June 21, 2004

Voice patients get in tune with virtual listeners


By Kathi Baker

Professionals who use their voices to make a living are intensely aware of the problems tired and overstressed vocal cords can cause. The healing process includes learning proper use of the voice and practice, practice, practice.

But for the recuperating preacher or teacher, how are those practice sessions possible without turning entire congregations or classrooms into captive audiences? Enter modern technology, with its ability to simulate almost any real-life setting.
A system originally developed to help people who suffer from a paralyzing dread of public speaking now has been introduced into the voice therapy program at the Emory Voice Center. A customized virtual reality (VR) therapy simulating small and large meeting environments has been developed by Virtually Better Inc. to give patients the opportunity to practice in a realistic setting while still in the therapeutic environment.

Voice therapy, not unlike others types of therapy, is conducted in a step-by-step fashion: When one skill is learned, another, more difficult skill is introduced. The difference is that once the patient is ready to practice, he or she needs an audience. That aspect of the therapy is not always accessible, practical or desirable—for either the therapist or the patient.

“Many of my patients are performers, attorneys, politicians, schoolteachers or ministers,” said Edie Hapner, assistant professor of otolaryngology and voice therapist at the Emory Voice Center. “Each day with voice impairment becomes a potential detriment to their careers, their clients, their students, their parishioners. This technology gives them the opportunity to practice newly learned skills in front of an audience in the convenient and safe environment of the lab, with the therapist close by for immediate feedback.”

Each new patient is evaluated for the source of his or her voice problems, which can be caused by a variety of reasons (lesions, aging, hormonal changes, overuse of the vocal cords, etc.). Once a diagnosis has been made, a therapy program is developed to overcome the problem and to teach efficient use of the voice.

Most programs range from four to six sessions, depending on a patient’s needs and schedule. Once that initial program is accomplished, the patient’s next step is to use the newly developed skills. When possible, this part of the treatment takes place in front of a live audience, but often the therapist is not able to observe the patient in a real-life setting. VR presents a feasible alternative.

“We want our patients to be treated and released back to their careers as soon as possible,” said Michael Johns III, director of the voice center and assistant professor of otolaryngology. “When I realized we had this technology right here at Emory, it was obvious we could put it to good use by bringing the audience to the patient. Even though the virtual audience is not real, the patients are completely immersed and seem to have the same sense of challenge.”

In the virtual setting, patients wear a VR helmet with a screen in front of their eyes on which the simulated environment is projected. The illusion is so convincing that patients are able to stand at a “podium” and speak to large or small audiences, even projecting PowerPoint slides as they might in an actual presentation.

“This is a real-time system we use to obtain insight into ‘real-life’ voice use,” Hapner said. “The patients become immersed in the environment, forget they are in a therapy room and allow the therapist to observe their actual speech behaviors and voice skills in a realistic setting.”

Emory Voice Center, the first to use VR technology for this purpose, plans to conduct a study to evaluate the advantages of its new resource.