The effect of stretch-and-flow voice therapy on measures of vocal function and handicap

Christopher R. Watts, Shelby S. Diviney, Amy Hamilton, Laura Toles, Lesley Childs, Ted Mau

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Objectives To investigate the efficacy of stretch-and-flow voice therapy as a primary physiological treatment for patients with hyperfunctional voice disorders. Study Design Prospective case series. Methods Participants with a diagnosis of primary muscle tension dysphonia or phonotraumatic lesions due to hyperfunctional vocal behaviors were included. Participants received stretch-and-flow voice therapy structured once weekly for 6 weeks. Outcome variables consisted of two physiologic measures (s/z ratio and maximum phonation time), an acoustic measure (cepstral peak prominence [CPP]), and a measure of vocal handicap (voice handicap index [VHI]). All measures were obtained at baseline before treatment and within 2 weeks posttreatment. Results The s/z ratio, maximum phonation time, sentence CPP, and VHI showed statistically significant (P < 0.05) improvement through therapy. Effect sizes reflecting the magnitude of change were large for s/z ratio and VHI (d = 1.25 and 1.96 respectively), and moderate for maximum phonation time and sentence CPP (d = 0.79 and 0.74, respectively). Conclusions This study provides supporting evidence for preliminary efficacy of stretch-and-flow voice therapy in a small sample of patients. The treatment effect was large or moderate for multiple outcome measures. The data provide justification for larger, controlled clinical trials on the application of stretch-and-flow voice therapy in the treatment of hyperfunctional voice disorders.

Original languageEnglish (US)
Pages (from-to)191-199
Number of pages9
JournalJournal of Voice
Issue number2
StatePublished - Mar 1 2015


  • Dysphonia
  • Flow phonation
  • Speech therapy
  • Stretch-and-flow
  • Vocal handicap
  • Voice therapy

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Speech and Hearing
  • LPN and LVN


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