Voice therapy delivered in a water-based setting for unilateral vocal fold paralysis: a case report

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Rita Alegria, Susana Vaz Freitas, Fátima Maia e Maria Conceição Manso

 

RESUMO

 

Introduction: There is a lack of scientific evidence on the effectiveness of voice therapy conducted in a water-based setting, To the best of our knowledge, no case report thus far has been published investigating this type of therapeutic approach on an individual with UVFP. Given this knowledge gap, there is a clear need for further investigation into the potential benefits and effectiveness of water-based intervention programs for individuals with UVFP. Objective: The objective of this case report is to provide a detailed description of a voice therapy program conducted in a water-based setting for a patient with Unilateral Vocal Fold Paralysis (UVFP) following thyroid surgery. Methods: A case report of a sixty-four years old man, professional voice user (teacher), ex-smoker, who underwent a total thyroidectomy for a thyroid cancer. He participated in a voice therapy program in a water-based setting once a week, for 8 weeks. Voice therapy strategy included a combination of direct and indirect techniques. Direct water-based exercises aimed to reduce vocal fold gap, reduce supra-glottic structures hyperfunction and improve voice quality. A pre- and post-therapy multidimensional assessment and a six-month follow-up were performed. Results: There was a change in the voice outcome measures after completion of treatment (visual perceptual, audio-perceptual, acoustic and self-perception). At six-month follow-up assessment, patient reported a return to its almost normal – professional and social – voice use. Conclusions: Water-based therapy can create a gentle, engaging, motivational and supportive context for voice treatment. The properties of water create an environment for safe practice of skills. Advantages of combining water-based therapy with voice therapy are promoting communication and improving breathing and phonation control. Further studies with larger samples are needed to draw any realistic conclusions on the efficacy of water-based voice therapy in patients with UVFP.

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KEYWORDS: case report; unilateral vocal fold paralysis; speech-language therapy; water-based intervention