The Effects of Adding Expiratory Muscle Strength Training in Voice Therapy

Inclusion Criteria: * Individuals with glottic insufficiency. * Adequate cognition evidenced by score of 24 or higher on the Mini-Mental State Examination (MMSE) survey to determine if the subject has the mental capacity to participate in therapy * Completed voice combination evaluation with speech pathologists and otolaryngologist. * Individuals 18 years of age or older Exclusion Criteria: * Adults unable to consent * Non English or Spanish speakers * Pregnant women * Prisoners * Individuals with significant uncontrolled chronic and progressive respiratory diseases including COPD, interstitial lung disease, and cystic fibrosis. * Individuals with uncontrolled blood pressure. * Individuals with significant GI disease and/or gastroesophageal surgery with the exception of well-controlled GERD. * Individuals with a history of abdominal hernia. * Individuals with difficulty complying due to neuropsychological dysfunction (e.g., severe depression, psychosis). * Individuals with other neurological disorders and/or neuromuscular disease other than Parkinson's Disease