Unpacking the black box of voice therapy: A clinical application and revision of the Motor Learning Classification Framework (MLCF)

Abstract

Purpose

Voice therapy is a complex behavioural intervention. Understanding its components is integral for continued advancement of voice therapy research, translation of evidence into the clinical setting and improved client care. The Motor Learning Classification Framework (MLCF) offers an excellent opportunity for increasing such knowledge, specifically in relation to identifying variables that affect motor learning (ML), an important mechanism hypothesised to bring about voice change during voice therapy. The MLCF has shown promising results in identifying speech-language pathologists’ (SLPs) use of ML variables during experimentally controlled voice therapy contexts. The purpose of this study was to test the feasibility of applying the framework in the clinical context of everyday voice therapy practice.

Method

Data consisted of two video-recorded voice therapy sessions representing usual voice therapy care. Classification of ML variables used by SLPs during the recorded sessions was attempted based on the MLCF.

Result

Several problematic features of the framework were identified. Based on deliberations between the authors of the current paper, the MLCF was revised using an iterative process. This resulted in the construction of an updated version of the framework (MLCF-V2). The MLCF-V2 organises ML strategies into two broad categories: directly observable behaviours and learning processes. The framework incorporates greater consideration of theory and empirical evidence supporting motivational, attentional focus and subjective error estimation influences on ML. Several examples of each ML variable are included as well as an attempt to provide clearer classification instruction.

Conclusion

It is anticipated that the MLCF-V2 will provide a more useful and reliable classification for use in future investigations of SLPs’ use of ML variables during usual voice therapy practice.

Keywords:

• voice therapy
• motor learning
• behavioural intervention classification

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Acknowledgements

The authors would like to thank the SLPs and their clients who participated in the research and Associate Professor Cate Madill for her contributions to the larger study. Clare Eastwood was partially supported by The University of Sydney with an Australian Post Graduate Award and by Speech Pathology Australia with a higher degree research grant for this research.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.

Supplementary material

Supplemental data for this article can be accessed at http://dx.doi.org/10.1080/17549507.2022.2079723

Notes

1 Intraception is defined as “the tendency to engage in attempts to understand one's own behaviour or the behaviour of others” Schmidt, C. P., & Andrews, M. L. (1993). Consistency in clinicians' and clients' behavior in voice therapy: an exploratory study. Journal of Voice, 7(4), 354-358. https://doi.org/10.1016/S0892-1997(05)80258-9

2 As defined in Baker (2007). In her paper, Baker uses the term Muscle Tension Voice Disorder. We have used the term MTD as it used more commonly.

Additional information

Funding

This research was supported by an Australian Post Graduate Award granted to the first author by The University of Sydney in 2013 and a Higher Degree Research Grant awarded by Speech Pathology Australia in 2016.