Effectiveness of a Voice Training Program for Religious Officials in Turkey.

This study examines the effectiveness of a voice training program designed for Islamic religious officials, who are occupational voice users with a significant vocal load. The participants included 34 healthy religious officials whose acoustic measures were within normal voice ranges for healthy adults (jitter < 1%; shimmer < 3%) and reported no voice complaints. Participants were randomly divided into two groups (experimental, n = 17; control, n = 17). The two-stage voice training program consisted of 32 sessions over 8 weeks with informative and voice exercise stages. Objective and subjective voice measurements were performed at the beginning and end of the research. Objective measurements included fundamental frequency, percentage of vocal pitch perturbation (jitter), percentage of vocal intensity perturbation (shimmer), and harmonics-to-noise ratio. Subjective voice measurements included the Singing Voice Handicap Index, Vocal Fatigue Index (VFI), and Voice-Related Quality of Life (V-RQoL) scores. All initial measurements other than VFI scores were within acceptable limits for both groups. There were no significant differences between the groups initially (p > 0.05) and no significant changes in the control group in the second evaluation (p > 0.05). However, there was significant improvement in the experimental group after the training program in all measures, including VFI scores (p < 0.05). This study shows the positive results of a voice training program. Voice training should be integrated into the formal education of occupational voice users or in-service training programs of relevant institutions.

The effect of voice training interventions on patients with oropharyngeal dysphagia: a systematic review.

BACKGROUND: Voice training has been proposed as an intervention to improve swallowing function in patients with dysphagia. However, little is known about the effects of voice training on swallowing physiology. OBJECTIVES: This systematic review investigates the effect of voice training on the swallowing function of patients with oropharyngeal dysphagia and provides the theoretical basis for improving the swallowing function and life quality of patients with oropharyngeal dysphagia. DATA SOURCES: A systematic review using a narrative synthesis approach of all published studies was sought with no date restrictions. Five electronic databases (EMBASE, PubMed, CINAHL, Web of Science, and The Cochrane Library) were searched from inception to April 2022. STUDY SELECTION: Eight studies were included. Two researchers screened the literature according to inclusion and exclusion criteria, extracted data, and carried out quality control according to the Cochrane handbook5.1.0. Data were analyzed narratively and descriptively. CONCLUSIONS: In general, statistically significant positive therapy effects were found. Voice training improves the oral and pharyngeal stages of swallowing in patients with neurological causes of dysphagia, such as stroke, and in patients with non-neurological causes of dysphagia, such as head and neck cancer. However, the current literature is limited and further primary research is required to provide more evidence to support voice training intervention in dysphagia.  Future studies could  further refine the content of voice training interventions, increase the number of patients enrolled, assess the long-term effects of voice training interventions and add associated assessments of the quality of life after treatment.

Utilizing Virtual Reality for Gender-Affirming Voice Training: Surveying the Attitudes and Perspectives of Potential Consumers.

BACKGROUND: Undertaking voice and communication training is an important part of the gender-affirming journey for many trans, gender-diverse and non-binary individuals. Training supports the alignment of voice with gender identity helping to reduce gender dysphoria as individuals are better able to connect with their voices. However, for training to be effective, regular practice is needed and the demands of training can often be difficult to meet. AIMS: To investigate the interest, attitudes and perspectives on the use of immersive virtual reality (VR) to support gender-affirming voice and communication training by transgender, gender non-binary and gender-diverse people, and speech-language pathologists providing gender-affirming voice and communication training. METHODS & PROCEDURES: A mixed-methods survey (i.e., collecting quantitative data through multiple-choice question and qualitative data through free text questions) was hosted online from 23 August to 21 September 2021. A total of 17 questions asked about technology use, and attitudes and perspectives towards VR. The survey included video examples of three different voice-activated VR applications to prompt participant responses about the technology. OUTCOMES & RESULTS: A total of 70 survey responses were included in the analysis. All participants had previous experience using smart phones, but only 27.2% had previously used VR. Four key themes were identified relating to potential uptake of VR in gender-affirming voice and communication training: (1) general audience appeal, (2) perceived therapeutic value, (3) exposure to or protection from harm and (4) relatability to real life. CONCLUSIONS & IMPLICATIONS: VR games may represent a viable option to support practice of voice exercises. Gamification through VR is likely to motivate some to increase frequency of practice. VR applications that are used in voice training need to be fit-for-purpose, and detailed co-design is necessary to build appropriate applications for future use. This study provides a foundation to inform the design, development and implementation of VR applications to be used in gender-affirming voice training. WHAT THIS PAPER ADDS: What is already known on the subject? Speech-language pathologists work closely with transgender and gender-diverse individuals to help them achieve gender congruent voice and communication. Clients need to undertake regular and ongoing practice outside of training sessions to achieve and maintain their ideal voice. Motivation and adherence to regular practice sessions remain an ongoing challenge. What this study adds to the existing knowledge This study explores the use of immersive VR technologies to create safe, motivating and enjoyable environments to encourage regular practice of gender-affirming voice and communication exercises. It engages stakeholders in an early-stage participant-involved design to gauge interest in, and perspectives on, VR and technology-based training support tools. The results suggest that voice-activated VR applications would highly motivate some individuals if they were appropriately designed but would not be ideal for all. What are the actual and clinical implications of this work? Immersion in VR can be a highly motivating tool to enhance adherence to practice schedules for some individuals. However, tools need to be specifically designed with outcomes in mind to be fit-for-purpose, to support individual goals and to minimize the risk of harm. The few existing VR voice-activated applications that are available require further assessment, and redesign through co-design with users to functionally and safely support gender-affirming voice and communication training.

Multi-dimensional investigation of the clinical effectiveness and prognostic factors of voice therapy for benign voice disorders.

BACKGROUND/PURPOSE: Voice therapy is frequently recommended as the first-line treatment for benign voice disorders. This study investigated the clinical effectiveness of voice therapy and the prognostic factors of treatment outcomes. METHODS: We recruited 103 consecutive patients with voice disorders, namely vocal nodules, polyps, and muscle tension dysphonia (MTD), from September 2014 to July 2016. All the patients received voice therapy as the primary treatment. Treatment outcomes were evaluated using auditory perceptual evaluation, acoustic analysis, maximum phonation time, and 10-item voice handicap index (VHI-10). Clinical effectiveness of voice therapy was defined by either 1) a posttreatment VHI-10 score ≤ 10 points or 2) decline of VHI-10 ≥ 4 points. RESULTS: After voice therapy, VHI-10 and perceptual rating of voice quality improved significantly (p < 0.05) in the three disease categories. In patients with nodules, all the outcome parameters improved significantly (p < 0.05). Patients with good adherence to voice therapy (attending more than four sessions) had a significantly higher effectiveness than those with poor adherence (87% vs. 64%, p < 0.05). Patients with high occupational vocal demand also demonstrated a better effectiveness than those with routine vocal demand (90% vs. 70%, p < 0.05). Subsequent multivariate analyses revealed that adherence and vocal demand were independently and significantly correlated with clinical effectiveness (p = 0.03). CONCLUSION: Voice therapy is effective for patients with vocal nodules, polyps, and MTD. Adherence to voice therapy and occupational vocal demand are significant prognostic factors for treatment outcomes.

Perceived Gender and Client Satisfaction in Transgender Voice Work: Comparing Self and Listener Rating Scales across a Training Program.

BACKGROUND/AIM: Scales used to collect perceptual ratings related to a speaker's gender are widely used in gender affirming voice training for trans individuals. Such scales may be used as outcome measures to gain insight into whether training has helped clients meet personal goals related to gender expression. These scales are also widely used in general research investigating the relationship between vocal characteristics and perceptions of speaker gender. However, past studies in these areas have varied in the terminology used to label rating scales and the impact of this variation is currently unknown. Additionally, research has not yet fully explored the relationship between self- and listener ratings of trans participant voices and trans participant satisfaction with voice, and whether or not these relationships change after trans participants undertake gender affirming voice training. This research paper aimed to explore these relationships and address these research gaps. METHODS: A group of 34 trans participants were asked to rate their voices before and after participating in gender affirming voice training. Trans participant voice samples from before and after training were also presented to a group of 25 listeners for rating. Perceptual ratings were made on two visual analogue scales (VAS) with anchors "very feminine/very masculine" and "very female/very male." Trans participants also rated their satisfaction with their current voice on a VAS with anchors "very satisfied/very unsatisfied." Correlation coefficients were calculated to investigate the relationship between collected ratings. RESULTS: Differences in scale labels were found to have minimal impact on ratings made by both trans participants and listeners. Trans participant self-ratings were found to correlate with listener ratings, but this correlation was not strong. Trans participant self-ratings had a consistently stronger relationship with their self-rated vocal satisfaction. The study contributed new findings that these differences may be more pronounced after trans participants have completed voice training. DISCUSSION/CONCLUSION: This study suggests that results from past studies that have used differently labelled scales to collect ratings related to gender perception based on voice are suitable to compare. This study also discusses the implications reported differences between trans participant self-ratings and listener ratings may have for research and clinical practice.

Effect of voice therapy with or without transcutaneous electrical stimulation on recovery of injured macroscopically intact recurrent laryngeal nerve after thyroid surgery.

PURPOSE: Electrical stimulation-supported therapy is an often used modality. However, it still belongs to experimental methods in the human larynx. Data are lacking with which to evaluate the real effect in recurrent laryngeal nerve injury. The aim of this study was to investigate whether transcutaneous electrical stimulation added to voice therapy has a beneficial effect compared to voice therapy alone on vocal fold movement recovery in the case of an injured macroscopically intact recurrent laryngeal nerve. METHODS: Adults with unilateral vocal fold paralysis after thyroidectomy, in which the recurrent laryngeal nerve was left macroscopically intact, were included in this case-control study performed in tertiary referral hospital between September 2006 and June 2018. Among 175 eligible participants, 158 were included. Compliance with 6 months follow-up was 94.3%. INTERVENTIONS: medicament therapy and voice therapy (group 1) vs. medicament therapy and voice therapy and transcutaneous electrical stimulation (group 2). MAIN OUTCOME: vocal fold movement. RESULTS: A total of 149 patients were included in the analysis (group 1, 89 patients; group 2, 60 patients). The groups were homogenous. In groups 1 and 2, 64% and 60% of vocal folds, respectively, were improved after 6 months (P = 0.617). No difference was found between patients who improved and patients who did not improve. CONCLUSIONS: Adding transcutaneous electrical stimulation to voice therapy provided no beneficial effect on the recovery of vocal fold movement. Therefore, its indications should be re-evaluated; it is questionable whether stimulation should be routinely recommended.

Effects of a Voice Training Program on Acoustics, Vocal Use, and Perceptual Voice Parameters in Catalan Teachers.

OBJECTIVES: To assess the effect of EVES (Education for a Healthy and Efficient Voice), a voice training program aimed at promoting the use of an efficient and healthy voice in teachers. SAMPLE AND METHOD: Twenty-two teachers in the city of Granollers (Catalonia, Spain) were included in this research. The effect of the EVES program was evaluated focusing on the analysis of physiologic parameters on the one side (stroboscopy analysis), and on perceptual parameters on the other (Q-EVES questionnaire, Voice Handicap Index-10 [VHI-10], and GRBAS [Grade, Roughness, Breathiness, Asthenia, Strain Scale]). RESULTS: The teachers incorporated the vocal strategies in their professional life and reported that the perception of difficulty in using their voice decreased. We observed a significant improvement in VHI-10 markers, in voice management abilities in the classroom, in perceptive and subjective voice parameters, and in some functional lesions. CONCLUSIONS: The results suggest that the educational intervention model may have a positive effect on teachers' vocal care.

Influence of Voice Focus Adjustments on Oral-Nasal Balance in Speech and Song.

OBJECTIVES: This study investigated the effect of training backward and forward voice focus adjustments on oral-nasal balance in speech and singing in typical speakers. METHODS: Twenty participants (10M/10F) aged 24.25 (SD 3.73) years read phonetically balanced, nasal and oral speech stimuli, and sang a song in both forward and backward voice focus conditions. A Nasometer 6450 was used to obtain nasalance scores in the different conditions. RESULTS: Results indicated that forward voice focus resulted in more nasality (p < 0.01) for the oral stimulus and song. Backward voice focus caused a decrease in nasality (p < 0.01) for the nasal stimulus, the phonetically balanced paragraph, and the song. During production of the song, males were more nasal in the forward voice focus condition than females (p = 0.01). CONCLUSIONS: Voice focus can influence oral-nasal balance in normal speakers. More research is needed to investigate whether voice focus adjustments could be helpful to speakers with oral-nasal balance disorders.

Water Resistance Therapy as Vocal Warm-Up Method in Contemporary Commercial Music Singers.

BACKGROUND/AIMS: Although water resistance therapy (WRT) has been widely used in voice training, no data are supporting the effectiveness of WRT as vocal warm-up for singers. The present study aimed to determine the effects of WRT as a vocal warm-up method in contemporary commercial music (CCM) singers. METHODS: Twenty-two CCM singers were randomly assigned to one of two types of 15-min vocal warm-up: open vocal tract (OVT) warm-up and WRT. Self-perceived resonant voice quality and aerodynamic, electroglottographic, and acoustic measures were assessed before, immediately after vocal warm-up, and after 40 min of vocal loading. RESULTS: Significant results were found immediately after vocal warm-up. Subglottic pressure and inspiratory airflow duration decreased in both groups. SPL decreased for the OVT group. No changes in SPL were found for the WRT group. Significant results were observed after vocal loading. Subglottic pressure and inspiratory airflow duration decreased for both groups after vocal loading. Expiratory airflow duration and electroglottographic contact quotient decreased for the OVT group. CONCLUSION: Some objective data suggest that the WRT method is more effective as vocal warm-up than OVT exercises. Since outcomes in self-perceived resonant voice quality for both methods were similar but physiological effects were different, vocal warm-up strategies might produce a placebo effect.

Massed versus spaced practice in vocology: effect of a short-term intensive voice training versus a longer-term traditional voice training.

BACKGROUND: In contrast with most medical and pharmaceutical therapies, the optimal dosage for voice therapy or training is unknown. AIMS: The aim of this study was to compare the effect of a short-term intensive voice training (IVT) with a longer-term traditional voice training (TVT) on the vocal quality and vocal capacities of vocally healthy non-professional voice users. METHODS & PROCEDURES: A pre-/post-test randomized control group design with follow-up measurements was used. Twenty healthy female non-professional voice users with a mean age of 21.7 years (range = 20-24 years) were randomly assigned into a short-term IVT group (n = 10) or a longer-term TVT group (n = 10). Both groups received an identical 6-h lasting voice training. Only the distribution of practice varied between the groups: 2 h a day for 3 consecutive days for the IVT group versus two 30-min sessions a week for 6 weeks for the TVT group. In both groups, a voice assessment protocol consisting of subjective (questionnaire, participant's self-report, auditory-perceptual evaluation) and objective (maximum performance task, acoustic analysis, voice range profile, dysphonia severity index) measurements and determinations was used to evaluate the participants' voice pre- and post-training and at 6 weeks follow-up. Groups were compared over time using linear mixed models and generalized linear mixed models. Within-group effects of time were determined using post-hoc pairwise comparisons with Bonferroni corrections. OUTCOMES & RESULTS: No significant time-by-group interactions were found for any of the outcome measures, indicating no significant differences in evolution over time between the groups. Significant time effects were found for maximum phonation time, lowest intensity, lowest frequency, highest frequency and dysphonia severity index, all improving over time in both groups. More in-depth within-group analyses indicate a preference for the IVT group regarding the evolution of maximum phonation time, lowest frequency and dysphonia severity index, and a preference for the TVT group regarding the evolution of lowest intensity. CONCLUSIONS & IMPLICATIONS: Short-term IVT may be equally, or even more, effective in training vocally healthy non-professional voice users compared with longer-term TVT.

[Psychological effects of preventive voice care training in student teachers]. / Psychologische Effekte eines präventiven Stimmtrainings im Lehramtsreferendariat.

BACKGROUND: Studies on the effectiveness of preventive voice care programs have focused mainly on voice parameters. Psychological parameters, however, have not been investigated in detail so far. OBJECTIVES: The effect of a voice training program for German student teachers on psychological health parameters was investigated in a longitudinal study. METHODS: The sample of 204 student teachers was divided into the intervention group (n = 123), who participated in the voice training program, and the control group (n = 81), who received no voice training. Voice training contained ten 90-min group courses and an individual visit by the voice trainer in a teaching situation with feedback afterwards. Participants were asked to fill out questionnaires (self-efficacy, Short-Form Health Survey, self-consciousness, voice self-concept, work-related behaviour and experience patterns) at the beginning and the end of their student teacher training period. RESULTS: The training program showed significant positive influences on psychological health, voice self-concept (i.e. more positive perception and increased awareness of one's own voice) and work-related coping behaviour in the intervention group. On average, the mental health status of all participants reduced over time, whereas the status in the trained group diminished significantly less than in the control group. Furthermore, the trained student teachers gained abilities to cope with work-related stress better than those without training. CONCLUSION: The training program clearly showed a positive impact on mental health. The results maintain the importance of such a training program not only for voice health, but also for wide-ranging aspects of constitutional health.

Use of Auditory Feedback Amplifier in Women Without Voice Complaints: A Comparison of Acoustic Measures, Self-Rated Vocal Effort, and Voice Intensity.

OBJECTIVE: To compare the immediate effects of using MindVox in women without voice complaints for 1, 3, 5, and 7 minutes of reading tasks, on acoustic measurements of the vocal signal in low, medium, and strong intensity emissions; on self-rated effort vocal, and on the intensity of voice reception and production. METHODS: Participants read one text using MindVox for 1, 3, 5, and 7 minutes. After each time, measures of self-rated vocal effort were collected (BORG CR10-BR Scale), as well as samples of the vowel /e/ at low (>70 dB), moderate (≥70 dB and ≤80 dB), and high intensities (>80 dB). Acoustic measurements (F0, short-term acoustic measurements, and cepstral peak prominence measurements) were also collected before and after the procedure and subsequently analyzed in the CTS 5.0 Vox-Metria Program. Voice reception and production intensities were captured during the reading task using two decibel meters. One decibel meter was installed near the ear (average intensity received by the ear (EAVG)) and the other near the lips (average intensity captured near the lips (LAVG)), and the data were submitted for analysis. RESULTS: The Cepstral Peak Prominence-Smoothed increased in the first minute, the Cepstral Peak Prominence increased in the third minute, and the jitter decreased from the first minute. All these changes were observed at low intensity and were maintained at the other time points. For every 5 dB of amplification (EAVG), there was a 1 dB decrease in voice production (LAVG). CONCLUSION: Using MindVox in women without voice complaints brings positive immediate effects in cepstral measures and jitter at low intensity. There is a connection between the intensity of the voice received by the ear and the intensity of voice production.

Auditory-Perceptual Assessment and Acoustic Analysis of Gender Expression in the Voice.

OBJECTIVE: Determine if acoustic measurements exist that are predictive of Auditory-Perceptual Assessment (APA) of gender expression in the voice of transgender, nonbinary, and cisgender Brazilian speakers by transgender, nonbinary, and cisgender judges, as well as speech-language pathologists in the area of voice studies. METHODS: Cross-sectional study. Clips of speech (automatic speech and expressive reading of poetry) and sustained vowel emission of people of different genders were recorded and underwent APA for gender expression in the voice using a visual analog scale across 100 points, ranging from very masculine to very feminine. Sixteen acoustic measurements were extracted (noise, perturbation, spectral, and cepstral measurements). A descriptive and inferential analysis was performed using interclass coefficients of correlation and stepwise multiple linear regression, considering P < 0.05 for statistical significance. RESULTS: Forty-seven people of different genders had their voices recorded. The perceived gender of these voices was judged by 236 people (65 speech-language pathologists, 101 cisgender people, and 70 transgender and nonbinary people). The perceptions and measurements that were predictive of gender perception in the voice differed according to the task (vowel or speech) and the group of judges. The predictive acoustic measurements that were common in all groups were: speech-median F0, harmonic-to-noise ratio (HNR), F0 standard deviation (F0sd), average width between F0 peaks, and spectral emphasis (Emph); vowels-median F0, HNR, F0sd, and average width between F0 peaks. Divergent measurements between groups were: speech-coefficient of variation of intensity, speech rate (Sr), minimum and maximum F0, jitter, and shimmer; vowels-coefficient of variation of intensity, Emph, Sr, and minimum and maximum F0. CONCLUSION: There are acoustic measures that may predict APA; however, each group of judges considers different measures to evaluate gender, revealing an important influence of context on the evaluator in gender assessment through the voice.

Fear of public speaking: the effects of a communicational improvement training on physiological parameters and the perception of communication.

Presentations to audiences are often seen as challenging by university students, causing physiological reactivity on cortisol levels and heart rate, for example. Many students perceive that they have difficulties expressing themselves or do not consider themselves to be good communicators. With the thought that efficient communication is able to bring well-being and more confidence, it is understood that a communication skills training could mitigate adverse effects on the body during public speaking. This study aimed to verify whether a communicational improvement training can improve physiological parameters and perception when speaking in public among university students. This was a prospective, blinded, controlled, and randomized trial. Students from colleges and universities were recruited for this study. Invitations were either in person or via social networks and/or e-mail. There were 39 university students who completed the tasks, ages between 18 and 30. There were two groups: the intervention group (IG) and control group (CG). The intervention group participated in a communicational improvement program for six weeks to work on breathing, articulation, speech rhythm, pneumophonoarticulatory coordination, expressiveness and non-verbal communication. Data of heart rate measures, salivary cortisol analysis, self-perception of public speaking, and presentation ratings were collected. The intervention group presented with lower heart rates and cortisol levels, better presentation ratings, and higher self-perception of public speaking than the control group after participating in the communication improvement training. In this study it was possible to verify the efficiency of a communicational improvement training, being able to improve cortisol levels, heart rate, and perception when speaking in public in university students. Based on the results presented, new studies are suggested: (a) measuring the individual effect of the workshops demonstrated here and (b) comparing this type of intervention with other types of treatment used in the health area (medication, psychotherapeutic, holistic, etc.).

Water Resistance Therapy in Individuals with Parkinson's Disease: A Session-by-Session Analysis of the Vocal Quality.

OBJECTIVES: Verify session-by-session effects of the water resistance therapy (WRT) on the vocal quality of individuals with Parkinson's disease (PD). METHODS: This is a retrospective analytical study. Then, the samples were acquired from a database composed of 10 men aged between 50 and 90 years old diagnosed with PD. The participants underwent WRT with a resonance tube; then, they were guided to perform the following phonatory tasks: comfortable pitch and loudness, high pitch, low pitch, ascending and descending glissandos, and sentence uttering. Furthermore, tube depth ranged from 2 cm to 9 cm. Finally, WRT was implemented twice per week, totaling eight sessions, each lasting 45 minutes. Participants were assessed before and after each therapy session. Hence, the data were assessed with spectrographic analysis, vocal intensity, cepstral peak prominence-smoothed, alpha ratio, L1-L0, oscillatory frequency, and auditory-perceptual assessment of overall degree, roughness, breathiness, and instability. One-way repeated measures analysis of variance and Friedman tests were applied (P < 0.05). Furthermore, Holm-Sidak and Tukey tests were used as posthoc tests. RESULTS: After the sixth session, the spectrographic analysis revealed that the tracing color intensity of medium frequencies darkened, whereas a better result could be observed after the eighth session. Regarding vocal intensity, the improvement could be observed from the third session. Additionally, L1-L0 followed the same results. The overall degree auditory-perceptual assessment revealed the best results only after the second, third, and fourth sessions; however, after the eighth session, the instability increased. CONCLUSIONS: WRT allowed better results from the third session, with some improvements in the sixth session. However, the instability increased after the eighth session; thus, it is important to review the phonatory tasks and session numbers to avoid an overload in the phonatory system.

Word and Gender Identification in the Speech of Transgender Individuals.

Listeners use speech to identify both linguistic information, such as the word being produced, and indexical attributes, such as the gender of the speaker. Previous research has shown that these two aspects of speech perception are interrelated. It is important to understand this relationship in the context of gender-affirming voice training (GAVT), where changes in speech production as part of a speaker's gender-affirming care could potentially influence listeners' recognition of the intended utterance. This study conducted a secondary analysis of data from an experiment in which trans women matched shifted targets for the second formant frequency using visual-acoustic biofeedback. Utterances were synthetically altered to feature a gender-ambiguous fundamental frequency and were presented to blinded listeners for rating on a visual analog scale representing the gender spectrum, as well as word identification in a forced-choice task. We found a statistically significant association between the accuracy of word identification and the gender rating of utterances. However, there was no statistically significant difference in word identification accuracy for the formant-shifted conditions relative to an unshifted condition. Overall, these results support previous research in finding that word identification and speaker gender identification are interrelated processes; however, the findings also suggest that a small magnitude of shift in formant frequencies (of the type that might be pursued in a GAVT context) does not have a significant negative impact on the perceptual recoverability of isolated words.

Phonatory Tasks and Outcome Measures for Assessing Vocal Fatigue: A Scoping Review.

OBJECTIVES: To map the phonatory tasks and the result measures used to evaluate vocal fatigue in vocally healthy individuals. METHODS: This is a scoping review based on the following research question: What are the phonatory tasks and outcome measures used for the evaluation of vocal fatigue in vocally healthy individuals? The construction of the search strategy followed the PCC strategy; population: vocally healthy adult individuals; concept: phonatory tasks and vocal evaluation measures; and context: vocal fatigue. The search was performed electronically in the databases Medline (PubMed), LILACS (BVS), SCOPUS (Elsevier), Web of Science (Clarivate), EMBASE, and COCHRANE. A manual search in the references of the selected articles and in the journal with the highest number of publications was also performed. The selection of articles was based on reading the titles, abstracts, and full text, applying the eligibility criteria. The selected articles were related to the evaluation of vocal fatigue in healthy individuals from a predetermined vocal load task. Data regarding the characteristics of the publication, sample, phonatory tasks, and outcomes were extracted. The results were presented in a descriptive format, due to a frequency distribution analysis. RESULTS: In total, 3756 studies were identified during the search, of which 60 were selected. The most used vocal load activity was the reading task, with duration ranging from 46 to 120 minutes. The (1) sustained vowel /a/ and (2) the reading of texts and phrases, both in usual intensity and frequency without the interference of the researcher, were the most used evaluation tasks. The most used outcome measures are the following: (1) acoustic parameters-fundamental frequency [fo] (mean, variance), sound pressure level (mean), local jitter (%), local shimmer (%), cepstral peak prominence (mean); (2) vocal self-assessment by the validated instruments-Perceived Phonatory Effort Scale, Visual Analog Scale, Borg-CR-10 Scale. CONCLUSIONS: There is a diversity of phonatory tasks and outcome measures recurrently used in scientific articles to evaluate the signs of vocal fatigue in vocally healthy individuals. The most used vocal sample to evaluate vocal fatigue was the sustained vowel /a/ in habitual intensity and frequency without the interference of the researcher. The most frequently reported outcome measures for the assessment of immediate vocal fatigue effects were the acoustic analysis and vocal self-assessment.

First-Person Perspectives of Gender-Affirming Voice Feminization Training: A Mixed Methods Approach.

OBJECTIVES: Despite evidence for the validity of using client-led outcome measures in gender-affirming voice training (GAVT), the existing body of research on voice feminization relies heavily on acoustic-perceptual measures without additional qualitative exploration of client experience. Additionally, the authors are not aware of any existing studies prompting client input on the voice feminization methods they find most helpful in achieving their voice goals. The current study focuses on crucial client perceptions of GAVT for voice feminization and identifies the methods clients find most helpful. METHODS: Using a mixed-methods approach, we gathered numeric and qualitative survey data from 21 individuals who engaged in GAVT supporting voice feminization. We conducted follow-up interviews with five survey participants to gather additional qualitative data on client experiences and perceptions of GAVT. RESULTS: Quantitative and qualitative data reveal that clients are satisfied with GAVT supporting voice feminization, perceive their clinicians as being culturally inclusive, and identify oral/forward resonance work as one of the most helpful voice training methods. Interestingly, however, frequency of work on oral/forward resonance during training did not predict voice satisfaction post-training. CONCLUSIONS: Clients identified oral/forward resonance as one of the most helpful methods of voice feminization and found their GAVT experiences to be supportive of their voice goals. These findings emphasize the importance and value of client-led outcome measures when investigating effective approaches to GAVT.

Long-term Acoustic Effects of Gender-Affirming Voice Training in Transgender Women.

OBJECTIVES: One role of a speech-language pathologist (SLP) is to help transgender clients in developing a healthy, gender-congruent communication. Transgender women frequently approach SLPs to train their voices to sound more feminine, however, long-term acoustic effects of the training needs to be rigorously examined in effectiveness studies. The aim of this study was to investigate the long-term effects (follow-up 1: 3months and follow-up 2: 1year after last session) of gender-affirming voice training for transgender women, in terms of acoustic parameters. STUDY DESIGN: This study was a randomized sham-controlled trial with a cross-over design. METHODS: Twenty-six transgender women were included for follow-up 1 and 18 for follow-up 2. All participants received 14weeks of gender-affirming voice training (4weeks sham training, 10weeks of voice feminization training: 5weeks pitch elevation training and 5weeks articulation-resonance training), but in a different order. Speech samples were recorded with Praat at four different time points (pre, post, follow-up 1, follow-up 2). Acoustic analysis included fo of sustained vowel /a:/, reading and spontaneous speech. Formant frequencies (F1-F2-F3) of vowels /a/, /i/, and /u/ were determined and vowel space was calculated. A linear mixed model was used to compare the acoustic voice measurements between measurements (pre - post, pre - follow-up 1, pre - follow-up 2, post - follow-up 1, post - follow-up 2, follow-up 1 - follow-up 2). RESULTS: Most of the fo measurements and formant frequencies that increased immediately after the intervention, were stable at both follow-up measurements. The median fo during the sustained vowel, reading and spontaneous speech stayed increased at both follow-ups compared to the pre-measurement. However, a decrease of 16 Hz/1.7 ST (reading) and 12 Hz/1.5 ST (spontaneous speech) was detected between the post-measurement (169 Hz for reading, 144 Hz for spontaneous speech) and 1year after the last session (153 Hz and 132 Hz, respectively). The lower limit of fo did not change during reading and spontaneous speech, both directly after the intervention and during both follow-ups. F1-2 of vowel /a/ and the vowel space increased after the intervention and both follow-ups. Individual analyses showed that more aspects should be controlled after the intervention, such as exercises that were performed at home, or the duration of extra gender-affirming voice training sessions. CONCLUSIONS: After 10 sessions of voice feminization training and follow-up measurements after 3months and 1year, stable increases were found for some formant frequencies and fo measurements, but not all of them. More time should be spent on increasing the fifth percentile of fo, as the lower limit of fo also contributes to the perception of more feminine voice.

Effect of voice training intervention on swallowing function in patients with head and neck cancer undergoing radiotherapy: A randomized controlled trial.

PURPOSE: We aimed to evaluate the effect of voice training in patients with head and neck cancer who were undergoing radiotherapy. METHOD: This study used a randomized controlled trial design. IBM SPSS 26.0 was used to randomly divide 74 patients into a control group and an experimental group. The control group followed a swallowing exercises program, and the experimental group additionally received ABCLOVE voice training. Both training programs continued throughout the entire radiotherapy cycle. We compared standardized swallowing assessment (SSA), maximum phonation time (MPT), the Voice Handicap Index-10, and incidence of complications such as difficulty opening the mouth, malnutrition, and aspiration between the two groups at T1 (0 radiotherapy sessions, before radiotherapy), T2 (15-16 radiotherapy sessions, middle of radiotherapy), and T3 (30-32 radiotherapy sessions, end of radiotherapy). RESULTS: 70 participants completed this study. Swallowing function and MPT intergroup and interaction effects were statistically significant between the two groups (P < 0.05). At the end of radiotherapy (T3), the SSA score (20.77 ± 1.96) and MPT (10.98 ± 1.75) s in the experimental group were superior to those in the control group (SSA: 22.06 ± 2.38 and MPT: 9.49±1.41 s), with statistical significance (P<0.05). Moreover, the incidence of malnutrition and aspiration in the experimental group was lower than that in the control group (P < 0.05). CONCLUSION: Voice training can improve swallowing function and MPT and reduce complications related to swallowing disorders in patients with head and neck cancer.