Physiologic Voice Rehabilitation Based on Water Resistance Therapy With Connected Speech in Subjects With Vocal Fatigue

Marco Antonio Guzmán Noriega, Ilter Denizoglu, Daniela Fridman, Constanza Loncon, Constanza Rivas, Raimundo García, Camilo Morán, Camilo Quezada, Leandro Rodriguez

Research output: Contribution to journalArticlepeer-review


Purpose: The present study aimed to assess the effectiveness of a physiologic voice therapy program based on water resistance therapy (WRT) exercises including connected speech in a group of subjects with voice complaints (vocal effort and fatigue). Methods: Twenty-four participants with behavioral dysphonia were randomly assigned to one of two treatment groups: (1) voice treatment with WRT plus vocal hygiene program (n = 12), and (2) vocal hygiene program only (n = 12). Laryngoscopic assessment was performed in all subjects. Before and after voice therapy, participants underwent aerodynamic and electroglottographic assessment. The Voice Handicap Index (VHI) and self-assessment of resonant voice were also performed. The treatment included six voice therapy sessions. For the experimental group, the exercises consisted of a sequence of seven phonatory tasks performed with two different voice training devices (PocketVox and MaskVox). Comparison for all variables was performed between experimental group and control group. Results: Significant differences were found for experimental group for VHI physical subscale, and self-perceived resonant voice when comparing pre-post conditions. A strong negative correlation between self-perceived resonant voice and VHI physical sub-score was also reported. No significant differences were found for instrumented variables. Conclusion: Physiologic voice therapy based on WRT exercises including connected speech seems to be an effective tool to improve self-perceived voice in subjects diagnosed with voice complaints. Apparently, changes are more prone to occur in perceptual variables related with physical discomfort associate with voice production. A reduction in phonatory effort and perceptual aspects of vocal fatigue are the main improvements.

Original languageEnglish
JournalJournal of Voice
StateAccepted/In press - 2021

Bibliographical note

Funding Information:
Funding: This research was supported by grants from CONICYT (Grant FONDECYT 11180291 )

Publisher Copyright:
© 2020 The Voice Foundation


  • Semioccluded vocal tract
  • Vocal effort
  • Vocal fatigue
  • Water resistance therapy


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