الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
A
s the primary mean of communication, voice plays an important role in daily life. It conveys personal information such as social status, personal traits and the emotional state of the speaker.
Voice is the complex, dynamic product of vocal fold vibration that allows us to vocalize (make sound) and verbalize (produce language through speech).
Voice disorders are characterized perceptually by abnormalities in quality of voice, pitch and/or loudness that can limit the effectiveness of oral communication.
Non-organic voice disorders as hyperfunctional dysphonia is characterized by excessive tension of the laryngeal and/or extra laryngeal muscles or both result in poorly regulated laryngeal muscle tension and unbalanced aerodynamic forces.
In most cases, a voice therapy program uses a combination of indirect and direct treatment techniques. Regardless of the type of direct voice therapy, they all utilize auditory, somatosensory, vocal function, musculoskeletal, and/or respiratory functions.
Stretch and Flow (SnF) is a voice therapy program that targets initiating volitional control over the vocal subsystems using voiced and voiceless airflow stimuli while maintaining a perception of minimal muscular effort during phonation. It focuses on increasing ease and quality of voice production by increasing airflow during phonation which is achieved by patient progression through a structured hierarchy of progressively challenging vocal tasks. These tasks are designed to facilitate equilibrium between respiration, phonation, and resonance passing through 4 levels starting from airflow release, breathy phonation, flow phonation and finally reaching articulatory precision/clear speech.
Smith Accent (SA) method is a holistic approach that addresses pitch, loudness and timbre simultaneously, rather than focusing separately upon each of these vocal parameters.
The purpose of this work was to compare between Stretch and Flow voice therapy and Smith Accent method in treatment of hyperfunctional dysphonia in order to assess the benefit of using this new technique in management of hyperfunctional dysphonia.
So, a randomized controlled trial was conducted including a sample of 60 patients with hyperfunctional dysphonia divided into two groups, each group consisted of 30 patients: ”group A” received Stretch and Flow voice therapy (SnF) and ”group B” received Smith Accent (SA) method of voice therapy. The overall effectiveness of each voice therapy method was measured by the changes in APA, laryngoscopic examination, Arabic-VHI, acoustic voice analysis and aerodynamic measures. All these assessment measures listed were used to asses both groups twice: The first assessment (baseline) was completed before starting therapy program and the second one was applied after 6 weeks of therapy.
This study showed statistically significant improvement post-therapy for both groups in: grade of dysphonia, voice quality, laryngoscopic findings (vocal fold edema, vocal fold erythema, phonatory gap and ventricular hyperadduction), Arabic-VHI (total, physical, functional and emotional domains), Jitter %, Shimmer %, maximum phonation time and mean expiratory airflow. While there were a statistically significant improvement post-therapy regarding voice pitch in the SnF group only and a statistical significant improvement regarding voice loudness and Noise to Harmonic ratio in SA group only.
CONCLUSION
W
hen the effectiveness of Stretch and Flow (SnF) voice therapy was compared to the Smith accent (SA) technique of voice therapy, the findings revealed equivalent improvements for both treatment regimens. So, each of these voice therapy techniques shows a comparable ability of improving patients with hyperfunctional dysphonia.
So, SnF can be considered as an alternative approach for treating hyperfunctional dysphonia, offering a shorter duration and potentially being a simpler alternative for patients who struggle with the more intricate rhythms of the Smith Accent voice therapy method.
RECOMMENDATIONS
• The data provide justification for larger, controlled clinical trials on the application of Stretch and Flow voice therapy in the treatment of hyperfunctional dysphonia/primary MTD.
• Further studies with modifications to the frequency and duration of SnF voice therapy sessions could be done for better compliance as minimizing the duration of the 60 minutes session which was noticed to be long time to be tolerated by the patients. So, 30 minutes sessions twice per week could be tried instead.
• Further randomized control trials on the effect of SnF in other non–organic (functional) voice disorders as phonasthenia or benign vocal fold lesions that may benefit from voice therapy as bilateral vocal folds nodules are recommended.
• Studying other variables that may affect the outcomes of the therapy program as the type of patient, gender, occupation, education, duration of dysphonia and severity of symptoms.
• Further randomized control trials studying other important aerodynamic measures such as subglottal pressure are recommended.