Vocal Intensity Research Articles

Linguistic Dimensions of Accentedness, Comprehensibility and Intelligibility: Exploring Listener Effects in American, Moroccan, Turkmen and Chinese Varieties of English

AbstractThe present study examines accentedness, comprehensibility, and intelligibility of American English, Moroccan English, Turkmen English, and Chinese English, from the perspectives of three groups of listeners: native speakers of English and Chinese speakers of English with or without international experiences. Of the 145 listeners, 38 had face-to-face interviews. These listener groups were asked to listen to the recordings of the four English varieties and fill in a cloze test. Results indicated that the three listener groups differed significantly in rating comprehensibility of American English, Moroccan English and Chinese English but they did not give Turkmen English statistically different ratings; there were no significant differences in accentedness ratings except for Chinese English; and there were significant differences in the intelligibility scores of the four English varieties. In addition, with respect to seven linguistic variables—speed, clarity, intonation, smoothness and fluency, vocal intensity, pause, vocabulary and grammar, there were significant differences in three listener groups’ rating of six variables in American English except the one of “speed”. By contrast, Chinese English received significantly different ratings only in “proper speed”. No differences were found in the ratings for Moroccan English and Turkmen English. Finally, unlike Chinese listeners without international experiences, native listeners and Chinese listeners with international experiences shared some similarities in correlations between the ratings of accentedness and comprehensibility and those of linguistic variables on Moroccan English, Turkmen English, and Chinese English. However, the results for American English from Chinese listeners without international experiences and native listeners seemed to be more alike. Linguistic variables correlating with accentedness and comprehensibility of American English showed a mixed profile. Qualitative data provided more variant elaborations on the pronunciations and language uses of the speakers.

Ambulatory Voice Biofeedback: Acquisition and Retention of Modified Daily Voice Use in Patients With Phonotraumatic Vocal Hyperfunction.

Voice ambulatory biofeedback (VAB) has potential to improve carryover of therapeutic voice use into daily life. Previous work in vocally healthy participants demonstrated that motor learning inspired variations to VAB produced expected differences in acquisition and retention of modified daily voice use. This proof-of-concept study was designed to evaluate whether these VAB variations have the same desired effects on acquisition and retention in patients with phonotraumatic vocal hyperfunction (PVH). Seventeen female patients with PVH wore an ambulatory voice monitor for 6 days: three baseline days, one biofeedback day, one short-term retention day, and one long-term retention day. Short- and long-term retention were 1- and 7-days postbiofeedback, respectively. Patients were block-randomized to receive one of three types of VAB: 100%, 25%, and Summary. Performance was measured in terms of adherence time below a subject-specific vocal intensity threshold. All three types of VAB produced a biofeedback effect with 13 out of 17 patients displaying an increase in adherence time compared to baseline days. Additionally, multiple patients from each VAB group increased their adherence time during short- and/or long-term retention monitoring compared to baseline. These findings show that VAB can be associated with acquisition and retention of desired voice use in patients with PVH. Specifically, all three feedback types improved multiple patients' performance and retention for up to 1 week after biofeedback removal. Future work can investigate the impact of incorporating VAB into voice therapy.

Singing In The Mask: Effects Of A Variably Occluded Face Mask On Singing

A limitation of traditional semi-occluded vocal tract exercises (SOVTE) is the single sustained vowel task that precludes co-articulated singing. This study investigated immediate effects of a variably occluded face mask (VOFM) on vocal effort, acoustic, and aerodynamic measures in sung low and high pitches of healthy singers. Single-group, pre-post intervention study. The outlet ports of disposable anesthesia facemasks were fitted with plastic caps with two drilled openings sizes (9.6 mm, 6.4 mm). Twenty-three singers with no voice complaints provided baseline vocal effort, acoustic, and aerodynamic measures in high and low pitches. Participants trained in four conditions: two VOFM sizes (9.6 mm, 6.4 mm) in combination with the 20th and 80th percentile of the singer's pitch range. Participants were trained on three phonatory tasks: repeated consonant/vowel syllables, sung sentence, and sustained vowel. Vocal effort before and after training was compared using a visual-analog scale, while standardized mean differences captured acoustic and aerodynamic changes before and after training. Participants reported decreased vocal effort after VOFM training at all occlusion and pitch combinations. On average, consistent beneficial effect sizes were found in cepstral peak prominence (CPP) and cepstral spectral index of dysphonia (CSID) for all 4 occlusion-pitch combinations, and vocal intensity and mean estimated subglottal pressure increased for all 4 occlusion-pitch training combinations. Changes in mean phonatory airflow and resistance were less consistent. There was an immediate effect of decreased vocal effort in singing after VOFM training. Acoustic and aerodynamic effects were variable and modest. Future studies should explore changes in these outcomes after VOFM in singing voice therapy.

PD Check-In: The development and trial of a supported self-management program for people with Parkinson's disease following intensive speech intervention.

Debilitating speech and communication changes in Parkinson's disease (PD) lead to diminished quality of life for people with PD and their communication partners. Maintenance of the long-term effects of treatment such as LSVT LOUD® remains equivocal. Development of supported long-term maintenance programs is warranted. This article describes the development and preliminary outcome data for PD Check-In, a supported self-management intervention for the maintenance of speech and social communication for people with PD following LSVT LOUD. A narrative literature review of the principles of self-management and social cognitive theory of self-regulation was conducted to develop the core elements of PD Check-In. PD Check-In was conducted in person by a speech and language therapist (SLT) for three participants at 6 and 12 weeks, and at 6, 12 and 24 months following LSVT LOUD. Outcome measures included vocal intensity (SPL) during monologue and the dysarthria impact profile (DIP). PD Check-In utilized semi-structured discussion to develop, evaluate, and support the self-efficacy and skill of the person with PD in maintaining speech and social communication. Six conceptual elements of PD Check-In were identified in the development phase: partnerships, self-reflection, maintenance issues, revision, goal-setting and maintenance strategies. Preliminary intervention data revealed monologue vocal intensity at 24 months post-LSVT LOUD was maintained above pre-treatment level, but below levels achieved post-treatment. The psychosocial impact of speech changes from pre-LSVT LOUD to 24 months post-treatment as measured by the DIP was variable. Qualitative statements reflected participant experiences underlying the clinical data. The theoretical and practical underpinnings of PD Check-In were defined. The impact of PD Check-In on three persons with PD was variable but positive. Further evaluation of the model is warranted. What is already known on the subject LSVT LOUD provides efficacious treatment for the speech disorder associated with PD. Long-term maintenance of speech post-treatment varies following self-managed and group therapy interventions. People with PD have an unmet expectation of long-term maintenance of speech and improved quality of life following intensive treatment. What this paper adds to existing knowledge This study describes the development of a novel clinic-based approach to long-term maintenance of speech in PD based on the principles of self-management and self-efficacy. It provides preliminary data to demonstrate the method and its effects on three participants with varying speech difficulty, self-management skill development and psychosocial impact. What are the potential or actual clinical implications of this work? The positive impact of PD Check-In on the maintenance of monologue vocal intensity above baseline 24 months post-intensive treatment was independent of the variable impact on the quality of life of the participants. Further exploration of PD Check-In is warranted to determine the efficacy of this approach.

Manipulation of vocal communication and anxiety through pharmacologic modulation of norepinephrine in the Pink1-/- rat model of Parkinson disease

Vocal deficits and anxiety are common, co-occurring, and interacting signs of Parkinson Disease (PD) that have a devastating impact on quality of life. Both manifest early in the disease process. Unlike hallmark motor signs of PD, neither respond adequately to dopamine replacement therapies, suggesting that their disease-specific mechanisms are at least partially extra-dopaminergic. Because noradrenergic dysfunction is also a defining feature of PD, especially early in the disease progression, drug therapies targeting norepinephrine are being trialed for treatment of motor and non-motor impairments in PD. Research assessing the effects of noradrenergic manipulation on anxiety and vocal impairment in PD, however, is sparse. In this pre-clinical study, we quantified the influence of pharmacologic manipulation of norepinephrine on vocal impairment and anxiety in Pink1-/- rats, a translational model of PD that demonstrates both vocal deficits and anxiety. Ultrasonic vocalization acoustics, anxiety behavior, and limb motor activity were tested twice for each rat: after injection of saline and after one of three drugs. We hypothesized that norepinephrine reuptake inhibitors (atomoxetine and reboxetine) and a β receptor antagonist (propranolol) would decrease vocal impairment and anxiety compared to saline, without affecting spontaneous motor activity. Our results demonstrated that atomoxetine and reboxetine decreased anxiety behavior. Atomoxetine also modulated ultrasonic vocalization acoustics, including an increase in vocal intensity, which is almost always reduced in animal models and patients with PD. Propranolol did not affect anxiety or vocalization. Drug condition did not influence spontaneous motor activity. These studies demonstrate relationships among vocal impairment, anxiety, and noradrenergic systems in the Pink1-/- rat model of PD.

Factors Influencing Sexual Vocalization in Human Females.

Human females use numerous signals to attract male attention which can be ultimately motivated by enhanced paternal investment in the offspring. Sexual vocalization is a form of female sexual signaling. The majority of hypotheses attempting to explain the functional significance of vocalizations have been applied on non-human primates, while research on human females is scarce. This study investigated factors underlying sexual vocalization with a sample of 403 heterosexual Slovak females. Sexual vocalization was most frequent during penetration itself compared with other forms of sexual activities, which supports its signaling function. The most frequently reported sexual vocalizations were moaning/groaning, followed by screams and instructional commands, squeals, and words. Both the frequency and intensity of sexual vocalizations were significantly and positively associated with sexual arousal during the last sexual vaginal intercourse and sociosexuality. About 38% of females reported that they pretended vocalization and, in turn, pretended vocalization was exclusively associated with pretending orgasm. No direct evidence was found for any associations between self-reported frequency and intensity of sexual vocalization and partner satisfaction/physical attractiveness/ambition/dominance, self-perceived attractiveness, or occurrence of orgasm. The frequency (but not intensity) of sexual vocalization was positively influenced by the conception risk. On the proximate level, it seems that sexually less restricted females may use sexual vocalization to increase their sexual attractiveness to their current partner by means of boosting their partner's self-esteem. Enhanced vocalization by sexually unrestricted females may ultimately secure higher paternal investment and increase the confidence of the paternity of current sexual partner.

PHARYNGEAL, UPPER ESOPHAGEAL SPHINCTERIC AND ESOPHAGEAL PRESSURES RESPONSES RELATED TO VOCAL TASKS AT THE LIGHT OF HIGH RESOLUTION MANOMETRY.

High-resolution manometry (HRM) represents a potential tool for measuring pharyngoesophageal phonation pressures. This study aims to evaluate pharyngeal, esophageal upper sphincteric and esophageal pressures during different phonation tasks. 12 (six males, mean age 27 years) professional singers underwent HRM and produced four different vocal tasks at low, medium and high vocal loudness: vowel /ae/, ascending five note scale, word /hey/ and word /go/. Pressures were measured at pharynx, upper esophageal sphincter (UES) and esophagus. Visual analysis of the HRM topographic plots were performed. Esophageal pressures are higher during vocalization than at rest. Pharyngeal and UES phonation pressures does not differ significantly from rest pressures. Visual analysis of the topographic plots showed an important UES pressure increasement during phonation. HRM is a valuable tool for measuring pharyngoesophageal pressures during phonation. Esophageal pressures are higher during phonation than at rest and tend to increase with vocal loudness increment. The topographic plot provides additional data about phonatory mechanism physiology, especially at the UES region.

Adults with a history of recreational cannabis use have altered speech production

Stereotypical depictions of speech in cannabis users often suggest slow, laboured output, yet objective evidence supporting this assumption is extremely limited. We know that depressants or hallucinogenic drugs such as cannabis can cause acute changes in communication and speech rate, but the long-lasting effects of cannabis use on speech are not well described. The aim of this study was to investigate speech in individuals with a history of recreational cannabis use compared to non-drug-using healthy controls. Speech samples were collected from a carefully described cohort of 31 adults with a history of cannabis use (but not use of illicit stimulant drugs) and 40 non-drug-using controls. Subjects completed simple and complex speech tasks including a monologue, a sustained vowel, saying the days of the week, and reading a phonetically balanced passage. Audio samples were analysed objectively using acoustic analysis for measures of timing, vocal control, and quality. Subtle differences in speech timing, vocal effort, and voice quality may exist between cannabis and control groups, however data remain equivocal. After controlling for lifetime alcohol and tobacco use and applying a false discovery rate, only spectral tilt (vocal effort and intensity) differed between groups and appeared to change in line with duration of abstinence from cannabis use. Differences between groups may reflect longer term changes to the underlying neural control of speech. Our digital analysis of speech shows there may be a signal differentiating individuals with a history of recreational cannabis use from healthy controls, in line with similar findings from gait and hand function studies.

Influence of the characteristics of home office work on self-perceived vocal fatigue during the COVID-19 pandemic

Purpose To verify the influence of work characteristics and the occupational voice use on the self-perception of vocal fatigue symptoms in individuals working in the home office during the COVID-19 pandemic. Methods This was a cross-sectional, observational, and descriptive study. The sample consisted of 206 individuals (123 women and 83 men), with an average age of 34 years, working exclusively in a home office mode due to the pandemic. Through an online form, all participants responded to the Vocal Fatigue Index (VFI) protocol and the questionnaire on the characterization of work and the occupational voice use during the pandemic, developed by the authors of this study. Multiple linear regression using the backward elimination technique was performed. Results The variables the interlocutor does “not listen to me in home office work,” “noise in the home office work environment,” “the daily workload in home office,” “vocal quality worsened in home office work,” “increased vocal loudness in home office work” and “lack of training about voice use in home office work” are predictors of the dependent variable vocal fatigue symptoms. Conclusion The characteristics of work and occupational voice use influence the self-perception of vocal fatigue symptoms in individuals working in the home office mode during the COVID-19 pandemic.

Impact of hydration on vocal loading using phonetogram measures

<p><strong>Background:</strong> Vocal loading is a phenomenon that affects the vocal folds and voice parameters. Prolonged vocal loading may cause vocal fatigue. Hydration is one of the easiest precautions to reduce the effect of vocal loading. Voice range profile is an analysis of a participant’s vocal intensity and fundamental frequency ranges. Speech range profile is a graphical display of frequency intensity interactions occurring during functional speech activity. Phonetogram software can analyse VRP and SRP.</p><p><strong>Methods:</strong> Total sixty normophonic participants (thirty male and thirty female) were included in this study. Phonetogram, version 4.40 by Tiger DRS, software used to measure the voice range profile and speech range profile. For VRP, participants were asked to produce vowel /a/ and a passage reading task was given for SRP measurement.</p><p><strong>Results:</strong> All sample recording were done at pre vocal loading task, VLT and after hydration. Parameter that were used to measure the effects were Fo-range, semitone, max-F, min-F, SPL range, max-I, min-I, area (dB). Result showed that after VLT all other parameters like Fo-range, semitone, max-F, min-F, SPL range, max-I, min-I, area (dB) in VRP and SRP were reduced except min-F VRP in male, min-I VRP and min-I SRP in both male and female participants. After hydration all other parameters were improved except max-F VRP and min-F VRP in female, max-I VRP, min-F VRP and area VRP.</p><p><strong>Conclusions:</strong> This study concluded that vocal loading has negative impact on vocal fold tissue and mass. </p>

Aerosol emission in professional singing of classical music

In this study, emission rates of aerosols emitted by professional singers were measured with a laser particle counter under cleanroom conditions. The emission rates during singing varied between 753 and 6093 particles/sec with a median of 1537 particles/sec. Emission rates for singing were compared with data for breathing and speaking. Significantly higher emission rates were found for singing. The emission enhancements between singing and speaking were between 4.0 and 99.5 with a median of 17.4, largely due to higher sound pressure levels when singing. Further, significant effects of vocal loudness were found, whereas there were no significant differences between the investigated voice classifications. The present study supports the efforts to improve the risk management in cases of possible aerogenic virus transmission, especially for choir singing.

Conversational Vocal Intensity in Parkinson's Disease: Treatment and Environmental Comparisons

BackgroundVibrotactile Feedback (VF) using wearable devices is an emerging treatment option for hypophonia in Individuals with Parkinson's disease (IwPD). Studies evaluating the effectiveness of VF in improving conversational vocal intensity in real-life environment in IwPD are limited. ObjectiveTo determine the effect of VF on conversational vocal intensity and compare vocal intensity between a) clinic and real-life environment b) VF and Lee Silverman Voice Treatment (LSVT LOUD®)vs. VF alone in IwPD using a portable voice monitor (VocaLog2). MethodsEight individuals with hypophonia secondary to PD were randomly assigned to two treatment groups- VF and LSVT LOUD® (Group 1) and VF (Group 2). VF was provided using VocaLog2 device. Duration of treatment was 4 weeks for both groups. Vocal intensity was measured in the real-life environment at baseline, during treatment, and at one-month follow-up.Vocal intensity in clinic was obtained at baseline and one-month follow-up. Voice Handicap Index (VHI) questionnaire was administered at baseline and one-month follow-up. ResultsThere was no significant difference in conversational vocal intensity between a) clinic and real-life environment at any point of time b) baseline and follow up for both treatment groups c) the two treatment groups at baseline, during each of the 4 weeks of treatment and at follow up d) VHI baseline and one month follow up scores. ConclusionVF, including when combined with LSVT LOUD®, is limited in improving conversational vocal intensity in real-life in IwPD. The effects of frequency and duration of VF on conversational vocal intensity must be systematically investigated using large scale studies in IwPD.

Differences and Reliability of Linear and Nonlinear Acoustic Measures as a Function of Vocal Intensity in Individuals With Voice Disorders

Linear acoustic indices are significantly influenced by speaking voice intensity. The main aim of this work was to compare acoustic measures based on linear and nonlinear models in different speaking voice intensity levels and to analyze the reliability of those measures in different intensity levels in subjects with voice disorders. 435 samples from subjects (314 women, 121 men with a mean age of 41.07 ± 13.73) diagnosed with various voice disorders were used. In total, 17 acoustic measures were derived from the vowel /ɛ/ sustained at three intensity levels (soft, comfortable, and loud). Five were linear (standard deviation of the fundamental frequency (f0), jitter, shimmer, harmonics-to-noise ratio (HNR) and smoothed cepstral peak prominence (CPPS)), and twelve were nonlinear measures, namely correlation dimension (D2), correlation entropy (H2), first minimum of the mutual information function (FMMI), relative entropy (ENTR-R), largest Lyapunov exponent (Lyap), determinism (DET), transitivity, mean diagonal line length (Lmed), Shannon entropy (ENTR-S), mean length of vertical structures, also known as trapping time (TT), laminarity (LAM) and recurrence period density entropy (RPDE). Differences between speaking voice intensity levels were assessed by Friedman's test and Nemenyi as posthoc test. Intraclass correlation coefficient was used to investigate if each acoustic measure remains in agreement (reliability) between different voice intensity levels. There were significant differences in all acoustic measures about vocal intensity level (P < 0.001). Intraclass correlation coefficient was very good for HNR (>0.61) and good for Lyap, DET, ENTR-S, Lmed, RPDE, and TT (0.41-0.60). All acoustic measures varied as a function of vocal intensity in voice disordered adults, while this relation was different for linear and nonlinear measures. Only the measures HNR, Lyap, DET, ENTR-S, Lmed, RPDE and TT had an acceptable reliability between different voice intensity levels. Therefore, patient`s voice SPL should be controlled or indicated during acoustic vocal assessment.

Voice Acoustics and Vocal Effort in Mask-Wearing Healthcare Professionals: A Comparison Pre- and Post-Workday

We evaluated voice acoustics and self-perceptual ratings in healthcare workers required to wear face masks throughout their workday. Eighteen subjects (11 cisgender female, 7 cisgender male; M=33.72 years, SD=8.30) completed self-perceptual ratings and acoustic recordings before and after a typical workday. Chosen measures were specific to vocal effort, dysphonia, and laryngeal tension. Mixed effects models were calculated to determine the impact of session, mask type, sex, and their interactions on the set of perceptual and acoustic measures. The subjects self-reported a significant increase in vocal effort following the workday. These perceptual changes coincided with an increase in vocal intensity and harmonics-to-noise ratio, but decrease in relative fundamental frequency offset 10. As expected, men and women differed in measures related to fundamental frequency and vocal tract length. Healthcare professionals wearing masks reported greater vocal symptoms post-workday compared to pre-workday. These symptoms coincided with acoustic changes previously related to vocal effort; however, the degree of change was considered mild. Further research is needed to determine whether vocal hygiene strategies may reduce vocal symptoms in mask-wearing workers.

Relationship Between Tasked Vocal Effort Levels and Measures of Vocal Intensity.

Purpose Patients with voice problems commonly report increased vocal effort, regardless of the underlying pathophysiology. Previous studies investigating vocal effort and voice production have used a range of methods to quantify vocal effort. The goals of the current study were to use the Borg CR100 effort scale to (a) demonstrate the relation between vocal intensity or vocal level (dB) and tasked vocal effort goals and (b) investigate the repeated measure reliability of vocal level at tasked effort level goals. Method Three types of speech (automatic, read, and structured spontaneous) were elicited at four vocal effort level goals on the Borg CR100 scale (2, 13, 25, and 50) from 20 participants (10 females and 10 males). Results Participants' vocal level reliably changed approximately 5 dB between the elicited effort level goals; this difference was statistically significant and repeatable. Biological females produced a voice with consistently less intensity for a vocal effort level goal compared to biological males. Conclusions The results indicate the utility of the Borg CR100 in tracking effort in voice production that is repeatable with respect to vocal level (dB). Future research will investigate other metrics of voice production with the goal of understanding the mechanisms underlying vocal effort and the external environmental influences on the perception of vocal effort.

Skin Acceleration Levels Estimated by a Neck-surface Accelerometer during Phonation Are Affected by The Mechanical Properties of The Anterior Cervical Skin

The aim of the present study was to assess whether skin acceleration levels (SAL) estimated by a neck-surface accelerometer (ACC) are affected by the anterior neck skin condition. Each of six healthy non-dysphonic participants wore a headset microphone (MIC), had an ACC sensor fitted on the skin over the cervical trachea, and were subsequently asked to gradually increase the vocal loudness during sustained phonation of the vowel /e:/ (crescendo task), while the sound pressure levels on a sound level meter (SPLSLM) and MIC/ACC signals were simultaneously recorded. Root mean squared values were calculated from the MIC and ACC signals as the sound pressure level (SPLMIC) and SAL, respectively, and the relationships between SPLSLM and SAL were compared between neck anteflexion and retroflexion or between outward and inward skin retraction on both sides of the sensor. In the total samples for the successful crescendo performance in a natural head position, the SPLMIC and SPLSLM showed a strong linear correlation (r=0.980), whereas the correlation between the SAL and SPLSLM showed a distorted regression line (r=0.765) with individual differences. In all participants, the anteflexion and inward skin retraction decreased the SAL value at the same SPLSLM value, whereas the retroflexion increased the SAL value at the same SPLSLM value. These results demonstrate that the signal intensity of a neck-surface ACC is affected by the condition of the anterior cervical skin, perhaps leading to inter-individual variability in SAL measurements.

Effects of Sidetone Amplification on Vocal Function During Telecommunication

Society has become increasingly dependent on telecommunication, which has been shown to negatively impact vocal function. This study explores the use of sidetone regulation during audio-visual communication as one potential technique to alleviate the effects of telecommunication on the voice. The speech acoustics of 18 participants with typical voices were measured during conversational tasks during three conditions of sidetone amplification: baseline (no sidetone amplification), low sidetone amplification, and high sidetone amplification. Vocal intensity, vocal quality (estimated using acoustic measures of the low-high ratio and the smoothed cepstral peak prominence), and self-perceived vocal effort were used to measure the impacts of sidetone amplification on vocal function. Compared to baseline, there were statistically significant decreases in vocal intensity and increases in low-high ratio in the high level of sidetone amplification condition. Changes in these measures were not significantly correlated. When asked to rank conditions based on their perceived vocal effort, participants most often ranked the high level of sidetone amplification as least effortful; however, the visual-analog ratings of vocal effort were not significantly different between conditions. The smoothed cepstral peak prominence did not change with varying levels of sidetone amplification. Vocal intensity decreased with high levels of sidetone amplification. High levels of sidetone amplification also resulted in increases in the low-high ratio, which were shown to be more than just a byproduct of decreased vocal intensity. The impact of sidetone amplification on vocal effort was less clear, but results suggested that participants generally decreased their vocal effort with increased levels of sidetone amplification. This was a preliminary study and future work is warranted in a population of participants with voice complaints and in a more noisy, realistic environments.

Effect of Combined Respiratory Muscle Training (cRMT) on Dysphonia following Single CVA: A Retrospective Pilot Study

Although dysphonia is less prevalent than dysphagia following cerebrovascular accidents, dysphonia does contribute to the burden of disease resulting from stroke. Strengthening muscles of the larynx and respiratory tract through respiratory muscle training (RMT) has proven effective in improving voice after neurological insult. However, approaches to strengthen only the expiratory muscle groups (EMST) dominate the clinical study literature, with variable outcomes. By focusing on exhalation, the contribution of inspiratory muscles to phonation may have been overlooked. This study investigated the effect of combined respiratory muscle training (cRMT) to improve voice function in stroke patients. Recorded data of twenty patients with dysphonia following stroke were allocated to an intervention (IG) or a control group (CG) based upon whether they chose cRMT or not while awaiting pro bono voice therapy services. The intervention group (n=10) was treated daily with three 5-minute sessions of combined resistive respiratory muscle training for 28 days, while the control group (n=10) received no cRMT or other exercise intervention. Perceptual and acoustic measurements as well as a pulmonary function test were assessed pre-and post-intervention. The intervention group demonstrated significant improvements after 28 days of cRMT in peak flow (127%), patient self-perception of voice improvement (84.41%), as well as in all categories of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V): overall severity (63.22%), roughness (54.76%), breathiness (61.06%), strain (63.43%), pitch range (48.11%) and loudness (57.51%), compared to the control group who did not receive treatment. Furthermore, cRMT also led to significant improvements in maximum phonation time (212.5%), acoustic parameters of vocal intensity, and total semitone range (165.45%). This pilot study shows promise of the feasibility and effectiveness of cRMT to lessen the signs and symptoms of dysphonia while simultaneously improving breath support.

Multidisciplinary intensive outpatient rehabilitation program for patients with moderate-to-advanced Parkinson's disease.

Intensive, multi-disciplinary, rehabilitation programs for patients with Parkinson's disease (PWPs) have shown to be effective. However, most programs are based on in-patient service, which is expensive. To demonstrate the feasibility of a multidisciplinary, intensive, outpatient rehabilitation program (MIOR) for moderate to advanced Parkinson's Disease (H&Y≥2). The MIOR program takes place at a community rehabilitation center ('Ezra Le'Marpe'), 3 times a week, 5 hours, 8 weeks, and includes 20 PWPs in each cycle. The multi-disciplinary team includes physical, occupational, speech and hydro therapists. Additional activities include, social work groups, boxing, dancing and bridge. Data was collected retroactively for the first two years. Data analysis includes 158 patient files who completed the program (mean disease duration 10.1±6 and mean H&Y stage 2.8±0.67). Assessments were performed at the beginning and end of the intervention. Positive results were collected: improvement in number of falls (p < 0.0001), Functional Independence Measure (p < 0.0001), quality of life (p < 0.01), balance (p < 0.0001), upper limb function (p < 0.0001) and paragraph reading vocal intensity (p < 0.01). MIOR is a feasible program, showing positive results in moderate to advanced PWP's, improving quality of life, daily function, and motor performance. The current outcomes demonstrate feasibility of MIOR in addition to medical treatment.

The Reliability of Vocal Intensity and Pitch Range in Unilateral Vocal Fold Palsy Patients

The Reliability of Vocal Intensity and Pitch Range in Unilateral Vocal Fold Palsy Patients