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Interactive Learning Tool using a Neural Network Algorithm for Speech-Delayed Child is a system that was developed mainly for speech-delayed children that utilized a multi-sensory approach and interactive learning technique in assessing the speech disorder. Phonology was focused as the content of the learning tool the lessons are based on the consonant-acquisition chart which contains the rules and system for speech sound production. Speech recognition was implemented to analyze, recognized, and matched the child’s speech to the exact word in the lesson. The system’s functionality is internet based and Google’s voice recognition is implemented to carry out the matching process. Neural Network Algorithm methodology is used to calculate the child’s test result. The application software is developed using HTML, Java, and PHP as the main programming language and Android Studio with Android Developer Tools as the working environment. It uses mySQL in managing its database The software is developed for the android operating system, with the version starting which stored the child’s information and results. The set of lessons is categorized by age namely: AGES 3-4, AGES 4-5, AGES 5-6, and AGES 6-7. Each category has a unique set of lessons categorized by: syllables with 67 lessons, words with 57 lessons, and phrases which contains 26 lessons. When the user finishes all the lessons prepared the system will generate the result, and the submit button transfers the data result into the teachers’ record in a separate system installed on a desktop/laptop computer.

Dysphonia is a ubiquitous problem impacting a broad range of people. As communication is central to the human experience, any perturbation of the voice can be frustrating for the patient and the physician. Nutritional, psychological, and physical means of preventing and treating hoarseness have been used by humans since the beginning of written record. Today, we use a selection of these approaches, along with traditional medicine, to alleviate problems of the vocal tract.

Summary Objective To verify the immediate effects of voiced gargling on the electrical activity of extrinsic laryngeal muscles and vocal self-assessment. Methods A sample of 20 individuals of both sexes, mean age of 31.95 (±11.57) years, were equally divided in two groups according to the presence or absence of vocal complaint. Both groups were evaluated by surface electromyography of the suprahyoid (SH) and infrahyoid (IH) muscle areas during rest, phonation of the sustained vowel [Ɛ] in habitual and strong intensities; phonation of rising and falling glissando; and counting from 1 to 10. Surface electromyography was assessed before and after the voiced gargling exercise, which lasted 1 minute. All participants self-rated their voice and phonatory comfort after the exercise. Wilcoxon and Mann-Whitney tests were applied, as well as Fisher's exact test and linear-to-linear test. The level of significance was 5%. Results The percentage of electrical activity of the SH muscle area decreased in the glissando and counting tasks in the group with vocal complaint, as well as in phonation of sustained vowel in strong intensity in the group without complaint. Decrease was also observed in the right IH muscle area at rest and during sustained vowel phonation at habitual and strong intensities. Percentage of muscular electrical activity was lower in the group with complaint in the following situations: IH muscle area on both sides, at rest and during habitual phonation of sustained vowel and glissando before and after the exercise; right IH muscle area, during counting and strong phonation of sustained vowel before and after exercise; left IH muscle area, in the counting task, just after intervention. Most participants noticed improvement in voice (70%) and phonatory comfort (65%). Conclusions Voiced gargling during 1 minute promotes immediate effects on the electrical activity of the extrinsic laryngeal muscles in individuals with or without vocal complaint. Most individuals reported improved voice and phonatory comfort after exercise.

Purpose: The aim of this clinical focus article is to provide recommendations for implementation of telepractice services for the evaluation and treatment of voice disorders and to use case examples to highlight the advantages of this modality of service delivery. Method: In this clinical focus article, key factors for successful telepractice evaluation and treatment of voice and related disorders are discussed relative to clinical outcome measures. Case examples of telepractice voice therapy are described for a pediatric, transgender, and chronic cough client including associated acoustic, auditory–perceptual, and quality-of-life treatment outcomes. Results: Acoustic, perceptual, and quality-of-life outcome measures demonstrated functional voice improvements after treatment using the telepractice modality. The pediatric client showed decreased perceptual voice strain and increased speech intelligibility. The transgender client showed increased habitual speaking fundamental frequency (pitch) and quality of life. The chronic cough client showed improved vocal hygiene and reduced cough severity. Conclusions: A review of the literature shows comparable outcomes for in-person and telepractice voice therapy, but special considerations must be made to ensure therapeutic success. We present three representative types of voice cases that illustrate implementation of voice evaluation and treatment using the telepractice modality. In all three cases, the clients' personal therapeutic goals were achieved without needing to travel to the clinic. Furthermore, asynchronous practice opportunities were found to be positive byproducts of using the telepractice modality.

Purpose: Voice rest is frequently prescribed after phonosurgery, but optimal type and duration for voice outcomes have not been demonstrated. Studies to date have been characterized by heterogeneity in surgical procedures and laryngeal diagnoses. We sought to analyze the effect of recommended absolute voice rest duration on outcomes of microflap surgery for benign vocal fold lesions. A secondary purpose was to identify patient factors associated with postoperative voice outcomes. Method: Forty-three patients were included in this retrospective review of patients aged 18 years and above who underwent direct microlaryngoscopy with microflap for vocal fold polyp or cyst over a 5-year period at a multidisciplinary voice center. Duration of recommended postoperative absolute voice rest was classified as less than 7 days, 7 days, and more than 7 days. Demographic and vocal hygiene data and voice treatment history were collected. Outcome measures consisted of one pre- and two postoperative Voice Handicap Index (VHI) scores. Effects of recommended voice rest on outcomes were analyzed using mixed models for repeated measures. Effects of patient factors on outcomes were analyzed as exploratory measures. Stroboscopy ratings were analyzed descriptively. Results: Thirteen patients were recommended 7 days of absolute voice rest, 15 were recommended less than 7 days, and 15 were recommended more than 7 days. Postoperatively, VHI scores significantly improved for all patients. Voice rest as a continuous variable was associated with the Functional subscale score in the short term, but there was no effect on VHI total score and no longer term effect of voice rest on any outcome. Age, sex, and preoperative voice therapy were associated with at least one VHI subscale score on at least one time point. Conclusion: VHI outcomes of microflap surgery for polyps and cysts do not differ by duration of recommended absolute postoperative voice rest. Supplemental Material: https://doi.org/10.23641/asha.19178459

Summary Objective Semioccluded vocal tract (SOVT) exercises are routinely included in many voice therapy programs because they have been shown to improve acoustic, aerodynamic, and patient-reported voice outcomes. One limitation of the traditional SOVT exercise is that the nature of phonation through straws or semioccluded oral postures allows only for single phoneme production. A variably occluded facemask (VOFM) allows for use of articulated connected speech beyond the production of single phonemes, while still providing occlusion and, presumably, the vocal efficiency benefits that arise from it. This study reports on the effect of time duration of phonation with a variably occluded facemask on voice outcomes in patients with voice disorders. Design Prospective, randomized cohort study. Methods Fifteen patients with voice disorders phonated for 5 minutes through a VOFM with diameter openings of 3.2, 6.4, and 9.6 mm. Acoustic and aerodynamic voice measures were collected before and after each occlusion trial. These results were compared to a historical patient group that received the same phonation training for 2 minutes. Results Positive effect sizes were found for acoustic and aerodynamic improvements for all patients for at least one occlusion diameter. Effect sizes for aerodynamic outcomes were greater in the 5-minute conditions for both the 9.6- and 6.4-mm occlusions than the 2-minute condition. Effect sizes for acoustic outcomes were greater in the 5 minute than 2-minute trial for the 9.6- and 6.4-mm occlusion diameter, but greater in the 2 minute than 5-minute trial for 3.2-mm diameter. Discussion This study provides evidence that all three occlusion sizes may elicit beneficial changes for different patients; however, 5 minutes of phonation into a facemask with end occlusion of 6.4-mm diameter results in improved acoustic and aerodynamic voice outcomes for many patients with voice disorders. Future studies should further explore phonatory physiologic changes of the VOFM in a larger sample of patients and translate effects into clinical treatment for patients with voice disorders.

Summary Objective Several techniques have been practiced in the field of voice therapy to balance glottal pressures and improve glottal adduction. As such, Semioccluded Vocal Tract Exercises using narrow diameter straws have shown promise as a technique to increase glottal contact as reflected by Closed Quotients (CQ) measured from electroglottograph (EGG). This study explored the effect of nasal resistance (NR) technique, a manually induced NR approach, on glottal adduction in phononormal subjects as a possible new therapeutic technique to assist in glottal closure. Subjects Thirty-four vocally healthy adult females qualified for this study. All subjects were reportedly and perceptually normal. Methods Subjects were instructed to perform tasks including (a) steady modal phonation, (b) straw phonation, (c) humming, and (d) NR technique in a random order. EGG measures included calculation of the CQ and jitter during the mid-section of each stimuli for a minimum of 10 EGG cycles. One-way repeated measures ANOVAs and Bonferroni post-hoc comparisons were calculated to determine differences between each phonatory task for the outcome measures of CQ and jitter. Results Analyses revealed that the mean CQ was significantly different in all the tasks performed with humming (33.99%) at the lowest and NR technique at highest (43.88%). Though the CQ of straw phonation (40.53%) was higher than modal steady phonation (36.65%), jitter was found to be significantly lower for NR technique (0.23%). Jitter during straw phonation (0.43%) did not differ significantly from modal phonation (0.44%). Conclusion These results provide preliminary evidence that NR technique can increase CQ with lower levels of jitter compared to straw phonation using a narrow diameter of 2 mm. Future studies should expand enrollment to men, larger age ranges, and patients with hypofunctional symptoms (eg, Parkinson disease) to evaluate the potential benefits of NR as a therapeutic technique.

Summary Objectives (1) To describe factors influencing the content, timing, and intensity of pre- and postoperative voice therapy for patients undergoing phonosurgery for benign vocal fold lesions. (2) To understand experts’ rationale for decisions made. (3) To critically analyze factors influencing intervention in relation to the wider literature in order to contribute to the development of a complex intervention. Design Qualitative interview study. Setting Multidisciplinary voice clinics in England. Participants Ten expert voice therapists with a mean of 22 years experience. Main outcome measures Participants were asked to describe factors influencing their current practice and views on optimum treatment for patients undergoing phonosurgery for benign vocal fold lesions. Data were analyzed using the Framework Method of thematic analysis. Results Factors influencing intervention related to four key themes. Pathophysiological, Patient, Therapist, and Service factors influenced the content, timing, and duration of the voice therapy provided. Consensus on core elements included delivering indirect and direct therapy preoperatively to manage underlying causative factors and address patient expectations. Postoperative intervention focused on indirect therapy to facilitate wound healing and direct therapy to improve vibratory characteristics of the vocal fold. Elements of therapy were highly individualized within participants according to the four themes above, but similarity between participants on broad parameters of intervention was high. Conclusions Expert voice therapists use direct and indirect methods pre- and postoperatively to treat patients with benign vocal fold lesions. Optimizing wound healing and mobilization of the epithelium postoperatively are concerns for expert voice therapists which distinguish postoperative patients from other dysphonic patients. This study provides an insight into the factors influencing clinician's intervention provision which can contribute to the development of an optimal pre- and postoperative voice therapy intervention. Further research to refine and test the effectiveness of an intervention is now required.

Objective: The purpose of this investigation was to assess clinician and patient feedback about voice therapy using a variably occluded face mask (VOFM) and to determine if voice therapy augmented via a VOFM would result in favorable changes in patient self-perceived handicap, as well as acoustic and aerodynamic measures. Methods/Design: This pilot study used a prospective, pre-post single group design. Eleven patients with dysphonia due to primary muscle tension dysphonia (8) or benign vocal fold lesions (3) were recruited. Data collected included patient and clinician feedback of voice therapy using a VOFM, voice handicap index (VHI)-10, acoustic and aerodynamic measures. Data were collected before treatment (baseline) and 1-week post-therapy. Wilcoxon signed-rank tests were used to compare data pre- and post-therapy. Results: Statistically significant improvement was observed for the VHI-10 with a median delta of −7. Clinician feedback generally reported that patients liked the VOFM, using the VOFM within the first two sessions of therapy, and within less than 10 min of use. All clinicians ranked the conversation level of the hierarchy as the most effective level. Three themes emerged from the Therapy Feedback Form: the VOFM was a (1) “Facilitator for Sensation,” (2) a “Physical Tool,” and that there was (3) “No Program Needed” to use the VOFM in voice therapy. There was a statistically significant improvement in cepstral peak prominence (p = 0.0329) and cepstral spectral index of dysphonia (p = 0.0164) in sustained vowels. Discussion: This pilot study represents the first investigation into clinician and patient perceptions of using a VOFM. Reported measures via patient perception, as well as clinician perceptions, and some acoustic and aerodynamic measures showed that participants got better with VOFM voice therapy. Last, in general, both clinicians and patients liked utilizing a VOFM in voice therapy.

RESUMO Objetivo Identificar os efeitos de um programa de fonoterapia da voz em grupo de pacientes com disfonia, por meio de avaliações perceptivo-auditiva e autopercepção vocal. Métodos Estudo-piloto de ensaio clínico não controlado, com amostra de conveniência. O estudo contou com 22 participantes com diagnóstico otorrinolaringológico de disfonia. Dentre eles, 15 mulheres e sete homens, com média de idade de 59,4 ± 12,53. Foram realizadas dez sessões de terapia fonoaudiológica em grupos de cinco a seis pessoas, com abordagens diretas e indiretas, baseadas no Programa Integral de Reabilitação Vocal (PIRV). Os participantes foram avaliados individualmente, antes e após a realização do programa terapêutico. A avaliação incluiu análise de autopercepção com a Escala de Sintomas Vocais (ESV) e perceptivo-auditiva da qualidade vocal com a escala Grade, Roughness, Breathness, Asteny, Strain, (GRBAS), realizadas por fonoaudiólogos especialistas em voz. Resultados Após o programa terapêutico, observou-se diferença significativa na pontuação de grau geral de alteração da ESV (p=0,002) e também nas subescalas Limitação (p=0,002) e Emocional (p=0,006), indicando autopercepção de redução dos sintomas vocais após intervenção. No entanto, destaca-se que não foram encontrados resultados significativos na comparação pré e pós-tratamento com relação à qualidade vocal. Conclusão O programa de fonoterapia da voz teve efeitos estatisticamente significativos em relação aos sintomas vocais autorrelatados, sinalizando um caminho promissor de abordagem eclética para a terapia vocal em grupo. ABSTRACT Purpose To identify the effects of a phonotherapy program in a group of patients with dysphonia through auditory-perceptual and vocal self-perception assessments. Methods Pilot study: an uncontrolled clinical trial with a convenience sample. Twenty-two patients with an otorhinolaryngological diagnosis of dysphonia participated in the study, including 15 women and 7 men, with a mean age of 59.4 ± 12.53, who underwent 10 speech therapy sessions in groups of 5 to 6 people, with direct and indirect therapy based on the Comprehensive Vocal Rehabilitation Program (CVRP). Patients were individually assessed before and after the therapeutic program, the assessment included auditory-perceptual analysis with the Vocal Symptoms Scale (VSS) and auditory-perceptual analysis of voice quality GRBAS, performed by speech-language pathologists specializing in voice. Results After the therapeutic program, there was a significant difference in the score for the general degree of change in the VSS (p=0.002), and also in the limitation (p=0.002) and emotional (p=0.006) subscales, indicating selfperceived reduction in vocal symptoms after intervention. However, no significant results were found in the pre- and posttreatment comparison regarding vocal quality. Conclusion The study demonstrated that the voice therapy program had statistically significant effects in relation to self-reported vocal symptoms, thus signaling a promising path for an eclectic approach to group vocal therapy.

Objective: to map speech therapy interventions with a focus on the development of professional communication on radio and television. Introduction: Radio announcers and journalists who work on TV need to participate in training to develop more competent and adequate communication for the demands of their work without compromising their vocal health. However, scientific production on speech therapy interventions carried out with this public is insipid and heterogeneous, thus making it difficult to generalize and systematize the strategies reported in intervention studies with this population. Methods: The design of this review is based on the acronym PCC in which the population is professionals or students who work in radio and television; the concept is any speech therapy intervention focused on the development of professional communication in radio and TV; and the context are the possibilities of places of speech therapy with professionals or students working in radio and TV. The following study designs will be considered: studies and case series, studies before and after intervention, quasi-experimental studies and experimental studies. Searches will be carried out in the following databases: Pubmed/Medline, Cochrane Library, EMBASE, LILACS, Scopus, SciELO and Web of Science. A manual search and mapping of references will also be performed. The data will be analyzed using simple statistics and will be presented in tables, charts and graphs. Results: It is hoped that the results will guide the clinician in working with these voice professionals and expand new paths in scientific research on this topic. Conclusions: This protocol presented a scoping review proposal to map speech therapy interventions focused on professional radio and television communication. There is an expectation that the results of this review will guide the clinician in working with these voice professionals, thus offering a more personalized treatment considering the existing scientific literature associated with the patient's preferences. In addition, this review is expected to expand new paths in scientific research on this topic.

Objective: to analyze the knowledge about self-care practices with the voice acquired by teachers comparing two periods. Method: A cross-sectional study was conducted with 129 teachers who attended a blended course and answered a questionnaire to assess the knowledge acquired. Participants were divided into two groups: G1 (n=74) and G2 (n=55), including those who responded six months and one year after completing the course, respectively. The collected data were subjected to statistical tests. Results: When comparing the two groups, a difference (p=0.031) was found in the category “voice self-care practices included in daily professional life”, in which G1 was higher (100.0%) than G2 (92,7%). There was also a difference (p=0.004) associated with the responses to “think about using strategies to improve the work environment” (G1=75.7%; and G2=94.5%). Conclusion: The most reported aspects were “concern with hydration,” “performing vocal exercises” and “not forcing the voice/not screaming”. A little difference was found between the groups. Objetivo: analizar el conocimiento sobre las prácticas de autocuidado con la voz adquirida por los docentes comparando dos periodos. Método: investigación transversal, realizada con 129 profesores que realizaron un curso ofrecido en la modalidad semi-presencial y respondieron un cuestionario para evaluar el conocimiento adquirido. Los participantes se dividieron en dos grupos: G1 (n=74), que respondió seis meses después de la finalización del curso, y G2 (n=55), un año. Los datos recogidos fueron sometidos a pruebas estadísticas. Resultados: la comparación entre las dos clases evidenció que la categoría "práctica de autocuidado con la voz en el día a día profesional" registró diferencia (p=0,031), en que G1 fue mayor (100,0%) que G2 (92,7%). También hubo diferencia (p=0,004) en cuanto al aspecto "piensa en usar estrategias para mejorar el ambiente de trabajo" (G1=75,7% y G2=94,5%). Conclusión: los aspectos más mencionados fueron preocupación con hidratación, realizar ejercicios vocales y no forzar la voz/no gritar. Hubo poca diferencia entre los grupos. Objetivo: analisar o conhecimento sobre práticas de autocuidado com a voz adquirido por professores comparando dois períodos. Método: pesquisa transversal, realizada com 129 professores que realizaram um curso oferecido na modalidade semipresencial e responderam um questionário para avaliar o conhecimento adquirido. Os participantes foram divididos em dois grupos: G1 (n=74), que respondeu seis meses após a conclusão do curso, e G2 (n=55), um ano. Os dados coletados foram submetidos a testes estatísticos. Resultados: a comparação entre as duas turmas evidenciou que a categoria “prática de autocuidado com a voz no dia a dia profissional” registrou diferença (p=0,031), em que G1 foi maior (100,0%) do que G2 (92,7%). Também houve diferença (p=0,004) quanto ao aspecto “pensa em usar estratégias para melhorar o ambiente de trabalho” (G1=75,7% e G2=94,5%). Conclusão: os aspectos mais mencionados foram preocupação com hidratação, realizar exercícios vocais e não forçar a voz/não gritar. Houve pouca diferença entre os grupos.

Introduction: Pansori is a traditional Korean dramatic art form, which likely appeared in the mid-eighteenth century in the southern region of Korea. In pansori there is a strong inclination toward preserving tradition, especially in regard to training, which is generally considered particularly demanding in terms of risks to vocal health. Nevertheless -as highlighted by recent studies- some innovations took place in pansori characteristics and performances in the last few decades. Objective: We hypothesize that these innovations have impacted the attitudes of singers and teachers towards pansori training and vocal health issues, and that a new approach to voice training in pansori might be recommended. Method: Starting with recent evolutions of pansori and considering previous studies, we discuss how these changes might produce innovations -or at least a demand for innovation- in pansori’s training. We also try to capture the viewpoint of pansori students and performers, through an anonymous survey. Results: Although further investigation is required, the results suggest that a new approach in teaching pansori is emerging and it is increasingly requested by the trainee performers, despite some criticisms from traditionalists. Conclusion: Unlike previously thought, perhaps a more scientific and health-conscious approach to pansori voice training will be something from which many pansori singers can benefit. Resumen Introducción: Pansori es una forma de arte dramático tradicional coreano que probablemente apareció a mediados del siglo XVIII en la región sur de Corea. En pansori hay una fuerte inclinación a preservar la tradición, especialmente en lo que respecta al entrenamiento, que generalmente se considera particularmente exigente en términos de riesgos para la salud vocal. Sin embargo, como destacan estudios recientes, se produjeron algunas innovaciones en las características y actuaciones del pansori en las últimas décadas. Objetivo: Hipotetizamos que estas innovaciones han impactado las actitudes de cantantes y profesores hacia la formación del pansori y los problemas de salud vocal, y que podría recomendarse un nuevo enfoque para el entrenamiento de la voz en pansori. Método: Comenzando con las evoluciones recientes de pansori y considerando estudios previos, discutimos cómo estos cambios pueden producir innovaciones, o al menos una demanda de innovación, en la formación de pansori. También tratamos de captar el punto de vista de los estudiantes e intérpretes de pansori, a través de una encuesta anónima. Resultados: Aunque se requiere más investigación, los resultados sugieren que está surgiendo un nuevo enfoque en la enseñanza del pansori y es cada vez más solicitado por los artistas en formación, a pesar de algunas críticas de los tradicionalistas. Conclusión: A diferencia de lo que se pensaba anteriormente, quizás un enfoque más científico y consciente de la salud para el entrenamiento de la voz en pansori será algo de lo que muchos cantantes de pansori puedan beneficiarse.

Celem artykułu jest zaprezentowanie podejścia całościowego do głosu i pracy nad jego prawidłową emisją. Holistyczne ujęcie nie koncentruje się wyłącznie na samym głosie, ale wskazuje na ciało, jako instrument wydobywania głosu, na czele z aparatem oddechowym, zestawem rezonatorów, narządami mowy, ale również świadomością własnego głosu i psychosomatyką etc. W tym podejściu cały człowiek jest instrumentem, a efektem jest jego głos, który wydobywa z ciała. Idąc tym tropem zamierzamy zaprezentować innowacyjną, słabo jeszcze rozpoznaną na gruncie polskim metodę DVT (DoctorVox Voice Therapy), która koncentruje się na kompleksowym, całościowym, wychodzącym od potrzeb jednostki modelu doskonaleniakompetencji w zakresie emisji głosu. Jest ujęciem procesowym, zakładającym etapy, przez które powinna być przeprowadzona osoba rozwijająca swoje kompetencje pracy głosem. Jednocześnie zamiarem Autorek publikacji jest przybliżenie propozycji warsztatów inspirowanych metodą DVT, podczas których uczestnicy studiów podyplomowych mieli okazję doświadczyć konstruktywistycznego modelu doskonalenia własnych kompetencji. Ich opinie, refleksje i efekty, z jakimi ukończyli 15-godzinny kurs zostały ujęte w końcowej części artykułu, stanowiąc ilustrację odbioru proponowanej metody w procesie doskonalenia warsztatu pracy głosem., The aim of the article is to present a holistic approach to voice and training on its correct projection. The holistic approach does not focus only on the voice itself, but points at the body as an instrument of voice production, led by the breathing apparatus, a set of resonators, and speech organs, but also awareness of one’s own voice and psychosomatic condition of the body, etc. In this approach, the whole person is an instrument, and the effect is his/her voice, which he/she brings out of the body. Following this path, we intend to present an innovative DVT (DoctorVox Voice Therapy) method, which is still poorly recognized in Poland. It focuses on a comprehensive, holistic model for improving voice projection based on the needsof the individual. It is a process approach, assuming stages through which a person developing his/her voice skills should be conducted. At the same time, the intention of the authors of the publication is to present the proposal of workshops inspired by the DVT method, during which the participants of postgraduate studies had the opportunity to experience a constructivist model of improving their own competences. Their opinions, reflections, and effects with which they completed the 15-hour course are included in the final part of the article, that illustrates the reaction of teachers to the proposed method in the process of improving the voice quality and projection.

RESUMO Objetivo Verificar se a estimulação das habilidades auditivas de fonoaudiólogos com e sem dificuldades no processamento auditivo central (PAC) interfere no desempenho da avaliação perceptivo-auditiva (APA) do desvio vocal predominante. Métodos Estudo prospectivo, quase-experimental, realizado com 26 fonoaudiólogos, desenvolvido em cinco etapas: Etapa1: Pré-intervenção - primeira APA, composta por 30 amostras da vogal sustentada /ε/, acrescidas de 20% de repetição (seis amostras repetidas), apresentadas randomicamente, na qual os participantes deveriam identificar o desvio vocal predominante; Etapa 2: Triagem das habilidades do PAC com nove testes da plataforma AudBility; Etapa 3: Treinamento perceptivo-auditivo do desvio vocal predominante e segunda APA, idêntica à anterior; Etapa 4: Intervenção - estimulação das habilidades auditivas (EHA), realizada por 14 fonoaudiólogos, sendo oito que não passaram na triagem da Etapa 2 (Grupo1) e seis que passaram na triagem e, espontaneamente, realizaram a EHA (Grupo G2a). Os outros 12 participantes não realizaram EHA e formaram o Grupo G2b; Etapa 5: Pós-intervenção - realização da terceira APA, idêntica às anteriores, por todos os fonoaudiólogos. A acurácia das respostas e confiabilidade intra-avaliadores foram verificadas ao longo das três APAs. Resultados Os três grupos apresentaram desempenhos semelhantes nas três APAs. G1 e G2a não apresentaram melhora no desempenho da análise do desvio vocal predominante pós-EHA. A confiabilidade intra-avaliador pré-intervenção no G1 foi inferior a do G2a e G2b nas APA1 e APA2, e similar a eles na APA3, pós-intervenção. Conclusão EHA proposto não impactou a acurácia da APA, mas influenciou a confiabilidade intra-avaliador dos fonoaudiólogos com dificuldades nas habilidades auditivas do PAC. ABSTRACT Purpose To verify if the stimulation of auditory skills of speech therapists with and without difficulty in auditory processing (CAP) interferes in performance of auditory-perceptual assessment (APA) regarding predominant vocal deviation. Methods Prospective, quasi-experimental study, conducted with 26 speech therapists and developed in five stages: Stage1: Pre-intervention - APA, composed of 30 samples of sustained vowel emissions /ε/, plus 20% repetition (six repeated samples) in which participants should identify the predominant vocal deviation. Stage2: Screening of CAP skills through nine tests of AudBility web platform. Stage3: Perceptual-auditory training of predominant vocal deviation and, later, second APA, identical to previous one. Stage4: Intervention - Stimulation of auditory skills (EHA) performed by 14 participants, eight of which failed the screening from Stage2 and six who passed th e screening and spontaneously performed EHA (Group G2a ). The other 12 participants did not perform EHA and formed the G2b Group. Stage5: Post-intervention - Third execution of APA, identical to previous, by all participants. Accuracy of analysis and intra-rater reliability were assessed in all APAs. Results The three groups showed similar performances in the three APAs. G1 and G2a showed no improvement in the performance of the analysis of predominant vocal deviation after EHA. Pre-intervention intra-rater reliability in G1 was lower than in G2a and G2b in APA1 and APA2, and similar to them in APA3, post-intervention. Conclusion Proposed EHA had no impact on APA accuracy, but influenced in intra-rater reliability of speech therapists with difficulty in the hearing skills of CAP.

Background/Aim: Scales used to collect perceptual ratings related to a speaker’s gender are widely used in gender affirming voice training for trans individuals. Such scales may be used as outcome measures to gain insight into whether training has helped clients meet personal goals related to gender expression. These scales are also widely used in general research investigating the relationship between vocal characteristics and perceptions of speaker gender. However, past studies in these areas have varied in the terminology used to label rating scales and the impact of this variation is currently unknown. Additionally, research has not yet fully explored the relationship between self- and listener ratings of trans participant voices and trans participant satisfaction with voice, and whether or not these relationships change after trans participants undertake gender affirming voice training. This research paper aimed to explore these relationships and address these research gaps. Methods: A group of 34 trans participants were asked to rate their voices before and after participating in gender affirming voice training. Trans participant voice samples from before and after training were also presented to a group of 25 listeners for rating. Perceptual ratings were made on two visual analogue scales (VAS) with anchors “very feminine/very masculine” and “very female/very male.” Trans participants also rated their satisfaction with their current voice on a VAS with anchors “very satisfied/very unsatisfied.” Correlation coefficients were calculated to investigate the relationship between collected ratings. Results: Differences in scale labels were found to have minimal impact on ratings made by both trans participants and listeners. Trans participant self-ratings were found to correlate with listener ratings, but this correlation was not strong. Trans participant self-ratings had a consistently stronger relationship with their self-rated vocal satisfaction. The study contributed new findings that these differences may be more pronounced after trans participants have completed voice training. Discussion/Conclusion: This study suggests that results from past studies that have used differently labelled scales to collect ratings related to gender perception based on voice are suitable to compare. This study also discusses the implications reported differences between trans participant self-ratings and listener ratings may have for research and clinical practice.

Purpose This study primarily aimed at observing the possible tissue mobilization on facial, neck, and chest tissues caused by different double source of vibration semioccluded vocal tract exercises (DSV-SOVTEs). Another goal was to inspect the degree of self-perceived sensation of a massage-like sensation. Method Fifty-five participants engaged in a set of several DSV-SOVTEs: (a) phonation with a silicone tube submerged 2 and 8 cm below water surface, (b) Acapella Choice device, (c) lip trills, and (d) tongue trills. A self-perceived massage-like sensation was also assessed. All exercises were performed at three loudness levels. Tissue mobilization signal was captured by four accelerometers placed in four different body regions: (a) over the cheek, (b) over the neck, (c) over the thyroid cartilage, and (d) over the suprasternal notch. Results There is a differential effect of all DSV-SOVTEs on tissue mobilization. All four observed dependent variables from tissue oscillation modulation (frequency, amplitude, jitter, and shimmer) showed significant three-way interactions. In general, amplitude and frequency of tissue oscillation modulation increases with loudness. A self-perceived massage-like sensation showed highly significant differences between DSV-SOVTEs. Conclusions All DSV-SOVTEs do mobilize tissues. Type of exercise, loudness level, and body region produce an effect on all tissue oscillation variables. Acapella device produces the largest amplitude of vibration, lowest frequency, and more regular oscillation of tissue. Water resistance therapy showed the most irregular tissue oscillation. Control of these variables is likely to be relevant to obtain the best outcomes in patients.

Summary Objective Vocal performance students at the collegiate level are faced with rigorous training protocols for which they are required to maintain optimal vocal quality and function. The purpose of this study was to compare the vocal habits and hygiene practices of incoming undergraduate Bachelor of Music (BM), Master of Music (MM), Doctor of Musical Arts (DMA), and Artist Diploma (AD) vocal performance students at a tier I music conservatory. To date, no study has compared the reported vocal habits of undergraduate and graduate vocal performance students within the same music conservatory. Methods Two-hundred and eighty six incoming vocal performance majors including undergraduate (n = 79), graduate master's candidates (n = 171), and graduate doctoral/AD candidates (n = 36) at the University of Cincinnati College–Conservatory of Music over a period of 9 years (2008–2017) completed a questionnaire designed to gain information about their baseline vocal patterns and hygiene practices. The intake form included questions about daily liquid intake, past voice treatment, current adverse voice symptoms, warm-up and cool-down use, average time spent singing daily, and any harmful voice hygiene practices such as phonotraumatic behaviors (ie, yelling, frequent throat clearing). This data was retrospectively analyzed for significant findings within groups and between groups. Results/Conclusions Results from the questionnaires detailing the undergraduate voice performance participants’ self-reported current and past vocal symptoms, current vocal health and hygiene practices, reported voice training habits, and other pertinent factors that may lead to potential voice problems in comparison to those same factors presented in the graduate master's and doctoral/artist diploma voice performance participants’ questionnaires are provided. Data gained from the voice performance participants revealed that the potential for voice-related problems exists within all groups, as 45.5% of undergraduate students, 38.6% of graduate master's students, and 44.4% of graduate doctoral/artist diploma students stated at least one current voice issue or adverse symptom. The findings indicate that there is no significant difference regarding level of education in relation to percentage of subjects that reported at least one current adverse vocal symptom, current voice problem, and/or reported negative hygiene practice. The information provided in this study may be beneficial for those who are vocal performers as well as those involved in the training of collegiate-level vocal performance students.

Background: Hypophonia is a prevailing problem in people with multiple sclerosis (PwMS). However, evidence supporting the effectiveness of voice rehabilitation is lacking. Objective: The aim of this study was to identify the most effective method to reduce hypophonia. Methods: In this randomized controlled trial, 44 PwMS were randomized to intensive and high-effort voice treatment groups, the LSVT-LOUD®, and conventional treatment group. Subjects received 16 treatments (4 sessions/week) lasting 45 minutes. The primary outcome was voice intensity (dB) in monologue, vocalization, and sentences while voice handicap index (VHI) measured voice self-perception. Outcomes were assessed by a blinded observer at baseline, post-treatment, and 15-month follow-up (FU). Results: Linear models revealed a significant post-intervention between-group mean difference in favor of LSVT-LOUD for monologue: +6.3 dB (95% CI: 2.5 to 10.1); vocalization: +7.4 dB (95% CI: 2.3 to 12.5); and sentences: +9.5 dB (95% CI: 4.7 to 14.3). However, 43.7% PwMS in the LSVT-LOUD and 10% in the conventional treatment group obtained a full recovery of voice intensity (>60 dB) post-treatment, Fisher’s test = 13.3, p Conclusion: LSVT-LOUD can be a valid treatment to increase voice intensity in PwMS. However, results suggest the need for FU interventions targeting maintenance.

The aim of this research is to investigate whether yoga, which is an important approach in the relaxation of body and mind and one of the oldest known relaxation methods; its practices including posture, breathing and meditation, makes any difference in students’ performance in vocal education. As a method, experimental research, which is an important type of quantitive research, and a pre-test post-test control group design, which is a design of it, were used. The study group of the research consisted of 18 students (9 experiments-9 controls) determined by random assignment method among the first-grade students who took the vocal education class in the Department of Music Education of Burdur Mehmet Akif Ersoy University in the 2019-2020 academic year. The data in the study were collected through the "Individual Voice Training Performance Scale" which was developed by Ertek Babac and Dalkiran (2019). After having yoga instructor training course by the researcher, the students in the experimental group were practiced Hatha Yoga posture, breathing and meditation practices for 1,5 hours a week for 10 weeks. It had been investigated whether there was a significant difference between the vocal performance of the students who had not started yoga practices yet and their vocal performances at the end of the yoga practices that had been in coordination with vocal training lessons for 10 weeks. The changes of the students in the control group, who did not participate in yoga practice but took part in the vocal training course only, were also measured at the end of 10 weeks. Besides, it was investigated whether there was any difference between the students of the experimental group who practiced yoga and the students of the control group who did not. In the conclusion section of the study, it was stated that yoga contributed to the performance of students in the experimental group and to all of the target behaviors that were discussed as sub-problems. In comparison between the experimental and the control groups, a significant difference was detected in all target behaviors except for the target behaviors of performing the work with correct articulation and diction and performing the work with the correct notation. It has been concluded that yoga supports the development of performance skills of the students in vocal training in overall performance.

Summary Objective The aim of this study was to describe the effect of superficial hydration, with or without systemic hydration, on voice quality in future female professional singers by assessing acoustic and perceptual parameters of voice production as well as symptoms of vocal fatigue. Study Design This is an experimental design study. Methods A study was performed on a sample of 24 female voice majors to ascertain the effect of superficial hydration, with or without systemic hydration, on acoustic parameters and perception of vocal fatigue. The study replicated a prior study by van Wyk et al (2016) with some modifications; we looked at the effect of both systemic and superficial hydration independently and together on voice quality and vocal fatigue. Acoustic measurements including GRBASI, jitter, shimmer, F0 MPT, frequency min and max, intensity min and max, and dysphonia severity index were measured along with perceived vocal fatigue using the Vocal Fatigue Index. Results A statistically significant increase in MPT values were obtained when comparing pre- and post-test results of the hypo hydrated (P = 0.015) and superficial hydration condition (P = 0.004). A significant increase in frequency min (Hz) within the hypo hydrated condition was also observed (P = 0.019). A significant increase was observed in the intensity min (dB) (P = 0.010) and F0 min (Hz) (P = 0.002) within the combined hydration condition. Also, when superficial hydration was applied, mean shimmer % (P = 0.016), MPT (sec) (P = 0.003) and dysphonia severity index (P = 0.020) scores increased significantly in a between-group, post-test comparison. A significant reduction in mean intensity max (dB) (P = 0.049) and intensity min (dB) (P = 0.018) was also observed. Conclusions This study demonstrates that the use of superficial hydration results in positive outcomes of perceptual parameters of voice quality and symptoms of vocal fatigue in future female professional singers. However, mixed results were observed regarding the acoustic parameters of voice. The superficial hydration data is compelling enough to warrant implementing in a vocal hygiene protocol for singers.

Introduction: the integration of speech therapy and physical therapy interventions is positive in improving the vocal performance of voice professionals. Objective: to analyze the effects after practice performed through vocal exercises (Semi-occluded Vocal Tract Exercises-SOVTE) and respiratory exercises (use of the Respiron Classic® device). Method: intervention study (pre and post), called Vocal and Respiratory Conditioning (CVR), which included three voice professionals who filled in before and after instruments to assess the self-reported presence of voice handicap (VDI-10), vocal fatigue ( IFV) and symptoms after their presentations (EASE-BR); were evaluated in terms of vocal quality parameters and maximum phonation time; and assessment of respiratory muscle strength and maximum voluntary ventilation. The exercises presented during the meetings were also performed at home, with a record of vocal and respiratory comfort (score from 0 to 10). Data were analyzed descriptively and subjected to statistical tests. Results: the indices referring to the instruments applied showed, in the post-mortem period, less disadvantage and vocal fatigue. The scores given to vocal and respiratory comfort were progressively better during the program (p

Purpose: The purpose of this study was to examine the respiratory strategies used by persons with Parkinson's disease (PD) to support louder speech in response to two voice interventions. Contrasting interventions were selected to investigate the role of internal and external cue strategies on treatment outcomes. LSVT LOUD, which uses an internal cueing framework, and the SpeechVive prosthesis, which employs an external noise cue to elicit louder speech, were studied. Method: Thirty-four persons with hypophonia secondary to idiopathic PD were assigned to one of three groups: LSVT LOUD ( n = 12), SpeechVive ( n = 12), or a nontreatment clinical control ( n = 10). The LSVT LOUD and SpeechVive participants received 8 weeks of voice intervention. Acoustic and respiratory kinematic data were simultaneously collected at pre-, mid- and posttreatment during a monologue speech sample. Intervention outcomes included sound pressure level (SPL), utterance length, lung volume initiation, lung volume termination, and lung volume excursion. Results: As compared to controls, the LSVT LOUD and SpeechVive participants significantly increased SPL at mid- and posttreatment, thus confirming a positive intervention effect. Treatment-related changes in speech breathing were further identified, including significantly longer utterance lengths (syllables per breath group) at mid- and posttreatment, as compared to pretreatment. The respiratory strategies used to support louder speech varied by group. The LSVT LOUD participants terminated lung volume at significantly lower levels at mid- and posttreatment, as compared to pretreatment. This finding suggests the use of greater expiratory muscle effort by the LSVT LOUD participants to support louder speech. Participants in the SpeechVive group did not significantly alter their respiratory strategies across the intervention period. Single-subject effect sizes highlight the variability in respiratory strategies used across speakers to support louder speech. Conclusions: This study provides emerging evidence to suggest that the LSVT LOUD and SpeechVive therapies elicit different respiratory adjustments in persons with PD. The study highlights the need to consider respiratory function when addressing voice targets in persons with PD.

Purposes: The purposes of this study were to determine whether the acoustic measures from glottal stops distinguished between controls and patients with unilateral vocal fold paresis/paralysis (UVFP) at initial evaluation and posttreatment/observation, to explore the types of false vocal fold (FVF) movement during glottal stop production in UVFP, and to assess the agreement between normalization of various measures and reported voice normalization. Method: Patients with UVFP and controls were recorded acoustically and laryngoscopically speaking two sets of five repeated /i/s, controls once and patients with UVFP initially and posttreatment/observation. Averaged intensity differences and slopes for offsets (maximum voicing intensity to minimum glottal stop intensity) and onsets (minimum glottal stop intensity to maximum voicing intensity) were measured. FVF movements were rated separately for paretic and nonparetic sides. Patients were asked to report voice normalization posttreatment/observation. Cohen's kappas were calculated for agreements between patient-reported voice normalization and normalization of Voice-Related Quality of Life (V-RQOL), translaryngeal flow, four acoustic measures of glottal stop production, and FVF movement. Results: Significant differences (analysis of variance [ANOVA]; p < .014) were found for all acoustic measures between controls and patients with UVFP and between patients with UVFP initially and posttreatment/observation (paired t tests; p < .05). In addition, 78% of UVFP patients had no FVF movement on the paretic side initially, and 42% had bilateral dynamic FVF movement posttreatment/observation. Cohen's kappa showed moderate agreement between voice normalization and V-RQOL, slight agreement with offset measures, and fair agreement with onset measures. Conclusion: This study provided proof of concept for using acoustic measures of glottal stops to distinguish between controls and patients with UVFP, both initially and posttreatment/observation.

Resumen Introducción: Los ejercicios de tracto vocal semiocluido (ETVSO) son herramientas utilizadas en la rehabilitación fisiológica de la voz. Los ETVSO son ejercicios vocales producidos por la semioclusión del tracto vocal, a través de una serie de posturas que buscan alargar y/o ocluir el tracto vocal, generando un cambio en el patrón vibratorio de los pliegues vocales, grado de aducción y el patrón respiratorio. Los ETVSO pueden dividirse, según el tipo de semioclusión, en sostenida, transitoria y oscilatoria, así como en ejercicios de mayor resistencia a menor resistencia. Objetivo: Describir los diferentes tipos de ejercicios de tracto vocal semiocluido, el tipo de semioclusión, el grado de resistencia y sus efectos en los pliegues vocales, patrón respiratorio y configuración del tracto vocal. Metodología: Se realizó una revisión de la literatura en las bases de datos PubMed, Medline y Science Direct, usando los siguientes términos: “Semi-Occluded Vocal Tract Postures”, "tract vocal semiocclude” y “ejercicios de tracto vocal semiocluido”. Se utilizaron operadores booleanos "AND" y "OR" para especificar la búsqueda. Resultados: Los beneficios de estos ejercicios impactan positivamente en variables aerodinámicas, en la función glótica y en la configuración del tracto vocal. Conclusiones: Los ejercicios de tracto vocal semiocluido son una familia de ejercicios vocales producidos por semioclusión sostenida, transitoria y oscilatoria del tracto vocal, a través de una serie de posturas que buscan alargar y/o ocluir el tracto vocal, cuyos beneficios impactan positivamente los pliegues vocales y el tracto vocal. Abstract Introduction: Semi-occluded vocal tract exercises (SOVTE) are tools used in physiologic voice rehabilitation. Semi-occluded vocal tract exercises are vocal exercises produced by the semi-occlusion of the vocal tract through a series of postures that seek to lengthen and/or occlude the vocal tract, generating a change in the vibratory pattern of vocal folds, degree of vocal folds adduction, and the respiratory pattern. SOVTE can be divided, according to the type of semi-occlusion, into sustained, transient and oscillatory, as well as exercises with high and low degree of airflow resistance. Objective: To describe the different types of semi-occluded vocal tract exercises, the type of semi-occlusion, the type of resistance, and their effects on the vocal folds, respiratory pattern, and configuration of the vocal tract. Methodology: A literature review was performed in the PubMed, Medline, and Science Direct databases, using the following terms: "Semi-occluded vocal tract postures", "Semi-occluded vocal tract" and "Semi-occluded vocal tract exercises”. Boolean operators "AND" and "OR" were used to specify the search. Results: The benefits of these exercises positively impact aerodynamic variables, glottal function, and configuration of the vocal tract. Conclusions: The semi-occluded vocal tract exercises are a family of vocal exercises produced by the sustained, transitory, and oscillatory semi-occlusion of the vocal tract, through a series of postures that seek to lengthen and/or occlude the vocal tract, whose benefits positively impact on vocal folds and vocal tract.

Glottal adduction is a crucial aspect in voice education and vocal performance: it has major effects on phonatory airflow and, consequently, on voice timbre. As the voice is a non-visible musical instrument, controlling it could be facilitated by providing real-time visual feedback of phonatory airflow. Here, we test the usefulness of a flow ball (FB) training device, visualizing, in terms of the height of a polystyrene ball placed in a plastic basket, phonatory airflow during phonation. Audio and electroglottographic recordings of five postgraduate, classically trained singer students were made under three subsequent conditions: before, during, and after phonating into the FB. The calibrated audio signal was inverse-filtered, using an electroglottograph signal to guide the manual tuning of the inverse filters. Mean phonatory airflow, peak-to-peak pulse amplitude, and normalized amplitude quotient were extracted from the resulting flow glottograms. After the FB condition, increases of mean flow and peak-to-peak pulse amplitude were observed in four singers. In addition, the singers’ mean normalized amplitude quotient increased significantly. The findings, although exploratory, suggest that reduction of glottal adduction can be observed immediately after FB phonation.

Objectives: The dual-microphone voice range profile (VRP) is an objective measurement of vocal frequency and intensity. Precise assessments are required to ensure correct interpretation of treatment outcome. The objective of this study was to investigate the interrater reliability of the assessment. Study Design: Prospective repeated measures. Methods: Thirty-five healthy participants underwent two VRP assessments with an interval of 2–84 days. Seven speech-language pathologists with special training in the used VRP protocol conducted the assessments. Dependent variables were voice frequency and intensity (minimum, maximum, and ranges), and VRP area. Results: In the frequency measures and highest intensity, intraclass correlations were moderate to excellent and there were no statistically significant differences between test and retest. VRP area, minimum intensity, and intensity range showed poor to moderate reliability and significant enlargement in the retest; VRP area (117 cells, [{95% CI: 69–164}, P < 0.001]), softest intensity (−2.2 dB [{95% CI: −3.3 to −1.0}, P < 0.001]), and intensity range (2.3 dB [{95% CI: 0.5–4.1}, P < 0.001]). The 10% and 90% percentiles were provided. Minor systematical differences were detected in max SPL, max fo, and VRP area; otherwise no systematical sources of error could explain the results. Conclusion: The VRP assessment is a reliable tool when assessing frequency and maximum intensity. Care must be taken in interpretation of minimum intensity, intensity range, and VRP area. Different speech-language pathologists can assess the individual voice before and after treatment, if they are trained in and adhere to the same protocol.

Summary Introduction Voice therapy plays a critical role in the treatment of voice disorders. Despite positive outcomes in patients who attend voice therapy, otolaryngologists, and speech-language pathologists continue to struggle with patient compliance. Previous studies evaluating the multidisciplinary clinic model have shown better completion, VHI-10 scores, and fewer cancelation and no-shows (NS). We sought to review our own patient experience to better identify factors that predict NS rates in voice therapy. Methods A retrospective chart review of patients at a tertiary medical center were included if they had a scheduled appointment during a 6-month period that was cancelled or a NS. Charts were reviewed for age, gender, race, diagnosis, number of sessions attended, reason for discharge, and attending physician. NS percentage is calculated as a ratio of number cancellations to total number sessions scheduled. A multivariable general linear model was used to examine the association between NS and the listed covariates. Findings The study included 146 patients mean (SD) age 52.7 (16.6), where 62% were female and 72.6% were white. There is evidence that not being seen in a multidisciplinary clinic is significantly associated with NS rates in voice therapy (χ2 = 4.09, P = 0.0431). There is also evidence that non-white race is significantly associated with NS rates in voice therapy (χ2 = 11.76, P = 0.0006). Conclusions Data presented in this study further support the use of a multidisciplinary model to improve NS rates in voice therapy. The relationship between nonwhite patients and lower NS suggests another determining factor in nonadherence to voice therapy.

The article examines the General provisions of vocal pedagogy: the relevance of the issue, principles, goals, objectives and methods of teaching singing; the criteria, methods of selection and basic skills necessary for those wishing to learn vocal art.

Gender-affirming behavioral voice modification has primarily been directed by cisgender clinicians who do not actively live or master the process of voice modification themselves but instead observe it from the outside looking in. The lack of a "lived experience" by cisgender instructors naturally leaves gaps and oversights that may reduce the effective potential of voice training. Input from transgender people who have learned voice modifications techniques is key to providing the best possible care. Ear training, direct vocal modeling, and mastery of gender-modification techniques are crucial elements that are less emphasized in the current system.

Vocal dysphoria is present for many transgender individuals. Voice goals are defined by each individual client. Voice modification work can be challenging for both clinicians and clients, involving both direct and indirect aspects of intervention. The latter are likely to be less known to otolaryngologists but can form a significant part of clinical practice for experienced speech pathologists. Varying experience levels of treating clinicians can in turn have a bearing on the vocal outcomes achieved by clients. Those who do seek surgical assistance benefit from appropriate presurgery speech and language therapy evaluation and postsurgical voice rehabilitation and treatment.

Background and Objectives: The efficiency and optimal voice rest period following phonosurgery remains debatable. Platelet-rich plasma (PRP) is a safe and cheap alternative to many bioactive agents being studied on animal models, and is already in use in many medical areas. We investigate the short-term effects of PRP and voice rest on voice outcomes following phonosurgery as an alternative to voice rest alone. Materials and Methods: A prospective single-blinded pilot study was conducted. Sixteen patients with a diagnosis of vocal fold cyst and polyps were included, forming equal groups (PRP and voice rest vs. voice rest alone). Voice analysis was carried out on the preoperative day, day three, and week three following surgery. The measured parameters were fundamental frequency (F0), noise–signal ratio (NSR), harmonic poverty (HP), attack alteration (AL), pitch instability (PI), and amplitude instability (AI).VHI(Voice Handicap Index)-30 questionnaires were carried out before surgery and three weeks following surgery to assess the impact of subjective voice change on quality of life. PRP was obtained using commercial kits with separator gel. Results: An average 3.68-fold increase in platelets was obtained with PRP. No side effects were noted after injection. All voice parameters improved on day three and week three following surgery. Statistical significance was noted only in the fundamental frequency of male patients (p = 0.048) in favor of the PRP-voice rest group. In addition, the VHI- 30 questionnaire results between preoperative and postoperative assessments showed statistically significant differences in total VHI score (p = 0.02) as well as the physical (p = 0.05) and emotional (p = 0.02) scale in favor of the PRP-voice rest group. Conclusions: PRP presents short term safety in patients who undergo phonosurgery, although long-term outcomes are unknown. PRP and voice rest are superior to voice rest alone when considering subjective assessment of the voice. When analyzing acoustic parameters, PRP and voice rest are not superior to voice rest alone.

A lively, organic, efficient word on the theater stage, on the set, on television and radio is one of the main factors of acting professionalism, which determines the level of culture of theatrical art in general. Today’s experience of theater teachers is based on the profound discoveries of directors, actors, and theater theorists around the world. In Drama Theater, the director’s view of the function and meaning of the body on stage, on its interaction with language, often determined the direction of the artist’s artistic search. And the task of «Stage Speech» teachers, taking into account the desire of directors to implement their creative idea, is to prepare students of higher art educational institutions as professionally as it possible for this. Therefore, the aim of the article is to find out and determine the methodological foundations for combining external technology and internal psychotechnics in the stage speech classes in order to consolidate and deepen speech and voice skills of senior students of art educational institutions. In the process of the research, the following methods were used: analytical method was used for studying of existing theoretical interpretations of speech and voice training and its practical application; comparative method was used in comparison and comparative analysis of the practice of various exercises applying; logically-summarizing method was used for generalizing and summarizing the results of the study and in order to formulate the conclusions. Therefore, the combination of constant training of technical qualities of speech (the so – called external technique: breathing, diction, resonance) with training of internal psychotechnics (vision, assessment, attitude) provides students with the opportunity to learn how to improve speech mastery in a systematic, methodological and logical direction. Such forms of work with students are being introduced that help them to improve the ways of training, opening up ways to the subconscious. Various program sections of the discipline «Stage Speech» are used, which in a complete combination with each other encourage an organic word in the embodiment of an indivisible artistic and ideological idea on stage or film sets. Methodological directions for improving the stage-speech versatility of the actor’s word are indicated. The article proves the expediency of choosing a specific pedagogical tactic, which should be applied each time personally, depending on the composition, level of professional training of the student team and on the tasks which take place while working on the diploma repertoire of art educational institutions.

OBJECTIVES/HYPOTHESIS To investigate the effects of acute vocal exertion on individuals with vocal fatigue and to determine whether semi-occluded vocal tract exercises (SOVTEs) are more effective than vocal rest in mitigating acute effects. STUDY DESIGN Prospective, repeated-measures design. METHODS On consecutive days, 10 individuals (6 males, 4 females) with scores indicating vocal fatigue on the Vocal Fatigue Index completed two 10-minute vocal exertion tasks. Vocal rest or SOVTEs were interspersed in counterbalanced order between exertion tasks. Respiratory kinematic, acoustic, aerodynamic, and self-perceptual measures were collected at baseline, following vocal exertion, following SOVTE/vocal rest, and following the second exertion task. RESULTS Acute vocal exertion worsened phonation threshold pressure (P

When people listen to speech in noisy places, they can understand more words spoken by someone familiar, such as a friend or partner, than someone unfamiliar. Yet we know little about how voice familiarity develops over time. We exposed participants ( N = 50) to three voices for different lengths of time (speaking 88, 166, or 478 sentences during familiarization and training). These previously heard voices were recognizable and more intelligible when presented with a competing talker than novel voices—even the voice previously heard for the shortest duration. However, recognition and intelligibility improved at different rates with longer exposures. Whereas recognition was similar for all previously heard voices, intelligibility was best for the voice that had been heard most extensively. The speech-intelligibility benefit for the most extensively heard voice (10%–15%) is as large as that reported for voices that are naturally very familiar (friends and spouses)—demonstrating that the intelligibility of a voice can be improved substantially after only an hour of training.

Semi-occluded vocal tract exercises (SOVTEs) are increasingly popular as therapeutic exercises for patients with voice disorders. This popularity is reflected in the growing research literature, investigating the scientific principles underlying SOVTEs and their practical efficacy. This study examines several acoustic, articulatory, and aerodynamic variables before, during, and after short-duration (15 s) SOVTEs with a narrow tube in air. Participants were 20 healthy young adults, and all variables were measured at threshold phonation levels. Acoustic variables were measured with a microphone and a neck accelerometer, and include fundamental frequency, glottal open quotient, and vocal efficiency. Articulatory variables were measured with ultrasound, and include measures of the tongue tip, tongue dorsum, and posterior tongue height, and horizontal tongue length. Aerodynamic variables were measured with an intraoral pressure transducer and include subglottal, intraoral, and transglottal pressures. Lowering of the posterior tongue height and tongue dorsum height were observed with gender-specific small changes in the fundamental frequency, but there were no significant effects on the transglottal pressure or vocal efficiency. These findings suggest that the voices of healthy young adults already approach optimal performance, and the continued search for scientific evidence supporting SOVTEs should focus on populations with voice disorders.

Summary Purpose The purpose of this study was to investigate whether a relationship exists between employment status, perception of life quality (ie, vocal impairment, health, life satisfaction, and social support), and adherence to voice therapy for persons with muscle tension dysphonia (MTD). This study extends recent work as it evaluates investigating the impact of social support and life satisfaction on adherence to voice therapy for MTD. Method A cross-sectional study of 45 individuals diagnosed with MTD who participated in voice therapy between January 2014 and December 2015 at the University of Arkansas for Medical Science's Voice and Swallowing Center in Little Rock, Arkansas participated in this study. Participants provided information regarding employment status and completed the Satisfaction with Life Scale and the Quality of Relationships Inventory. Result Sixty percent of participants completed voice therapy. Patients who completed voice therapy were more likely to report gainful employment (P = 0.038) or less confidence in a specific and significant personal relationship (P = 0.004). Conclusion This study discovered a moderate effect between employment status and adherence to voice therapy for MTD as well as relationship confidence and adherence.

SUMMARY Background Low vertical larynx results in reduced musculoskeletal tension and easier vocal fold vibration what is critical not only for professional voice users but also for patients with dysphonia. High-resolution manometry (HRM) provides real time upper esophageal sphincter positioning as a surrogate for laryngeal location and it may be a tool for laryngeal excursion biofeedback. This study aims to evaluate HRM as a biofeedback instrument to control vertical laryngeal position. Methods Ten (50% males, mean age 28 years) professional singers were asked to raise and descent their larynx using any strategy with HRM transnasal catheter in place. The tasks were repeated after the computer screen was positioned at the visual field of the participant that was instructed on how to self-evaluate laryngeal positioning based on the upper esophageal sphincter color plot and the variations with real time images. Results Median downward laryngeal excursion was 2.0 cm without biofeedback and 3.1 cm after biofeedback (P = 0.03). Median upward laryngeal excursion was 0.2 cm without biofeedback and 0.5 cm after biofeedback (P = 0.4). Conclusions Singers can improve laryngeal vertical movements, especially the lowering of the larynx, when biofeedback is provided. HRM biofeedback allows singers to visualize the larynx position while singing, facilitating real-time vocal tract position modification and may serve as an efficient tool for singing training.

Purpose This systematic review aims to identify, classify, and evaluate existing information regarding treatment for benign vocal fold lesions in children and to identify gaps and limitations that may limit effective pediatric voice treatment. Method A literature search was performed using electronic databases (PubMed and Google Scholar) as well as reference lists from previous reviews, studies, and books. Included in the present review are studies that described behavioral treatment for children with benign vocal fold lesions presumed to be phonotraumatic (vocal fold nodules and edema). Results Twenty-one studies were eligible for inclusion in the review. Eight different research designs were used, and three intervention types were identified: direct voice intervention (voice training), indirect treatment (vocal hygiene or counseling), and comparative studies that contrasted different treatment methods. The most commonly used treatment method was eclectic direct intervention, which focused on vocal exercises or voicing patterns. Postintervention improvement was reported in all studies. In general, findings suggested an advantage of direct over indirect intervention and of longer treatment duration over short-term approaches. Conclusions The findings suggest that behavioral voice therapy may be generally effective in treating children with vocal fold nodules. Several limitations emerged in the corpus of studies reviewed including heterogeneity of research methods, missing information about outcome measures, and inappropriate statistical analyses. Thus, a need exists for further well-designed controlled studies to enhance the body of knowledge about developmental factors affecting vocal treatment outcomes, in particular, vocal fold structure as well as cognitive and linguistic development.

Objective: To identify the speech therapy strategies used to promote vocal health to teachers of early childhood, elementary and high school, participating in programs/actions for prevention and promotion of vocal health, as well as to describe and analyze their effects through an integrative literature review.Methods: An integrative review was conducted, which consisted of searches in the Lilacs, SciELO, and Medline databases.Inclusion criteria were complete articles available online in any language and year of publication that addressed strategies for promoting vocal health and preventing disorders in the target population, used in vocal health programs/actions with teachers.Results: Of the 624 articles that were included, six were selected to compose the study.It was possible to verify that the most used resources were educational strategies, through programs of guidance and attention to the teacher's vocal health.The results of the interventions were analyzed using self-assessment questionnaires, some of which have been standardized, with validation and adaptation to Brazilian Portuguese.Among practical strategies, exercises involving semi-occluded vocal tract, breathing, relaxation, resistance, and vocal projection, as well as vocal warm-up and cool-down, were the most used.Conclusions: Vocal health programs present diversified strategies, such as time and results analysis.The accurate study allowed to verify that the programs are effective and allow better vocal performance to the teacher, notably, through direct and indirect strategies. Objetivo: Identificar as estratégias fonoaudiológicas utilizadas para promoção da saúde vocal aos professores do ensino infantil, fundamental e médio participantes de programas/ações de prevenção e promoção à saúde vocal, bem como descrever e analisar seus efeitos, por meio de uma revisão integrativa da literatura. Métodos: Foi realizada uma revisão integrativa que consistiu em buscas nas bases de dados Lilacs, SciELO e Medline. Os critérios de inclusão foram: artigos completos disponíveis online em qualquer idioma e ano de publicação que abordassem estratégias para promoção da saúde vocal e prevenção aos distúrbios na população-alvo, empregadas em programas/ações de saúde vocal com professores. Resultados: Dos 624 artigos que foram incluídos, seis foram selecionados para compor o estudo. Foi possível verificar que os recursos mais utilizados foram estratégias educativas, por meio de programas de orientação e atenção à saúde vocal do professor. Os resultados das intervenções foram analisados com a utilização de questionários de auto avaliação, sendo alguns já padronizados, com validação e adaptação para o português brasileiro. Entre as estratégias práticas, os exercícios que envolvem trato vocal semiocluído, respiração, relaxamento, resistência e projeção vocal, bem como a realização de aquecimento e desaquecimento vocal, foram os mais utilizados. Conclusões: Os programas de saúde vocal apresentam estratégias bem diversificadas, tal como o tempo e análise dos resultados. O estudo acurado permitiu constatar que os programas são eficazes e permitem uma melhor performance vocal ao professor, notadamente, por meios de estratégias diretas e indiretas.

Summary Purpose The present study aimed to assess the effectiveness of a physiologic voice therapy program based on water resistance therapy (WRT) exercises including connected speech in a group of subjects with voice complaints (vocal effort and fatigue). Methods Twenty-four participants with behavioral dysphonia were randomly assigned to one of two treatment groups: (1) voice treatment with WRT plus vocal hygiene program (n = 12), and (2) vocal hygiene program only (n = 12). Laryngoscopic assessment was performed in all subjects. Before and after voice therapy, participants underwent aerodynamic and electroglottographic assessment. The Voice Handicap Index (VHI) and self-assessment of resonant voice were also performed. The treatment included six voice therapy sessions. For the experimental group, the exercises consisted of a sequence of seven phonatory tasks performed with two different voice training devices (PocketVox and MaskVox). Comparison for all variables was performed between experimental group and control group. Results Significant differences were found for experimental group for VHI physical subscale, and self-perceived resonant voice when comparing pre-post conditions. A strong negative correlation between self-perceived resonant voice and VHI physical sub-score was also reported. No significant differences were found for instrumented variables. Conclusion Physiologic voice therapy based on WRT exercises including connected speech seems to be an effective tool to improve self-perceived voice in subjects diagnosed with voice complaints. Apparently, changes are more prone to occur in perceptual variables related with physical discomfort associate with voice production. A reduction in phonatory effort and perceptual aspects of vocal fatigue are the main improvements.

Intensive schedules in behavioral voice therapy and training have been proposed to have a range of positive benefits including enhanced outcomes, high client and clinician satisfaction, and reduced client attrition. In the sub-field of behavioral voice training for trans and gender diverse clients, intensive schedules may also present a means of increasing service access opportunities for a vulnerable population. Despite the proposed benefits there has been limited research investigating client experiences in intensive voice training programs. The current study utilized a mixed-methodological approach to compare participant experiences in an intensively scheduled (three 45-minute sessions per week, over 4 weeks) versus a traditionally scheduled (one 45-minute session per week, over 12 weeks) voice training program for trans and gender diverse participants aiming to develop a perceptually feminine-sounding voice. Participant experiences were compared using a satisfaction questionnaire delivered to both training groups as well as thematic analysis of semi-structured interviews conducted with participants in the intensive group. Results suggested that individuals in the intensive training program had both positive and negative experiences related to the intensive schedule, but all viewed the program favorably and expressed a preference for intensive training based on their experiences. However, it was also found that overall satisfaction and attrition did not differ significantly between the intensive and traditional training groups and that many factors contributing to participant satisfaction in the intensive program were unrelated to the intensive schedule. Results from the current study also suggest that experiences in intensive programs may be highly variable and mediated by factors such as clients' individual personalities and preferences. The current study concludes that intensive schedules present a viable alternative to traditional schedules in practice, with additional considerations and directions for future research also discussed.

To achieve pedagogic goals and deal with environmental constraints such as noise when lecturing, teachers adapt their speech production in terms of frequency, intensity, and temporal aspects. The mastery of appropriate vocal skills is key to teachers’ speech intelligibility, health, and educational effectiveness. This project tests the relevance of virtual reality (VR) for training teachers’ vocal skills by simulating a lesson in a realistic VR environment characterized by adjustable constraints such as background noise and fidgety children. The VR environment depicts an elementary school classroom with 16 pupils aged 9 to 12 years old animated with typical childlike actions. To validate this virtual classroom in terms of speech characteristics, we conducted acoustic analyses on the speech productions of 30 female teachers in three conditions: (1) giving a free speech while facing the experimenter (control), (2) teaching in their usual classroom (in vivo), and (3) teaching the same lesson in a virtual classroom (in virtuo). The background noise in the VR setting was adjusted for each talker so it was similar to the level measured in vivo. Repeated measures ANOVAs showed that teachers significantly increased their voice frequency, intensity, and intonation and made longer pauses while speaking in vivo and in virtuo, compared to the control condition (p

This paper describes Project Spectra, a collective of open source developers that aims to build free and open source voice training technology for transgender people. We demonstrate how a design prioritizing the agency of trans users was made possible through sustained community collaboration. Using an autoethnographic approach, we discuss our community-based design process, which was documented with memos, online meetings and text conversations, sketches, and other data sources. We illustrate how we articulated our values as a group: deciding our programming framework (including a Statement of Principles), elaborating our "Experience Goals" (the feelings we wanted our design to elicit), and determining the features we wanted to implement in our app. We conclude with a reflection on the benefits and challenges of conducting community-based design research through an open-source organizational model.

Functional assessment and therapy methods are necessary for a client-centered approach that addresses the client's vocal needs across all environments. The purpose of this article is to present the approach with the intent to encourage discussion and implementation among educators, clinicians, researchers, and students. The functional approach is defined and its importance is described within the context of the World Health Organization's International Classification of Functioning, Disability, and Health with support provided by synchronous and asynchronous telepractice, the VoiceEvalU8 app, server, and web portal, and a framework that defines voice qualities (e.g., resonance, twang, loud, and others) by the anatomy and physiology of the voice production system (i.e., Estill Figures for Voice). Case scenarios are presented to highlight application of the functional voice approach.

Purpose: The purpose of this study was to establish and characterize age- and gender-specific normative data of the singing voice using the voice range profile for clinical diagnostics. Furthermore, associations between the singing voice and the socioeconomic status were examined. Methods: Singing voice profiles of 1,578 mostly untrained children aged between 7.0 and 16.11 years were analyzed. Participants had to reproduce sung tones at defined pitches, resulting in maximum and minimum fundamental frequency and sound pressure level (SPL). In addition, maximum phonation time (MPT) was measured. Percentile curves of frequency, SPL and MPT were estimated. To examine the associations of socioeconomic status, multivariate analyses adjusted for age and sex were performed. Results: In boys, the mean of the highest frequency was 750.9 Hz and lowered to 397.1 Hz with increasing age. Similarly, the minimum frequency was 194.4 Hz and lowered to 91.9 Hz. In girls, the mean maximum frequency decreased from 754.9 to 725.3 Hz. The mean minimum frequency lowered from 202.4 to 175.0 Hz. For both sexes, the mean frequency range ∆f showed a constant range of roughly 24 semitones. The MPT increased with age, for boys and girls. There was neither an effect of age nor sex on SPLmin or SPLmax, ranging between 52.6 and 54.1 dBA and between 86.5 and 82.8 dBA, respectively. Socioeconomic status was not associated with the above-mentioned variables. Conclusion: To our knowledge, this study is the first to present large normative data on the singing voice in childhood and adolescence based on a high number of measurements. In addition, we provide percentile curves for practical application in clinic and vocal pedagogy which may be applied to distinguish between normal and pathological singing voice.

Objectives: Currently, not much is known about the interactions between voice and growth hormone (GH). We have described large kindred with isolated GH deficiency (IGHD) due to a GHRH receptor mutation, resulting in severe short stature and high-pitched voice. These IGHD individuals have little interest in GH treatment, as they consider themselves “short long-lived people”, rather than patients. Interestingly, they report normal general quality of life, but they rate their Voice-Related Quality of Life (V-RQOL) as low. Here, we assessed the social and auditory-perceptual impacts of artistic-intervention voice therapy with semioccluded vocal tract exercises (SOVTE) and choral singing, on their voices. Material and methods: Seventeen GH-naïve adult IGHD individuals were enrolled in a single-arm interventional pre-post study with 13 weekly sessions of choir singing over 90 days. Outcome measures were V-RQOL scores, self-assessment of voice, and auditory-perceptual analysis (GRBAS scale, G: grade of the severity of dysphonia; R: roughness; B: breathiness; A: asthenia; and S: strain). Results: Marked improvements in total (p = 0.0001), physical (p = 0.0002), and socioemotional (p = 0.0001) V-RQOL scores and in self-assessment of voice (p = 0.004) were found. The general grades of vocal deviation (p = 0.0001), roughness (p = 0.0001), breathiness (p = 0.0001) and strain (p = 0.0001) exhibited accentuated reductions. Conclusions: Voice therapy with semioccluded vocal tract exercises and choral training improved social impact and perceptual voice assessments in IGHD subjects and markedly improved their voice-related quality of life. This is particularly important in a setting where GH replacement therapy is not widely accepted.

Professional competence of a teacher of music education includes, among other things, his command of musical terms and vocabulary, one segment of which is related to vocal singer’s voice training technique. The оbjective of the article is to unify, in theory and practice, the ways in which we can shape fundamental ideas pertaining to voice training of a vocal singer in the educational process of professional training of a teacher of musical arts. The article provides theoretical justification and substantiation of key notions and concepts pertaining to voice training (voice coaching); the author has defined, listed, and explained varieties of a vocal singer’s voice (in a table); the author has linked theory with practice of musical and pedagogic training of students for their mastering of professional competences; it has been ascertained that shaping fundamental ideas pertaining to vocal singer’s voice training constitutes prerequisites essential to the achievement of a result in practical sessions, as only when and if a student properly masters corresponding terms (vocabulary), only then he or she becomes fully aware of his or her actions and activities and becomes motivated towards self-actualisation and development of one’s capacities, as he or she discovers the cause-and-effect relation between efforts put into vocal training and results achieved (or not achieved). We therefore equip our modern-day vocal singing student (who will soon become a teacher of musical arts) with the process of voice development based upon his or her understanding of regularities in vocal activities, specifically: as he or she enhances one’s vocal performanship skills with actual knowledge on how one’s voice apparatus functions, thus becoming able to select one’s individual operational mode, to shape one’s voice hygiene practices, to select the best methods for training/coaching one’s vocal and technical skills, and so on, and so forth. The process of shaping fundamental ideas and competences pertaining to voice training inevitably entail interdisciplinary integration in the system of knowledge including such disciplines as Ukrainian language, folk studies, ethnology and ethnography, human anatomy and physiology, cultural studies and suchlike., Характеристикою фахової компетентності вчителя музичного виховання є володіння ним музичною термінологією, яка, зокрема, означує техніки постановки співацького голосу. Засвоєння студентом понятійно-термінологічного апарату вокалу, встановлює передумови для досягнення результату на практичних заняттях, дає усвідомлення дій і діяльності, мотивує до самопізнання, розвитку індивідуальних здібностей, допомагає встановити причинново-наслідковий зв’язок між докладеними зусиллями у заняттях вокалом і отриманими результатами (чи їх відсутністю).