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ABSTRACT: OBJECTIVES/HYPOTHESES: To assess the utility of a targeted voice hygiene (VH) program compared to VH plus voice training intervention (VH+VT) for the prevention and treatment of voice problems in student teachers. STUDY DESIGN: Prospective, randomized. METHODS: Thirty-one student teachers with low (good) and high (poor) voice handicap index (VHI) scores in Pittsburgh and Hong Kong were randomly assigned to (1) a targeted, individually tailored VH program, (2) the VH program plus resonant VT (VH+VT), or (c) a control group. Participants assigned to intervention groups were monitored for their adherence to their programs for their first 4 weeks of student teaching. VHI data were collected again 4 weeks postintervention (both sites) and 8 weeks postintervention, following a no-contact washout period (Pittsburgh). RESULTS: Descriptive data analysis indicated that across both sites, for initially healthy participants, the VH program was sufficient to prevent worsening of VHI scores that occurred in all control participants over the first 4-8 weeks of student teaching. The addition of VT did not consistently enhance protective benefits over VH alone. In contrast, for participants with initially poor VHI scores, the VH program failed to produce VHI benefits over the control condition. The addition of VT was required to optimize results for that cohort. CONCLUSIONS: Preliminary data suggest that a minimalist, individually tailored VH program may be sufficient to prevent voice problems from teaching in healthy student teachers. However, for student teachers with existing voice problems, VT may be required to optimize results of intervention.
Journal of voice: official journal of the Voice Foundation 08/2012; · 0.95 Impact Factor
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ABSTRACT: The study investigated the effect of immediate feedback in training listeners to perceive subtle differences in voice quality, a perceptual skill that is important for speech-language pathologists. Sixty naive listeners were randomly assigned to a feedback group (Group F), a no feedback group (Group NF), and a no training group acting as a control group (Group C). The task was to evaluate the severity of a perceptual voice quality (breathiness) by using a reference-matching paradigm. All participants took part in three rating sessions (pre-training, 2 days after training and 1 week after training). Group F and Group NF participated in a training session immediately after the first rating session, where Group F practiced with immediate feedback given and Group NF practice with no immediate feedback given. The results showed that Group F and Group NF had significant improvement after training, but Group F did not retain the improvement in the third rating session. The use of a reference-matching training paradigm without giving frequent immediate feedback is suggested for auditory-perceptual voice evaluation training. The most effective frequency of immediate feedback is yet to be determined.
International Journal of Speech-Language Pathology 05/2012; 14(4):363-9. · 1.00 Impact Factor
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ABSTRACT: High speed laryngoscopic study provides new information on the vocal fold vibratory patterns which has not been made possible before. Qualitative analysis of high speed laryngoscopic images is commonly reported in the literature. However, quantitative studies are necessary to provide objective measures for research and clinical purposes. This study reports the development of the High Speed Video Processing Program in analysing high-speed laryngoscopic video images obtained from 15 non-dysphonic speakers. Nine glottal ratio indices that represented the full opened glottal area, glottal width and glottal length were computed using the processing program. Data from two dysphonic participants were included to illustrate the manifestation of these glottal measures in dysphonic voices. Some of these glottal ratio index measures showed high variability across participants. However, significant differences were found in a number of index measures among the creaky, modal and falsetto registers in the non-dysphonic participants. In addition, the glottal area ratio index was found to be specifically sensitive in detecting dysphonia in high speed glottal images. The proposed semi-automatic High Speed Video Processing Program showed value in the analysis of high speed laryngoscopic images.
International Journal of Speech-Language Pathology 12/2010; 12(6):520-8. · 1.00 Impact Factor
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ABSTRACT: This study investigated the effect of acupuncture on emotional stress in subjects with phonotraumatic injuries. This study used a prospective randomized, placebo-controlled group design. The independent variable included the types of acupuncture (genuine vs sham) and the sampling time points (two pre-needling, one in the midway of needling, and two post-needling measurements). The dependent variable was the concentration of cortisol obtained from subjects' saliva samples. Eighteen female subjects with phonotraumatic injuries were randomized to receive either genuine or sham acupuncture at the same acupoints during a 30-minute session. Saliva samples were collected from each subject at 10 minutes pre-needling, immediately pre-needling, mid-needling, immediately postneedling, and 10 minutes post-needling time points. The findings suggested that the subjects' salivary cortisol concentration did not reduce after acupuncture, and thus, acupuncture may not be able to reduce the emotional stress level in female dysphonic speakers.
Journal of voice: official journal of the Voice Foundation 11/2010; 24(6):719-23. · 0.95 Impact Factor
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ABSTRACT: The present study investigated the effects of practice variability on the learning of relaxed phonation using a motor learning perspective. Twenty-one individuals with hyperfunctional voice problems were evenly and randomly assigned to three groups of practice conditions: constant, blocked, and random practice conditions. During training, participants in the constant practice condition were asked to read aloud sentence stimuli with four Chinese characters. Participants in the blocked practice condition were asked to read aloud sentence stimuli with increasing sentence length, starting from sets of two characters to five characters. Participants in the random practice condition were asked to practice reading sentence stimuli of variable length from two to five characters presented in a random fashion. Surface electromyographic feedback (sEMG) from the thyrohyoid muscle site was given to each participant after reading every two sentence stimuli. Results demonstrated that for all the participants, voice motor learning was evidenced by the decreased sEMG levels in delayed retention test. Generalization to untrained passage was shown as well. However, results did not reveal any difference in the learning among the three practice conditions. The findings from the present study did not support the hypothesis of contextual interference, which states that practice using variable items presented in a random mode is more beneficial to learning than practice using constant items.
Journal of voice: official journal of the Voice Foundation 04/2010; 25(3):e103-13. · 0.95 Impact Factor
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ABSTRACT: Perception of the impact of voice disorders may differ across different cultural backgrounds. This study investigated the difference in the perception of the impact of voice disorders between the American (Pittsburgh) and Chinese (Hong Kong) cultures. Study Design and Setting: Sixty dysphonic subjects from Hong Kong, China, and 60 dysphonic subjects from Pittsburgh, USA, were recruited to complete the Chinese and English versions of the Voice Activity and Participation Profile (VAPP), respectively. Data analyses using independent t tests were conducted on (1) the total profile scores; (b) total activity limitation score (ALS) and total participation restriction score (PRS); (c) section scores of job, daily communication, and social communication; and (d) section ALS and section PRS. Results: Hong Kong subjects showed significantly higher scores than the Pittsburgh subjects in total profile and other subsections except in the job PRS. Conclusion: Results support the possible influence of individualist and collectivist cultures on the perceived impact of voice disorders on the activity and participation.
Journal of voice: official journal of the Voice Foundation 03/2010; 25(3):348-53. · 0.95 Impact Factor
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ABSTRACT: To investigate (1) speech intelligibility and acceptability in using 4 different alaryngeal speech methods: esophageal (ES), electrolaryngeal (EL), pneumatic device (PD), and tracheosophageal (TE) speech; and (2) communication-related quality of life (QOL) in the alaryngeal speakers who used these 4 alaryngeal speech methods.
Survey.
Alaryngeal speakers who had undergone speech rehabilitation and were recruited from the New Voice Club of Hong Kong.
Speech samples collected from 49 alaryngeal speakers were rated by 6 judges for speech intelligibility and acceptability. The speakers also completed a communication-related QOL questionnaire called the Communication Activity and Participation After Laryngectomy.
We found that the ES and EL speakers showed considerably poorer speech intelligibility and communication-related QOL. The PD speakers demonstrated notably better speech intelligibility and acceptability ratings. However, high intelligibility and acceptability do not necessarily mean better QOL. The TE speakers, who demonstrated only the second highest speech intelligibility and acceptability, showed the best functional QOL.
In speech rehabilitation after laryngectomy, QOL and speech intelligibility and acceptability should be considered together to find a balance that is acceptable to the patient.
Archives of otolaryngology--head & neck surgery 08/2009; 135(7):704-11. · 1.92 Impact Factor
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ABSTRACT: Perceptual voice evaluation is a common clinical tool. However, to date, there is no consensus yet as to which common quality should be measured. Some available evidence shows that voice quality is a language-specific property which may be different across different languages. The familiarity of a language may affect the perception and reliability in rating voice quality.
The present study set out to investigate the effects of listeners' cultural and language backgrounds on the perception of voice qualities.
Forty speech pathology students from Australia and Hong Kong were asked to rate the breathy and rough qualities of synthesized voice signals in Cantonese and English.
Results showed that the English stimulus sets as a whole were rated less severely than the Cantonese stimuli by both groups of listeners. In addition, the male Cantonese and English breathy stimuli were rated differently by the Australian and Hong Kong listeners.
These results provided some evidence to support the claim that cultural and language backgrounds of the listeners would affect the perception for some voice quality types. Thus, the cultural and language backgrounds of judges should be taken into consideration in clinical voice evaluation.
Folia Phoniatrica et Logopaedica 02/2008; 60(3):107-19. · 1.12 Impact Factor
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ABSTRACT: The aim of this article is to describe how the World Health Organization's International Classification of Functioning, Disability and Health (ICF) can be adapted to describe the consequences of voice disorders. It first describes voice disorders under the four key components of the ICF: Body Functions, Body Structures, Activities and Participation, and Contextual (Environmental and Personal) Factors. It then describes the assessment and treatment tools for voice disorders using the ICF framework. Finally, a case example illustrating how the ICF frames the rehabilitation of an individual with voice disorders is presented.
Seminars in Speech and Language 12/2007; 28(4):343-50.
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ABSTRACT: One of the ways to improve the reliability in perceptual voice quality rating is to provide listeners with external anchors. A paired comparison matching paradigm using synthesized Cantonese voice stimuli that covered a range of rough and breathy qualities were used to investigate the rating reliability. Twenty-five speech pathology students rated the severity of roughness and breathiness of natural pathological voice samples using two paradigms: an eight-point anchored matching (paired comparison) paradigm and an eight-point non-anchored equal-appearing-interval (EAI) scale paradigm. The listeners also rated their confidence in judging each testing stimulus on a seven-point EAI scale. The results showed that the paired comparison method specifically improved the inter-rater reliability in rating male rough stimuli and mildly dysphonic female stimuli. The intra-rater agreement and confidence ratings remained similar across the two rating paradigms. These results suggest that the paired comparison paradigm may be used as an alternative perceptual voice quality evaluation tool.
Clinical Linguistics & Phonetics 03/2007; 21(2):129-45. · 0.64 Impact Factor
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ABSTRACT: The purpose of this study was to determine the most appropriate scaling procedure for evaluating voice activity limitation (AL) and voice participation restriction (PR). In a randomly counterbalanced design, 32 dysphonic individuals rated their self-perceived extents of voice AL and PR using two scaling procedures [equal-appearing interval (EAI) scaling and visual analogue (VA) scaling]. Results revealed that test-retest reliabilities were similar for the two scaling procedures. The overall extents of voice AL and PR obtained from the two scaling procedures were similar. Moreover, the significant linear relationships obtained between the EAI and VA data of voice AL and PR suggest both dimensions as metathetic in nature. Therefore, either EAI or VA scaling procedure would be considered as appropriate for rating voice AL and PR. However, the relative ease to use by consumers favours the choice of EAI over VA scaling procedure for evaluating voice AL and PR.
Folia Phoniatrica et Logopaedica 02/2007; 59(2):74-82. · 1.12 Impact Factor
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ABSTRACT: In recent years, the multiparametric approach for evaluating perceptual rating of voice quality has been advocated. This study evaluates the accuracy of predicting perceived overall severity of voice quality with a minimal set of aerodynamic, voice range profile (phonetogram), and acoustic perturbation measures. One hundred and twelve dysphonic persons (93 women and 19 men) with laryngeal pathologies and 41 normal controls (35 women and six men) with normal voices participated in this study. Perceptual severity judgement was carried out by four listeners rating the G (overall grade) parameter of the GRBAS scale. The minimal set of instrumental measures was selected based on the ability of the measure to discriminate between dysphonic and normal voices, and to attain at least a moderate correlation with perceived overall severity. Results indicated that perceived overall severity was best described by maximum phonation time of sustained /a/, peak intraoral pressure of the consonant-vowel /pi/ strings production, voice range profile area, and acoustic jitter. Direct-entry discriminant function analysis revealed that these four voice measures in combination correctly predicted 67.3% of perceived overall severity levels.
Journal of Voice 10/2006; 20(3):380-90. · 1.39 Impact Factor
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ABSTRACT: Modal and falsetto registers are the basic vocal qualities used in female speaking voices. The purpose of this study was to identify the frequency at which modal register changed to falsetto register and the frequency range of each modal and falsetto register produced under three loudness levels: soft, comfortable and loud phonations in normal and dysphonic speakers. These data provide information on the relationship between vocal registers. It is hypothesized that vocal pathologies affect the frequency at which register change from one mode to another mode. Fifteen dysphonic and 15 non-dysphonic females were assessed on their ability to produce tone series from the lowest to the highest frequency at soft, comfortable and loud phonations. Fourteen listeners served as judges to identify the first production of falsetto voice in each tone series. The first falsetto tone perceived was considered to represent the frequency at which the modal-falsetto register change occurred perceptually. The change from modal to falsetto register in the tone series occurred between G4 (360.74 Hz) and B4 (485.23 Hz) in the dysphonic group and between A4 (421.00 Hz) and B4 (476.13 Hz) in the non-dysphonic group among the three loudness levels. The results showed that the presence of dysphonia affected the production of vocal registers The dysphonic group demonstrated the modal-falsetto register change at a significantly lower frequency and reduced frequency range in the modal register than those of the non-dysphonic group in the soft and comfortable phonations. In producing falsetto register, the dysphonic group demonstrated reduced ability in producing falsetto register in soft and loud phonations when compared to the non-dysphonic group. Physiological explanations are used to account for the observations.
Clinical Linguistics & Phonetics 09/2006; 20(6):463-81. · 0.64 Impact Factor
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ABSTRACT: Studies have raised concerns about the reliability of traditional clinical perceptual voice evaluation. References, training, and the analysis-by-synthesis method were proposed to improve this reliability. However, no study has directly compared the effectiveness of these methods. This study compared two training programs that are based on an anchors method and a paired comparison method. The aim of the programs was to improve the ability of naive listeners to detect subtle differences in breathiness. This study found that trained listeners showed significant improvement after training. Equivocal results were found as to which of these training methods was more effective. However, it is suggested that listeners should be trained before they use the analysis-by-synthesis method. The findings of this study provided more information on developing the theoretical framework proposed by Kreiman et al, in particular the "nature" of the internal representations of voice quality. An exemplar-based approach for processing breathiness is proposed.
Journal of Voice 07/2006; 20(2):229-41. · 1.39 Impact Factor
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ABSTRACT: This study's broad objective was to examine the effectiveness of surface electromyographic (EMG) biofeedback for motor learning in the voice production domain. The specific objective was to examine whether concurrent or terminal biofeedback would facilitate learning for a relaxed laryngeal musculature task during spoken reading.
Twenty-two healthy adult speakers were randomly assigned to 1 of 2 groups. One group received real-time EMG waveform displays of muscle activation from bilateral thyrohyoid sites during reading trials (concurrent feedback group). The other group received static terminal EMG waveform displays about activation levels for the same sites on completion of successive trials (terminal feedback group). All participants were instructed to minimize EMG amplitudes from the thyrohyoid sites during phonation in an oral reading task. Signals were also collected from control, orofacial sites, but participants received neither instructions nor feedback for those sites.
The pooled data (2 feedback groups x 2 electrode sites) showed that, overall, muscle activation levels did decrease across baseline, training, and no-feedback test phases. However, no clear evidence was seen of reliable changes in the targeted laryngeal muscle activation levels across the phases, for either the concurrent or the terminal feedback groups. Paradoxically, and entirely unanticipated, reliable decreases were seen in muscle activation for the orofacial, no-feedback control sites. Those decreases were equivalent across concurrent and terminal feedback groups.
The unanticipated findings indicate that the provision of biofeedback for a target muscle group facilitated incidental learning in another, untargeted muscle group. Discussion focuses on the possible role of locus of attention in motor learning. Building on literature from other domains, the hypothesis is advanced that attention to muscular contractile force during training trials may suppress intentional learning for attended target sites but may benefit incidental learning for nearby, unattended sites.
Journal of Speech Language and Hearing Research 01/2006; 48(6):1254-68. · 1.88 Impact Factor
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ABSTRACT: Karaoke singing is a very popular entertainment among young people in Asia. It is a leisure singing activity with the singer's voice amplified with special acoustic effects in the backdrop of music. Music video and song captions are shown on television screen to remind the singers during singing. It is not uncommon to find participants singing continuously for four to five hours each time. As most of the karaoke singers have no formal training in singing, these amateur singers are more vulnerable to developing voice problems under these intensive singing activities. This study reports the performance of 20 young amateur singers (10 males and 10 females, aged between 20-25 years) on a series of phonatory function tasks carried out during continuous karaoke singing. Half of the singers were given water to drink and short duration of vocal rests at regular intervals during singing and the other half sang continuously without taking any water or rest. The subjects who were given hydration and vocal rests sang significantly longer than those who did not take any water or rest. The voice quality, as measured by perceptual and acoustic measures, and vocal function, as measured by phonetogram, did not show any significant changes during singing in the subjects who were given water and rest during the singing. However, subjects who sang continuously without drinking water and taking rests showed significant changes in the jitter measure and the highest pitch they could produce during singing. These results suggest that hydration and vocal rests are useful strategies to preserve voice function and quality during karaoke singing. This information is useful educational information for karaoke singers.
Journal of Voice 07/2003; 17(2):216-27. · 1.39 Impact Factor
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ABSTRACT: Perceptual voice analysis is a subjective process. However, despite reports of varying degrees of intrajudge and interjudge reliability, it is widely used in clinical voice evaluation. One of the ways to improve the reliability of this procedure is to provide judges with signals as external standards so that comparison can be made in relation to these "anchor" signals. The present study used a Klatt speech synthesizer to create a set of speech signals with varying degree of three different voice qualities based on a Cantonese sentence. The primary objective of the study was to determine whether different abnormal voice qualities could be synthesized using the "built-in" synthesis parameters using a perceptual study. The second objective was to determine the relationship between acoustic characteristics of the synthesized signals and perceptual judgment. Twenty Cantonese-speaking speech pathologists with at least three years of clinical experience in perceptual voice evaluation were asked to undertake two tasks. The first was to decide whether the voice quality of the synthesized signals was normal or not. The second was to decide whether the abnormal signals should be described as rough, breathy, or vocal fry. The results showed that signals generated with a small degree of aspiration noise were perceived as breathiness while signals with a small degree of flutter or double pulsing were perceived as roughness. When the flutter or double pulsing increased further, tremor and vocal fry, rather than roughness, were perceived. Furthermore, the amount of aspiration noise, flutter, or double pulsing required for male voice stimuli was different from that required for the female voice stimuli with a similar level of perceptual breathiness and roughness. These findings showed that changes in perceived vocal quality could be achieved by systematic modifications of synthesis parameters. This opens up the possibility of using synthesized voice signals as external standards or "anchors" to improve the reliability of clinical perceptual voice evaluation.
The Journal of the Acoustical Society of America 10/2002; 112(3 Pt 1):1091-101. · 1.55 Impact Factor
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Edwin M L Yiu
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ABSTRACT: Teachers are vulnerable to developing voice problems due to their specific occupational demands during teaching. Information on how the teaching profession is impacted by voice problems and what the profession perceives to be useful information for preventing voice problems is important for health care service providers. A total of 122 subjects from the teaching profession (55 practicing teachers and 67 prospective teachers) were therefore surveyed to ascertain their perception of their voice condition and the impact of voice problems on their communication, social life, personal emotions, and occupation. The results showed that the practicing teachers perceived their voice to be significantly worse than the prospective teachers. In addition, the teachers also faced significantly more difficulties in their daily communication than the prospective teachers. These two groups of subjects believed that information on breathing exercises and specific vocal hygiene strategies would help them prevent voice problems.
Journal of Voice 07/2002; 16(2):215-28. · 1.39 Impact Factor
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ABSTRACT: Perceptual voice evaluation is a common clinical tool for rating the severity of vocal quality impairment. However, the evaluation process involves subjective judgment, and reliability is therefore a major issue that needs to be considered. When listeners are asked to judge the quality of a voice signal, they use their own internal standards as the references. These internal standards can be variable, as different individuals may have acquired different standards in prior situations. In order to improve the reliability of the perceptual voice evaluation process, external anchors and training are provided to counteract the effect of these internal standards. This study investigated to what extent the provision of anchors and a training program would improve the reliability of perceptual voice evaluation by naive listeners. The results show, in general, that anchors and training helped to improve the reliability of perceptual voice evaluation, especially in the rating of male voices. Furthermore, it was found that anchors made up of synthesized signals combined with training were more effective in improving reliability in judging perceptual roughness and breathiness than natural voice anchors.
Journal of Speech Language and Hearing Research 03/2002; 45(1):111-26. · 1.88 Impact Factor
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ABSTRACT: Aerodynamic measures are frequently used to analyse and document pathological voices. Some normative data are available for speakers from the English-speaking population. However, no data are available yet for Chinese speakers despite the fact that they are one of the largest populations in the world. The high variability of aerodynamic measures between and within subjects raises the issue of reliability and usefulness of this procedure in discriminating between normal and pathological voices. This study aimed to investigate the use of mean airflow rate and sub-glottal pressure in predicting normal and pathological voices. It also aimed to determine whether a higher number of repeated airflow measures would provide a better representation of the normative data in distinguishing normal from abnormal voices. The study provided a small set of preliminary normative data for Chinese speakers. Aerodynamic measures were collected from 56 Cantonese female adults using a Kay Elemetrics Aerophone II. The results showed that the accuracy in predicting a voice to be dysphonic or normal using aerodynamic measures was as high as 91.1%. The accuracy was found to improve when the number of measurements for each aerodynamic parameter was increased from three to five. The overlapping of data between the dysphonic and non-dysphonic groups, however, suggests that the aerodynamic measures should be used as an adjunct to assessment of voice disorders rather than as a diagnostic tool alone.
Clinical Linguistics & Phonetics 18(6-8):463-78. · 0.64 Impact Factor
