# Use of ambulatory biofeedback to improve behavioral treatment of vocal hyperfunction

> **NIH NIH P50** · MASSACHUSETTS GENERAL HOSPITAL · 2024 · $440,786

## Abstract

Project Summary
Vocal hyperfunction (VH) is ostensibly caused by and/or associated with pathological daily voice use and
involves the most commonly treated voice disorders by speech-language pathologists, e.g., vocal fold nodules,
muscle tension dysphonia. Voice therapy is the primary curative option for VH. For example, even when
patients undergo laryngeal surgery to remove lesions, they are still thought to be at risk for recurrence unless
they successfully complete post-surgical voice therapy. However, voice therapy suffers from high rates of
patient dropout. Patients and clinicians report that generalizing desired vocal behaviors from the therapy
session into daily life is one of the most significant barriers to successful voice therapy. Despite this critical
barrier, voice therapy remains entirely dependent upon episodic delivery within an in-clinic or virtual session.
Thus, this project will test if adding Ambulatory Voice Monitoring with Biofeedback (AVM-B) significantly
addresses this generalization challenge, as it can directly extend therapeutic activities into the patient’s daily
life. A clinical trial will randomize patients with VH to receive an evidence-based therapy (Conversation
Training Therapy; CTT) or CTT with AVM-B added. In Aim 1, it is hypothesized that, compared to patients who
only received CTT, patients who receive CTT and AVM-B will demonstrate significantly better generalization
during therapy which will be retained immediately after therapy and six months later. In Aim 2, we will explore
patient factors that mediate the relationship between therapy and generalization, hypothesizing that
stimulabilty—how easily a patient can modify their voice—and engagement—the patient’s level of effort during
therapy—will be positively correlated to the amount of generalization in daily life. If successful, this work would
result in multiple paradigm-shifting impacts with potential to improve the efficiency of clinical practice. AVM-B
would become one of the first evidence-based voice treatment activities taking place primarily outside the
therapy session. Future work could investigate how AVM-B could transition voice therapy from once-a-week
sessions into a continuous process integrated into the patient’s daily life. Further inquiry could improve
generalization by identifying evidence-based methods to tailor therapy based on individual patient factors such
as stimulability and engagement. After discharge, AVM-B could provide a means for patients to “recalibrate”
themselves and prevent relapse without having to see a clinician. Finally, implementation work could help
clinicians adopt/adapt AVM-B and evaluate its effects on dropouts.

## Key facts

- **NIH application ID:** 10829486
- **Project number:** 5P50DC015446-07
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Jarrad Van Stan
- **Activity code:** P50 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $440,786
- **Award type:** 5
- **Project period:** 2017-04-15 → 2028-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10829486

## Citation

> US National Institutes of Health, RePORTER application 10829486, Use of ambulatory biofeedback to improve behavioral treatment of vocal hyperfunction (5P50DC015446-07). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10829486. Licensed CC0.

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