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Assessment of professional singers using laryngeal, respiratory, and airflow measurements

Purpose In the pedagogy of classical vocal singing, it can be difficult to determine the human voice fach, especially for the voice of aspiring vocalists. Hence, an objective metric-based system for the determination of the human voice is needed. In the present study, we investigated the anthropological and aerodynamic parameters for 60 professional singers with a professionally confirmed singing range. Methods Amongst the 60 included professional singers, there were ten participants each for sopranos, mezzo-sopranos, altos (female vocal fach), and tenors, baritones, basses (male vocal fach). Airflow measurements were recorded using spirometry whilst anthropological measurements were taken using CT scans. Appropriate statistical analyses were done using the Mann-Whitney U test and Kruskal Wallis H test with post-hoc tests and Bonferroni correction. p < 0.05 was considered statistically significant. Results Soprano singers, who have the highest pitch, were found to be the shortest and least heavy, whilst basses, who have the lowest pitch, were found to be tallest and heaviest amongst the study participants. Furthermore, sopranos had the smallest lung volumes while the basses had the largest lung volumes (raw spirometry measures). However, when normalized ratios were considered, no differences were observed. Finally, laryngeal size showed sexual dimorphism due to developmental changes. Conclusions A mix of anthropological and aerodynamic measurements may be useful to assist singers and vocal pedagogues to assess and determine voice types before the beginning of their vocal studies.

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The prevalence and risk factors of hoarseness among pupils in elementary schools in the South of Finland

Purpose: Hoarseness and voice problems are one of the chronic conditions experienced by children. The aim of this study was to investigate the prevalence of hoarseness, possible risk factors and effects of the remediation of school buildings to the prevalence of hoarseness among school children. Methods: The material was gathered from all the schools in a large city in the south of Finland and the collection method used was an e-mail survey sent to the parents of the pupils and a simultaneous survey sent to the personnel in the schools. Results: All 51 schools participated, and 5889 pupils returned the questionnaire (39%). The exposure data was obtained from two building experts who knew the repair history of the schools. A subjective estimation of the quality of the indoor air was obtained from teachers and the parents. The overall prevalence of hoarseness among pupils was 6.3%; prevalence being higher in unrepaired school buildings than in schools in a good condition or buildings with a thorough remediation. Hoarseness was associated with asthma and allergies, several respiratory symptoms, and respiratory infections. Exposure to tobacco smoke increased the risk, and consumption of caffeine containing drinks seemed to reduce the risk. Noise, stuffiness of the indoor air and microbial smells correlated strongly with the occurrence of hoarseness in a logistic regression model when controlled for age, gender, asthma, passive smoking, and caffeine consumption. Conclusions: We recommend renovations in school buildings with the aim of providing better acoustics, sufficient ventilation, and a reduction in exposure to moisture damage microbes.

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The effect of sound field amplification systems on vocal demand response in teachers during lessons

Purpose Sound pressure level (SPL), fundamental frequency (F0), time dose (Dt), cycle dose (Dc), and distance dose (Dd) are components affecting a vocal demand response. The study aimed to investigate the impact of sound field amplification systems (SFAS) on teachers’ vocal parameters and determine the user comfort of SFAS use in teachers. Methods Twenty female teachers underwent long-term voice dosimetry with Vocal Holter Med (PR.O.Voice Srl) during everyday teaching activities. The SFAS PentaClassRuna (Certes) was installed in classrooms. Voice dosimetry was provided in two different acoustical conditions—without the use of SFAS (one to two days) and with SFAS (one to three days). Teachers underwent voice acoustic and laryngoscopic evaluation before voice dosimetry. Two teachers’ groups were formed: teachers with and without vocal nodules. The visual analogue scale measured the user comfort of SFAS. Results There were no significant differences in vocal parameters and vocal doses between teachers with and without vocal nodules. Voice amplification significantly decreased average F 0(−4.4 Hz), Dt%(−3.1%), Dc (−0.4 kcycles), and Dd (−1.3 m) in teachers without vocal nodules and F 0 (−8.9 Hz) in teachers with vocal nodules. Vocal doses (Dt%, Dc, Dd) significantly decreased in classrooms with longer reverberation time. The user comfort of the SFAS during the lessons was high in both teachers groups. Conclusions SFAS was a mediator between the classroom’s environment and the teacher’s vocal demand response; it changed teachers’ voice production parameters and reduced vocal demand response to satisfy the communication requirements. In addition, voice amplification was more beneficial for teachers without vocal fold lesions.

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Enabling people living with dementia to make choices during creative workshops: a conversation analysis study of co-creativity, choice-sequences, and the supportive actions of carers

Purpose Creative workshops can promote various positive outcomes for people with dementia, such as reductions in undesirable symptoms and achieving levels of autonomy. Although these are undoubtedly positive outcomes, there is little understanding of the specific processes that can enable such outcomes. To address this issue, our study investigates the interactional processes of “choice-sequences,” in which a PlwD makes a choice pertaining to materials (e.g. pens, coloured papers) for a creative activity. Methods This Conversation Analysis study draws upon around 60 hours of video-recorded creative workshops involving artists, people with dementia, and carers. Drawing upon the notion of “co-creativity,” we examine the collaborative work that goes into accomplishing choice- sequences. Results While these sequences typically begin with an artist presenting a choice to a PlwD, carers routinely enter these interactions and provide various forms of support needed to accomplish each basic action of a choice-sequence. Conclusions This study shows carers working alongside the artist to pursue the PlwD’s choice in a triadic participation framework, and carers supporting the PlwD in a dyadic participation framework with the artist having exited the interaction. In providing such support, carers can utilize their understandings of the communicative norms and requirements of the PlwD.

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Qualifications, professional roles and service practices of nurses, occupational therapists and speech-language pathologists in the management of adults with oropharyngeal dysphagia: a Nordic survey

Purpose To identify the qualifications, professional roles and service practices of nurses, occupational therapists (OTs) and speech-language pathologists (SLPs) in the management of adults with oropharyngeal dysphagia (OD) in the Nordic countries. Methods A web-based survey was developed that consisted of 50 questions on respondent demographics, education, experience, roles and service practices provided for adults with OD. The survey was distributed to practicing nurses, OTs, and SLPs in five Nordic countries via professional associations, social media, online networks and snowballing. Results Data from 396 nurses, OTs and SLPs whom provided services for adults with OD revealed that the majority of respondents worked in acute care and inpatient rehabilitation facilities. Most respondents had minimal undergraduate education and practical clinical training in OD. Notable variances in roles and service practices in OD between professions and countries were found. OTs were the primary service provider for OD management in Denmark, while SLPs had this role in the other Nordic countries. Nurses were mainly involved in screening and some compensatory treatments in most Nordic countries. Limited use of evidence-based screening, non-instrumental or instrumental clinical assessments and rehabilitative therapeutic methods was evident. Conclusions Study results highlight challenges in education and training of professionals responsible for the management of adults with OD in the Nordic countries. Increased use of evidence-based assessment and exercise-based treatments to improve swallowing are warranted. Adherence to European and international clinical practice guidelines for the management of adults with OD is recommended.

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Factors affecting speech-language pathologists’ language assessment procedures and tools – challenges and future directions in Sweden

Purpose: National surveys of speech-language pathologists’ (SLP) practices play an important role in professional development, and previous research show that many challenges faced by the profession are similar across the globe. This study aims to describe Swedish SLP assessment practices, examine factors that may affect this practice, and discuss the results in the light of international studies. Methods: Data from 584 SLPs were collected through an online questionnaire with multiple choice and open-ended questions. A mixed-method design was deployed where a deductive qualitative analysis of free-text responses complemented quantitative data. Results: In line with previous results from English-speaking countries, both standardized discrete skill tests and contextualized assessments were used by the respondents but fewer used language sample analysis and dynamic assessment procedures, despite international recommendations. There were few differences based on experience, work setting, proportion of multilingual assessments and socio-economic status of the health catchment area. Main challenges reported were lack of time and difficulty prioritizing, and assessment and/or diagnosis of multilingual/L2 children, which is similar to challenges faced by SLPs in other countries. Swedish SLPs also reported lack of national clinical guidelines as a main challenge. Factors contributing to better assessments included experience, and the combination of many sources of information, including professional and interprofessional discussions. Conclusions: The accumulated evidence from this and previous studies show that to address challenges and build on strengths, changes on a systemic level are needed. This includes more time and resources for continuing education and implementation of recommended assessment methods, as well as professional and interprofessional collaborations.

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The influence of the low-frequency transcutaneous electrical nerve stimulation application moment in vocal quality of dysphonic women

Objective: to compare the immediate effects of low-frequency TENS employment on vocal quality in women with behavioral dysphonia before and after vocal exercises. Methodology: 30 women (mean = 31.3 years old), diagnosed with behavioral dysphonia received low-frequency TENS before (TENS + VE Group) and after vocal exercises (VE + TENS Group) with a 1-week washout. They had their sustained vowel/a/and running speech recorded before and after each procedure for auditory-perceptual analysis and acoustic measures. The low-frequency TENS parameters applied were symmetrical biphasic quadratic pulse, 200 µs phase, 10 Hz frequency, intensity on the motor threshold, and the electrodes were positioned on the submandibular and superior fibers of the trapezius muscle region. The vocal exercises: tongue trill, humming, finger kazoo, and water resistance therapy were performed totalizing 20 min. Results: intragroup analysis of sustained vowel/a/showed reduction in both groups of strain parameter and increased the breathiness; only VE + TENS Group increased the instability parameter, decreased fundamental frequency, and increased in SPI values; the running speech analysis showed an increase in the overall degree, roughness, and breathiness parameters. However, in VE + TENS Group, there was a statistically significant decrease in the intensity of the strain and an increase in breathiness. The acoustic measures showed that VE + TENS Group had a higher variation than TENS + VE Group regarding NHR. Conclusion: vocal exercises followed by low-frequency TENS have more immediate positive effects on voice quality than the low-frequency TENS followed by vocal exercises. This is a preliminary immediate effects study, and these effects could be verified through long-term assessments.

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Female adolescent singing voice characteristics: an exploratory study using LTAS and inverse filtering

Background and Aim: To date, little research is available that objectively quantifies female adolescent singing-voice characteristics in light of the physiological and functional developments that occur from puberty to adulthood. This exploratory study sought to augment the pool of data available that offers objective voice analysis of female singers in late adolescence. Methods: Using long-term average spectra (LTAS) and inverse filtering techniques, dynamic range and voice-source characteristics were determined in a cohort of vocally healthy cis-gender female adolescent singers (17 to 19 years) from high-school choirs in Aotearoa New Zealand. Non-parametric statistics were used to determine associations and significant differences. Results: Wide intersubject variation was seen between dynamic range, spectral measures of harmonic organisation (formant cluster prominence, FCP), noise components in the spectrum (high-frequency energy ratio, HFER), and the normalised amplitude quotient (NAQ) suggesting great variability in ability to control phonatory mechanisms such as subglottal pressure (Psub), glottal configuration and adduction, and vocal tract shaping. A strong association between the HFER and NAQ suggest that these non-invasive measures may offer complimentary insights into vocal function, specifically with regard to glottal adduction and turbulent noise in the voice signal. Conclusion: Knowledge of the range of variation within healthy adolescent singers is necessary for the development of effective and inclusive pedagogical practices, and for vocal-health professionals working with singers of this age. LTAS and inverse filtering are useful non-invasive tools for determining such characteristics.

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Self-reported voice difficulties in educational professionals during COVID-19 in Quebec: a cross-sectional mixed-methods study

Background: The health measures imposed by COVID-19 on workplaces created adverse communication settings. Our cross-sectional study aimed to document the nature and severity of the vocal difficulties experienced by educational professionals a few weeks after the implementation of health measures in schools and early childhood settings in Quebec, Canada while teaching in class. Methods: To this end, we conducted a self-report survey containing nine close-ended questions and one open-ended question regarding self-reported vocal difficulties and the implementation of health measures. The survey was answered by 194 educational professionals in October 2020. Results: Since the introduction of the health measures, respondents reported often or always: having difficulty making themselves heard (66.5%), needing to strain their voice (68.1%), having throat pain after work (38.1%), and being concerned about their vocal health (25.2%). 35.6% perceived that their voice changed moderately or a lot and 75.3% did not feel equipped to take care of their vocal health. Fisher's exact tests revealed the difficulties overall were more present in women (p < 0.05). Discussion: The qualitative analysis of open-ended question answers shows a circular process at play, where the vocal responses to the COVID-19-induced communication barriers contribute to creating more problematic communication settings, thus increasing the challenges for vocal health. Better equipping the professionals to take care of their vocal health by developing resources in their professional settings to help them face vocal challenges in both every day as well as extreme situations, should be a priority.

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Organic and functional dysphonias: comparison of Self-Assessment protocols by confirmatory factor analysis

Objective This study aims to see if the effects of the sub-domains of the Voice Handicap Index-10 (VHI-10) and Voice Related Quality of Life (VRQoL) differ in organic (OD) and functional dysphonia (FD). Method A total of 162 patients completed the validated Turkish versions of the Voice Handicap Index-10 (VHI-10) and Voice-Related Quality of Life (VRQoL). Physical (pVHI-10), emotional (eVHI-10) and functional (fVHI-10) sub-domains of VHI-10 and physical-functional (PF-VRQoL), socio-emotional (SE-VRQoL) dimensions of VRQoL were assessed. Confirmatory factor analysis (CFA) was used to compare the sub-domains of these questionnaires between diagnostic categories. Results The total and sub-domain scores of both VHI-10 and VRQoL were not statistically different between the two etiologic categories of dysphonia (MANOVA, p > .05). The total VHI-10 and total VRQoL scores were significantly and moderately correlated in both the OD and FD groups. During CFA, 4 models were constructed for the OD and FD groups for VHI-10 and VRQoL factors. There was no significant difference between OD and FD groups in terms of path coefficients of sub-domains (z test, p > .05). Conclusion In terms of VHI-10 and VRQoL, the sub-domains of each questionnaire are equally important in both organic and functional dysphonia. Functional disorders do not depend only on “emotional” factors, and neither do organic problems. Factor analysis should be included when performing a study on patient-reported outcome measures.

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