What Causes Hyperfunctional Voice Disorders? Cara Stepp researches the objective assessment of laryngeal function to improve treatment strategies. Foundational Questions
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Foundational Questions  |   May 01, 2017
What Causes Hyperfunctional Voice Disorders?
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Speech, Voice & Prosodic Disorders / Voice Disorders / Speech, Voice & Prosody / Foundational Questions
Foundational Questions   |   May 01, 2017
What Causes Hyperfunctional Voice Disorders?
The ASHA Leader, May 2017, Vol. 22, online only. doi:10.1044/leader.FQ.22052017.np
The ASHA Leader, May 2017, Vol. 22, online only. doi:10.1044/leader.FQ.22052017.np
Assistant professor and director of the Sensorimotor Rehabilitation Engineering Lab, Boston University
ASHFoundation awards:
  • 2012 New Century Scholars Research Grant ($10,000), “Improving the Reliability of Estimates of Voice Relative Fundamental Frequency”

  • 2012 ASHA Research Conference Travel Grant

  • 2011 New Investigators Research Grant ($5,000), “Voluntary Control of Anterior Neck Musculature in Dysphagia”

What is the focus of your research?
The broad focus of my research is to use engineering tools to aid in the assessment and rehabilitation of voice and speech disorders. One area that I have been studying is how to improve the objective assessment of laryngeal function in individuals with hyperfunctional voice disorders. As part of that work I am specifically interested in laryngeal tension and its potential role in the development of phonotraumatic lesions, muscle tension dysphonia, and people’s perceptions of vocal effort in their daily lives.
How did your award from the ASHFoundation lead to your current work?
In 2013 I was honored to receive a New Century Scholars Research Grant on “Improving the Reliability of Estimates of Voice Relative Fundamental Frequency.” This project allowed me to refine an acoustic measure (relative fundamental frequency, or RFF) that had shown some promise as an acoustic correlate of laryngeal tension. It was because of the ASHFoundation grant that I was able to secure an early-career (R03 at the time) grant from the National Institute on Deafness and other Communication Disorders (NIDCD) to further refine the measure and develop automated algorithms for its estimation. Those automated algorithms were a key feature of my current R01 grant from NIDCD; the algorithms facilitate the ability to do a very large study, in which we determine whether RFF might be a useful adjunct in clinical assessment of hyperfunctional voice disorders.
What do you hope to demonstrate through your research—or what has it already demonstrated?
So far we’ve been able to find a few different objective measures that are implicated in speakers with hyperfunctional voice disorders (individuals with vocal strain, hoarseness, or roughness). However, we have a lot of work to do to figure out which objective measures can provide useful information and are also clinically feasible—that is, inexpensive, easy to use, and fast. Part of this question has to do with the how much individual variation there is in hyperfunctional voice disorders. Because the underlying causes of these disorders are not yet known, it’s possible that not everyone actually has the same physiology. That’s why some of the work we do is to use these objective measures to try to better understand the underlying etiology of hyperfunctional voice disorders.
Why did you choose this particular research focus?
I came into our field as an engineer who was interested in solving problems. I had the marvelous opportunity as a doctoral student at the Massachusetts General Hospital Voice Center to be exposed to individuals with hyperfunctional voice disorders. I was (and continue to be) inspired by the complexity of this disorder and its effects on the quality of life of those who have it. I also love the interdisciplinary nature of this focus—my group includes speech-language pathologists, laryngologists, neuroscientists and engineers, all bringing different views and skills to the problem.
How has ASHFoundation funding affected your professional life?
The ASHFoundation funding directly led to my NIH funding, which has allowed me to rapidly amplify the impact of my research. That $10,000 grant led to a $450,000 R03, which led to a $2 million R01.
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May 2017
Volume 22, Issue 5