Feasibility and Preliminary Efficacy of Two Technology-assisted Vocal Interventions for Older Adults Living in a Residential Facility

  • Aaron M. Johnson
    Address correspondence and reprint requests to Aaron M. Johnson, Department of Otolaryngology-Head and Neck Surgery, Department of Rehabilitation Medicine, NYU Grossman School of Medicine, NYU Langone Health, 222 East 41st Street, 8th Floor, New York, NY, 10017.
    Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine. New York, New York, United States
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  • Farrah Pukin
    Department of Communicative Disorders, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, United States
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  • Vaishnavi Krishna
    Department of Speech and Hearing Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
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  • Madhura Phansikar
    Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
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  • Sean P. Mullen
    Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois

    Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois

    Center for Social & Behavioral Science, University of Illinois at Urbana-Champaign, Urbana, Illinois

    Illinois Informatics Institute, University of Illinois at Urbana-Champaign, Champaign, Illinois
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      An increasing number of older adults are seeking behavioral voice therapy to manage their voice problems. Poor adherence to voice therapy is a known problem across all treatment-seeking populations. Given age-related physical and cognitive impairments and multiple chronic conditions, older adults are more susceptible to low adherence to behavioral therapies. The purpose of this study was to test the feasibility of an at-home, vocal training intervention for older adults without a known voice disorder living in a senior living community, as well as compare the effects of two modes of mobile health (mHealth) technology-assisted vocal training targeting vocal function and adherence in older adults.

      Study Design

      Parallel Group – Randomized Trial.


      Twenty-three individuals were recruited from a single residential retirement community and randomly allocated into two experimental groups. Both groups were asked to practice the Vocal Function Exercises with increasing frequency over an 8-week period. Tablets with instructions for performing the exercises were provided to all participants. The feedback group's tablets also contained an application providing real-time feedback on pitch, loudness, and duration. Acoustic and aerodynamic measures of vocal function and cognitive measures were obtained before and after the intervention. Self-reported measures of practice frequency, perceived vocal progress and changes, and motivation were obtained weekly.


      The feedback control group adhered to the requested practice sessions more in the latter half of the intervention (weeks 5 and 8). Vocal function measures remained stable. Overall, a pattern reflecting self-reported vocal progress and a general improvement in working memory and global cognitive functioning was observed in the feedback group.


      This study demonstrated that an 8-week mHealth intervention is viable to facilitate vocal practice in older adults. Although vocal ability did not improve with training, results indicated that vocal performance remained stable and age-related vocal changes did not progress. Future research on implementation of mHealth applications in conjunction with behavioral voice therapy is warranted to assess adherence and improvements in vocal function in individuals with age-related voice problems.

      Key Words

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