Article

Cervical Spine Abnormalities in Professional Singers

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Abstract

A systematic X-ray study of the cervical spine of three populations of subjects (professional singers, beginning singers, and non-singers) who exhibited no vertebral column pathology or postural disorders provided evidence of abnormalities in the shape of the cervical spine in all of the professional singers studied. The disorders observed included hypolordosis, and more frequently, cervical rectitude or hypocyphosis without functional hindrance. The findings can be explained in terms of deformations undergone by the cervical spine after many years of intensive singing. The resulting functional postures are memorized and become an integral part of the singer's corporal schema. The considerable amount of anterior-posterior movement of the cervical spine in singing explains why lesions which prevent its mobility have an overall impact on the singer's voice, particularly in the upper pitch range.

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... On average, the change from humming a low note to humming a high note was accompanied by an increase in the upper craniocervical angles, a rise of the hyoid and larynx in relation to the cranial base, and greater distances between the sternum and hyoid, and between C3 and the menton. Finding a rise in pitch to be associated with greater craniocervical angles was Craniocervical changes have been reported in association with voice production but these studies were based within a phonetic context and changes attributed to jaw opening (20) or the development of a more forward head posture (21). In a little known study, Mitchinson 9 and Yoffey (1948) (22) used X-ray to investigate vocal fold changes while humming at each end of the vocal range. ...
... These findings are important and require further investigation as the implications are wide-ranging. For example, a better understanding of structural adjustments accompanying changes of pitch might help explain cervical curvature changes while singing, the increased incidence of cervical abnormalities in professional opera singers compared with non-singers (20,21,26,27), and the development of voice difficulties in some patients (especially female singers) following cervical spine surgery, (28). These findings are also relevant in the light of recent suggestions that cervical muscles might have a role in "fine-tuning" during pitch production (27). ...
... However, details of the mechanisms underlying this highly complex and coordinated activity remain unclear. Although reports and suggestions of synergistic activity between vocal structures are increasing in voice research literature, (12,20,(32)(33)(34)(35)(36)(36)(37)(38) a coherent framework within which to explain these observations is so far lacking (39,40). We suggest that knowledge and awareness of pitch-dependent patterns of However, the patterns of highly and very highly correlated variables (r ≥ 0.79) associated with the hyocervical distance, hy-c3, warrant special attention (Figs.3.4 and 3.5). ...
Article
Traditional voice research occurs within a phonetic context. Accordingly, pitch-related contributions are inseparable from those due to articulator input. In humming, articulator input is negligible. Using magnetic resonance imaging, we test the hypothesis that voice production is accompanied by pitch-related adjustments unrelated to articulatory or postural input. In this cross-sectional study, 10 healthy volunteers (five men, five women, aged 20-47 years, median 25 years), including singers (6 months to 10 years tuition, median 2 years) and non-singers, were assessed to establish the lowest and highest notes they could comfortably sustain while humming over 20 seconds. With head position stable, midsagittal images were acquired while volunteers hummed these predetermined low and high notes. Twenty-two craniocervical, angular, and linear dimensions defined on these images were compared using one-way repeated-measures analysis of variance. Correlations between variables were sought using Pearson correlation coefficient. We found significant differences between low- and high-note conditions in six of 22 measures and widespread pitch-related correlations between variables (r≥0.63, P<0.05). Compared with low-note humming, high-note humming was accompanied by increased craniocervical angles opt/nsl and cvt/nsl (P=0.008 and 0.002, respectively); widening of the C3-menton distance (P=0.003), a rise of the larynx and hyoid in relation to the cranial base (P=0.012 and <0.001, respectively), and an increased sternum-hyoid distance (P<0.001). Voice production is accompanied by pitch-related adjustments that are currently being masked by, or mistakenly attributed to, articulatory or postural input, identification of which could improve understanding of mechanisms underlying speech and song.
... Professional opera singing involves interactions between the laryngeal structures and the cervical spine vertebrae, which vary according to the singer's vocal timbre and intensity [16]. Correct postural alignment of the head and neck is a necessary element in the optimization of voice production [24]. ...
... Positional changes to head and neck posture have been shown to alter the quality of the voice thereby supporting the hypothesis that the motor system controlling phonation is functionally coupled with the motor system controlling posture of the head and neck [11]. Any process impairing anterior-posterior movement of the cervical spine is likely to impact on the exquisite control of airflow and air pressure through the vocal tract required for accuracy of the singing task [16]. The inability to undergo discrete positional adjustments of the cervical spine vertebrae may be a factor that contributes to singing impairment, a rare but important complication reported subsequent to cervical spine discectomy and fusion procedures [25]. ...
... During singing, the trained singer combines physiological strategies including adjustments taking place between the respiratory, articulatory and laryngeal systems, which are different from the untrained singer [3]. Results from studies by Scotto di Carlo [16] have also demonstrated that there are specific head and cervical spine postures for each of the three vowel registers. ...
Article
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Difficulty with singing is a rare but important complication following cervical spine surgery but there is little objective information regarding the cervical and head postural changes taking place during singing. The aim of this study was to identify postural changes in the cranio-cervical region associated with the demands of voice production in professional opera singing. The two Roentgen-cephalograms, one of which are taken whilst performing a specified singing task were taken from 18 professional opera students, 12 females (mean age 20.86 +/- 3.07 years) and six males (18.66 +/- 1.36 years). A paired t test compared mean cranio-cervical postural and pharyngeal/hyoid variables between the two registrations (P = 0.05). The association between the cranio-cervical postural variables and the pharyngeal/hyoid region in each registration position was examined using Spearman's rank correlation coefficient. In singing, the position of the atlas with respect to the true vertical (P < 0.001), the axis (P < 0.001) and the C4 vertebra both with respect to the horizontal (P < 0.001), and the axis with respect to the cranium (P < 0.001), were all significantly different to those at rest. Of the cranio-cervical postural variables in the singing registration, the angles measuring positional change of the atlas and C4 relative to the true horizontal were shown be significantly related to an increased pharyngeal airway space at the C3 level (P < 0.01). An appreciation of the requirement for the cervical spine to undergo postural change during professional opera singing has relevance to the potential impact on voice quality in professional opera singers should they undergo cervical spine surgery.
... Additionally, a deviant body posture, especially an increased lumbal lordosis with consequently a distorted elevation of the neck, reduces a fl exible breathing pattern and results in a reduction and compression of the vocal tract [6] . Pitch problems in singers are explained as being caused among others by cervical abnormalities [5] . The position of the larynx, assumed to be important for phonation, can be affected by the inhalatory behaviour of the speaker [6] . ...
... In this study more than 70% of the subjects ( fi g. 2 ) had an anteroposition of the head. The deviant cervical lordosis may negatively infl uence the control of pitch regulation and fi ne tuning of the phonation process [5,10,21,30] . The speaker or singer needs an increased muscle tension, or at least a compensation mechanism, to be able to reach the same aim. ...
Article
The aim of this study was to investigate the relationship between extrinsic laryngeal muscular hypertonicity and deviant body posture on the one hand and voice handicap and voice quality on the other hand in teachers with persistent voice complaints and a history of voice-related absenteeism. The study group consisted of 25 female teachers. A voice therapist assessed extrinsic laryngeal muscular tension and a physical therapist assessed body posture. The assessed parameters were clustered in categories. The parameters in the different categories represent the same function. Further a tension/posture index was created, which is the summation of the different parameters. The different parameters and the index were related to the Voice Handicap Index (VHI) and the Dysphonia Severity Index (DSI). The scores of the VHI and the individual parameters differ significantly except for the posterior weight bearing and tension of the sternocleidomastoid muscle. There was also a significant difference between the individual parameters and the DSI, except for tension of the cricothyroid muscle and posterior weight bearing. The score of the tension/posture index correlates significantly with both the VHI and the DSI. In a linear regression analysis, the combination of hypertonicity of the sternocleidomastoid, the geniohyoid muscles and posterior weight bearing is the most important predictor for a high voice handicap. The combination of hypertonicity of the geniohyoid muscle, posterior weight bearing, high position of the hyoid bone, hypertonicity of the cricothyroid muscle and anteroposition of the head is the most important predictor for a low DSI score. The results of this study show the higher the score of the index, the higher the score of the voice handicap and the worse the voice quality is. Moreover, the results are indicative for the importance of assessment of muscular tension and body posture in the diagnosis of voice disorders.
... 6 Craniocervical positional changes have been reported to influence voice production. 8 Therefore, posture has been understood as an important component of voice quality, especially from studies of functional dysphonia and more precisely with the introduction of the classification of the vocal abuse/misuse syndrome also referred to as the Bogart-Bacall syndrome and muscle tension dysphonia. 9 A good posture is considered an optimum alignment of the body, with minimal energy requirements from the neuromuscular system without causing excessive strain on the various tissues. ...
... 5,31 Craniocervical changes have been reported in association with impairments in voice production. 8 Mitchinson and Yoffey 32 observed that the change from humming a low note to a high note was accompanied by increased anteroposterior thickness of the prevertebral soft tissues. Some studies included in this review 28,29,31 also related craniocervical changes with voice production. ...
... 6 Craniocervical positional changes have been reported to influence voice production. 8 Therefore, posture has been understood as an important component of voice quality, especially from studies of functional dysphonia and more precisely with the introduction of the classification of the vocal abuse/misuse syndrome also referred to as the Bogart-Bacall syndrome and muscle tension dysphonia. 9 A good posture is considered an optimum alignment of the body, with minimal energy requirements from the neuromuscular system without causing excessive strain on the various tissues. ...
... 5,31 Craniocervical changes have been reported in association with impairments in voice production. 8 Mitchinson and Yoffey 32 observed that the change from humming a low note to a high note was accompanied by increased anteroposterior thickness of the prevertebral soft tissues. Some studies included in this review 28,29,31 also related craniocervical changes with voice production. ...
Article
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Objective: The study aimed to systematize the associations between posture, voice, and dysphonia in order to support future research directions and possible clinical interventions. Study design: The study is a systematic review. Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart, a search on PubMed/Medline, SciELO, RCAAP, LILACS, Cochrane Library, PEDro, and Isi Web of Knowledge was performed from their inception through January of 2017 using the key words "posture" and ("voice" or "dysphonia"). The inclusion criteria were full-text journal articles in French, English, Portuguese, or Spanish, exploring the relationship between posture and voice or dysphonia, in adult human beings. The exclusion criteria coupled treatments for voice disorders, literature reviews and meta-analyses, case studies, opinion articles, and studies linking breathing with posture without assessing voice. Studies were analyzed using a modified version of the Newcastle-Ottawa Scale (NOS). Results: Twelve papers met the inclusion criteria with high methodological quality through the NOS. The review shows that a correct posture is necessary for an efficient voice production; however, the relation between dysphonia and posture seems to be contradictory. Conclusion: An effective posture allows a subject in a static posture or while moving to more easily shift the tension between muscles, allowing for a free movement of the larynx without blockages and with benefits to voice production.
... La estabilidad cervical proporciona una base para la movilidad laríngea importante para la emisión vocal (Scotto di Carlo, 1998;Kooijman et al., 2005). ...
Article
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El presente estudio supone una aproximación a la voz, su fenomenología y rehabilitación, a través de la investigación de un caso único con diagnóstico de disfonía por presencia de quiste en cuerda vocal (CV) derecha debido a abuso y mal uso vocal en una mujer de 29 años profesora de Educación Primaria con especialidad en música. Lo que aquí se plantea es un tipo de intervención de entre todos los posibles para la rehabilitación de patología vocal. La terapia presentada en este estudio está basada y desarrollada a través de una concepción holística del ser humano, partiendo del propio diseño, para su rehabilitación. Para ello, se han diseñado: un protocolo de observación para el profesional logopeda, compuesto por una serie de ítems relativos a la anatomía y fisiología del cuerpo humano y su influencia en la fonación, y otro protocolo de autopercepción de la voz por parte del paciente y cómo esta afecta a la efectividad de la terapia. Se ha utilizado para este estudio, un diseño A-B-A-B y se han analizado los resultados. Se ha establecido un tratamiento en 2 fases: 1.- Intervención sobre la postura y la respiración, en base al protocolo de observación, y teniendo en cuenta las respuestas del paciente al protocolo de autopercepción de la voz. 2.- Intervención sobre la acústica de la voz, sobre la base de la postura y la respiración. La autopercepción de la voz por parte del paciente ha sido variable control para decidir la eficiencia de la rehabilitación.
... Keywords: voice, voice disorders, physiotherapy, complementary therapies, manual therapy, acupuncture, osteopathy, systematic review iNTRODUCTiON Postural changes and muscle tension have been reported in association with voice production (1,2). Increased muscle tension around the shoulders, neck, and thorax may compromise the quality of the singing voice (3)(4)(5). ...
Article
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Objective: to verify the effectiveness of physiotherapy and complementary therapies on voice disorders. Research on electronic databases PubMed/Medline, SciELO, and LILACS was performed using the combination: voice AND (treatment OR intervention) according to PRISMA guidelines. Only randomized controlled trials (RCTs) were included in the review. Studies were analyzed using the physiotherapy evidence database (PEDro) scale and the Center for Evidence-Based Medicine's Levels of Evidence scale. Eight papers met the inclusion criteria. From the RCTs included in this review, six assessed massage, one transcutaneous electrical nerve stimulation (TENS), one refer to spinal manipulative therapy, and one to acupuncture. The literature regarding the effectiveness of physiotherapy and complementary therapies was good in both quality and results, indicating that massage, TENS, and acupuncture seem to be effective treatments to reduce voice complaints and improve voice quality, supporting the inclusion of complementary therapies but mostly physiotherapy interventions in the treatment of patients with voice disorders.
... 11 Cervical stability is important, as it provides the necessary basis for cervical and larynx mobility, both of which are important in classical singing. [12][13][14] When people fail to have a good postural alignment or overall functioning, coordination patterns can change and can at the end lead to pathology. 15 Changes in alignment lead to disturbances in the coordination of the pelvic floor muscles. ...
Article
This study aimed at reporting on an intervention for optimizing postural alignment and voice parameters. Case report. A clinical examination, including an evaluation of postural alignment, was performed and several voice parameters were investigated before, during, and after an individual rehabilitation program aimed at optimizing joint mobility, muscular stability, and posture. This program was given to a 26-year-old female classical singing student. After a nine-session intervention (4 months), postural alignment was improved. The patient showed a good breath support and was able to maintain the lateral dimensions of the thorax, except for the high tones. Furthermore, she had a normalized cervical and scapulothoracic stability. At the last session, she had a lack of relaxation of the masseter muscle while singing. The vocal dynamic and pitch range were extended with smoother curves connecting the measuring points of the maximal and minimal vocal intensity, measured by means of the voice range profile. Results show that, in this student singer, postural alignment could be changed within 4 months and that it could influence some voice parameters. Further research in larger samples is necessary to see whether these findings can be generalized to other singers.
... This prolonged condition in Pacchierotti, combined with his osteoporosis, can account for the eroded states of his cervical vertebrae. Di Carlo carried out a systematic X-ray study of cervical spine of three populations of subjects (professional singers, beginning singers and non-singers), which showed deformations of cervical spine after many years of intensive singing 39 . According to research in phoniatrics 40,41 , the ideal posture of the neck in a singer is with the back of the neck elongated compared with the position of the shoulders, so that the rotation of the neck-head is not limited. ...
Article
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Following the birth of modern opera in Italy in 1600, the demand for soprano voices grew up and the prepuberal castration was carried out to preserve the young male voice into adult life. Among the castrati, Gaspare Pacchierotti was probably one of the most famous. The remains of Pacchierotti were exhumed for the first time in 2013, for a research in the reconstruction of his biological profile, to understand the secrets behind his sublime voice and how the castration influenced the body. All the findings discovered, through anthropological and Computed Tomography analyses, are consistent both with the occupational markers of a singer and with the hormonal effects of castration. The erosion of cervical vertebrae, the insertion of respiratory muscles and muscles of the arms can be an effect of the bodily position and exercise during singing. The hormonal effect of castration were related to osteoporosis and to the disorders of spine.
... 1,2 The head and neck posture has been shown to be related to temporomandibular disorders, voice and swallowing disorders, neck pain, and headache. [1][2][3][4][5][6][7][8][9][10][11][12][13] Also, recent studies have shown the biomechanical relationship between head posture and vertebral column, dentofacial structure, vocal structure, speech and swallowing organs, pharyngeal air space, and breathing status. [14][15][16][17] Hence, the evaluation of head and neck posture is essential to various professionals, including physiotherapists (PTs), speech and language pathologists (SLPs), singing teachers, orthodontists, orthopedic specialists, and others. ...
Article
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Introduction: Different professionals such as speech and language pathologists and voice scientists are involved in the evaluation of head and neck posture. Therefore, a reliable, time-efficient, and precise method of posture assessment is essential for use in clinical and research settings. Photogrammetry is one of the most commonly used methods to assess head and neck posture. The objectives of this study were to evaluate the intrarater reliability of the method with a large sample size and the interrater reliability by two different specialists (a physiotherapist and a speech and language pathologist). Method: A total of three hundred four subjects (144 males and 160 females) aged between 18 and 28 years participated in the study. During the test session, a photograph was taken of the left-side profile of each subject in their ordinary and comfortable position. The head posture angle of each picture was calculated by two raters. The whole procedure was repeated in a retest session, 24 hours later. A total number of eight analyses were performed for each subject. The reliability was evaluated at several stages hierarchically and after confirming the reliability in each step, the next step was investigated. Paired t tests on the differences of scores obtained at all the aforementioned stages were used to ensure the absence of any systematic bias. To assess the reliability, intraclass correlation coefficients (ICCs) and the standard error of measurements (SEMs) were calculated. Results: There was no significant difference between the mean values of the test and the retest angles at any stage of calculating the head posture angle in both pictures by both examiners (P > 0.05). The ICC and SEM values calculated for all stages were between 0.86-0.97 and 0.52-1.53, respectively. Conclusion: Systematic bias has not occurred at any stage. The ICC and SEM values calculated have demonstrated that there were appropriate relative and absolute reliabilities in all stages. This method is suggested to be used simply in research and clinical areas by different specialists.
... En ce qui concerne la physiologie, cela va des mécanismes mis en place pour l'émission de l'aigu qui sont différents en fonction de la puissance et du timbre de la voix [02] ou du cas d'une soprano professionnelle qui utilise une posture compensatoire afin de pouvoir émettre l'aigu en dépit d'une hypomobilité laryngée importante [03] au mécanisme des attaques [04] ou à l'étude du voile du palais en cours d'émission [05]. Je mentionnerai également, les conséquences de l'entraînement vocal sur la courbure du rachis cervical [06], le rétro-contrôle auditif et proprioceptif chez les chanteurs professionnels [07] ou encore le rôle prédominant de la mémoire proprioceptive dans l'appréciation des hauteurs sonores chez les chanteurs d'opéra qui ont une oreille absolue un peu particulière [08]. Dans le domaine de la phonétique, j'ai énormément travaillé sur l'intelligibilité de la voix chantée [09]; j'ai aussi abordé les phénomènes microprosodiques , c'est-à-dire les micro-variations du fondamental, en étudiant l'influence des consonnes sur la justesse des voyelles subséquentes [10] et je viens de terminer une étude sur l'organisation temporelle de la syllabe dans la parole et dans le chant [11] qui met en évidence une structuration syllabique complètement différente dans le chant. ...
Article
Cet article répond aux questions que se posent les thérapeutes qui ont en charge la rééducation de chanteurs professionnels, sur le fonctionnement de la voix chantée. L'étude scientifique de la technique vocale utilisée par les artistes lyriques telle qu'elle est réalisée par l'odologue, met à leur disposition une source d'information extrêmement riche qui leur permet de mieux comprendre non seulement ce qu'est un fonctionnement vocal harmonieux mais également les enseignements que l'on peut en tirer pour rééduquer les troubles de la voix chantée (dysodies).
... Akel et al. (2010) reported that the neck and chin region is one of the poorest placed by performing flautists. Scotto Di Carlo (1998) observed that all vocalists increased the craniocervical angle, inverting the curvature of this region, when singing their top note, and that in repose, presumably by generalization of performing posture to nonperforming posture, they likewise exhibited diminished, zero or inverted cervical curvature. By contrast, Skrgatic et al. (1979), who found that the most evident spinal alterations among professional musicians affected the cervical vertebrae, observed exaggerated but non-inverted curvature in 63%. ...
Article
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Postural quality during musical performance affects both musculoskeletal health and the quality of the performance. In this study we examined the posture of 100 students at a Higher Conservatory of Music in Spain. By analysing video tapes and photographs of the students while performing, a panel of experts extracted values of 11 variables reflecting aspects of overall postural quality or the postural quality of various parts of the body. The most common postural defects were identified, together with the situations in which they occur. It is concluded that most students incur in unphysiological postures during performance. It is hoped that use of the results of this study will help correct these errors. Copyright © 2015 Elsevier Ltd. All rights reserved.
Article
This paper presents a case study of a professional soprano with reduced laryngeal mobility caused by substantial calcification of the laryngeal cartilage. Unlike other singers, she lowers her head when singing high notes. A cephalometric analysis revealed a compensatory posture in the upper register consisting of moving the occipital bone backwards and upwards in such a way that the styloid and mastoid processes are also tipped in those directions. This in turn causes the hyoid bone, which is connected to the styloid and mastoid processes by the lesser cornua, to move up and back. Becoming more vertical, it pulls on the superior cornua of the thyroid cartilage to which it is connected by the hyothyroid membrane. This considerably tilts the thyroid cartilage on the cricoid. In reality, this soprano does not lower her head to sing in the upper register; she moves her occipital bone upwards and backwards in order to achieve greater and thus more effective tilting of the thyroid cartilage.
Article
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Objective The shape of the vocal tract and associated structures (eg, tongue and velum) is complicated and varies according to development and function. This variability challenges interpretation of voice experiments. Quantifying differences between shapes and understanding how vocal structures move in relation to each other is difficult using traditional linear and angle measurements. With statistical shape models, shape can be characterized in terms of independent modes of variation. Here, we build an active shape model (ASM) to assess morphologic and pitch-related functional changes affecting vocal structures and the airway. Method Using a cross-sectional study design, we obtained six midsagittal magnetic resonance images from 10 healthy adults (five men and five women) at rest, while breathing out, and while listening to, and humming low and high notes. Eighty landmark points were chosen to define the shape of interest and an ASM was built using these (60) images. Principal component analysis was used to identify independent modes of variation, and statistical analysis was performed using one-way repeated-measures analysis of variance. Results Twenty modes of variation were identified with modes 1 and 2 accounting for half the total variance. Modes 1 and 9 were significantly associated with humming low and high notes (P < 0.001) and showed coordinated changes affecting the cervical spine, vocal structures, and airway. Mode 2 highlighted wide structural variations between subjects. Conclusion This study highlights the potential of active shape modeling to advance understanding of factors underlying morphologic and pitch-related functional variations affecting vocal structures and the airway in health and disease.
Article
Introduction: Differences in classical and non-classical singing are due primarily to aesthetic style requirements. The head position can affect the sound quality. This study aimed at comparing the head position for famous classical and non-classical male singers performing high notes. Method: Images of 39 Western classical and 34 non-classical male singers during live performances were obtained from YouTube. Ten raters evaluated the frontal rotational head position (depression versus elevation) and transverse head position (retraction versus protraction) visually using a visual analogue scale. Results: The results showed a significant difference for frontal rotational head position. Discussion and conclusion: Most non-classical singers in the sample elevated their heads for high notes while the classical singers were observed to keep it around the neutral position. This difference may be attributed to different singing techniques and phonatory system adjustments utilized by each group.
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Voice therapy has undergone a considerable growth in knowledge and application in recent decades. Partially that has been a consequence of the increasing dissemination of information obtained from clinical practice worldwide. Because of global efforts to achieve evidence based practices, voice therapy is becoming an ever more well-informed clinical practice. This dissertation is a contribution to this global effort aimed at further our understanding of a subgroup of voice therapy techniques called semi-occluded vocal tract exercises (SOVTEs). In particular, two aspects of SOVTEs were assessed: Firstly, the differences between commonly used SOVTEs with regards to acoustical and physiological aspects were studied by means of electroglottography (EGG) and acoustic analysis. Twenty-three healthy volunteers participated as subjects of the study in which audio and EGG signals were obtained while SOVTEs were performed. Changes in contact quotient (CQ) and fundamental frequency (F0) values were analysed, as well as the potential acoustic interaction between vocal folds and vocal tract estimated by the proximity of the F0 to the first formant (F1). The amount of variation of CQ observed during the different SOVTEs showed statistically significant differences dividing the exercises into two distinct groups: 'steady' presenting a single source of vibration (i.e., vibration of the vocal folds laryngeal airflow) in the vocal tract and 'fluctuating', presenting two sources of vibration (i.e., vocal folds plus another vibrating object) in the vocal tract. Steady exercises showed closer proximity of F0 to F1 than the fluctuating exercises suggesting more interaction of the vocal tract with the F0 of the voice source in the steady exercises. It is speculated that the steady exercises may promote the feeling of an easier phonation (as suggested by Titze in 2004 and 2006), whereas the fluctuating exercises may be used to elicit a “massage effect” (as suggested by Radolf et al. in 2013 and later by Granqvist et al in 2014). The potential differences between these two groups of SOVTEs seem appealing from a therapeutic perspective and deserve more attention in future studies. Secondly, a sample of straws and tubes commonly used for SOVTEs was studied using a flow-driven vocal tract simulator to obtain the pressure-flow relationship for each tube. Larger straws were also assessed with the distal end submerged into water as commonly used in resonance tube and LaxVox techniques. The results showed that in relation to tube resistance, changes in tube diameter are more effective than changes in tube length. Additionally, once tubes are submerged into water the back pressure needs to overcome the water column above the tubes’ ends before flow starts. Larger tubes with the distal end submerged into water were shown to maintain a relative constant back pressure controlled mainly by the depth of tube submersion in the water, while the thin tubes in air present larger changes in back pressure as a function of flow. An additional observational study looked at the differences in head position between famous classical and non-classical singers for high notes. This study aimed at improving our understanding of differences between the classic and non-classic singing techniques. Head position is related to body posture which has been considered important for correct and healthy singing technique. The results show that classical singers produced high notes with the head in the neutral position while non-classical singers tended to raise their heads. This difference may be attributed to the different singing techniques and phonatory system adjustments utilized by each group and should be kept in mind when evaluating the head posture in singers for training and therapeutic purposes. Altogether, these three studies help better understand different aspects of voice production. More specifically, the studies addressing SOVTEs contribute to improving voice therapy by providing a better awareness of physiological and acoustical properties of SOVTEs which have currently been explored in clinical practice around the world. The gathered pieces of information can prospectively aid practitioners to better target their therapy using SOVTEs in future.
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Purpose Determine the work environment factors related to hazards in voice production for elementary school teachers, as well as the impact of vocal rest and teaching methodology. Methods This research features a quantitative, cross-sectional, non-experimental, correlational study, which applies an instrument consisting of a fill-out form and a questionnaire performed by the evaluator to 90 elementary school teachers. The following variables were taken into account: classroom size, acoustics, noise, amount of students in the classroom, chemical substances, temperature, subject taught, teaching method and classroom vocal use time. The statistical analysis was performed using the PASW statistical software, version 20. Results Regarding the external acoustic insulation, the windows are made of glass or structures with metal bars, and no elements covering the surface of the window, zinc sheets or cement in ceilings and aluminum doors. The average noise measurement in the classroom is 77 dB, and the temperature and humidity measurements show a warm humid weather tendency. The most frequent teaching method is the lecture-type class. Elementary teachers must teach all of the subjects, and have an average voice rest period of 30 minutes. The inferential analysis using the chi-square test found no correlation between work environment factors of the teacher and the presence of dysphonia. Conclusion The elements of the teaching environment and the intrinsic factors of the teaching practice are not directly related to the presence of dysphonia, but they are associated elements that do not generate vocal disorders by themselves.
Article
A study was undertaken to identify the effect of head flexion/extension on singing voice quality. The amplitude of the fundamental frequency (F0) and the singing power ratio (SPR), an indirect measure of Singer's Formant activity, were measured. F0 and SPR scores at four experimental head positions were compared with the subjects’ scores at their habitual positions. Three vowels and three pitch levels were tested. F0 amplitudes and low-frequency partials in general were greater with neck extension, while SPR increased with neck flexion. No effect of pitch or vowel was found. Gains in SPR appear to be the result of damping low-frequency partials rather than amplifying those in the Singer's Formant region. Raising the amplitude of F0 is an important resonance tool for female voices in the high range, and may be of benefit to other voice types in resonance, loudness, and laryngeal function.
Chapter
De behandeling van stemstoornissen, maar ook de preventieve training van stemmen, kent een lange voorgeschiedenis. Zo schreef Guttmann al in 1861 een boekje over de ‘Gymnastik der Stimme’ waarbij allerlei adviezen en oefeningen werden aangereikt om de stemgeving te trainen (Guttman, 1861). Het gedachtegoed over stem en spraak stamt uit een periode waarin de foniatrie en de logopedie tot wasdom kwamen.
Article
Objective: An analysis of the salient characteristics of research papers published between 1989 and 2015 that evaluate the relationship between postural quality during musical performance and various performance quality and health factors, with emphasis on musculoskeletal health variables. Methods: Searches of Medline, Scopus and Google Scholar for papers that analysed the subject of the study objective. The following MeSH descriptors were used: posture; postural balance; muscle, skeletal; task performance and analysis; back; and spine and music. A descriptive statistical analysis of their methodology (sample types, temporal design, and postural, health and other variables analysed) and findings has been made. The inclusion criterion was that the body postural quality of the musicians during performance was included among the target study variables. Results: Forty-one relevant empirical studies were found, written in English. Comparison and analysis of their results was hampered by great disparities in measuring instruments and operationalization of variables. Conclusions: Despite the growing interest in the relationships among these variables, the empirical knowledge base still has many limitations, making rigorous comparative analysis difficult.
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De behandeling van stemstoornissen, maar ook de preventieve training van stemmen, kent een lange voorgeschiedenis. Zo schreef Guttmann al in 1861 een boekje over de ‘Gymnastik der Stimme’ waarbij allerlei adviezen en oefeningen werden aangereikt om de stemgeving te trainen (Guttman, 1861). Het gedachtegoed over stem en spraak stamt uit een periode waarin de foniatrie en de logopedie tot wasdom kwamen. Dit tijdstip ligt rond de jaren 1920-1930. In de jaren dertig vertrokken veel van de grondleggers van het foniatrische/logopedische werkveld naar Amerika (Von Leden, 1990; Kooijman, 1993). Dit vertrek leidde tot twee verschillende visies op het gebied van de stembehandeling. Er bestaat een Europese, meer op ervaringsleren gebaseerde manier van werken, waarbij veel lichaamswerk en ademtraining in gebruik zijn. De Amerikaanse manier van werken is directer en meer op systematisch gedragsveranderende principes gebaseerd.
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Objective: It is known that bad posture increases the risk that a musician may suffer from musculoskeletal disorders. This study compared posture quality required by different instruments or families of instruments. Methods: Using an ad hoc postural observation instrument embracing 11 postural variables, four experts evaluated the postures of 100 students attending a Spanish higher conservatory of music. Results: The agreement of the experts' evaluations was statistically confirmed by the Cohen κ value between .855 and 1.000 and a Kendall value between 0.709 and 1.000 (p < 0.001 in all cases). Moreover, a χ(2) tests revealed significant association between instrument families and seated posture with respect to pelvic attitude, dorsal curvature, and head alignment in both sagittal and frontal planes. This analysis also showed an association between instrument families and standing posture with respect to the frontal plane of the axis of gravity, pelvic attitude, head alignment in the frontal plane, the sagittal plane of the shoulders, and overall posture. Conclusions: While certain postural defects appear to be common to all families of instruments, others are more characteristic of some families than others. The instrument associated with the best posture quality was the bagpipe, followed by percussion and strings.
Article
Female singers often wear high heels for auditions and performances. Heel height research in non-singing contexts indicates that wearing heels can affect body alignment and head position. Studies in orthodontics, sleep apnea, and voice science suggest that head and neck positioning can alter the vocal tract. The purpose of this study was to assess the effects, if any, of heel height (barefoot, 10.16-cm stilettos) on three angles of singer head position (calculated from C7–tragus–nasion), long-term average spectra data, and perceptual data (questionnaire) acquired from female (N = 30) soloists during alternating periods of silence and singing. Results indicated that all participants (100%) significantly decreased head position angle measurements (inferior and posterior head and neck movement) when singing in high heels compared with singing barefoot. Participants, on average, significantly increased head position angle measurements (superior and anterior head and neck movement) when singing compared with standing silently, and did so to a greater degree when transitioning from silent heels to singing heels compared with transitioning from silent barefoot to singing barefoot. Long-term average spectra data indicated significant spectral energy differences between barefoot and high heel singing conditions across participants. Most participants (n = 21, 70.00%) indicated they felt comfortable and sang their best while barefoot. Results of this study, the second in a series of experiments addressing the effects of shoe heel height on female singers' vocal production, were discussed in terms of application to vocal pedagogy and directions for future research.
Article
Objective: To quantify the prevalence of dysphonia in a sample of teachers of the north of Portugal and to determine what factors and symptoms are associated to it. Study design: Cross-sectional study of teachers in the public service, with lecture component, of the first grade of education (primary). Participants: Participated 1158 of the 2333 teachers contacted (proportion of answers: 49.6%). The 922 female teachers filled a general questionnaire built to this study, with questions that allowed the identification, professional characterisation, auto-perception and symptoms of dysphonia, and description of the habits and lifestyle. Measures of results: Prevalence of auto-perceived dysphonia and associated symptoms, for each of the personal and occupational factors. Results: The prevalence of dysphonia in teachers was 10.6%, growing significantly with age (p= 0.004) and with the number of years of teaching (p=0.002). The more perceived symptoms were from laryngeal sensibility (pain - 62.8%, dryness - 61.9%) and hoarseness (64.3%). All (except pain and burn up) reflected significantly in the prevalence of dysphonia (p<0.001). Conclusions: Teachers have a high prevalence of dysphonia, which rises with age and years of teaching activity. The habits and lifestyle characteristics did not have a significant role in the variable studied.
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