A Conceptual Framework and Treatment Taxonomy for Respiratory Lung Volume Training (RLVT)

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ObjectivesThe purpose of this study was to describe the theoretical and procedural framework of a novel intervention, Respiratory Lung Volume Training (RLVT), and to implement a standardized treatment taxonomy to operationalize the RLVT treatment paradigm. Study DesignThis study involved a prospective design with a consensus treatment classification process. MethodsThe Respiratory Lung Volume Training (RLVT) paradigm was developed based on biomechanical constructs governing the interactions of the respiratory and phonatory systems in voice production and principles of motor learning theory. In RLVT, higher levels of lung volume during speech are trained using multiple speech breathing targets while providing real-time visual biofeedback with superimposed guidelines for desired lung volume initiation and termination levels. For people with primary muscle tension dysphonia, RLVT can capitalize on non-muscular respiratory forces to increase efficiency of voice production with reduced speaking effort. To define and operationalize the treatment components of RLVT, six investigators with training in RLVT used the Rehabilitation Treatment Specification System (RTSS) to delineate the treatment targets, mechanisms of action, ingredients and dosing through a multi-stage, consensus decision-making process. ResultsThe finalized taxonomy for RLVT included four treatment targets, with three addressing the area of Respiratory Function and one addressing Somatosensory Function. For each treatment target, three categories of ingredients were defined: 1) Provide opportunities to practice breathing during voicing/speech, 2) Provide feedback, and 3) Provide volition ingredients. Within each ingredient category, three to seven specific ingredients were ultimately defined to further operationalize RLVT. ConclusionsThe RLVT paradigm is a theoretically driven approach for optimizing speech breathing patterns to increase efficient voice production in people with primary muscle tension dysphonia. By applying a standardized, systematic treatment taxonomy system to specify the components of RLVT, future researchers and clinicians can implement RLVT with improved fidelity and consistency to optimize treatment outcomes.