[Assessment of vocal intensity in lecturers depending on acoustic properties of lecture rooms]. / Poziom natezenia glosu lektorów w zaleznosci od wlasciwosci akustycznych sal wykladowych.

BACKGROUND: Lombard's effect increases the level of vocal intensity in the environment, in which noise occurs. This article presents the results of the author's own study of vocal intensity level and A-weighted sound pressure level of background noise during normal lectures. The aim of the study was to define whether above-mentioned parameters depend on acoustic properties of rooms (classrooms or lecture rooms) and to define how many lectors speak with raised voice. MATERIAL AND METHODS: The study was performed in a group of 50 teachers and lecturers in 10 classrooms with cubature of 160-430 m3 and reverberation time of 0.37-1.3 s (group A consisted of 3 rooms which fulfilled, group B consisted of 3 rooms which almost fulfilled and group C consisted of 4 rooms which did not fulfill criteria based on reverberation time (maximum permissible value is 0.6-0.8 s according to PN-B-02151-4:2015). Criteria of raising voice were based on vocal intensity level (maximum value: 65 dB according to EN ISO 9921:2003). The values of above-mentioned parameters were determined from modes of A--weighted sound pressure level distributions during lectures. RESULTS: Great differentiation of vocal intensity level between lectors was found. In classrooms of group A lectors were not using raised voice, in group B--21%, and in group C--60% of lectors were using raised voice. CONCLUSIONS: It was observed that acoustic properties of classrooms (defined by reverberation time) exert their effect on lecturer's vocal intensity level (i.e., raising voice), which may contribute to the increased risk of vocal tract illnesses. The occurrence of Lombard's effect in groups of teachers and lecturers, conducting lectures in rooms, was evidenced.

Telerehabilitation for Lee Silverman Voice Treatment (Tele-LSVT)-Loud on voice intensity and voice use in daily living in people with multiple sclerosis: A protocol for a feasibility and pilot randomized controlled study.

Objective: Alterations in voice intensity and quality may constitute a social life limitation in people with multiple sclerosis (MS), but only 2% of cases receive speech therapy. Especially the Lee Silverman Voice Treatment (LSVT)-Loud is a highly effective intensive method for voice intensity, requiring subjects' repeated attendance at the clinic. Telerehabilitation may represent a feasible solution to bypass potential barriers related to speech therapy attendance, scaling up the beneficial effects of the treatment to a broader population. The proposed protocol aims to test the feasibility and the pilot efficacy of the LSVT-Loud delivered in telerehabilitation (Tele-LSVT-Loud), compared to the same treatment delivered in the clinic (LSVT-Loud). Methods: A single-blinded, parallel, two-arm, pilot randomized (1:1 ratio) controlled trial will be performed involving 20 people with MS. Patients will be allocated to 4 weeks of Tele-LSVT-Loud by accessing a telerehabilitation platform at home or LSVT-Loud conventionally delivered in the clinic. Feasibility and pilot effectiveness will be evaluated three times: before (T0), after the treatment (T1), and 3-month follow-up (T2). Feasibility measures will include adherence, adverse events, user experience, motivation, engagement, and acceptability. Vocal intensity during a 1-minute monologue will be the primary outcome measure. Secondary outcome measures will be the vocal quality during a 1-minute monologue, sustained /a/ voice intensity, quality and stability, voice use in daily life, voice subjective perception in daily life, and quality of life. Results: Expected results will be (1) high feasibility of Tele-LSVT-Loud and (2) a non-inferiority effect of Tele-LSVT-Loud compared with face-to-face treatment delivery on voice intensity and quality outcomes. Conclusions: Tele-LSVT-Loud may be a feasible intervention for MS alteration in voice intensity and quality with a non-inferior effect compared to LSVT-Loud.

Vocal Fold Collision Speed in vivo: The Effect of Loudness.

Mechanical impact stress on the vocal fold surface, particularly when excessive, has been postulated to cause the so-called phonotraumatic tissue lesions, such as nodules and polyps. The collision stress between the vocal folds depends on the vocal fold velocity at the time of impact. Hence this vocal fold collision speed is a relevant parameter when considering biomechanical economy of phonation, especially in voice professionals needing a louder voice than normal. Combining a precise photometric measurement of glottal area and simultaneous measurements of translaryngeal impedance (electroglottogram) for identifying the time of the maximum rate of increase of vocal fold contact allows computing the vocal fold collision speed in a wide range of loudnesses. The vocal fold collision speed is - for modal voicing - always smaller than the maximum vocal fold velocity during the closing phase, but it strongly increases with intensity. Moreover, this increase shows a biphasic pattern, with a significant enhancement from a certain value of dB on. Understanding physiological variables that influence vocal fold collision forces provides relevant insight into the pathophysiology and the prevention of voice disorders associated with phonotraumatic vocal hyperfunction.

The effects of a simulated fMRI environment on voice intensity in individuals with Parkinson's disease hypophonia and older healthy adults.

PURPOSE: Functional magnetic resonance imaging (fMRI) has promise for understanding neural mechanisms of neurogenic speech and voice disorders. However, performing vocal tasks within the fMRI environment may not always be analogous to performance outside of the scanner. Using a mock MRI scanner, this study examines the effects of a simulated scanning environment on vowel intensity in individuals with Parkinson's disease (PD) and hypophonia and older healthy control (OHC) participants. METHOD: Thirty participants (15 PD, 15 OHC) performed a sustained /ɑ/ vowel production task in three conditions: 1) Upright, 2) Mock Scanner + No Noise, and 3) Mock Scanner + MRI noise. We used a linear mixed-effects (multi-level) model to evaluate the contributions of group and recording environment to vowel intensity. A second linear mixed-effects model was also used to evaluate the contributions of PD medication state (On vs. Off) to voice intensity. RESULTS: Vowel intensity was significantly lower for PD compared to the OHC group. The intensity of vowels produced in the Upright condition was significantly lower compared to the Mock Scanner + No Noise condition, while vowel intensity in the Mock Scanner + MRI Noise condition was significantly higher compared to the Mock Scanner + No Noise condition. A group by condition interaction also indicated that the addition of scanner noise had a greater impact on the PD group. A second analysis conducted within the PD group showed no effects of medication state on vowel intensity. CONCLUSION: Our findings demonstrate that performance on voice production tasks is altered for PD and OHC groups when translated into the fMRI environment, even in the absence of acoustic scanner noise. For fMRI studies of voice in PD hypophonia, careful thought should be given to how the presence of acoustic noise may differentially affect PD and OHC, for both group and task comparisons.

Associations of Speaking-Voice Parameters With Personality and Behavior in School-Aged Children.

OBJECTIVES: Previous studies suggest a link between voice disorders and personality traits. However, nearly nothing is known about the relationship between personality and voice parameters in healthy children. The present study investigated associations between children's personality and the intensity and frequency of their speaking voice. STUDY DESIGN: This is a cross-sectional analysis. METHODS: The study participants included 871 German children aged from 7 to 14 who had not yet experienced voice change in puberty. Within the framework of the LIFE Child study, all participants were asked to perform a speaking-voice task at four different intensity levels (quietest, conversational, presentation, and shouting voice). Associations of fundamental frequency and voice intensity with children's personality and behavioral strengths and difficulties (assessed using parent-reported questionnaires) were estimated using multiple linear regression analyses. RESULTS: With respect to children's personality, the analyses revealed significant positive associations between speaking-voice intensity and extraversion (eg, for the conversational voice, ß = 0.16, P < 0.001) as well as significant negative associations between voice intensity and emotional stability (eg, for the shouting voice, ß = -0.15, P = 0.004) and conscientiousness (for the shouting voice, ß = -0.10, P = 0.033). Regarding behavioral strengths and difficulties, we observed significant positive associations between voice intensity and peer-relationship problems (eg, for the conversational voice, ß = 0.14, P = 0.001) and prosocial behavior (for the conversational voice, ß = 0.11, P = 0.015). In contrast, no significant association was found between speaking fundamental frequency and personality or behavioral difficulties/strengths. CONCLUSIONS: In children, associations exist between a child's speaking-voice intensity and his or her personality, especially extraversion and emotional stability, and behavioral characteristics.

The Effects of Respiratory Muscle Training on Phonatory Measures in Individuals with Parkinson's Disease.

INTRODUCTION: In individuals with Parkinson's disease (PD), respiratory muscle weakness and rigidity, bradykinesia of abdominal muscles and stiffness of the chest wall, affect the respiratory component of voice intensity due to reduced pulmonary capacity and airflow needed to vibrate the vocal folds. It may be possible to improve voice production by strengthening respiratory muscles. The purpose of this study was to evaluate the effects of inspiratory and expiratory muscle training on voice production outcomes in individuals with PD. METHOD: Thirty-one participants with PD were randomly allocated to three study groups (control group n = 10, inspiratory training group, n = 11, and expiratory training group, n = 11). The inspiratory and expiratory group performed a home-based inspiratory and expiratory muscle training program, respectively (five sets of five repetitions). Both groups trained six times a week for 2 months using a progressively increased resistance. The control group performed expiratory muscle training using the same protocol and a fixed resistance. Phonatory measures, maximum inspiratory/expiratory pressure, and spirometric indexes were assessed before and at 2 months after training. RESULTS: Differences in peak subglottic pressure were moderate (d = 0.59) between expiratory and inspiratory groups, large between inspiratory and control groups (d = 1.32), and large between expiratory and control groups (d = 1.96). Differences in maximum phonation time were large (d = 1.26) between inspiratory and control groups, moderate (negative) between expiratory and inspiratory groups (d = -0.60), and moderate between expiratory and control groups (d = 0.72). Differences in peak sound pressure level were large (d = 1.27) between inspiratory and control groups, trivial between expiratory and inspiratory groups (d = -0.18), and large between expiratory and control groups (d = 1.10). CONCLUSIONS: Inspiratory muscle training is effective in improving maximum phonation time, and expiratory muscle training is more effective for improving peak subglottic pressure, and peak sound pressure level in individuals with PD.

Clinical relevance of speaking voice intensity effects on acoustic jitter and shimmer in children between 5;0 and 9;11 years.

BACKGROUND: Current voice assessment recommendations for dysphonic children comprise instrumental acoustic measurements of the perturbation parameters jitter and shimmer. In healthy adults and children changes in speaking voice sound pressure level (voice SPL) have significant confounding effects on both parameters. In adults these effects were considerably reduced in phonations with controlled voice SPL >80dBA (10cm distance). However, it is unclear if these findings apply to children and if children are able to control for their own voice intensity. OBJECTIVE: This cross-sectional single cohort study investigates voice SPL effects on jitter and shimmer in children between 5;0 and 9;11 years phonating at individually "medium" (modeling "comfortable" loudness of the usual clinical protocol), "soft" and "loud" voice and a prescribed intensity level of ">80dBA" (10cm distance, with visual control). Further both their ability to phonate at a prescribed voice intensity level and the effect on SPL related confounding effects were studied. SUBJECTS AND METHODS: A total of 68 healthy children (39 f/29m) aged 5;0 to 9;11 years were included. All phonated the vowel/a/for 5s, three times at four defined voice intensity levels (soft/medium/loud/>80dBA) each. Jitter (%), shimmer (%) and voice SPL (dBA) were determined using PRAAT. Voice intensity level effects were assessed by descriptive statistics, Analysis of Variance (ANOVA) and Linear Mixed Models (LMM). RESULTS: There were significant differences for jitter and shimmer between all voice tasks (p<.01). Jitter and shimmer were lowest and showed the smallest spread in controlled phonations ">80dBA". 19 children below 7;0 years could not perform the voice tasks and were excluded from the study. CONCLUSIONS: This practical study demonstrated a significant effect of voice loudness and task on jitter and shimmer in children. Since the observed confounding effects were large compared to treatment effects, jitter and shimmer may not be meaningful without adequate control of voice SPL. In phonations at ">80dBA" (10cm distance) voice SPL related effects were considerably reduced. However, this assessment protocol was suitable only for children above 7;0 years. Application of this task to future studies of dysphonic children may yield clinically valuable information.

Effects of tactile biofeedback by a portable voice accumulator on voice sound level in speakers with Parkinson's disease.

OBJECTIVES: To study the effects of biofeedback on voice sound level (SL) in subjects with reduced voice SL, secondary to Parkinson disease (PD), using a portable voice accumulator. STUDY DESIGN: Prospective intervention study. METHODS: Voice SL, phonation time, and level of background noise were registered with a portable voice accumulator during three consecutive registration periods. Six subjects with reduced voice SL secondary to PD participated. Biofeedback, in the form of a vibration signal when voice SL went below an individually set threshold level, was administered during the second registration period only. Mean voice SL was calculated for registration periods with and without feedback. Data on phonation time and level of background noise was also collected. Field registrations with the portable voice accumulator were also compared with registrations made in a recording studio. In addition, subjects were asked about subjective experiences of using the portable voice accumulator for up to 15 days. RESULTS: There was a statistically significant increase in voice SL during the period when biofeedback of voice SL was administered. Subjects reported that using the portable voice accumulator was a positive experience. Several participants wished to continue using the device. In general, subjects handled the device independently with no major problems and did not report any negative experiences. CONCLUSIONS: Although this study was a first trial including six subjects with reduced voice SL secondary to PD, the findings indicate that biofeedback of voice SL administered via a portable voice accumulator may be a useful treatment tool for this group of patients and that further studies are needed.