Vocal Fatigue Index in Finnish-Speaking Population.

BACKGROUND AND OBJECTIVE: Vocal fatigue is an important complaint that may indicate a voice disorder or a risk thereof. There is a need for a reliable tool to detect and quantify vocal fatigue and distinguish dysphonic and vocally healthy speakers. The Vocal Fatigue Index (VFI) questionnaire has been found valid and reliable among speakers of different languages. This study aims to validate it for speakers of Finnish. STUDY DESIGN: Experimental comparative study. METHODS: The VFI questionnaire was translated from English to Finnish according to the WHO recommendations. Next, it was subjected to the validation procedure. In total, 160 Finnish speakers volunteered to participate in the study. Hundred-and-eight were voice patients (83 males, 25 females) and 52 were vocally healthy controls (37 females, 15 males). As a comparison, the Voice Handicap Index (VHI) questionnaire was completed and voice samples were recorded to enable Acoustic Voice Quality Index (AVQI03.01FIN) analysis. RESULTS: Results from the first and second completions of the VFI(F) questionnaire correlated strongly (Spearman's rho 0.901, P = 0.01). Answers to the individual questions the VFI(F) also correlated strongly, showing high internal consistency. Factor 1 (Tiredness of voice and avoidance of voice use) of the VFI correlated strongly with the VHI, and the two other factors (Physical discomfort associated with voicing and Improvement of symptoms) correlated moderately with the VHI. Factor one of the VFI(F) correlated moderately with AVQI03.01FIN and its sub-parameters, CPPS, HNR, and shimmer. The VFI(F) showed good construct validity, differentiating voice patients and controls at cut-off 13.5, with sensitivity of 0.963 and specificity of 0.885. Discriminatory power was strong for all factors: F1 AROC = 0.985, F2 AROC = 0.864, and F3 AROC = 0.821. CONCLUSION: The VFI(F) correlates with the VHI and with AVQI01.01FIN and it is a valid and reliable tool for detecting vocal fatigue in Finnish speakers.

Prosodic features in Finnish-speaking adults with Parkinson´s disease.

The aim of this study was to assess prosodic features in Finnish speakers with (n = 16) and without (n = 20) Parkinson's disease (PD), as there are no published studies to date of prosodic features in Finnish speakers with PD. Chosen metrics were articulation rate (syllables/second), pitch (mean F0) and pitch variability (standard deviation F0), energy proportion below 1 kHz (epb1kHz), normalised pairwise variability index (nPVI), and a novel syllabic prosody index (SPI). Four statistically significant results were found: (1) energy was distributed more to lower frequencies in speakers with PD compared to control speakers, (2) male PD speakers had higher pitch and (3) higher syllabic prosody index compared to control males, and (4) female PD speakers had narrower pitch variability than controls. In this study, PD was manifested as less emphatic and breathier voice. Interestingly, male PD speakers' dysprosody was manifested as an effortful speaking style, whereas female PD speakers exhibited dysprosody with a monotonous speaking style. A novel syllable-based prosody index could be a potentially useful tool in analysing prosody in disordered speech.

Has the Prevalence of Creaky Voice Increased Among Finnish University Students From the 1990'S to the 2010'S?

Everyday observations indicate that creaky voice has become common in Finland in recent years. Previous studies suggest that this trend is also occurring in other countries. This cross-sectional study investigates the use of creaky voice among Finnish university students from the 1990's to the 2010's. Material was obtained from a sound archive. It consisted of 200 samples from normophonic speakers (95 males, 105 females; mean age 23.7 years, SD 3.3 years, range 19-35 years). Normophonia was checked by two speech therapists in a preliminary perceptual analysis. Thereafter, two voice specialists rated the amount of creak and strain. A scale of 0-4 was used (0 = none, 4 = a lot). The inter- and intrarater reliability for the listening evaluations were satisfactory (for creaky phonation, rho = 0.611, P < 0.001 for interrater reliability and rho = 0.540, P < 0.001 for intrarater reliability; for strain, rho = 0.463, P < 0.001 and rho = 0.697, P < 0.001 for inter- and intrarater reliability, respectively). These results revealed a significant increase in the amount of perceived creak in females (from 1.04, SD 0.69 to 1.55, SD 1.06; P < 0.05, Mann-Whitney U test). In males, no significant change was found. However, the frequency of creaky voice use increased in both genders. No male speakers from the 1990's were rated as using "a lot" of creaky voice, but 2.3% of male speakers from the 2010's received this rating. Male speakers who were rated "quite a lot" increased from 5.9% in the 1990's to 18.1% in the 2010's. Female speakers rated "a lot" increased from 0% to 6%, and female speakers rated "quite a lot" increased from 7% to 25.8% over the studied time periods. Creaky phonation and strain correlated slightly in males (rho = 0.24, P < 0.05) and moderately in females (rho = 0.55, P < 0.001). Age did not correlate with the amount of creaky phonation (rho = 0.005, P > 0.10 for males, rho = -0.011, P > 0.10 for females). It can be concluded that the prevalence of creaky voice has increased among young Finnish speakers, particularly females.

Does the Acoustic Voice Quality Index (AVQI) Correlate with Perceived Creak and Strain in Normophonic Young Adult Finnish Females?

BACKGROUND: The Acoustic Voice Quality Index (AVQI) is a correlate of dysphonia. It has been found to differentiate between dysphonic and normophonic speakers and to indicate the effects of voice therapy. This study investigates how the AVQI reacts towards creak and strain, which are common in normophonic speakers. METHODS: The material was obtained from an earlier study on 104 Finnish female university students (mean age 24.3 years, SD 6.3 years) with no known pathology of voice or hearing and a perceptually normal voice (G = 0 in GRBAS), who were recorded while reading aloud a standard text and sustaining the vowel [a:]. Perceptual analysis for the amount of creak and strain was carried out by 2 expert listeners. In this study, the AVQI v03.01 was analyzed and correlated with perceptual evaluations. Samples with low and high amounts of creak and strain were compared with t tests. RESULTS: On average, the AVQI was below the threshold value of dysphonia in the Finnish population. The AVQI (ρ = 0.35, p = 0.000) and its subparameters, smoothed cepstral peak prominence (CPPS; ρ = -0.35, p = 0.000) and harmonics-to-noise ratio (HNR; ρ = -0.30, p = 0.002) showed low but significant correlations with creak. Strain had low but significant correlations with spectral Slope (ρ = 0.38, p = 0.000) and Tilt (ρ = -0.40, p = 0.009). The AVQI was lower (better) in samples that were evaluated as having a high amount of strain, but the difference was not significant. Only CPPS differentiated significantly between low and high amounts of creak. CONCLUSION: The AVQI does not seem to differentiate between high and low amounts of creak and strain in normophonic speakers.

The Efficacy of the NHS Waterpipe in Superficial Hydration for People With Healthy Voices: Effects on Acoustic Voice Quality, Phonation Threshold Pressure and Subjective Sensations.

OBJECTIVES: This study examined the efficacy of the NHS waterpipe as a superficial hydration treatment in voice production in healthy young women. STUDY DESIGN: This is a prospective, single-blind, within- and between-subject experimental design. METHODS: Thirty six female university students (mean age 24.6 years, range 19-45 years) were recruited to the study. Participants were randomized to two experimental groups (E1 and E2) and a control group. E1 underwent hydration treatment with the NHS waterpipe filled with 0.9% saline that was immersed in a cup of heated water. E2 underwent a similar treatment but without heated immersion. The control group received no treatment. Acoustic Voice Quality Index (AVQI v03.01) and its subparameters, phonation threshold pressure, self-perceived phonatory effort and sensation of throat dryness was measured at three time points (before the intervention and immediately and 15 minutes after it). RESULTS: The Tilt of the AVQI's subparameters increased significantly in the E1 (P = 0.027) and E2 groups (P = 0.027) after the intervention. Furthermore, the E1 group had significantly lower harmonics-to-noise-ratio values at the third measurement point compared to the E2 group (P = 0.023). These findings may result from fluid transported to the vocal fold level. The sensations of throat dryness decreased in the E1 (P = 0.001) and E2 groups (P < 0.0005) after the intervention. Perceived phonatory effort decreased statistically significantly at the final measurement point in the E1 (P = 0.002) and E2 (P = 0.031) groups. No variables changed in the control group. CONCLUSIONS: The waterpipe seems to be efficient in hydrating vocal folds on single use. It seems to be more efficient when employed with a hot water bath, albeit slightly impairing some acoustic values in the short term. Without the heated fluid, it still seems to decrease sensations of throat dryness and affect acoustic voice quality. The waterpipe does not seem to have an effect on phonation threshold pressure, and it seems to lower self-perceived effort just as efficiently whether the waterpipe is employed using a hot water bath or not. Further research is needed to prove the efficacy of long-term usage and usage with voice patients.

Acoustic Voice Quality Index as a Potential Tool for Voice Screening.

INTRODUCTION: To diminish the risk of voice disorders in people who are highly dependent on their voices, such as teachers, vocal screening is important already at the beginning of such individuals' professional studies. A reliable, specified screening tool is needed. The Acoustic Voice Quality Index (AVQI) has been found to differentiate normal voices from abnormal voices and to serve as a treatment outcome measure. This study investigated whether AVQI could be a screening tool in combination with auditory- and self-perception of the voice to discriminate normal from slightly poor voices. TYPE OF STUDY: Experimental. METHODS: Some 128 female teaching students (mean age 26.39 years, SD 9.80 years) with no diagnosed voice disorders participated in this study. They read aloud a text in Finnish, sustained the vowel /a:/, and filled the Voice Handicap Index (VHI) questionnaire. Voice samples were recorded with an AKG C544L headset microphone, iFocusrite soundcard, and Praat software using a 44100 sample rate and 16-bit amplitude quantization. Five expert voice therapists evaluated the samples to determine the grade of dysphonia (G) using a scale of 0-0.5 (=normal), 0.5-1 (=mild), 1-2 (=moderate), and 2-3 (=severe). Three medial seconds of [a:] and the first 31 syllables of the text were analyzed using AVQI script version 03.01 in Praat (5.3.55). The analysis gives one AVQI score per participant (scale 0-10). The AVQI threshold of normal and disordered voices for Finnish speakers is 1.83; a Gmean = 0.0-0.5 and VHI score <19 were considered normal. Statistical analysis was done using the receiver operating characteristic (ROC) curve, Spearman's correlation coefficient, and the independent samples t test. RESULTS: According to the AVQI results, the area under the curve (AROC) was 0.554, which is fair. The Youden index gave a cutoff value of 0.30 with a sensitivity of 85% and a specificity of 81.1%. There were weak but significant correlations between Gmean and AVQI and two AVQI parameters, smoothed cepstral peak prominence and harmonic-to-noise ratio (r = 0.27; --0.24; -0.20, respectively; |P < 0.05); and between total VHI and AVQI score and cepstral peak prominence (r = 0.21; 0.20, respectively; P < 0.05). Furthermore, the AVQI scores differed significantly between the groups with a VHI total score <19 and ≥19. CONCLUSIONS: AVQI did not differentiate between voices that had been perceptually judged as normal or slightly abnormal, but a combination of perceptual assessment in the form of AVQI and VHI could better screen slightly deviant voices.

Effects of Humidification of the Vocal Tract and Respiratory Muscle Training in Women With Voice Symptoms-A Pilot Study.

OBJECTIVE: The aim of this study was to determine the efficacy of a 4-week breathing exercise intervention in participants with voice symptoms. METHODS: Six nonsmoking women (mean age 49) experiencing voice symptoms used a novel device WellO2 for respiratory exercises that provides counter pressure during both inspiration and expiration and warms and humidifies the breathing air. Speech samples were acoustically (Acoustic Voice Quality Index) and perceptually (grade, roughness, breathiness, asthenia, and strain scale) analyzed, and perceived voice symptoms and self-reported effort in breathing and phonation were obtained. Respiratory measurements included breathing frequency and pattern, peak expiratory flow, forced vital capacity, and forced expiratory volume in 1 minute. RESULTS: The total scores of Acoustic Voice Quality Index and some of its subcomponents (shimmer and harmonic-to-noise ratio), and the grade, roughness, and strain of the GRBAS scale indicated significantly improved voice quality. However, neither the nature or frequency of the experienced voice symptoms nor the perceived phonatory effort changed as the function of intervention. According to the participants, their breathing was significantly less effortful after the intervention, although no significant changes were observed in the objective respiratory measurements with a spirometer. CONCLUSION: Training with the WellO2 device has the potential to improve voice quality. The combination of inspiratory and expiratory training and warmed, humidified air is a multifaceted entity influencing several parts in the physiology of voice production. The effects of using WellO2 need to be confirmed by further studies with a larger number of participants.

Relations between Creaky Voice and Vocal Symptoms of Fatigue.

BACKGROUND: The use of a creaky voice in speech has become more common. Laryngeal findings relate creaky voice with strong adductive tension in the glottis, and thus it may be expected to be related to an increased risk of vocal fatigue. METHODS: The present study investigated the relation of creaky voice use and vocal symptoms in 104 Finnish female university students (mean age 24.3 years, SD 6.3 years). They had no known pathology of voice or hearing. The participants were recorded while reading aloud a text of approximately 40 s in duration. They also filled in a questionnaire consisting of the Voice Handicap Index (VHI, translation in Finnish), and half of them also answered questions about the frequency and severity of symptoms of vocal fatigue. The samples were perceptually analysed for the amount of creakiness and strain by a speech therapist and a voice trainer. RESULTS: The interrater reliability of the listeners was acceptable (Pearson's χ2 = 100.159, p = 0.000 for creak; χ2 = 69.199, p = 0.000 for strain). Neither creakiness nor strain correlated with vocal symptoms. Participants with a low and a high amount of creakiness or strain did not differ from each other in terms of vocal symptoms or VHI scores. Symptoms' total score correlated with VHI total score and total scores of VHI's physical subscale. Creakiness and strain correlated positively with each other (r = 0.40, p = 0.000). CONCLUSION: No significant relations were found between creakiness or strain and vocal symptoms in this sample of university students.

The acoustic voice quality index version 02.02 in the Finnish-speaking population.

Background: The Acoustic Voice Quality Index (AVQI) is a multiparametric tool for objectively measuring the general acoustic characteristics of voice. The AVQI uses both sustained vowel and continuous speech in its analysis, and therefore, a validation is required for different languages. In the present study, validation was performed in the Finnish-speaking population.Methods: The study included 200 native Finnish-speaking participants of whom 115 were voice patients attending a phoniatric clinic, and the remaining 85 subjects participated in the study as healthy controls. Voice samples were recorded, and the auditory evaluation was performed by five speech therapists. An ordinal four-point interval scale was used to evaluate the degree of voice abnormality (Grade, G). Several statistical analyses were performed to test the validity and the diagnostic accuracy of the AVQI in the Finnish-speaking population.Results: The inter-rater reliability of four of the five raters was high enough to allow the use of Gmean in the validation. There was a statistically significant correlation between the AVQI scores and the evaluation of overall perceptual voice quality (r = 0.74).Conclusions: The results confirmed the good discriminatory power of the AVQI in differentiating between normal and abnormal voice qualities. The AVQI 02.02 threshold value for dysphonia was 2.87 in the Finnish-speaking population.

Teachers' and Children's Experiences after an Acoustic Intervention and a Noise-Controlling Workshop in Two Elementary Classrooms.

INTRODUCTION: Treating sources of noise is a novel aspect of voice ergonomics intended to enhance the preconditions for good voice production and easy listening. OBJECTIVE: To improve experiences of listening and voice ergonomics in classrooms. METHODS: Participants were two female elementary school teachers with voice symptoms and their pupils (n = 50). Two interventions were performed: the acoustic intervention and then the workshop intervention where the teachers and pupils were active. Teachers' voice symptoms and pupils' and teachers' experiences of the interventions were elicited by questionnaire. RESULTS: The teacher with many voice symptoms experienced more annoyance from sounds and benefitted more from the interventions. After the interventions both teachers suffered fewer voice breaks and voice symptoms such as lump and mucus in the throat. The pupils reported improvement in the teachers' voice clarity and audibility (p = 0.001). Pupils aged 12-13 years were more annoyed by sounds than those aged 8-9 years (p = 0.003). The older pupils experienced less sound annoyance after both interventions and the younger ones after the workshop intervention. CONCLUSIONS: The importance of good acoustics and individuals' ability to improve voice ergonomics and listening conditions was demonstrated.

The Others Are Too Loud! Children's Experiences and Thoughts Related to Voice, Noise, and Communication in Nordic Preschools.

BACKGROUND: High noise levels affect hearing, voice use, and communication. Several studies have reported high noise levels in preschools and impaired voice quality in children. Noise and poor listening conditions impair speech comprehension in children more than in adults and even more for children with hearing or language impairment, attention deficits, or another first language. AIM: The aim of this study was to explore how children in Finland, Sweden, and Iceland describe the preschool environment in relation to noise, voice, and verbal communication; what were their experiences, knowledge and ideas in relation to voice, noise, and communication. Children's awareness of effects of noise, reactions, and coping strategies were also studied. In addition, country and gender differences were analyzed. METHODS: Eighteen Icelandic, 14 Finnish, and 16 Swedish children were interviewed using a common interview-guide. Swedish and Finnish children were interviewed in focus groups and Icelandic children individually. All interviews were transcribed verbatim and analyzed thematically by the native speaker. The interviews were translated to English to be re-analyzed for inter-judge reliability of identified themes. Inter-judge reliability was calculated using percentage absolute agreement. RESULTS: The interviews resulted in 1052 utterances, 471 from focus groups, and 581 from individual interviews. Three themes were identified, Experiences, Environment, and Strategies with two to three subcategories. Inter-judge agreement for the themes was excellent, 92-98%. Experiences occurred in 55% of the utterances. The subcategories were bodily and emotional experiences and experiences of hearing and being heard. Environment occurred in 20% of the utterances, with subcategories indoor vs. outdoor and noise. Strategies was found in 15%, with subcategories games and problem oriented actions. The only significant difference between the countries was for the theme Strategies where the Swedish children produced more utterances than the Finnish. No gender differences were found. CONCLUSION: Children are aware of high noise levels and mainly blame other children for making noise and shouting. They describe reactions and strategies related to noise like impaired communication and effects on hearing but are less aware of effects on voice. Expressed thoughts were similar across countries. No gender differences were found.

Teachers' Working Postures and Their Effects on the Voice.

OBJECTIVE: To evaluate associations between voice and working postures used during teaching. METHODS: A researcher assessed 30 teachers' typical working postures of the torso, head, shoulders, upper back, and arms by observing and/or asking questions about them. Teachers' options to rest and to adjust furniture according to their needs were also elicited. Voice symptoms were evaluated through 2 self-assessment forms. Fundamental frequency, sound pressure level (SPL), and alpha ratio were calculated from voice samples recorded before, during, and after teaching. RESULTS: The head was most typically in an unergonomic posture while speaking (in 60% of participants). Other frequently used unergonomic postures were hunched upper back (55%), raised shoulders (46%), and twisted torso (43%). Head and torso twisted and arms upheld were associated with specific voice symptoms and head postures and hunched upper back with voice use. The number of postures was also connected with voice use: if the teachers used over 3 unergonomic postures, their SPL was higher and the voice broke more often than in those with a lower number of postures. CONCLUSION: Unergonomic postures during speaking affect the voice. It is important to evaluate working postures as part of voice ergonomic assessment in voice patients.

Relationship between Activity Noise, Voice Parameters, and Voice Symptoms among Female Teachers.

OBJECTIVE: Our interest was in how teachers' voices behave during the delivery of lessons in core subjects (e.g., mathematics, science, etc.). We sought to evaluate the relationship between voice sound pressure level (SPL), vocal fundamental frequency (F0), voice symptoms, activity noise, and differences therein during the first and the last lessons in core subjects of the day. PATIENTS AND METHODS: The participants were 24 female elementary school teachers. Voice symptoms were evaluated by questionnaire. The data were recorded on 2 portable voice accumulators (VoxLog) from the first and last lessons of the day. The versions of accumulators differed by frequency weighting; therefore, the analysis and the results of noise and voice SPL were treated separately: unweighted (group 1) and A-weighted (group 2). RESULTS: Difference in voice SPL followed difference in activity noise. F0 increased between the first and last lessons. Correlations were found between differences in the noise and the voice symptoms of tiredness and dryness. Irritating mucus was associated with high F0 during the first lesson. CONCLUSION: An apparent increase in voice loading due to the activity noise was observed during lessons in core subjects. Collaboration between specialists in voice and acoustics and teachers and pupils is needed to reduce this voice loading.

Effects of pedagogical ideology on the perceived loudness and noise levels in preschools.

High activity noise levels that result in detrimental effects on speech communication have been measured in preschools. To find out if different pedagogical ideologies affect the perceived loudness and levels of noise, a questionnaire study inquiring about the experience of loudness and voice symptoms was carried out in Iceland in eight private preschools, called "Hjalli model", and in six public preschools. Noise levels were also measured in the preschools. Background variables (stress level, age, length of working career, education, smoking, and number of children per teacher) were also analyzed in order to determine how much they contributed toward voice symptoms and the experience of noisiness. Results indicate that pedagogical ideology is a significant factor for predicting noise and its consequences. Teachers in the preschool with tighter pedagogical control of discipline (the "Hjalli model") experienced lower activity noise loudness than teachers in the preschool with a more relaxed control of behavior (public preschool). Lower noise levels were also measured in the "Hjalli model" preschool and fewer "Hjalli model" teachers reported voice symptoms. Public preschool teachers experienced more stress than "Hjalli model" teachers and the stress level was, indeed, the background variable that best explained the voice symptoms and the teacher's perception of a noisy environment. Discipline, structure, and organization in the type of activity predicted the activity noise level better than the number of children in the group. Results indicate that pedagogical ideology is a significant factor for predicting self-reported noise and its consequences.

Classroom Noise and Teachers' Voice Production.

PURPOSE: The aim of this study was to research the associations between noise (ambient and activity noise) and objective metrics of teachers' voices in real working environments (i.e., classrooms). METHOD: Thirty-two female and 8 male teachers from 14 elementary schools were randomly selected for the study. Ambient noise was measured during breaks in unoccupied classrooms and, likewise, the noise caused by pupils' activity during lessons. Voice samples were recorded before and after a working day. Voice variables measured were sound pressure level (voice SPL), fundamental frequency, jitter, shimmer, and the tilt of the sound spectrum slope (alpha ratio). RESULTS: The ambient noise correlated most often with the fundamental frequency of men and voice SPL, whereas activity noise correlated with the alpha ratio and perturbation values. Teachers working in louder ambient noise spoke more loudly before work than those working in lower noise levels. Voice variables generally changed less during work among teachers working in loud activity noise than among those working in lower noise levels. CONCLUSIONS: Ambient and activity noises affect teachers' voice use. Under loud ambient noise teachers seem to speak habitually loudly, and under loud activity noise teachers' ability to react to loading deteriorates.

Associations between voice ergonomic risk factors and acoustic features of the voice.

The associations between voice ergonomic risk factors in 40 classrooms and the acoustic parameters of 40 schoolteachers' voices were investigated. The risk factors assessed were connected to participants' working practices, working postures, and the indoor air quality in their workplaces. The teachers recorded spontaneous speech and sustained /a/ before and after a working day. Fundamental frequency, sound pressure level, the slope of the spectrum, perturbation, and harmonic-to-noise ratio were analysed. The results showed that the more the voice ergonomic risk factors were involved, the louder the teachers' voices became. Working practices correlated most often with the acoustic parameters; associations were found especially before a working day. The results suggest that a risky voice ergonomic environment affects voice production.

Connections between voice ergonomic risk factors and voice symptoms, voice handicap, and respiratory tract diseases.

OBJECTIVES: The aim of the study was to investigate the connections between voice ergonomic risk factors found in classrooms and voice-related problems in teachers. METHODS: Voice ergonomic assessment was performed in 39 classrooms in 14 elementary schools by means of a Voice Ergonomic Assessment in Work Environment--Handbook and Checklist. The voice ergonomic risk factors assessed included working culture, noise, indoor air quality, working posture, stress, and access to a sound amplifier. Teachers from the above-mentioned classrooms reported their voice symptoms, respiratory tract diseases, and completed a Voice Handicap Index (VHI). RESULTS: The more voice ergonomic risk factors found in the classroom the higher were the teachers' total scores on voice symptoms and VHI. Stress was the factor that correlated most strongly with voice symptoms. Poor indoor air quality increased the occurrence of laryngitis. CONCLUSIONS: Voice ergonomics were poor in the classrooms studied and voice ergonomic risk factors affected the voice. It is important to convey information on voice ergonomics to education administrators and those responsible for school planning and taking care of school buildings.

Connections between voice ergonomic risk factors in classrooms and teachers' voice production.

OBJECTIVE: The aim of the study was to investigate if voice ergonomic risk factors in classrooms correlated with acoustic parameters of teachers' voice production. METHODS: The voice ergonomic risk factors in the fields of working culture, working postures and indoor air quality were assessed in 40 classrooms using the Voice Ergonomic Assessment in Work Environment - Handbook and Checklist. Teachers (32 females, 8 males) from the above-mentioned classrooms recorded text readings before and after a working day. Fundamental frequency, sound pressure level (SPL) and the slope of the spectrum (alpha ratio) were analyzed. RESULTS: The higher the number of the risk factors in the classrooms, the higher SPL the teachers used and the more strained the males' voices (increased alpha ratio) were. The SPL was already higher before the working day in the teachers with higher risk than in those with lower risk. CONCLUSION: In the working environment with many voice ergonomic risk factors, speakers increase voice loudness and use more strained voice quality (males). A practical implication of the results is that voice ergonomic assessments are needed in schools.

Comprehension of before and after in frontotemporal degeneration.

Frontotemporal lobar degeneration (FTLD) is a dementia syndrome with behavioural problems and deterioration of language functions. The other cognitive domains are relatively preserved for at least the first two years of the disease. We studied the ability of patients with FTLD to understand before and after constructions expressed in Finnish. Ten patients and eight controls were presented eight sentences with different relations and asked questions to test their comprehension. The results showed that the patients generally found after constructions more difficult. The difficulty was not, however, related to normal ageing, as was shown by the performance of the control group.