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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


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
Pages (from-to)300.e1-300.e10
JournalJournal of Voice
Issue number2
StatePublished - 2021

Bibliographical note

Publisher Copyright:
© 2020 The Voice Foundation


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


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