Due to the COVID-19 pandemic, telepractice has grown rapidly. To date, synchronous
telepractice (i.e., in real-time videoconferencing) has been the focus of most research
with asynchronous telepractice (i.e. information stored and accessed later) being used
minimally only to record synchronous encounters. Descriptions of voice therapy concepts
are minimally available in the literature with no standard reporting framework and no
clinical efficacy or effectiveness data. Thus, the proposed study will address these
barriers. First, an asynchronous method will be developed that will impact both in-person
and telepractice services by offering repeated learning opportunities in the client's
environment. The method includes ecological momentary intervention (EMI) through a daily
voice therapy practice app, server, and web portal that is flexible in its programming to
meet the needs of the client, offers performance feedback, and charts results over time.
Second, voice therapy concepts will be tested improving our knowledge about such concepts
that facilitate successful client-centered outcomes for both prevention and treatment of
voice problems. The participants in the study will be teachers who have a high prevalence
of voice problems, impact the healthcare system when treatment is needed, and negatively
affect students' learning abilities in the classroom when communicating with a voice
problem. Third, the Rehabilitation Treatment Specification System (RTSS) framework will
be used to describe the voice therapy concepts. The concepts include: training multiple
voices to meet all the clients' vocal needs, defining voice qualities by the anatomy and
physiology of the voice production system, generalizing voice targets into hierarchical
speech tasks, and using "new" vs "other/old" voice to help the client become their own
clinician. Vocally healthy student teachers and professional teachers with voice
complaints will be randomized into one of four voice therapy conditions delivered via
telepractice. Both groups of teachers are needed to assess the concepts for prevention
and treatment. Condition 2, which fully represents the proposed voice therapy concepts,
will be superior to the other three conditions, which do not fully represent the
concepts, by demonstrating a greater decrease in client-reported primary outcome measures
of the Voice Handicap Index-10 and factor 1 and 2 of the Vocal Fatigue Index. Secondary
outcomes of acoustic measures, Borg Category Ratio-10 scales for vocal and mental effort,
and voice therapy satisfaction surveys will also be investigated. The results will be
useful at a practical level by advancing asynchronous telepractice and by improving
efficacy of voice therapy concepts. In addition, the results will lay the groundwork for
future studies involving development of EMI platforms in other areas of speech-language
pathology and testing additional voice therapy concepts that facilitate successful
client-centered outcomes.