Effects of Occupation-Specific Vocal Stress on the Mental Health of Day Care Teachers.

INTRODUCTION: Kindergarten teachers are exposed to numerous kinds of strains, such as noise, which can negatively affect their voices. This cross-sectional study investigates whether and to what extent the profession-specific high vocal demand is associated with the educators' mental health. METHODS: One hundred and ninety-two kindergarten teachers from Magdeburg, Germany and its surrounding areas aged 43.4 ± 12.8 years, voluntarily participated in a survey. Vocal demand and vocal demand response, general strain factors, and mental health were assessed by using questionnaires (self-check on voice demands, Rudow checklist, General Health Questionnaire, and Maslach Burnout Inventory). The statistical analyses were carried out using SPSS. RESULTS: The interviewed educators felt stressed by the excessive number of work tasks and children in each class, noisy work environment, and loud conversations. In addition, educators complained of headaches and neck pain (66%), while 28% of them experienced hoarseness and a burning throat. The mental health of 39 of the educators was impaired, and nine were at an increased risk of burnout. Self-reported voice effort correlated low with mental health (r = 0.287; p < 0.001) and burnout risk (r = 0.306; p < 0.001). CONCLUSION: The vocal demands on educators in day care settings are very high, which is a major associated factor for the development of burnout syndrome and is also associated with headaches and neck pain. Measures for the prevention of occupational voice disorders and voice training should be a mandatory part of the educators' training and must be offered as in-service training.

Does the wearing of masks change voice and speech parameters?

PURPOSE: The authors aim to review available reports on the potential effects of masks on voice and speech parameters. METHODS: A literature search was conducted using MEDLINE and Google Scholar databases through July 2021. Several targeted populations, mask scenarios and methodologies were approached. The assessed voice parameters were divided into self-reported, acoustic and aerodynamic. RESULTS: It was observed that the wearing of a face mask has been shown to induce several changes in voice parameters: (1) self-reported-significantly increased vocal effort and fatigue, increased vocal tract discomfort and increased values of voice handicap index (VHI) were observed; (2) acoustics-increased voice intensity, altered formants frequency (F2 and F3) with no changes in fundamental frequency, increased harmonics-to-noise ratio (HNR) and increased mean spectral values in high-frequency levels (1000-8000 Hz), especially with KN95 mask; (3) aerodynamics-maximum phonatory time was assessed in only two reports, and showed no alterations. CONCLUSION: Despite the different populations, mask-type scenarios and methodologies described by each study, the results of this review outline the significant changes in voice characteristics with the use of face masks. Wearing a mask shows to increase the perception of vocal effort and an alteration of the vocal tract length and speech articulatory movements, leading to spectral sound changes, impaired communication and perception. Studies analyzing the effect of masks on voice aerodynamics are lacking. Further research is required to study the long-term effects of face masks on the potential development of voice pathology.

Predictive Risk Factors and Occupational Impact of Self-Perceived Voice Problems in Preschool-Kindergarten versus First- to Sixth-Grade Teachers.

AIM: The aim of this investigation was to complete a further analysis of existing data to compare risk factors of voice problems as well as create a hierarchical ranking of risk factors in preschool-kindergarten and 1st- to 6th-grade teachers in order to develop a voice hygiene program and prioritize its goals for each group of teachers. METHODS: An online survey was completed by 148 preschool-kindergarten and 301 1st- to 6th-grade public school teachers. Participants were divided into four groups, preschool-kindergarten and 1st- to 6th-grade teachers with no self-perceived voice disorders and preschool-kindergarten and 1st- to 6th-grade teachers with self-perceived voice disorders. A χ2 test and a multivariate logistic regression model were used to examine the differences in answers between the preschool-kindergarten teachers with and without voice disorders and the 1st- to 6th-grade teachers with and without voice disorders and to identify the most important predictors. RESULTS: The significant predictors for preschool-kindergarten teachers are frequently or sometimes continuing to talk after a breath cycle and being exposed to an excessive or a lot of noise generated in the classroom. The significant predictors for 1st- to 6th-grade teachers include having short breaks between classes and continuing to talk frequently after a breath cycle. CONCLUSIONS: Job-related risk factors in preschool-kindergarten and in 1st- to 6th-grade teachers may vary. Therefore, a preventative vocal hygiene education program specifically tailored for each population of teachers is suggested.

One-Year Follow-Up of a Vocal Hygiene Program for School-Age Children.

OBJECTIVE: This study investigated the effects of a school-based vocal hygiene education program "Green Voice for School" on promoting knowledge of healthy voice use for primary school students. METHODS: Thirty-nine grade 4 and 5 students from local primary schools participated in the "Green Voice for School" program. Students received 6 weekly vocal hygiene training sessions with the aim of enhancing their voice care knowledge. Their voice care knowledge was assessed by a 15-item questionnaire. Students' voice care knowledge was examined before training, immediately after, and 1 year after completion of the program. RESULTS: Students showed significant improvements in their voice care knowledge immediately after they received the vocal hygiene training sessions. Such improvements were maintained 1 year after the students completed training. CONCLUSIONS: The results suggest that "Green Voice for School", a school-based vocal hygiene education program, can be effective in promoting long-term improvements of voice care knowledge in school-age children.

Functional Voice and Swallowing Outcome Analysis After Thyroid Lobectomy: Transoral Endoscopic Vestibular Versus Open Approach.

BACKGROUND: The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a scarless remote-access thyroidectomy technique. This study compared subjective and objective voice outcomes and swallowing outcomes of patients who underwent thyroid lobectomy using the TOETVA versus conventional open thyroidectomy (OT). METHODS: In addition to questionnaires, acoustic and aerodynamic analyses were performed to compare subjective and objective voice outcomes of the two groups. Swallowing outcome analyses were conducted using Swallowing Impairment Index-6 (SIS-6) scores. Assessments were performed preoperatively and 3 and 6 months after surgery. Propensity score matching was performed to compare the outcomes of the two groups. RESULTS: One hundred and two patients were included in this study (52 TOETVA and 50 OT). Excluding two patients who had vocal cord palsy and open conversion in the TOETVA group, 100 patients completed 3-month postoperative surveys. There were no significant differences between the groups in VAS, GRBAS, or VHI-10 scores at the preoperative and 3- and 6-month assessments. For both groups, there were no significant changes in acoustic or aerodynamic parameters during the 3-6-month postoperative period. The TOETVA group had lower SIS-6 scores at the postoperative 6-month assessment, but the SIS-6 scores after 12 months were similar between groups before and after propensity score matching. CONCLUSIONS: Following TOETVA lobectomy, there were no significant changes in voice outcomes 3 and 6 months after surgery, and the outcomes were comparable with those of OT. The TOETVA group also had swallowing outcomes that were comparable with the OT group.

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.

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.

Neoglottis reconstruction with sternohyoid muscles on upper-tracheal orifice after laryngectomy.

Ideal speech restoration remains a difficult challenge for patients undergoing laryngectomy so far. Our aim was to explore the feasibility of neoglottic reconstruction with sternohyoid muscles on upper-tracheal orifice after total laryngectomy which can obtain relatively ideal voice rehabilitation. Fifteen male patients are laryngectomized, of whom eight with standard total laryngectomy and seven underwent nonstandard total laryngectomy with epiglottis conserved. After laryngectomy, the upper margin of the anterior hypopharyngeal mucosa (postcricoid mucosa) was stitched to the posterior margin of upper-tracheal orifice and a triangle-shaped neoglottis on upper-tracheal orifice was reconstructed using bilateral sternohyoid muscles near the hyoid bone which were sutured to the posterior wall and bilateral of upper-tracheal orifice. Then tracheolingual root anastomosis was done and reconstruction surgery was completed. Finally, a satisfactory voice was achieved in 14 of 15 patients except one whose neoglottis is stenosed and 11 cases had no severe complications including aspiration erroneous deglutition. The stomach catheters were removed successfully from 4 to 6 weeks after surgery in 11 cases, respectively. The neoglottis had to be closed in three patients because of aspiration problem. One neoglottis was closed 3 weeks after surgical reconstruction because of tracheal rings tear which created a bigger neoglottis. One neoglottis was removed 32 moths after total laryngectomy due to big neoglottis. Another one was closed 3 weeks after surgery by reason of the fear of aspiration without psychological preparation. Therefore, it is feasible to use the sternohyoid muscles for creation of a neoglottis on upper-tracheal orifice and provide an alternative surgical method of the voice restoration for the patients after laryngectomy.

[The comparative assessment of the vocal function in the professional voice users and non-occupational voice users in the late adulthood]. / Sravnitel'naia otsenka golosovoi funktsii u professionalov golosa pozhilogo vozrasta i lits negolosovykh professii.

The objective of the present study was to evaluate the clinical and functional condition of the voice apparatus in the elderly patients and to elaborate recommendations for the prevention of disturbances of the vocal function in the professional voice users. This comprehensive study involved 95 patients including the active professional voice users (n=48) and 45 non-occupational voice users at the age from 61 to 82 years with the employment history varying from 32 to 51 years. The study was designed to obtain the voice characteristics by means of the subjective auditory assessment, microlaryngoscopy, video laryngostroboscopy, determination of maximum phonation time (MPT), and computer-assisted acoustic analysis of the voice with the use of the MDVP Kay Pentaxy system. The level of anxiety of the patients was estimated based on the results of the HADS questionnaire study. It is concluded that the majority of the disturbances of the vocal function in the professional voice users have the functional nature. It is concluded that the method of neuro-muscular electrophonopedic stimulation (NMEPS) of laryngeal muscles is the method of choice for the diagnostics of the vocal function of the voice users in the late adulthood. It is recommended that the professional vocal load for such subjects should not exceed 12-14 hours per week. Rational psychotherapy must constitute an important component of the system of measures intended to support the working capacity of the voice users belonging to this age group.

Effects of speech style, room acoustics, and vocal fatigue on vocal effort.

Vocal effort is a physiological measure that accounts for changes in voice production as vocal loading increases. It has been quantified in terms of sound pressure level (SPL). This study investigates how vocal effort is affected by speaking style, room acoustics, and short-term vocal fatigue. Twenty subjects were recorded while reading a text at normal and loud volumes in anechoic, semi-reverberant, and reverberant rooms in the presence of classroom babble noise. The acoustics in each environment were modified by creating a strong first reflection in the talker position. After each task, the subjects answered questions addressing their perception of the vocal effort, comfort, control, and clarity of their own voice. Variation in SPL for each subject was measured per task. It was found that SPL and self-reported effort increased in the loud style and decreased when the reflective panels were present and when reverberation time increased. Self-reported comfort and control decreased in the loud style, while self-reported clarity increased when panels were present. The lowest magnitude of vocal fatigue was experienced in the semi-reverberant room. The results indicate that early reflections may be used to reduce vocal effort without modifying reverberation time.

Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises.

Concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer (HNC) is associated with substantial early and late side effects, most notably regarding swallowing function, but also regarding voice quality and quality of life (QoL). Despite increased awareness/knowledge on acute dysphagia in HNC survivors, long-term (i.e., beyond 5 years) prospectively collected data on objective and subjective treatment-induced functional outcomes (and their impact on QoL) still are scarce. The objective of this study was the assessment of long-term CCRT-induced results on swallowing function and voice quality in advanced HNC patients. The study was conducted as a randomized controlled trial on preventive swallowing rehabilitation (2006-2008) in a tertiary comprehensive HNC center with twenty-two disease-free and evaluable HNC patients as participants. Multidimensional assessment of functional sequels was performed with videofluoroscopy, mouth opening measurements, Functional Oral Intake Scale, acoustic voice parameters, and (study specific, SWAL-QoL, and VHI) questionnaires. Outcome measures at 6 years post-treatment were compared with results at baseline and at 2 years post-treatment. At a mean follow-up of 6.1 years most initial tumor-, and treatment-related problems remained similarly low to those observed after 2 years follow-up, except increased xerostomia (68%) and increased (mild) pain (32%). Acoustic voice analysis showed less voicedness, increased fundamental frequency, and more vocal effort for the tumors located below the hyoid bone (n = 12), without recovery to baseline values. Patients' subjective vocal function (VHI score) was good. Functional swallowing and voice problems at 6 years post-treatment are minimal in this patient cohort, originating from preventive and continued post-treatment rehabilitation programs.

[The value of supracricoid partial laryngectomy in moderately advanced laryngeal cancer (T3-T4a)]. / Stellenwert der suprakrikoidalen Teilresektion beim moderat fortgeschrittenen Glottiskarzinom (T3-T4a).

BACKGROUND: Transoral laser microsurgery (TLM) is the method of choice for partial laryngectomy in Germany. In advanced stages, chemoradiotherapy is increasingly indicated for organ preservation. OBJECTIVE: This report considers the indications for and outcomes of supracricoid partial laryngectomy (SPL), also known as crico-hyoido-(epiglotto)-pexy, as an option for surgical organ preservation in moderately advanced laryngeal cancer (T3-T4a), in the well-defined gap between TLM and chemoradiotherapy protocols in Germany. METHODS: Retrospective evaluation of functional and oncological outcomes of all SPLs conducted between 2008 and 2014. During this period, 17 SPLs with resection of rpT2 (n = 2), (r)pT3 (n = 11), and (r)pT4a (n = 4) were performed with resection of one arytenoid. Mean age was 58 years (range 47-75 years). In 5 patients, SPL was for a first or second local recurrence after TLM or open partial laryngectomy. Adjuvant radiotherapy was received by 7 patients staged pT4a or pN+. RESULTS: Salvage laryngectomy with adjuvant radiotherapy was required by 2 patients. The remaining patients (n = 15) had a mean tumor-free follow-up of 4 years with a functional intact larynx: these patients can eat and drink, have a closed tracheotomy, and a good voice. After 3 years tumor-free follow-up with a functional intact larynx, 2 patients died due to cardiac comorbidity at the age of 76 years. DISCUSSION: SPL is a rare but valuable option for surgical larynx preservation in stage pT3-4a laryngeal cancer.

[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.

Impact on quality of life in teachers after educational actions for prevention of voice disorders: a longitudinal study.

BACKGROUND: Voice problems are more common in teachers due to intensive voice use during routine at work. There is evidence that occupational disphonia prevention programs are important in improving the quality voice and consequently the quality of subjects' lives. AIM: To investigate the impact of educational voice interventions for teachers on quality of life and voice. METHODS: A longitudinal interventional study involving 70 teachers randomly selected from 11 public schools, 30 to receive educational intervention with vocal training exercises and vocal hygiene habits (experimental group) and 40 to receive guidance on vocal hygiene habits (control group control). Before the process of educational activities, the Voice-Related Quality of Life instrument (V-RQOL) was applied, and 3 months after conclusion of the activities, the subjects were interviewed again, using the same instrument. For data analysis, Prox MIXED were applied, with a level of significance α < 0.05. RESULTS: Teachers showed significantly higher domain and overall V-RQOL scores after preventive intervention, in both control and experimental groups. Nevertheless, there was no statistical difference in scores between the groups. CONCLUSION: Educational actions for vocal health had a positive impact on the quality of life of the participants, and the incorporation of permanent educational actions at institutional level is suggested.

Pulmonary rehabilitation after total laryngectomy: a randomized cross-over clinical trial comparing two different heat and moisture exchangers (HMEs).

Post-laryngectomy heat and moisture exchanger (HME) use is known to have a beneficial effect on tracheal climate, pulmonary symptoms and related aspects. This study aims to investigate differences in clinical effects between the first and second generation Provox HMEs. The second generation (Provox XtraHME) has better humidification properties than the first generation (Provox HME), and has been shown to further improve tracheal climate. Forty-five laryngectomized patients, who were already using an HME, participated in a prospective, randomized cross-over clinical study in which each HME was used for 6 weeks. Results showed that for most parameters studied, the second generation HME performed equally well or better than the first generation HME. The improvement in tracheal climate translated into patients reporting significantly less tracheal dryness with the second generation than with the first generation (p = 0.039). Using an HME with better humidification properties is related to a reduction in tracheal dryness in our study population.

The association of a preschool voice education program with changes in yelling frequency.

Voice problems in children can occur as early as infancy. Early onset of voice problems can carry social and academic penalties, and negatively affect voice in adolescence or adulthood. Unfortunately, only 1% of school-aged children receive voice therapy despite a 6 to 24% prevalence of voice disorders in school-aged children. One alternative may be to use a classroom-based voice education curriculum to effectively reduce yelling frequency, the most common behavior associated with phonotrauma-related voice problems in children. A classroom-based voice education curriculum was administered to preschool children by the preschool speech-language pathologists in a university-affiliated program. Classroom teachers provided cueing and reinforcement of curriculum strategies for 8 weeks following the program. Baseline frequencies of participant yelling behaviors were compared with postprogram frequencies. Results demonstrated significant reduction in yelling frequencies from pre- to postprogram, particularly in those judged as high-frequency yellers prior to the program. Important factors for future consideration are discussed.

Speaking fundamental frequency and phonation time during work and leisure time in vocally healthy preschool teachers measured with a voice accumulator.

OBJECTIVE: More knowledge is needed about preschool teachers' voice use to identify voice behaviours related to work demands that increase the risk for vocal dysfunction. The purpose of this study was to: (1) determine if speaking fundamental frequency (F0) and phonation time differ between work and leisure time and (2) describe variation in F0 and phonation time across the workday in preschool teachers with healthy voices. METHODS: A portable voice accumulator was used to collect data on F0 and phonation time. Twelve vocally healthy female preschool teachers participated in recordings during both work and leisure time for 2 successive days. Their mean age was 35 years (range 21-53 years). RESULTS: Mean F0 was high during the working day (266 Hz) and decreased significantly after work (p < 0.0001). F0 was high also during leisure time (246 Hz) as compared to reference F0 values for Swedish females based on laboratory recordings. Phonation time at work varied widely among the participants, with an average of 12.0%, and decreased significantly to 5.5% during leisure time (p < 0.0001). Most participants had few opportunities for voice rest during work. CONCLUSION: Swedish preschool teachers use high levels of F0 and phonation time during work compared to leisure time indicating high vocal load caused by work. To clarify the role of daily voice use in the causation of vocal dysfunction in this profession, recordings over several days are needed. In addition to F0 and phonation time, recordings of voice sound pressure level and background noise level seem important.

[Effects of acaoustic adaptation of classrooms on the quality of verbal communication]. / Wyniki badan wplywu adaptacji akustycznych sal lekcyjnych na jakosc komunikacji werbalnej.

BACKGROUND: Voice organ disorders among teachers are caused by excessive voice strain. One of the measures to reduce this strain is to decrease background noise when teaching. Increasing the acoustic absorption of the room is a technical measure for achieving this aim. The absorption level also improves speech intelligibility rated by the following parameters: room reverberation time and speech transmission index (STI). This article presents the effects of acoustic adaptation of classrooms on the quality of verbal communication, aimed at getting the speech intelligibility at the good or excellent level. MATERIAL AND METHODS: The article lists the criteria for evaluating classrooms in terms of the quality of verbal communication. The parameters were defined, using the measurement methods according to PN-EN ISO 3382-2:2010 and PN-EN 60268-16:2011. Acoustic adaptations were completed in two classrooms. RESULTS: After completing acoustic adaptations the reverberation time for the frequency of 1 kHz was reduced: in room no. 1 from 1.45 s to 0.44 s and in room no. 2 from 1.03 s to 0.37 s (maximum 0.65 s). At the same time, the speech transmission index increased: in room no. 1 from 0.55 (satisfactory speech intelligibility) to 0.75 (speech intelligibility close to excellent); in room no. 2 from 0.63 (good speech intelligibility) to 0.80 (excellent speech intelligibility). Therefore, it can be stated that prior to completing acoustic adaptations room no. 1 did not comply and room no. 2 barely complied with the criterion (speech transmission index of 0.62). After completing acoustic adaptations both rooms meet the requirements.

A User-Centered Design Approach to Developing a Voice Monitoring System for Disorder Prevention.

BACKGROUND: Many individuals will experience a voice disorder in their lifetime, especially occupational voice users. While a number of voice monitoring systems have been developed, most were designed with the clinician/researcher as the end user. For a patient to use these systems, they need field experts to help them interpret data from the system to understand its meaning. Most of these systems would have challenges in being used in a preventative context with the occupational voice user as the sole system user. OBJECTIVE: The current study introduces a novel design approach: user-centered design (UCD) with paper prototypes in the creation of a voice monitoring system for voice disorder prevention (VDP). The goal of this design approach is to design systems that are engaging and intuitive for users so they will be interested in interacting with the system and be able to benefit from the system without the need of external support. METHODS: The current study was conducted in two phases: an iterative design phase and a test phase. In the iterative design phase, 15 participants gave their opinions on the measures and feedback designs they felt would be the most beneficial to users. In the test phase, the researchers collected real voice data over multiple sessions for 18 additional participants and provided this data using the final feedback displays from the design phase. RESULTS: By engaging in UCD, the researchers identified key design challenges for VDP: (1) educating the user, (2) balancing contextualization and granularity, and (3) addressing disconnection between user and system goals. CONCLUSION: UCD holds promise for designing VDP systems that are both engaging and intuitive for occupational voice users.