Vocal ergonomics with sports coaches: Co-devised approaches to occupational voice.

BACKGROUND: Work-system participation and factors are associated with occupational vocal health for vocally reliant workers, such as sports coaches. However, there is limited use of systems approaches and worker collaboration to address occupational voice. OBJECTIVE: The current research aimed to cooperatively consider coaches' vocally reliant systems participation, including addressing vocal ergonomic factors that can create barriers for occupational vocal health and voice use. METHODS: Collaborative action inquiries explored vocal ergonomics with coaches (n = 24) from nine professional basketball teams. Across three basketball seasons, coaches and a subject matter expert identified what influenced coaches' voices and trialed approaches to optimize vocally reliant coaching participation. Nine action inquiry methods were used, including search conferences, ergonomic approaches to enhance systems participation, and focus groups. Multi-level analyses were also undertaken. RESULTS: Participants cooperatively generated, implemented, and evaluated different strategies. A cumulative total of 57 strategies were explored within teams (team mean = 6.33, SD = 3, range = 4-14). Cross-case analysis identified 25 different strategy types. Overall, participants appraised 31.58% (18/57) strategies as supportive (i.e., enhanced facilitators for voice), 61.40% (35/57) strategies as somewhat supportive (i.e., some enhanced facilitators and some ongoing barriers), and 7.02% (4/57) strategies as unsupportive (i.e., pervasive ongoing barriers not mitigated by strategies). Further, factors across coaches' work-systems continued to influence coaches' voices in dynamic and complex ways. CONCLUSIONS: Collaboration with coaches enriched vocal ergonomic approaches by providing novel, context-anchored insights. Collaboration should form 'part' of broader mechanisms to support coaches' voice use and vocal health at work.

Action inquiry and vocal ergonomics: A pilot study with sports coaches.

BACKGROUND: Coaches critically rely on voice for occupational functioning, which has associated risks to vocal health. However, vocal occupational health and safety (OHS) and vocal ergonomics are not typically considered for, by, or with coaches. OBJECTIVE: This study piloted a participatory approach to vocal ergonomics, aiming to collaboratively (i) understand coaches' vocally reliant occupational participation, and (ii) consider vocal ergonomic factors. METHODS: This research was undertaken at an international tournament for floorball (also known as 'Innebandy', 'Salibandy', or 'Unihockey'). Three national coaches (n = 3) and the lead researcher undertook cooperative action inquiry. This piloted a participatory vocal ergonomics programme. Action inquiry methods included fieldnotes, interviews, observations, a workshop, ergonomics approaches, and a focus group. Multi-level analyses supported the findings, including categorical aggregation, direct interpretation, and reflexive thematic analysis. RESULTS: Participants identified vocal ergonomic factors present at the tournament; including personal, activity, physical environmental, and organisational factors. Participants developed four vocal ergonomic approaches responsive to factors. These were: (1) player consultation, (2) ongoing feedback discussions, (3) movement and postural change, and (4) specific task adaptation. Approaches 1-2 directly supported coaches' voices. Coaches posited limitations to other strategies, but made recommendations for future use. Coaches also reflected that this collaboration provided actionable voice insights and opportunities to address vocal ergonomics. They advocated for extended engagement with coaches, increased focus on vocal health, and inclusion of early career coaches in future programmes. CONCLUSIONS: These findings support engagement of coaches, and other vocally reliant workers, in addressing voice use and vocal health at work.

Further Evidence of the Construct Validity of the Transsexual Voice Questionnaire (TVQMtF) Using Principal Components Analysis.

OBJECTIVES: The Transsexual Voice Questionnaire (TVQMtF) is a population-specific self-report tool designed to capture the perceptions of male-to-female transsexual women (MtF women) regarding their vocal functioning and the voice-related impact on their everyday life. The aim of this study was to further the psychometric evaluation of the TVQMtF by examining its construct validity and confirming its reliability. STUDY DESIGN: This is a prospective validity and reliability study. METHODS: One hundred fifty-one MtF women provided data for principal components analysis with oblimin rotation. Data from 133 of these participants were also analyzed to evaluate the internal consistency of the TVQMtF. RESULTS: Principal components analysis identified a two-factor structure. The largest component (accounting for 51.99% of the variance) captured individuals' perceptions of their vocal functioning and included items related to the link between voice and gender identity. This component was labeled vocal functioning. The second component (5.82% of the variance) contained items that related to the impact of voice on the individual's participation in everyday life and was labeled social participation. Internal consistency was high (Cronbach's α = .97). CONCLUSIONS: The findings support the construct validity of the TVQMtF. Additionally, the high internal consistency of the TVQMtF found in the current study confirms that the content of the TVQMtF reliably measures the self-perceptions of MtF women regarding their voice. The current findings also support the clinical utility of the TVQMtF providing a means of organizing TVQMtF responses to inform the voice training process.

Occupational Vocal Health of Elite Sports Coaches: An Exploratory Pilot Study of Football Coaches.

OBJECTIVE: To explore the occupational voice use and vocal health of elite football coaches. STUDY DESIGN: This pilot study explored coaches' voice use patterns and vocal demands across workplace environments. Each coach's experiences of voice symptoms and voice problems were also investigated. METHODS: Twelve Australian professional football coaches participated in a mixed-methods data collection approach. Data were collected through acoustic voice measurement (Ambulatory Phonation Monitor), semistructured interviews, and a voice symptom questionnaire (Voice Capabilities Questionnaire). RESULTS: Acoustic measures suggested heavy vocal loads for coaches during player training. All participants reported experiencing voice symptoms. They also suggested that the structure of their working week, workplace tasks, and vocal demands impacted on their voices. Despite this, participants reported little previous reflection or awareness of what impacted on their voices. Coaches typically did not consider how to support their voices during daily work and discussed experiencing voice symptoms as an inevitable part of their jobs. CONCLUSIONS: This study demonstrates that occupational vocal demands may negatively impact on sports coaches' vocal health. This is particularly important, considering coaches' heavy vocal loads across coaching tasks and reported negative occupational vocal health experience. Furthermore, coaches' limited insight into voice use and vocal health management may impact on their vocal performance and health. Given the exploratory nature of this study, further research into coaches' occupational vocal health is warranted.

Voice Problems in New Zealand Teachers: A National Survey.

OBJECTIVE: This study determined the prevalence and nature of voice problems in New Zealand (NZ) teachers using a national self-report questionnaire. STUDY DESIGN: Epidemiological cross-sectional survey. METHODS: Participants were 1879 primary and secondary teachers (72.5% females). Three prevalence timeframes were estimated. Severity of voice problems, recovery time, days away from work, symptoms, health assistance, and voice education were also investigated. RESULTS: Prevalence of self-reported vocal problems was 33.2% during their teaching career, 24.7% over the teaching year, and 13.2% on the day of the survey. Primary teachers (P<0.001; odds ratio [OR]=1.74; confidence interval [CI]=1.33-2.40), females (P=0.008; OR=1.63; CI=1.13-2.37), and those aged 51-60 years (P=0.010; OR=1.45; CI=1.11-3.00) were more likely to report problems. Among teachers reporting voice problems during the year, 47% were moderate or severe; for 30%, voice recovery took more than 1 week. Approximately 28% stayed away from work 1-3 days owing to a vocal problem and 9% for more than 3 days. Women reported longer recovery times and more days away. Symptoms associated with voice problems (P<0.001) were voice quality alteration (OR=4.35; CI=3.40-5.57), vocal effort (OR=1.15; CI=0.96-1.37), voice breaks (OR=1.55; CI=1.30-1.84), voice projection difficulty (OR=1.25; CI=1.04-1.50), and throat discomfort (OR=1.22; CI=1.02-1.47). Of the teachers reporting voice problems, only 22.5% consulted a health practitioner. Only 38% of the teachers with chronic voice problems visited an otolaryngologist. Higher hours of voice training/education were associated with fewer self-reported voice problems. CONCLUSIONS: Voice problems are of concern for NZ teachers, as has been reported for teachers in other countries. There is still limited awareness among teachers about vocal health, potential risks, and specialized health services for voice problems.

Treatment of dysphonia in older people: the role of the speech therapist.

PURPOSE OF REVIEW: This review addresses speech therapy interventions for older adults experiencing voice impairments. The prevalence, impact, and nature of voice impairments in older people are outlined. Intervention methods and their effectiveness are discussed, with particular focus on behavioral treatments for presbyphonia. The strength of current evidence is discussed and recommendations for future research are presented. RECENT FINDINGS: There has been a substantial increase in the number of older people seeking voice management over the last 10-20 years. Reduced vocal effectiveness in older people is likely to be multifactorial and associated with normal physiological aging, maladaptive responses to vocal aging, and medical and psychosocial conditions that are common in older age. Although several authors have claimed that behavioral intervention for presbyphonia is effective, few studies were reported until 2008. Since then, 10 studies have been published as to the effectiveness of behavioral interventions for age-related dysphonia. Voice therapy techniques evaluated include vocal function exercises, phonation resistance training exercise, Lessac-Madsen resonant voice therapy, Lee Silverman voice treatment, neuromuscular electrical stimulation, semi-occluded vocal tract, and flow phonation. Findings suggest that behavioral interventions for presbyphonia have the potential to mitigate effects of vocal aging, but the overall evidence base is inadequate to allow definitive conclusions. SUMMARY: Because vocal effectiveness diminishes as people age and because diminished vocal capabilities are associated with negative impacts, the importance of establishing whether behavioral interventions are effective is now acknowledged. Although the number of studies on speech therapy interventions has increased, the body of evidence is limited and further research is required.

Patterns of emotional expression and responses to health and illness in women with functional voice disorders (MTVD) and a comparison group.

OBJECTIVES: To determine whether emotional expression, alexithymia, illness behavior, and coping strategies differed between women with muscle tension voice disorder (MTVD) and those without voice disorder and between women with and without mucosal pathology of the vocal folds, and to explore possible links between psychosocial constructs and clinical features in women with MTVD. STUDY DESIGN AND METHOD: A within-subjects design matched 20 women with MTVD and 20 women without voice disorder on validated self-report measures of the psychosocial constructs. The effect of mucosal pathology was assessed using between-groups analyses. Correlations assessed relationships between psychosocial constructs and clinical features. RESULTS: Comparisons between women with MTVD and those without voice disorder showed an elevated sense of illness identity and greater belief in the presence of somatic illness in women with MTVD. There was a trend toward women with MTVD showing lower levels of emotional awareness. Women without vocal fold pathology reported lower levels of emotional awareness than those with pathology, whereas women with pathology reported greater use of a mixed pattern of adaptive and maladaptive coping strategies than those with no pathology. Low vocal load was associated with higher scores on alexithymia, higher numbers of vocal symptoms were associated with the use of adaptive coping, and greater impact of symptoms was associated with higher levels of emotional awareness and greater belief in the presence of somatic illness. CONCLUSIONS: These findings encourage further investigation of relationships between emotional awareness, illness behavior, and coping in women with functional voice disorders.

Development and preliminary evaluation of the transsexual voice questionnaire for male-to-female transsexuals.

OBJECTIVE: This study reports on the preliminary psychometric evaluation of the Transsexual Voice Questionnaire for Male-to-Female Transsexuals (MtF)-TVQ(MtF), a tool designed to measure the perceptions of MtF transsexuals regarding their voice. The TVQ(MtF) evolved from an extensive review of the existing Transgender Self-evaluation Questionnaire (TSEQ). STUDY DESIGN: This study was conducted in two phases. In phase I, the TSEQ was reviewed. In phase II, classical test theory was applied to examine two psychometric properties (internal consistency and test-retest reliability) of the TVQ(MtF). METHOD: In phase I, two speech pathologists and two MtF individuals reviewed the TSEQ, and a comparison was made with the results of a thematic analysis of 137 voice-related extracts from the transcripts of in-depth interviews with 14 MtF individuals. In phase II, 29 Australian and six Canadian MtF transsexuals completed the new tool, the TVQ(MtF) twice with an interim period of 4-6 weeks to enable psychometric evaluation. RESULTS: Phase I led to substantial changes to the content and structure of the original measure, the TSEQ, and the subsequent development of the TVQ(MtF). In phase II, internal consistency of the TVQ(MtF) was found to be high (time 1 Cronbach's α=.964; time 2 α=.974). Excellent test-retest reliability was demonstrated (intraclass correlation coefficient=0.979; 95% confidence interval=0.968-0.988). CONCLUSIONS: This study provides psychometric evidence of the reliability of the TVQ(MtF). The MtF participants in this study reported a wide range of vocal functioning and voice-related difficulties. Voice pitch was reported as the most problematic aspect of vocal functioning, and psychosocial issues were the most frequently reported voice-related impacts.

Development of an auditory-perceptual rating instrument for the operatic singing voice.

Although considerable progress has been made in the development of acoustic and physiological measures of operatic singing voice, there is still no widely accepted objective tool for the evaluation of its multidimensional features. Auditory-perceptual evaluation, therefore, remains an important evaluation method for singing pedagogues, voice scientists, and clinicians who work with opera singers. Few investigators, however, have attempted to develop standard auditory-perceptual tools for evaluation of the operatic voice. This study aimed to pilot test a new auditory-perceptual rating instrument for operatic singing voice. Nine expert teachers of operatic singing used the instrument to rate the singing voices of 21 professional opera chorus artists from a national opera company. The findings showed that the instrument has good face validity, that it can be legitimately treated as a psychometrically sound scale, and that raters can use the scale consistently, both between and within judges. This new instrument, therefore, has the potential to allow opera singers, their teachers, voice care clinicians, and researchers to evaluate the important auditory-perceptual features of operatic voice quality.