗改善直接相关。但其与患者可感知的构念（如气息声、紧张感、气流和共鸣）的关联比音高和响度更为微妙。这项概念验证研究正式检验了基于H1-H2的动态生物反馈是否能帮助两名患者在嗓音治疗中改善推广效果。
方法： 两名VH患者在开始嗓音治疗前以及三次治疗会话后，在日常生活中佩戴了嗓音监测器。仅在第二次治疗会话后，日常生活中才开启生物反馈。生物反馈包括当H1-H2阈值超过500毫秒时，给予200毫秒的振动触觉提示。
结果： 两名患者在第一次会话后均未出现推广效果。对于两名患者，与基线监测（d = 0.8-1.6）和第一次会话（d = 1.2-1.7）相比，基于H1-H2的动态生物反馈与第二次会话后显著增加的推广效果相关。只有一名患者在第三次会话后关闭生物反馈时，与基线（d = 0.9）和第一次会话（d = 1.3）相比，保留了其增加的推广效果。
结论： 基于H1-H2的动态生物反馈改善了这两名VH患者的推广效果，然而，只有一名患者在关闭生物反馈后保留了改善。未来的工作应研究将H1-H2以及可能与病理生理学相关的其他生物标志物纳入VH患者动态生物反馈的疗效。

英文摘要

OBJECTIVES: Ambulatory biofeedback has been associated with improved generalization of modified pitch or loudness from the clinic into daily life for patients with Vocal Hyperfunction (VH). Pitch and loudness are auditory perceptual constructs readily detected and modified by many patients. They also have close connections to objective acoustic measures like fundamental frequency and sound pressure level. However, these constructs are not directly related to VH's pathophysiology. In contrast, H1-H2-the difference between the first two harmonics-is directly linked to abnormal vocal fold closure dynamics and treatment improvements. But its association with constructs that the patient can perceive-like breathiness, strain, airflow, and resonance-is more nuanced than pitch and loudness. This proof-of-concept study formally tested if ambulatory biofeedback based on H1-H2 can help two patients improve generalization in voice therapy.
METHOD: Two patients with VH wore a voice monitor in daily life before starting voice therapy and after three therapy sessions. Biofeedback was turned on in daily life only after the second therapy session. Biofeedback consisted of a 200-ms vibrotactile cue when a H1-H2 threshold was surpassed for 500-ms.
RESULTS: Neither patient generalized after session 1. For both patients, ambulatory biofeedback based on H1-H2 was associated with significantly increased generalization after session 2 compared to baseline monitoring (d = 0.8-1.6) and session 1 (d = 1.2-1.7). Only one patient retained his increased generalization when the biofeedback was turned off after session 3 compared to baseline (d = 0.9) and session 1 (d = 1.3).
CONCLUSIONS: Ambulatory biofeedback based on H1-H2 improved generalization for both VH patients, however, only one patient retained improvements after turning the biofeedback off. Future work should investigate the efficacy of incorporating H1-H2, and potentially other biomarkers associated with pathophysiology into ambulatory biofeedback for patients with VH.