{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T06:26:07Z","timestamp":1792477567506,"version":"4.5.0"},"reference-count":17,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,1,30]],"date-time":"2015-01-30T00:00:00Z","timestamp":1422576000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate the effect of stretch\u2010and\u2010flow voice therapy on vocal function and handicap.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Randomized controlled trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Participants with primary muscle tension dysphonia were randomly assigned to experimental or control groups. Experimental participants received vocal hygiene education followed by 6 weeks of stretch\u2010and\u2010flow voice therapy. Control participants received vocal hygiene education only. Outcome variables consisted of a measure of vocal handicap (Voice Handicap Index [VHI]), maximum phonation time, s\/z ratio, and acoustic measures. All measures were obtained at baseline prior to treatment and within 2 weeks posttreatment or at the end of the control period. The pre\u2010 to posttreatment measurement change (delta \u0394) was applied to statistical analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A multivariate analysis of variance revealed significant group differences in pre\u2010to\u2010post changes on measures of VHI, maximum phonation time, and cepstral peak prominence (CPP) in connected speech and vowels (<jats:italic>P<\/jats:italic>\u2009=\u20090.003, 0.013, 0.025, and 0.017 respectively), with a significant reduction of VHI (Cohen's <jats:italic>d<\/jats:italic>\u2009=\u20091.6), increase in maximum phonation time (Cohen's <jats:italic>d<\/jats:italic>\u2009=\u20091.2), increase of CPP in connected speech (Cohen's <jats:italic>d<\/jats:italic>\u2009=\u20091.2), and increase of CPP in vowels (Cohen's <jats:italic>d<\/jats:italic>\u2009=\u20091.1) in the experimental group compared to the control group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This preliminary small sample randomized controlled trial found significantly greater improvement in vocal handicap, maximum phonation time, and acoustic measures of vocal function after participants received stretch\u2010and\u2010flow voice therapy compared to participants receiving vocal hygiene education alone. Additional research incorporating larger samples will be needed to confirm and further investigate these findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>1b. <jats:italic>Laryngoscope<\/jats:italic>, 125:1420\u20131425, 2015<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.25155","type":"journal-article","created":{"date-parts":[[2015,1,30]],"date-time":"2015-01-30T11:06:47Z","timestamp":1422616007000},"page":"1420-1425","source":"Crossref","is-referenced-by-count":67,"title":["A randomized controlled trial of stretch\u2010and\u2010flow voice therapy for muscle tension Dysphonia"],"prefix":"10.1002","volume":"125","author":[{"given":"Christopher R.","family":"Watts","sequence":"first","affiliation":[{"name":"Department of Communication Sciences and Disorders Texas Christian University  Fort Worth"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Clinical Center for Voice Care Dept. of Otolaryngology\u2013Head and Neck Surgery University of Texas Southwestern Medical Center Dallas Texas U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Toles","sequence":"additional","affiliation":[{"name":"Clinical Center for Voice Care Dept. of Otolaryngology\u2013Head and Neck Surgery University of Texas Southwestern Medical Center Dallas Texas U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley","family":"Childs","sequence":"additional","affiliation":[{"name":"Clinical Center for Voice Care Dept. of Otolaryngology\u2013Head and Neck Surgery University of Texas Southwestern Medical Center Dallas Texas U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ted","family":"Mau","sequence":"additional","affiliation":[{"name":"Clinical Center for Voice Care Dept. of Otolaryngology\u2013Head and Neck Surgery University of Texas Southwestern Medical Center Dallas Texas U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,1,30]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"132","volume-title":"Phonatory Voice Disorders in Children","author":"Stone RE","year":"1982"},{"key":"e_1_2_7_3_1","first-page":"84","volume-title":"Voice Therapy\u2013Clinical Case Studies","author":"Gartner\u2010Schmidt J","year":"2010"},{"key":"e_1_2_7_4_1","volume-title":"Exercises for Voice Therapy","author":"Behrman A","year":"2008"},{"key":"e_1_2_7_5_1","unstructured":"SchneiderS.Vocal fold lesions and response to voice therapy. 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