Effectiveness of a Short Voice Training Program for Teachers: A Preliminary Study

The Efficacy of Voice Therapy via Hybrid Group Telepractice Program with Asynchronous Components for Primary School Teachers: A Pilot Study

PURPOSE

To determine the efficacy of a hybrid group telepractice program in voice therapy for primary school teachers.

METHOD

The participants, consisting of 12 teachers with voice disorders (three males and nine females), participated in 11 sessions of the telepractice program, divided into one training session on vocal hygiene, five practice sessions by themselves, and five group practice sessions in 5weeks. Data on the vocal handicap index (VHI) measure was obtained pre- and post-intervention. The voice analysis included fundamental frequency (local), jitter (local), shimmer (local), harmonic-to-noise ratio (local), and maximum phonation time assessed by Praat software.

RESULT

The VHI assessment revealed a statistically significant difference (P < 0.05) in the emotional domain. There was no statistically significant difference (P > 0.05) in physical, functional, and total scores. Both males and females had no statistically significant difference (P > 0.05) in mean fundamental frequency. However, there was a statistically significant difference (P < 0.05) in jitter (local), shimmer (local), harmonics-to-noise ratio (local), and the maximum phonation time.

CONCLUSION

The group telepractice program in voice therapy for primary school teachers was effective. It could be utilized for voice therapy to prevent voice disorder problems in teachers.

Influences of Preventive Voice Training on the Vocal, Mental Health, and Voice-Related Self-Concept of University Teachers and Academic Advisers: A Pilot Study

OBJECTIVES

The aim of the study was to investigate whether the vocal self-concept and potential vocal and related mental health problems of university teachers and academic advisers can be improved by participating in preventive voice training.

STUDY DESIGN AND METHODS

University teachers and academic advisers show an increased susceptibility to occupational risk factors related to their voice and an increased prevalence of developing a voice disorder in the course of their employment. An experimental, prospective, longitudinal study was conducted to examine whether voice training (1) improves physiological vocal function, vocal performance, vocal self-concept, and mental health of university teachers and academic advisers; (2) reduces unfavorable influencing factors at the university workplace; and (3) fewer voice problems are reported from the perspective of university teachers and academic advisers.

RESULTS

This study showed that voice training has positive influences on the voice (function and quality), voice self-concept, and well-being of university staff.

CONCLUSIONS

Workplace prevention programs can help to reduce the high prevalence of voice disorders among university teachers and advisers and counteract the risk factors. They should therefore be firmly integrated into continuing education/university health management and everyday life to cope with certain work-related vocal stresses and to maintain psychological and vocal well-being throughout the university career. Gender and age-related aspects should be considered.

Effect of a Workplace Vocal Health Promotion Program and Working Conditions on Voice Functioning of College Professors

OBJECTIVE

To determine the effect of a Workplace Vocal Health Promotion Program (WVHPP) and working conditions on voice functioning of college professors.

STUDY DESIGN

This is a pre-post intervention study.

METHODS

College professors were randomly assigned in a control group or an intervention group. Participants filled out a questionnaire and recorded a voice sample at baseline and at the end of the follow-up. This program contains four sessions (2 face-to-face and 2 virtual sessions; one per week) focused on voice hygiene, vocal training, and strategies to modify teaching-learning process.

RESULTS

The Intervention group (n = 15) showed increased scores in V-RQOL in comparison with the control group (n = 14), but the effect was not statistically significant. After the program, shimmer decreased (P = 0.05), whereas MPT and HNR increased (P = 0.02 and 0.04 respectively) among professors in the intervention group after the implementation of the WVHPP. Concerning working conditions, number of students per class was statistically associated with SPL. MPT was statistically associated with age and good acoustics inside the classroom.

CONCLUSIONS

Our results indicate that implementation of a WVHPP, as well as working conditions, influence voice functioning measured by means of instrumental voice measures and voice-related quality of life. Therefore, workplace promotion programs may be good approaches to decrease the high prevalence of voice disorders among professors.

Outcomes of Vocal Hygiene Program in Facilitating Vocal Health in Female School Teachers With Voice Problems

BACKGROUND

Teachers suffer greater impacts of voice problems due inappropriate voice use and other contributing factors such as physiological, environmental, and individual & work related issues. Structured vocal hygiene programs (VHP) prevent/reduce the risk of vocal trauma and promote vocal health in teachers. This study aimed to estimate the outcome of instituting a sociocultural relevant vocal hygiene program in facilitating vocal health among female school teachers using a comprehensive voice assessment protocol.

METHOD

VHP was developed emphasizing adequate hydration, healthy vocal diet, posture and alignment, vocal practices while teaching, and ideal speaking environment. This was administered via a face to face session to seventeen female teachers with voice concerns. All underwent a comprehensive voice assessment (subjective, objective, and self-perceptual vocal measures) before and four weeks after the VHP. Inter-rater reliability for perceptual and visual examination was estimated using Intra-Class Coefficient. Wilcoxon signed ranks test was used to compare the pre- and post-treatment measures of continuous variables (acoustic, Maximum phonation time, s/z ratio, Vocal Fatigue Index [VFI] & Voice Disorder Outcome Profile [V-DOP]), and McNemar test was used for categorical variables (vocal health questionnaire, visual examination of larynx and perceptual evaluation of voice).

RESULTS

Teachers reported reduction of unhealthy vocal & nonvocal practices after VHP. Improvements in vocal and related symptoms such as sensation of heart burn (P = 0.031), discomfort around the throat (P = 0.008), inadequate breath control while speaking (P = 0.016) were noticed. Perceptually, minimal improvement was seen in voice quality (overall grade). However, MPT & s/z ratio showed no significant difference. Improvement was observed in frequency range (P = 0.004), low I₀ (P = 0.044), shimmer (P = 0.017), and DSI (P = 0.013). Changes were evident in all parameters of stroboscopic evaluation (except nonvibratory portion & ventricular fold hyper-adduction). V-DOP scores indicated positive change in the overall severity (P = 0.002), physical (P = 0.003) and functional domain (P = 0.034). VFI indicated improvement in teachers voice after a period of voice rest (P = 0.048).

CONCLUSION

Though VHP facilitated in improving the teachers' awareness of at risk phono-traumatic behaviors and vocal health, its efficiency was limited in producing physiological improvement in teachers' voice. The comparison of vocal metrics before & after the treatment provides information on changes that can be expected in teachers after guiding them through a systematic VHP.

Are Occupational Voice Disorders Accurately Measured? A Systematic Review of Prevalence and Methodologies in Schoolteachers to Report Voice Disorders

PURPOSE

Different measuring instruments have been described to determine the prevalence of voice disorders in schoolteachers. However, the heterogeneity of prevalence figures has made it difficult in determining the impact of voice disorders in this group. This investigation aims to review and identify scientific evidence of methodological analysis of voice disorders in teachers, the relevance of measuring instruments, the prevalence of dysphonia, and the impact on the development of vocal health prevention programs.

METHODS

A systematic review was conducted by searching six important scientific databases. Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines were carried out. Articles were included whether they presented data related to the prevalence of dysphonia and the impact of therapy programs on teachers.

RESULTS

Twenty articles out of 8,998 were selected. The cross-sectional design type was predominant throughout the investigations. Differences were observed in the number of participants across studies, leading to heterogeneous prevalence figures - which ranged from 10.5% to 69.1%. The assessment instruments are not standardly used to effectively determine the disease burden. Despite the fact of the extensive evidence of the effectiveness of programs that address dysphonia in teachers, the scarcity of literature is yet evident on systematic programs promoted by either the government or educational institutions.

CONCLUSION

Findings suggest that future investigations should consider the consensus of a global definition for occupational dysphonia in teachers in order to develop accurately measuring instruments and to assist with voice care programs and treatment approaches in this population. This might be crucial since it could also assist with the implementation of Delphi-type studies that could support the development of further evidence-based agreements around these programs (voice care and treatment approaches) in schoolteachers.

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

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

Linguistic and Cultural Adaptation and Validation of the Vocal Fatigue Index into Polish

OBJECTIVE

The purpose of the present study was the cross-cultural and linguistic adaptation and validation of the Vocal Fatigue Index (VFI) in the Polish language.

METHODS

The Vocal Fatigue Index was adapted into Polish and was administered to 323 subjects (216 with voice disorders, and 107 without voice disorders). One hundred and four participants with voice disorders completed the VFI a second time to evaluate test-retest reliability. VFI was assessed for internal consistency, test-retest reliability, discriminant validity, criterion validity, and sensitivity and specificity.

RESULTS

The Polish VFI exhibited satisfactory psychometric properties. A high Cronbach's alpha coefficient for the three factors (α=0.971 for Factor 1, α=0.929 for Factor 2, α=0.930 for Factor 3) was obtained. Significantly higher scores were revealed in subjects with voice disorders (48.88±11.73 [mean±SD]) in comparison with vocally healthy subjects (12.25±6.75 [mean±SD]) in the total VFI score as well as in the three factors (all P-values < 0.01). The best cut-off for VFI Total Score was set at a 32.5 score with sensitivity of 0.931 and specificity of 0.991.

CONCLUSIONS

The translated version of the VFI is a valid and reliable tool for identifying vocal fatigue symptoms in the Polish-speaking population.

Vocal Behavior of Teachers Reading with Raised Voice in a Noisy Environment

(1) Objective: Teaching is a particularly voice-demanding occupation. Voice training provided during teachers’ education is often insufficient and thus teachers are at risk of developing voice disorders. Vocal demands during teaching are not only characterized by speaking for long durations but also by speaking in noisy environments. This provokes the so-called Lombard effect, which intuitively leads to an increase in voice intensity, pitch and phonation time in laboratory studies. However, this effect has not been thoroughly investigated in realistic teaching scenarios. (2) Methods: This study thus examined how 13 experienced, but vocally untrained, teachers behaved when reading in a noisy compared to quiet background environment. The quiet and noisy conditions were provided by a live audience either listening quietly or making noise by talking to each other. By using a portable voice accumulator, the fundamental frequency, sound pressure level of the voice and the noise as well as the phonation time were recorded in both conditions. (3) Results: The results showed that the teachers mainly responded according to the Lombard effect. In addition, analysis of phonation time revealed that they failed to increase inhalation time and appeared to lose articulation through the shortening of voiceless consonants in the noisy condition. (4) Conclusions: The teachers demonstrated vocally demanding behavior when speaking in the noisy condition, which can lead to vocal fatigue and cause dysphonia. The findings underline the necessity for specific voice training in teachers’ education, and the content of such training is discussed in light of the results.

A Nonrandomized Trial for Student Teachers of an In-Person and Telepractice Global Voice Prevention and Therapy Model With Estill Voice Training Assessed by the VoiceEvalU8 App

Purpose This study investigated the effects of the in-person and telepractice Global Voice Prevention and Therapy Model (GVPTM) treatment conditions and a control condition with vocally healthy student teachers. Method In this single-blinded, nonrandomized trial, 82 participants completed all aspects of the study. Estill Voice Training was used as the stimulability component of the GVPTM to train multiple new voices meeting all the vocal needs of the student teachers. Outcomes were assessed using acoustic, perceptual, and aerodynamic measures captured by the VoiceEvalU8 app at pre and post in fall and during student teaching in spring. Results Significant improvements were achieved for several acoustic and perceptual measures in the treatment conditions, but not in the control condition. The in-person and telepractice conditions produced similar results. The all-voiced phrase and connected speech were more successful in demonstrating voice change for some of the perturbation measures as compared to sustained /a/. Conclusions The treatment conditions were successful in improving the participants' voices for fundamental frequency and some acoustic perturbation measures while maintaining the improvements during student teaching. In addition, the treatment conditions were successful in decreasing the negative impact of voice-related quality of life and vocal fatigue during student teaching. Future research should address the effectiveness of the various components of the GVPTM, the application of the GVPTM with patients with voice disorders, the relevance of defining auditory-perceptual terms by the anatomy and physiology of the voice production system (i.e., Estill Voice Training), and the continued use of the VoiceEvalU8 app for clinical voice investigations. Supplemental Material https://doi.org/10.23641/asha.13626824.

Voice-Related Quality of Life, Anxiety, and Depression in Female Teachers: Finger Kazoo Intensive Short-Term Vocal Therapy

BACKGROUND

Among professional voice users, teachers are subject to higher risks of developing occupational dysphonia due to their abusive use of the voice, usually under unfavorable conditions.

OBJECTIVES

Quantify the vocal self-perception, the voice-related quality of life, and the anxiety, and depression symptoms, of dysphonic female teachers, after a brief and intensive short-term voice therapy using the finger kazoo technique.

METHODS

Blinded, randomized, and controlled clinical trial. Questionnaires applied to two study groups (15 subjects without structural laryngeal disorder in one group, and nine subjects with vocal nodules in the other), and to two control groups (9 subjects without structural laryngeal disorder in one group, and eight subjects with vocal nodules in the other).

RESULTS

The Vocal Tract Discomfort Scale, the Voice Activity and Participation Profile, the Voice Symptom Scale, and the Voice-Related Quality of Life Protocol, showed significant improvement in both study groups. The Vocal Perception Protocol showed that negative vocal self-perception reduced significantly in subjects without structural alteration of the vocal folds in the study group. Anxiety symptoms improved significantly in subjects with vocal nodules in the study group; depression symptoms improved significantly in subjects with vocal nodules in the control group, and in subjects without structural alteration of the vocal folds in the study group.

CONCLUSION

Brief and intensive short-term voice therapy using the finger kazoo technique provided improvement in the vocal self-perception, the voice-related quality of life, and in the symptoms of anxiety and depression in dysphonic teachers, more evidently in teachers with vocal nodules.

Long-Term Effects of a Voice Training Program for Teachers on Vocal and Mental Health

OBJECTIVES

The voice is an important occupational tool for teachers. Voice training programs have been shown to help strengthen the voice health and endurance. However, longitudinal studies on voice trainings are sparse. In this study, long-term effects nearly 2 years after a voice training program have been investigated.

METHODS

The acoustic voice quality (Dysphonia Severity Index [DSI]), the voice self-concept (Fragebogen zur Erfassung des Stimmlichen Selbstkonzepts), and the health-related quality of life (SF-12) of 55 teachers who participated in a prior voice training program of ten 90 minutes sessions were compared to 33 teachers without voice training. The participants were measured at three times: in a pre- and a post-training survey and in a 2-years follow-up survey.

RESULTS

The trained teachers increased in DSI over all three surveys while the nontrained teachers decreased in DSI with a significant interaction effect. Also the trained teachers significantly increased the awareness of voice use and their mental health compared to the nontrained group.

CONCLUSIONS

The positive effects of the voice training, which have been found between pre- and post-training and in comparison with the control group, clearly sustained in long-term 2 years after the end of the training. This finding emphasizes the importance of voice training for teachers as a long-term investment for a voice-related healthy working life.

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

<b><i>Objectives:</i></b> 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. <b><i>Sample and Method:</i></b> 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]). <b><i>Results:</i></b> 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. <b><i>Conclusions:</i></b> The results suggest that the educational intervention model may have a positive effect on teachers’ vocal care.

A Study of Vocal Facilitating Techniques Compared to Manual Circumlaryngeal Therapy in Teachers With Muscle Tension Dysphonia

OBJECTIVE

There are several voice therapy techniques been suggested in patients with muscle tension dysphonia (MTD), however a few studies are compared between them. The purpose of present study was to compare the effect of vocal facilitating techniques (VFTs) and manual circumlaryngeal therapy (MCT) in teachers with MTD.

STUDY DESIGN

This is a randomized clinical trial study.

METHODS

Sixteen teachers with MTD (female; mean age: 38.6 ± 4.6 years) participated in this study. The participants allocated to two treatment groups: the first group received VFTs (n: 8) and MCT was presented to the second one (n: 8). In each group, the voice therapy techniques were given for 10 individual sessions twice a week. The effect of both techniques was assessed using voice handicap index (VHI) and dysphonia severity index (DSI).

RESULTS

Within group comparison, the VHI, DSI, and theirs components showed significantly better results after both treatment groups (P ≤ 0.05). Although, effect size was strong for all target features (η2 > 0.36); the greatest magnitude was obtained on the physical subscale of VHI following MCT and for the DSI after VFTs (η2 = 0.92 and 0.90, respectively). Moreover, the interactive effect of time and treatment groups indicated that there was significant main effect on the physical and functional subscales of VHI (P = 0.00 and 0.02, respectively) as well as I-low and DSI (P = 0.01 and 0.02, respectively).

CONCLUSION

VFTs and MCT are two effective techniques in voice therapy of teachers with MTD. However, the greatest improvement obtained on the DSI following VFTs and for the physical aspect of VHI after MCT demonstrated voice therapist can use appropriate technique based on the voice complaints and results of voice assessments in MTD.

Maximum phonation times and vital capacity in dysphonic women

ABSTRACT Objective: to verify the correlation between vital capacity and maximum phonation times of /ė/ (unvoiced) and /s/, as well as compare and relate them with the professional voice use and age in women with functional or organic-functional dysphonia. Methods: a retrospective research with 524 records of dysphonic patients from a school clinic, including young adult women with a speech-language diagnosis of functional or organic-functional dysphonia based on medical reports. Neurological and psychiatric alterations, previous speech therapy treatment, symptoms of flu or allergies on the day of evaluation, pulmonary disease, organic dysphonia diagnosis, and hearing loss, were excluded. The sample resulted in 14 women with functional dysphonia and 21 with organic-functional dysphonia. Data on professional voice use, as well as results for vital capacity and maximum phonation times were collected. The data were statistically analyzed at a 5% significance level. Results: There was a positive correlation for both groups of dysphonic patients between the maximum phonation times of /ė/ and of /s/, as well as the maximum phonation times of /ė/, /s/, and vital capacity. Higher values for vital capacity and maximum times of /s/ and /ė/ for voice professionals were seen. The maximum phonation times of /ė/ were lower than those of /s/. Conclusion: as the maximum phonation times of /ė/ increased, the maximum phonation times of /s/ and the vital capacity also augmented in both groups, demonstrating the interrelation among these variables; there was no relation with the other variables studied.