Vocal Function Exercises Research Articles

Problems in Long-Term Maintenance of Efficacy of Vocal Function Exercises on Presbyphonia

Problems in Long-Term Maintenance of Efficacy of Vocal Function Exercises on Presbyphonia

Quantitative Assessment of Learning and Retention in Virtual Vocal Function Exercises.

Purpose Successful voice therapy requires the patient to learn new vocal behaviors, but little is currently known regarding how vocal motor skills are improved and retained. To quantitatively characterize the motor learning process in a clinically meaningful context, a virtual task was developed based on the Vocal Function Exercises. In the virtual task, subjects control a computational model of a ball floating on a column of airflow via modifications to mean airflow (L/s) and intensity (dB-C) to keep the ball within a target range representing a normative ratio (dB × s/L). Method One vocally healthy female and one female with nonphonotraumatic vocal hyperfunction practiced the task for 11 days and completed retention testing 1 and 6 months later. The mapping between the two execution variables (airflow and intensity) and one error measure (proximity to the normative ratio) was evaluated by quantifying distributional variability (tolerance cost and noise cost) and temporal variability (scaling index of detrended fluctuation analysis). Results Both subjects reduced their error over practice and retained their performance 6 months later. Tolerance cost and noise cost were positively correlated with decreases in error during early practice and late practice, respectively. After extended practice, temporal variability was modulated to align with the task's solution manifold. Conclusions These case studies illustrated, in a healthy control and a patient with nonphonotraumatic vocal hyperfunction, that the virtual floating ball task produces quantitative measures characterizing the learning process. Future work will further investigate the task's potential to enhance clinical assessment and treatments involving voice control. Supplemental Material https://doi.org/10.23641/asha.13322891.

Adapting Vocal Function Exercises for Voice Masculinization

Purpose The aim of this clinical focus article is to discuss the role of gender-diverse vocal function exercises (VFEs) in the context of voice and communication therapy for transgender men. Current literature on behavioral intervention with this population is very limited, and we present gender-diverse VFEs as a reasonable intervention approach. Method We developed a protocol for VFEs specific to voice masculinization, and we present a case study in which this technique was used for a transmasculine client who had not undergone hormone replacement therapy. Results Clinical measurements (acoustic, perceptual, and client self-rating) were collected before and after a course of voice therapy. Findings demonstrate decreased habitual speaking pitch and improved voice-related quality of life at the end of therapy, indicating successful outcomes for voice masculinization. Conclusions The recommended protocol for gender-diverse VFEs allows the trans male client to efficiently strengthen and coordinate the subsystems of voice production, particularly in the lower limits of his range. This clinical focus article also describes the need for strong research evidence to support all treatment modalities for transmasculine therapy, and this protocol offers one avenue for future investigations.

Respiratory Muscle Strength Training to Improve Vocal Function in Patients with Presbyphonia

The effects of presbyphonia are compounded by the decline in respiratory function that occurs with age. Commonly recommended exercises to optimize the use of respiratory muscles during speech, such as diaphragmatic breathing, are unlikely to be intensive enough to induce respiratory changes and impact vocal function. The objective of this study was to assess the effect of adding a targeted intervention, respiratory muscle strength training, to voice exercises in a sample of patients with presbyphonia. In this prospective, randomized-controlled trial, 12 participants received either (1) vocal function exercises (VFE), (2) VFE combined with inspiratory muscle strength training (IMST), or (3) VFE combined with expiratory muscle strength training (EMST). Data collected prior to and following 4 weekly intervention sessions included respiratory measures (pulmonary function and respiratory muscle strength) and voice measures (videostroboscopy, acoustic, auditory-perceptual, aerodynamic, and self-assessment measures). Participants who received IMST improved their voice quality during connected speech (smoothed cepstral peak prominence and ratings of overall voice quality) and their scores on the three self-assessment questionnaires with large to very large within-group effect sizes (|d|=0.82-1.61). In addition, participants in the IMST group reduced their subglottal pressure with a large effect size (d=-0.92). Participants who received EMST improved their maximum expiratory strength and smoothed cepstral peak prominence with large effect sizes (d=0.80 and 0.99, respectively) but had limited improvements in other outcomes. Participants who received only VFE decreased their amount of vocal fold bowing, improved their voice quality on a sustained vowel (amplitude perturbation quotient), and improved their Glottal Function Index score with large effect sizes (|d|=0.74-1.00). Preliminary data indicate that adding IMST to voice exercises may lead to the greatest benefits in patients with presbyphonia by promoting improved subglottal pressure control as well as increasing air available for phonation, resulting in improved self-assessment outcomes.

The effectiveness of voice therapy on voice-related handicap: A network meta-analysis.

Treatment approaches for voice therapy are diverse, yet their differential effects are not well understood. Evaluations of treatment effects across approaches are important for clinical guidance and evidence-based practice. To quantify the evidence of treatment effectiveness on the outcome measure Voice Handicap Index with the 30-items (VHI-30) from existing randomised controlled/clinical trials (RCT) of voice therapy using the statistical approach of a network meta-analysis (NMA) with a random effects model. Meta-analysis. We searched in MEDLINE (PubMed, 1950 to 2019), Embase (1974 to 2019) and Science Citation Index (1994 to 2019) using five key terms. The inclusion criteria were reports of randomised controlled/clinical trials (RCTs) published in English or German which evaluated the effectiveness of a specific voice therapy treatment using VHI-30 as an outcome measure in adult participants with non-organic or organic voice disorders. Studies were excluded if participants had been diagnosed with neurological motor speech disorders or who were vocally healthy. Furthermore, no medical, pharmacological or instrumental (eg voice amplification) treatments were considered. The primary outcome variable was VHI-30 with a score from 0 to 120. The pre-post treatment change in VHI-30 scores was an average score of 13 points related to various VHI-30 test-retest results. We retrieved 464 publications (ie with duplicates) and included 13 RCTs, which evaluated nine interventions, in the final analysis. The most effective intervention with a significant and clinically relevant effect was Stretch-and-Flow Phonation (SFP) (mean pre-post difference -28.37, 95% confidence interval [CI], -43.05 to-13.68). Resonant Voice (RV), the Comprehensive Voice Rehabilitation Program (CVRP) and Vocal Function Exercises (VFE) also demonstrated significant improvements. Of the nine voice interventions identified with the present NMA, SFP, RVT, CVRP, and VFE effectively improved VHI-30 scores from pre- to post-treatment. SFP proved to be the most significant and clinically relevant treatment. Further contributions of high-quality intervention studies are needed to support evidence-based practice in vocology.

A Study of Voice Therapy Effect by the Short Version of Vocal Function Exercise

A Study of Voice Therapy Effect by the Short Version of Vocal Function Exercise

Does a Systematic Vocal Exercise Program Enhance the Physiologic Range of Voice Production in Classical Singing Graduate-Level Students?

Purpose The purpose of this study was to assess the effects of vocal function exercises (VFEs) on the physiologic range of the operatic voice. The primary outcome measure was total voice range profile (VRP) area. Method Forty graduate-level opera majors were randomly assigned to experimental (training with VFE + vocal hygiene) and control (vocal hygiene only) groups. All participants underwent an acoustic voice assessment (modified VRP) pre and post 10 weeks of the assigned intervention. VRP total area was calculated and compared between and within the two groups. The total VRP area was subsequently divided into three area thirds (low, medium, and high). Results A significant improvement (increase) was observed in the VFE group for the primary outcome measure of VRP area when pre- and postvoice conditions were compared for total area, upper third, and middle third. No significant improvement was found in the vocal hygiene-only group. Conclusion Vocal training with VFEs over a 10-week period demonstrated positive effects on physiologic voice range as evidenced by an increase in the total VRP area and therefore may enhance the potential of those who already have professional voice training.

Efficacy of Voice Therapy in Improving Vocal Function in Adults Irradiated for Laryngeal Cancers: A Pilot Study

Radiation therapy (XRT) for laryngeal cancers causes acute and chronic vocal dysfunction. Although these deleterious effects of XRT are well-established, there is a dearth of research with respect to effective voice rehabilitation following XRT for laryngeal cancers. To obtain preliminary data on the efficacy of voice rehabilitation, using vocal function exercises (VFEs) in improving vocal function in adults irradiated for laryngeal cancer. The comparison treatment group (VH) received vocal hygiene counseling. Randomized clinical trial. Participants were randomized to the VFE + VH or VH group. Both interventions lasted 6 weeks. The primary outcome measure was improvement in VHI scores. Secondary outcome measures included auditory-perceptual assessments, acoustic and aerodynamic measures, and laryngeal imaging. Ten participants were recruited for the study. The VFE + VH (n = 6) group demonstrated a statistically significant improvement in the primary outcome measure (P = 0.03), as well as select parameters of all secondary outcome measures. The VH (n = 4) group did not demonstrate a statistically significant improvement in primary or secondary outcome measures. This study offers preliminary data for the utility of VFEs in the irradiated laryngeal cancer population. However, findings in the VFE + VH group lack generalizability, secondary to sample heterogeneity, and limited sample size.

A COOPERATION BETWEEN VOCAL TEACHER AND SPEECH AND LANGUAGE THERAPIST IN THE TREATMENT OF MULTIFACTORIAL VOICE DISORDERS

The aetiology of voice disorders is multifactorial. Neglecting of vocal hygiene and medical factors are common causes of voice disorders. The critical elements of the holistic approach to voice therapy are postural alignment, breathing and support, phonation and the speaking voice. The aim of the study is to make an analysis of the efficiency of the interdisciplinary treatment approach in a client with multifactorial voice disorders. Methods. This is a case study. The 57 years old female with moderate functional dysphonia received intervention by the vocal teacher and speech-language therapist. The following voice assessment methods were used in the study: a gathering of anamnesis, voice acoustic analysis, voice self-assessment. The vocal teacher used the following treatment methods: postural alignment exercises, Anna Sims’s breathing exercises, vocal and articulation exercises. Stemple’s Vocal function exercises, resonance therapy and biofeedback, were used by the speech-language therapist.Results. The harmonisation of posture, breathing, vocal folds vibration was achieved during the therapy. The objective measurements demonstrate improvement in Dysphonia Severity Index as well as the Voice Handicap Index. The client demonstrated satisfaction with the improvement of voice function.Conclusion. The cooperation of vocal teacher and speech-language therapist diversifies therapeutic approaches which allow finding unique, client-oriented intervention and achieving positive output.

Efficacy of Modified Vocal Function Exercise for Vocal Fold Atrophy

Efficacy of Modified Vocal Function Exercise for Vocal Fold Atrophy

Estudio bibliométrico de la producción científica encontrada en Scopus y Web Of Science sobre rehabilitación vocal fisiológica

IntroductionThe present study looks at the international scientific production found in Scopus and Web of Science, related to the Physiological Vocal Rehabilitation Current in the period 2006-2015. MethodologyExploratory-descriptive study with three phases of development: A) selection of keywords and search criteria; B) search and systematization of information; C) analysis of information. ResultsThe highest scientific production is identified in the Scopus search tool under the “voice therapy” search criterion. A total of 167 publications were analyzed, making correlations from the year, search criteria, authors, impact factor by quartile and by citation variables. ConclusionThere is a high correlation and degree of overlap between the two databases. However, Scopus compared to Web of Science, in relation to the Physiological Vocal Rehabilitation Current lines and for the period studied, presented a higher percentage of scientific production. The lines with the greatest scientific impact are “Lee Silverman therapy” and “vocal function exercises”. “SOVT exercises” and “resonant voice therapy”, with less percentage of publications, since 2011 progressively increase high impact factors.

Vocal function exercises for normal voice: With and without semi-occlusion

Purpose: This study examined the effect of varying degrees of vocal tract (VT) occlusion used during Vocal Function Exercises (VFEs) on attainment of maximum phonation time (MPT) goals in normal voice. Greater VT occlusion was expected to result in increased MPT. The overarching goal was to determine whether the semi-occluded vocal tract (SOVT) posture used during VFEs could be modified while preserving efficacy.Method: Twenty-six females ages 18–30 participated in this pre-post longitudinal group study. Participants were randomly assigned to three experimental groups and completed a six-week VFE protocol. The first group performed exercises using the prescribed SOVT posture; the second group used the vowel /o/; group three used the vowel /a/. The primary outcome measure was MPT as performed on the exercise tasks using the assigned vocal tract posture.Result: MPT significantly improved in the prescribed SOVT group, but did not significantly improve in the modified /o/ and /a/ groups.Conclusion: The SOVT posture used during VFEs is modifiable to a small extent without significantly undermining efficacy. Changes in MPT are less robust with reduced VT occlusion. Research in a clinical population is warranted.

Diagrama de Desvio Fonatório em dois programas de reabilitação vocal

Objetivo: Comparar a análise perceptivo-auditiva vocal, análise acústica e diagrama de desvio fonatório (DDF) de pacientes submetidos à terapia de voz com os exercícios de função vocal (EFV) e de pacientes submetidos ao Programa Integral de Reabilitação Vocal (PIRV). Métodos: 72 profissionais da voz com queixa vocal, encaminhados para reabilitação vocal por disfonia comportamental, foram acompanhados por seis sessões de terapia de voz. Os participantes foram divididos aleatoriamente em dois grupos. Um deles foi submetido ao PIRV e o outro, ao EFV. O material de fala analisado foi a vogal /ε/, gravada no módulo qualidade vocal do programa Voxmetria (CTS Informatica), para extração do DDF, nos momentos pré e pós-terapia. Os grupos foram comparados de acordo com o grau geral do desvio vocal, aspectos acústicos e com a distribuição das amostras vocais no DDF, em relação à área de normalidade, densidade, forma e localização nos quadrantes. Resultados: Houve diferença apenas quanto à densidade do registro do DDF no pós-terapia vocal, sendo que o grupo EFV apresentou registro concentrado no pós-terapia quando comparado ao grupo PIRV. Apenas indivíduos do grupo PIRV apresentaram diferenças na avaliação perceptivo-auditiva pré e pós, sendo que mais indivíduos tiveram suas vozes avaliadas como sem desvio no pós-intervenção. Conclusões: O Programa Integral de Reabilitação Vocal promoveu melhora da qualidade vocal, porém não houve correspondência da análise perceptivo-auditiva com a análise acústica, já que o diagrama de desvio fonatório foi sensível para identificar mudanças somente na avaliação dos pacientes submetidos aos exercícios de função vocal.

Vocal function exercises for normal voice: The effects of varying dosage

Purpose: This study examined the effect of varying dosage of vocal function exercise (VFE) home practice on attainment of pre-established maximum phonation time (MPT) goals in individuals with normal voice. High dosage VFE practice was expected to result in greatest MPT. The overarching goal of this study was to contribute to a VFE dosage-response curve, potentially including a point of observable toxicity.Method: Twenty-eight females ages 18–25 with normal voice participated in this pre-post longitudinal group study. Participants were randomly assigned to one of three experimental groups and completed a six-week VFE protocol with practice twice daily. The low dosage group performed each exercise once, the traditional group twice, and the high dosage group four times. The primary outcome measure was MPT as performed on the fourth VFE using the prescribed semi-occluded vocal tract posture.Result: No toxic effects were observed. MPT increased for all participants, with significant improvement for traditional and high dosage groups.Conclusion: High dosage VFEs may yield more rapid improvement in MPT, however benefits must be weighed against the risk of increased attrition. Low dosage VFEs insufficiently improved MPT. Further research on dosage is warranted, and should include individuals with disordered voice.

Efficacy of Voice Therapy for Patients With Early Unilateral Adductor Vocal Fold Paralysis

Although a variety of therapeutic techniques have been suggested for patients with unilateral adductor vocal fold paralysis (UAVFP), they were not aimed specifically at determining the efficacy of early intervention for these patients. The purposes of this study are to explore a protocol of voice therapy and to investigate its efficacy in voice therapy for patients with early UAVFP. A 12-week planned voice therapy protocol, including vocal function exercise, hard attack, and resonance voice therapy, was given to 10 patients within 6 months of initial diagnosis. Additionally, nine patients diagnosed with UAVFP within 6 months served as controls. Multidimensional evaluations of voice function were obtained for statistical analyses. Compared to a control group, the experimental group receiving voice therapy exhibited significant improvement in the following: (1) glottal closure; (2) voice quality of grade, breathiness, monotone, and resonance; (3) acoustic measurements of jitter, shimmer, and noise-to-harmonic ratio; (4) aerodynamics measurements of maximum phonation time, phonation threshold pressure, and phonation quotient; and (5) Voice Handicap Index of functional subscale. This prospective study established an effective protocol of early intervention of voice therapy in patients with UAVFP and demonstrated its efficacy in data on laryngeal physiology, voice quality, voice stability, voice efficiency, and communication function.

Randomized controlled trial of vocal function exercises on muscle tension dysphonia in Vietnamese female teachers.

This study evaluated the treatment effects of vocal function exercises on muscle tension dysphonia (MTD) in tonal language speakers. Single-blinded, randomized, controlled, clinical trial. Forty female primary school teachers from Northern Vietnam, diagnosed with MTD, were randomly allocated into a treatment group (n = 22), which used a full vocal exercise protocol (FE) (modified for use with Vietnamese speakers), and a control group (n = 18) which was treated with a partial vocal exercise protocol (PE). The treatment duration was 4 weeks for both groups. Acoustic and perceptual data were used as primary outcome measures. Acoustic parameters included frequency and amplitude perturbation, harmonics-to-noise ratio (HNR), mean fundamental frequency of the broken and rising tones, and parameters representing pitch movement in the rising tone. Perceptual analyses were performed on pre- and posttreatment samples of the sustained /a/ sound using anchor vocal samples. Self-report data, collected via a posttreatment questionnaire, comprised the secondary outcome measure. Significant changes in perturbation, HNR, and perceptual data were observed in the FE group but not in the PE group. The FE group showed increased size and speed of pitch change. Participants from both groups showed positive changes in some tonal parameters after treatment. However, the magnitude of change and the number of participants with positive changes were larger in the FE group. The data showed that vocal function exercises may be a cost-effective treatment for MTD.

高齢者の音声障害に対するVocal Function Exercisesの有効性

高齢者の音声障害に対するVocal Function Exercisesの有効性

Vocal Function Exercises for Muscle Tension Dysphonia: Auditory-Perceptual Evaluation and Self-Assessment Rating

Muscle tension dysphonia (MTD) is a functional dysphonia, which appears with an excessive tension in the intrinsic and extrinsic laryngeal musculatures. MTD can affect voice quality and quality of life. The purpose of the present study was to assess the effectiveness of vocal function exercises (VFEs) on perceptual and self-assessment ratings in a group of 15 subjects with MTD. The study comprised 15 subjects with MTD (8 men and 7 women, mean age 39.8 years, standard deviation 10.6, age range 24-62 years). All participants were native Persian speakers who underwent a 6-week course of VFEs. The Voice Handicap Index (VHI) (the self-assessment scale) and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale (perceptual rating of voice quality) were used to compare pre- and post-VFEs. GRBAS data of patients before and after VFEs were compared using Wilcoxon signed-rank test, and VHI data of patients pre- and post-VFEs were compared using Student paired t test. These perceptual parameters showed a statistically significant improvement in subjects with MTD after voice therapy (significant at P < 0.05 (*) and P < 0.004 (**)). Also results indicated statistically noticeable reduction in the mean VHI scores across subjects with MTD (significant at P < 0.05 (*) and P < 0.004 (**)). Significant improvement after therapy for participants has been observed by the aid of auditory-perceptual ratings of voice quality (with the GRBAS scale) and the patient's self-assessment ratings measurements (with the VHI). As a result, the data provide evidence regarding the efficacy of VFEs in the treatment of patients with MTD.

Voice Therapy outcomes in Type-I Sulcus Vocalis: Case Studies

In Sulcus vocalis, a groove on the medial surface of the free edge of varying etiologies in which the mucosal waves are diminished or absent during phonation affects the vocal efficiency. Two cases of physiological based etiology of type-I sulcus vocalis (according to Ford’s classification) taken in consideration for voice therapy using vocal hygiene, vocal function exercises and resonant voice therapy. Both cases showed improvement on overall techniques used to improve the vocal efficiency and the timbre of the voice. So, before going for surgical management the type of sulcus vocalis differentiation and the safe and adjuvant voice therapy should be recommended.

Immediate Effects of the Vocal Function Exercises Semi-Occluded Mouth Posture on Glottal Airflow Parameters: A Preliminary Study

The study aimed to quantify immediate alterations in the airflow glottogram between the Vocal Function Exercises semi-occluded mouth posture (/ol/ with lip buzz) and the sustained vowel /o/ in individuals with normal voices, and to determine if noted changes were in agreement with established semi-occluded vocal tract aerodynamic theory. Based on semi-occluded vocal tract aerodynamic theory, we hypothesized the following immediate changes in the flow glottogram during the /ol-buzz/ condition: a greater open quotient, a greater skewing quotient, a greater maximum flow declination rate, increased average airflow, decreased peak airflow, and increased minimum airflow. A cohort of eight men with normal voices produced the sustained vowel /o/ and the Vocal Function Exercises semi-occluded mouth posture (/ol-buzz/). Flow glottograms for both conditions were obtained from the inverse-filtered oral airflow signal via a circumferentially vented pneumotachograph mask. Data revealed that open quotient and minimum airflow rates increased significantly between conditions. All other measures trended in the directions predicted by aerodynamic theory, but were not statistically significant. The Vocal Function Exercises semi-occluded mouth posture appeared to provide an effective vocal tract semi-occlusion that immediately altered the flow glottogram in accordance with predictions made by computer-modeled aerodynamic theory.