Effectiveness of LLLT, WE ARE PUBLISHED, Gratitude, and PYV!

Enjoy some educational & inspiring blog reading & be sure to roll your shoulders & focus on "low and slow" nasal breathing as you do! Make it a GREAT day. YOU are worthy and YOUR VOICE is BEAUTIFUL. #DONTFORGETIT 

The Effectiveness of Low-Level Light Therapy (LLLT) in Attenuating Vocal Fatigue (Kagan & Heaton, 2017)

I personally love to incorporate both Eastern & Western medicine into my life & I love to lean on more holistic methods whenever possible. This study explored the effects of low-level light therapy(LLLT) on the VOICE (especially VOCAL FATIGUE), & the results were quite exciting. I really enjoyed reading about this study & I hope you do too!

LLLT has been PROVEN to be a noninvasive effective therapeutic procedure for REDUCING INFLAMMATION, PROMOTING WOUND HEALING & NERVE REGENERATION, & PREVENTING TISSUE DAMAGE (with efficacious light wavelengths being RED (approx 633nm) and INFRARED(IR) (approx. 830nm)). It has not yet been studied in the treatment of voice disorders; “the use of LLLT may be beneficial in the voice-disordered population, including for those whose pathologies encompass some alteration of the lamina propria (ex: trauma & fibrovascular changes)…Not only might LLLT speed the recovery of certain patients, but also it might relieve patients’ discomfort during the healing process as well”.

The objective of this study was to investigate the possible effectiveness of LLLT in attenuating symptoms of vocal fatigue created by a vocal loading task as measured by acoustic, aerodynamic, & self-reported vocal effort. 16 vocally healthy adults divided into 4 groups underwent a 1-hour vocal loading procedure (1 hour of greater than 75dB reading aloud) followed by 20mins of an infrared wavelength LLLT (828 hm), red wavelength LLLT (628 nm), heat, OR no heat-light (control) treatment targeting the laryngeal region of the ventral neck surface. Phonation threshold pressure(PTP), relative fundamental frequency(RFF), & Inability to produce soft voice(IPSV) self-perceptual rating scales were recorded at baseline, immediately after the vocal loading, after treatment, & 1 hr after treatment.

Vocal loading significantly increased PTP & IPSV & decreased onset & offset RFFs, consistent with a shift toward vocal dysfunction. Red light SIGNIFICANTLY NORMALIZED the combination of PTP, IPSV, & RFF measures compared to other conditions. RFF is sensitive to a vocal loading task in conjunction with PTP & IPSV, & RED LLLT may have a NORMALIZING EFFECT ON OBJECTIVE AND SUBJECTIVE MEASURES OF VOCAL FATIGUE. 

SLPs at Mass Gen Hospital Center for Laryngeal Surgery and Voice Restoration have anecdotally noted that the application of red light from a New-U unit placed on the neck surface overlying the larynx for 5-10 minutes can result in neck muscles feeling “more relaxed” as reported by some individuals undergoing voice therapy for MTD; they have also noted LLLT gives a similar feeling to being vocally “warmed up” (maybe related to the heat generated by the red wavelength although a placebo effect is possible).

“Radiographic testing conducted revealed that both red and IR light wavelengths from the New-U LLLT device are capable of at least partially penetrating the ventral neck surface through to the laryngeal mucosa within the airway, showing the potential for LLLT to affect laryngeal physiology. Specifically, the VFs and paraglottic tissues glow brightly during IR LLLT application when viewed with an IR sensitive camera or during red LLLT when viewed with a rigid endoscopy. LLLT involves exposing cells or tissues to levels of light, usually in the red and IR wavelengths that are relatively low in energy compared to what is used for purposes such as ablation, cutting, and thermally coagulating tissue”. APPLICATIONS OF LLLT HAVE GROWN SUBSTANTIALLY AND NOW INCLUDE WOUND HEALING, TISSUE REPAIR, RELIEF OF INFLAMMATION AND EDEMA OF INJURIES OR CHRONIC DISEASES, AND NERVE REGENERATION.

“The most promising theory is that LLLT acts on mitochondria to increase adenosine triphosphate(ATP) production and modulate reactive oxygen species, and this creates downstream effects resulting in increased transcription. Red and IR wavelengths absorbed by chromophores in mitochondria cause electrons within the chromophore to jump to a higher energy level, causing a reaction in the transmembrane complex in the electron transport chain. This photobiomodulation results in increased electron transport and thus increased production of ATP. Upregulation of mitochondria causes increased generation of reactive oxygen species, which activate more transcription factors, leading to increased stimulatory and PROTECTIVE GENES. This induction of transcription factors causes downstream effects, including INCREASED CELL PROLIFERATION, GROWTH FACTORS, INFLAMMATORY MODULATIONS, AND INCREASED TISSUE OXYGENATION”. 

“There has been a great deal of EVIDENCE demonstrating the POSITIVE effects of LLLT on WOUND HEALING, TISSUE REPAIR, RELIEF OF INFLAMMATION AND EDEMA OF INJURIES OR CHRONIC DISEASES, AND NERVE REGENERATION. To promote wound healing, it is theorized that LLLT induces the local release of cytokines, chemokines, and other biological response modifiers that increase the wound strength and reduce the time to heal. LLLT has also been found to PROMOTE COLLAGEN FORMATION AND INDUCE NEOVASCULARIZATION. In sports medicine, a field that shares similarities to vocal performance, LLLT has been shown to increase endurance, strength, and speed of recovery for athletes as well as aid in the relief of inflammation and edema of injuries or chronic diseases. Additionally, LLLT has been shown to improve neural regeneration after a stroke or traumatic brain injury, in neurodegenerative diseases, and after spinal cord and peripheral nerve damage”.

“When an individual is vocally fatigued, REACTIVE VOCAL HYPERFUNCTION of the intrinsic or extrinsic laryngeal musculature may occur, which negatively impacts the voice. Another source of vocal fatigue may result from MECHANICAL STRESS placed on the vocal fold mucosa, which increases vocal fold viscosity. Phonation threshold pressure(PTP) which is the lowest subglottal pressure needed to initiate and sustain vocal fold vibration, increases during vocally fatiguing tasks, largely because of the VFs’ increased viscosity.  Elevated IPSV (inability to produce soft voice) values have been found for up to 24 hours following acute phonotrauma, but ultimately resolve completely”. 

Vocal fatigue is normally classified as a subjectively reported symptom and typical complaints include increased effort and discomfort, reduced pitch range and flexibility, reduced loudness or impaired quality, increased fatigue over the course of a day, and improvement after vocal rest. “The treatment of vocal fatigue involves reducing muscular tension (if present) through exercises or palpation, preventing or limiting the inflammatory response through vocal hygiene/hydration/warm-ups, or promoting wound healing through vocal rest. Inflammation reduction and wound healing are both involved in treating vocal fatigue, which is typically a temporary yet debilitating voice condition. Therefore, LLLT is an ideal candidate for a pilot study of a new therapy for the treatment of vocal fatigue”. 

“The induction of transcription factors causes downstream effects, including INCREASED CELL PROLIFERATION, GROWTH FACTORS, INFLAMMATORY MODULATORS, AND INCREASED TISSUE OXYGENATION. These downstream effects are not present in heat treatment, which may partially explain the MORE BENEFICIAL IMPACT OF RED LIGHT. Additionally, although IR light penetrates tissue more deeply than red light wavelengths, it is possible that the fatigue induced by vocal loading was more efficiently resolved by addressing superficial structures more so than deeper structures”. 

“The dose of LLLT greatly impacts the treatment effect elicited. Repeated applications have often been used in pain reduction studies.  A single 20m application was chosen based on the recommendation of the user manual for the device used to apply LLLT. A 20min dose was assumed to be beneficial or at least not harmful based on the recommendations from the device’s manufacturer. The Omnilux New-U device was used for this experiment, which has red and IR wavelengths (20mins for either wavelength was used as the dosage in this study). Red and IR LLLT in doses of ten mins each has been applied in the MFGH Voice Center in individuals with MTD, with seemingly beneficial results per patient report.  The Willow Curve device produces both wavelengths simultaneously”. 

When analyzing change post-treatment & 1 hour post-treatment by condition, ONLY participants in the RED group exhibited SIGNIFICANTLY LOWER values 1 hr post-treatment compared to the post loading, indicating that the significant drop in the red group may account for most of the improvement in the participants as a whole. No significant treatment effects were found immediately post treatment, indicating that the mechanisms of LLLT may work on a longer time frame than the 20m application & possibly even beyond the one-he post treatment mark. 

Results indicate PROMISE FOR A NEW THERAPEUTIC TECHNIQUE as RED LLLT was shown to have a SIGNIFICANT TREATMENT EFFECT on RFF, PTP, & IPSV measures 1 hr following treatment & may be effective in improving acoustic, aerodynamic, & self-perceptual markers of vocal fatigue. LLLT is a simple, potentially efficacious TREATMENT FOR VOCAL FATIGUE that could have WIDE CLINICAL RELEVANCE TO POPULATIONS WITH VOICE DISORDERS OR OCCUPATIONS WITH HIGH VOICE USE DEMANDS.

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#voxfit #voice #lowlevellighttherapy #redlighttherapy #thinkoutsidethebox #vocalfatigue #research #voicesfittoinspire #cheerstoyourbestvoice #occupationalvoiceuser #professionalvoiceuser #speechpathologist #speechpathology #voicespecialist #poweredbypurpose #poweredbypassion

WE ARE PUBLISHED!!!.... 

Does the daily practice of a structured voice exercise protocol affect the fitness instructor’s self-perceived vocal effort, vocal fatigue, and voice handicap?

WE ARE PUBLISHED IN THE JOURNAL OF VOICE!!!! So excited!!!!!️

 

For those of you that have been following me for any length of time, you know my PASSION for merging the MEDICAL & FITNESS-related (voice) worlds… You also know that I LOVE research & being involved with research, especially about OCCUPATIONAL VOICE USERS. We completed a big study involving development of the most optimal “Fitpro voice protocol” a while back & are finally PUBLISHED with a comprehensive article about the results.
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A HUGE THANK YOU to all those #fitpros involved in our research!!! And to @oovostraw as well for providing #singrings to our participants in group 3 & also to those who wanted one (after completing the study).
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What did we find out?!!!!
-Fitness professionals AGREE that CONSISTENT performance of a VOICE PROTOCOL POSITIVELY IMPACTS the VOICE
-Overall conclusions reveal CONSISTENT POSITIVE CHANGES as compared to baseline in the instructor’s perceptual vocal quality AND their self-perceptions of vocal effort, vocal fatigue, & voice handicap
-ALL 3 group protocols PROVED to POSITIVELY IMPACT the voices of fitpros, although some more than others relative to specific outcomes (keep reading...), & therefore these protocols have the potential to IMPROVE THEIR VOICES & related instruction within the fitness studio & within their daily lives
-A structured protocol is EASILY PERFORMED within the fitpro’s daily life & ADHERENCE was MAINTAINED during the study AND at a 5-month post study (surprise) follow-up
-The findings of improvement in ALL participants amplify the importance of/need for STRUCTURED VOICE EXERCISES AND VOCAL TRAININGS for fitness instructors to PREVENT voice disorders, enhance class experience, & ensure healthy careers within this industry.
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The PURPOSE of this study was to identify an optimal “Fitpro voice protocol” & display the ease of applicability of this protocol in the fitness professional’s DAILY LIFE. This study also aimed to demonstrate the IMPACT of this protocol on the fitpro’s vocal QUALITY, as well as self-perceived vocal FATIGUE, vocal EFFORT, & VOICE HANDICAP.
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36 GROUP FITNESS INSTRUCTORS teaching at least 4 classes per week were randomized into 3 voice protocol groups. All participants completed baseline questionnaires, an audio recording of The Rainbow Passage, & were required to follow a specific VOCAL HEALTH PROTOCOL & VOICE–RELATED EXERCISE ROUTINE.
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Protocols involved semi-occluded vocal tract exercise (SOVTE) progressions & functional group-fitness specific exercises using conversation training therapy(CTT) concepts & cup phonation. SOVTEs within groups included straw phonation in water (group 1), straw phonation outside water (group 2), & use of the SingRing (group 3).
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Differences in questionnaires & CAPE-V measures from baseline to day 14 were tested within groups using paired t tests or Wilcoxon Signed Rank tests. General linear regression models were used to test for differences between groups.
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25 participants fully completed the study. POSITIVE INTERVENTION-RELATED CHANGES were observed in patient reported outcome measures including the Voice Handicap Index-10(VHI-10), Vocal Effort Scale(VES), & vocal fatigue index(VFI) & auditory perception of voice (CAPE-V) when comparing these outcomes across time points at baseline & 14 days (within groups AND between groups).
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Most improvement occurred with CONSISTENT PRACTICE longer than one week. Group 1 displayed the most improvement in VHI-10 scores, Group 3 displayed the most improvement on scores on the VES, Groups 1 & 3 displayed the most improvement in VFI scores, & Group 2 displayed the most improvement on CAPE–V scores.  Group 2 VFI part 2 SIGNIFICANTLY decreased from baseline mean. Group 3 VES SIGNIFICANTLY decreased from baseline mean. Group 3 also exhibited the lowest dropout rate (MOST ADHERENCE) & the investigators suspect this may be related to the CONVENIENCE of the SingRing device.
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“The POSITIVE VOCAL IMPACT that a daily structured protocol had on the participants was clear & certainly lends merit to the IMPORTANCE of SOLIDIFYING this practice into DAILY LIFE”.

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ALL participants agreed they would RECOMMEND the use of a VOICE PROTOCOL to other fitness professionals so they could also create POSITIVE VOCAL HABITS. An IMPROVEMENT in VOCAL QUALITY during fitness instruction was evident, but just as important was a POSITIVE CHANGE in the EVERYDAY USE of the voice outside fitness studios. This is another POSITIVE step in IMPROVING the overall CARE & USE of the fitness professional’s VOCAL INSTRUMENT.
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In addition, the study participants noted INCREASED HYDRATION in their daily life, an incorporation of “vocal naps”, & an improved awareness of phonotrauma—ALL of which are necessary to ENSURE the SUCCESS & EFFICACY of vocal exercise.
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Participants provided in–depth insight related to their personal experiences during the study (via an anonymous 20-question survey poststudy & an unannounced 3-question survey at 5-month follow-up) related to protocol performance/adherence, voice–related observations, & the study’s impact on their ability to use the voice while teaching fitness classes (& in general). Narrative comments/responses also revealed perceptions of improvement as well as commitment to continued use of the protocols &/or strategies, even after 5 months.

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The data & POSITIVE trends observed among ALL THREE GROUPS of fitness instructors related to IMPROVEMENT from baseline to day 14 REVEAL the EFFICACY of using a QUICK VOCAL WARM-UP that involves a SOVTE progression-based protocol, including application of CTT, respiratory-related concepts, & hydration-related standards.
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The results of the present study are in agreement with previous studies investigating the prevalence of DYSPHONIA among FITNESS PROFESSIONALS, the BENEFITS of SOVTEs & CTT on the VOICE, the lack of voice EDUCATION/TRAINING for fitness instructors, the high prevalence of dysphonia related to voice use/instruction within this population, & the overall AGREEMENT among instructors that healthy voice care & use SHOULD BE COVERED in their skill/studio training. Given the findings of the study it should be EXPECTED that structured protocols incorporating SOVTEs & CTT WILL POSITIVELY IMPACT the VOICES & LIVES of FITNESS PROFESSIONALS.

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️Click the LINK in the VOXFIT®️ bio to access the entire ARTICLE!!!!️
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Also, if YOU are a #fitpro or someone who cares about the VOICES of #fitpros, let this motivate you to check out the new VOXFIT®️ FITPRO VOCAL MASTERY course: Voices FIT to INSPIRE!! (Link also in bio, website, & stories)…the course also includes training on the protocols mentioned in this study (& others as well). My MISSION is to get this important training to as many fitpros as possible!!!

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#voxfit #voice #research #fitprovocalmastery #voicesfittoinspire #cheerstoyourbestvoice #occupationalvoiceuser #voicespecialist #speechpathologist #fitpro #fitnessinstructor #coach #professionalvoiceuser #vocalhealth #vocalefficiency #vocaldynamics #hoarsenessisnevernormal #dysphonia #vocalfitness #bevocallyfit #published #journalofvoice
 

 GRATITUDE 

 PYV: Anddd of course, always REMEMBER to PRIORITIZE YOUR VOICE! ... 

How are YOU prioritizing your voice today? And everyday? As an OCCUPATIONAL VOICE USER, it SHOULD be one of your top priorities! 

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What do you need to know to keep your voice healthy?  You should understand how the voice works, how to protect and care for your voice, and how to use your voice and entire vocal mechanism in the most efficient, effective, and dynamic ways possible.  
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I’m super PASSIONATE about this population of voice users (I’m one and most of you are too!), and am HERE TO HELP! Reach out with any questions, concerns, or if you’d like to work together. Email me at [email protected] or DM me on @voxfit_ ...

#prioritizeyourvoice