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Morton-Jones ME, Timmons Sund L, Castro ME, Hapner ER. Adult Normative Data for the OMNI-Vocal Effort Scale (VES). Laryngoscope 2024; 134:3726-3731. [PMID: 38686843 DOI: 10.1002/lary.31464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE To establish normative values for the OMNI-Vocal Effort Scale (VES) in healthy adults without voice complaints. Secondary objective is to determine if there are differences in perceived vocal effort across age groups and between sexes. STUDY DESIGN Prospective data collection across groups. METHOD A nine-item survey was administered by speech-language pathologists with specialization in voice to consenting adults 18 years or older. Participants underwent an auditory perceptual evaluation of voice and answered questions regarding age, history of voice problems, history of voice surgery, smoking history and hearing loss. Participants were instructed to rate their perceived vocal effort in conversational speech using the OMNI-VES. Multivariant analysis was conducted. RESULTS Two hundred and fifty-one participants were recruited. The majority of adults without voice complaints reported that producing conversational voice was within the "extremely easy" to "easy" range, 0-3 (92.4%). CONCLUSIONS This study provides preliminary data for perceived vocal effort. The OMNI-VES may be a useful tool in understanding changes in perceived vocal effort as a result of treatment for voice disorders. Further normative data are needed between sexes, across the gender spectrum, and older adult populations. Future directions include examining the magnitude of difference between numeric values on the scale and use of the scale with other dysphonic populations. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3726-3731, 2024.
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Affiliation(s)
- Mariah E Morton-Jones
- UAB Voice Center, Department of Otolaryngology-Head and Neck Surgery, University of Alabama, Birmingham, Alabama, U.S.A
- School of Kinesiology, Auburn University, Auburn, Alabama, U.S.A
| | - Lauren Timmons Sund
- USC Voice Center, Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - M Eugenia Castro
- USC Voice Center, Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
- Department of Communication Disorders, California State University Los Angeles, Los Angeles, California, U.S.A
| | - Edie R Hapner
- UAB Voice Center, Department of Otolaryngology-Head and Neck Surgery, University of Alabama, Birmingham, Alabama, U.S.A
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Apfelbach CS, Sandage M, Abbott KV. Effects of Back Pressure on the Feasibility and Tolerability of Laryngeal Diadochokinetic Exercise: A Pilot Study. J Voice 2024:S0892-1997(24)00158-9. [PMID: 38969542 DOI: 10.1016/j.jvoice.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND The term vocal demand response refers to how speakers meet vocal demands. Vocal loading tasks with predetermined demand parameters (duration, pitch, loudness, etc) have been used in research to study the vocal demand response; these have historically consisted of loud sustained vowel and loud speech tasks. Tasks founded on laryngeal diadochokinesis (LDDK) may be viable alternatives, especially if demand parameters such as exercise-rest ratio and fluid back pressure are concurrently modulated. OBJECTIVES To explore the effects of four fluid back pressure conditions (0, 5, 10, and 15 cm H2O) on several measures of subjective participant experience, feasibility, and tolerability during intervallic laryngeal diadochokinetic exercise. METHODS Participants (n = 12) completed 15-minute trials of LDDK in 30-second rest and exercise intervals against four counterbalanced back pressure conditions: 0, 5, 10, and 15 cm H2O. The effects of back pressure on (1) ratings of perceived vocal exertion, (2) prevalence of adverse effects such as shortness of breath or lightheadedness, (3) subjective difficulty of sustaining LDDK, (4) number of exercise intervals completed, (5) rankings of participant-preferred back pressure levels, and (6) expert ratings of auditory-perceptual diadochokinetic strength were assessed descriptively. RESULTS Perceived vocal exertion, lightheadedness, and subjective laryngeal diadochokinetic difficulty increased as back pressure increased. Number of intervals completed, auditory-perceptual diadochokinetic strength, and participant rankings of back pressure conditions, by contrast, decreased as back pressure increased. 0 and 5 cm H2O were the most preferred back pressure conditions overall. DISCUSSION Fluid back pressure was feasible and broadly tolerated during 15-minute trials of vocal exercise. However, the transition from 5 → 10 cm H2O appeared to represent an inflection point in our results: a minority of participants did not tolerate exercise at 10 cm H2O, becoming a majority at 15 cm H2O. We conclude that fluid back pressure should be restricted to values between 0 and 10 cm H2O during LDDK.
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Affiliation(s)
| | - Mary Sandage
- Department of Speech, Language & Hearing Sciences, Auburn University, Auburn, Alabama
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Hunter EJ, Berardi ML, Whitling S. A Semiautomated Protocol Towards Quantifying Vocal Effort in Relation to Vocal Performance During a Vocal Loading Task. J Voice 2024; 38:876-888. [PMID: 35168867 PMCID: PMC9372227 DOI: 10.1016/j.jvoice.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 11/19/2022]
Abstract
To increase the reliability and comparability of vocal loading studies, this paper proposes the use of a standardized approach with experiments that are [1] grounded on consistent definitions of terms related to vocal fatigue (vocal effort, vocal demand, and vocal demand response), and [2] designed to reduce uncertainty and increase repeatability. In the approach, a semi-automated vocal loading task that also increases efficiencies in collecting and preparing vocal samples for analysis was used to answer the following research question: To what extent is vocal effort and vocal demand response sensitive to changes in vocal demands (ie, noise only, noise plus duration)? Results indicate that the proposed protocol design consistently induced change in both vocal effort and vocal demand response, indicating vocal fatigue. The efficacy of future vocal loading studies would be improved by adopting a more consistent methodology for quantifying vocal fatigue, thus increasing interstudy comparability of results and conclusions.
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Affiliation(s)
- Eric J Hunter
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan.
| | | | - Susanna Whitling
- Department of Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
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Ferguson SH, Morgan SD, Hunter EJ. Within-talker and within-session stability of acoustic characteristics of conversational and clear speaking stylesa). THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2024; 155:44-55. [PMID: 38174965 PMCID: PMC10990565 DOI: 10.1121/10.0024241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/01/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
In speech production research, talkers often perform a speech task several times per recording session with different speaking styles or in different environments. For example, Lombard speech studies typically have talkers speak in several different noise conditions. However, it is unknown to what degree simple repetition of a speech task affects speech acoustic characteristics or whether repetition effects might offset or exaggerate effects of speaking style or environment. The present study assessed speech acoustic changes over four within-session repetitions of a speech production taskset performed with two speaking styles recorded in separate sessions: conversational and clear speech. In each style, ten talkers performed a set of three speech tasks four times. Speaking rate, median fundamental frequency, fundamental frequency range, and mid-frequency spectral energy for read sentences were measured and compared across test blocks both within-session and between the two styles. Results indicate that statistically significant changes can occur from one repetition of a speech task to the next, even with a brief practice set and especially in the conversational style. While these changes were smaller than speaking style differences, these findings support using a complete speech set for training while talkers acclimate to the task and to the laboratory environment.
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Affiliation(s)
- Sarah Hargus Ferguson
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah 84112, USA
| | - Shae D Morgan
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah 84112, USA
| | - Eric J Hunter
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan 48824, USA
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Schloneger M, Hunter EJ, Maxfield L. Quantifying Vocal Repertoire Tessituras Through Real-Time Measures. J Voice 2024; 38:247.e11-247.e25. [PMID: 34315650 PMCID: PMC8786980 DOI: 10.1016/j.jvoice.2021.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Voice teachers use anecdotal evidence and experience in determining the appropriateness of repertoire for each student's development. Tessitura is important in that determination, but until recently a straightforward, repeatable, and quantifiable method for determining tessitura has not existed. However, technology exists to provide the means to estimate the tessituras of standard vocal repertoire by measuring sung pitch (fundamental frequency) and vocal dose (amount of phonation) in real-time performance. PURPOSE The purpose of this study was to examine the combined use of tessituragrams, Voice Range Profiles (VRPs), a singer's self-perception of a performance, and expert listeners perception of a performance towards the goal of a more systematic way of selecting appropriate voice repertoire for singers. The following research questions guided this investigation: 1) How do Performance Range Profiles (PRPs, performance-based tessituragrams computed from neck skin surface vibration during singing), compare to score-based tessituragrams of the same selection in the same key? 2) How do PRPs of the same vocal score compare when performed in three different keys? 3) How do singer VRPs compare with PRPs of three performances of a score, each sung in a different key? and 4) How do singer and expert panel perceptions of the selection's "fit" in three different keys compare with the alignment of each singer's VRP to their PRPs? Four female singers and five expert voice pedagogues were enlisted to address these questions. RESULTS The distribution (histogram) of the score-based tessituragram closely matched the distribution of performance-based tessituragrams (PRP), suggesting that score-based tessituragrams have promise in accurately reflecting the performance-based tessitura of a musical vocal work. Acquired data revealed relationships of practical importance between score-derived tessituragrams, PRPs, acquired VRPs, and singer perceptions of ease in singing. These data suggest that score-based tessituragrams aligned with singer VRPs show promise in repertoire selection. However, there was only a minor relationship between expert panel perceptions of ease in singing and the acquired PRPs or singer perceptions of ease. Creation of a score-based tessituragram database could be combined with singer VRPs to assist in appropriate repertoire selection.
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Affiliation(s)
- Matthew Schloneger
- Division of Fine Arts, Friends University, 2100 W. University Avenue, Wichita, Kansas 67213.
| | - Eric J Hunter
- Dept of Communicative Sciences and Disorders, Michigan State University, 404 Wilson Rd, Room 291, Communication Arts and Sciences Building, East Lansing, MI 48824
| | - Lynn Maxfield
- Utah Center for Vocology, University of Utah, 240 S. 1500 E., Room 206, Salt Lake City, UT 84112
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Whitling S, Wan Q, Berardi ML, Hunter EJ. Effects of warm-up exercises on self-assessed vocal effort. LOGOP PHONIATR VOCO 2023; 48:172-179. [PMID: 35713650 PMCID: PMC10020864 DOI: 10.1080/14015439.2022.2075459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE An elevated sense of vocal effort due to increased vocal demand is frequently reported by patients with voice disorders. However, effects of vocal warm-up on self-assessed vocal effort have not been thoroughly examined. A recently developed version of the Borg CR-10 Scale facilitates vocal effort assessments, following different vocal warm-up tasks. METHODS Effects of a short (5 min) vocal warm-up on self-assessed vocal effort was evaluated using the Borg CR-10. Twenty-six vocally healthy participants (13F, 13M, mean age 22.6), in two randomised groups, underwent sessions of either reading aloud or semi-occluded vocal tract exercises (SOVTE). Vocal effort was evaluated at four times: pre to post vocal warm-up and two silence periods. Non-parametric analyses for repeated measures and calculations for within-subject standard deviation were applied in group comparisons. RESULTS Following vocal warm-up, vocal effort ratings were increased to a statistically significant degree in both intervention groups compared to baseline ratings. After a 5-min rest in silence following completion of the vocal warm-up, vocal effort ratings returned to baseline levels in both groups. The drop in ratings immediately post warm-up compared to 5 min later was statistically significant for the SOVTE group. CONCLUSIONS Five minutes of vocal warm-up caused increased self-perceived vocal effort in vocally healthy individuals. The increased sense of effort dissipated faster following warm-up for the SOVTE group. When using the Borg CR-10 scale to track vocal effort, it may be beneficial to apply experience-based anchors.
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Affiliation(s)
- Susanna Whitling
- Department of Logopedics Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Qin Wan
- School of Education Science, East China Normal University, Shanghai, China
| | | | - Eric J. Hunter
- Department of Clinical Sciences and Disorders, Michigan State University, East Lansing, USA
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Cantor-Cutiva LC, Calvache Mora C, Rincón-Pinilla MP, Hunter EJ. Association Between Bilingualism, Vocal Effort, and Background Noise With Voice Fundamental Frequency and LTAS Among Spanish-English Bilingual Teachers. J Voice 2023:S0892-1997(23)00275-8. [PMID: 37798218 PMCID: PMC10987393 DOI: 10.1016/j.jvoice.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND As the world becomes increasingly interconnected, the demand for bilingual teachers has grown exponentially. However, the unique combination of being a bilingual occupational voice user establishes challenges that warrant careful examination. OBJECTIVE To investigate the association between bilingualism, vocal effort, and background noise with fundamental frequency and long-term spectrum average among Spanish-English bilingual teachers. METHODS Exploratory cross-sectional correlational study with the participation of eight Spanish-English proficient bilingual teachers (native Spanish speakers) who were teaching online classes during the quarantines established to mitigate the propagation of COVID-19. Participants were asked to read two standardized texts (one in English and one in Spanish) under two background noise conditions (with and without background white noise). RESULTS There was a significant interaction between language and vocal effort considering that the association of vocal effort with fo was different for Spanish and English. There was also a significant main effect of background noise on fo. There were significant differences in voice spectral characteristics between productions in Spanish and English and between productions with and without background noise. The alpha ratio was significantly higher in productions in English and with background noise compared with productions in Spanish without background noise. The mid to high spectral energy ratio (1-5 K/5-8 K) was significantly lower in productions in English and with higher perceived vocal effort compared with productions in Spanish and with lower scores on the Borg Scale. CONCLUSION Our findings introduce a need perspective by emphasizing the impact of speaking a second language on the work-relatedness of voice disorders among teachers. These findings stress the necessity to factor in language and environmental conditions for the comprehensive evaluation and management of work-related voice disorders.
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Affiliation(s)
- Lady Catherine Cantor-Cutiva
- Communicative Sciences and Disorders Department, Michigan State University, East Lansing, Michigan; Communicative Sciences and Disorders Department, University of Iowa, Iowa City, Iowa.
| | - Carlos Calvache Mora
- Corporación Universitaria Iberoamericana, Department of Communication Sciences and Disorders, Bogotá, Colombia; Vocology Center, Bogotá, Colombia
| | | | - Eric J Hunter
- Communicative Sciences and Disorders Department, Michigan State University, East Lansing, Michigan; Communicative Sciences and Disorders Department, University of Iowa, Iowa City, Iowa
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Calvache Mora CA, Cantor-Cutiva LC, Hunter EJ, Guzmán M, Soláque L. Systematic Review of Literature on Vocal Demand Response: Understanding Physiology, Measurements, and Associated Factors. Folia Phoniatr Logop 2023; 76:1-21. [PMID: 37393892 DOI: 10.1159/000531678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/13/2023] [Indexed: 07/04/2023] Open
Abstract
PURPOSE Considering the conceptual migration from vocal load and vocal loading to vocal demand and vocal demand response, this review of literature aimed to identify physiological explanations, reported measurements, and associated factors (vocal demands) reported in the literature when considering the phonatory response to a vocal demand. METHODS A systematic review of literature, following the PRISMA Statement, was conducted using Web of Science, PubMed, Scopus, and ScienceDirect. Data were analyzed and presented in two parts. First, a bibliometric analysis, co-occurrence analysis, and content analysis were performed. Three criteria that got article inclusion were defined: (1) written in English, Spanish, and Portuguese; (2) published between 2009 and 2021; and (3) focused on vocal load and loading, vocal demand response, and voice assessment parameters. A total of 54 publications met the criteria and were included in this review. The second part included a conceptual framework based on the content analysis of three aspects of vocal demand response: (1) physiological explanations, (2) reported measurements, and (3) vocal demands. RESULTS AND CONCLUSION As would be expected since vocal demand response is a relatively new term and not yet commonly used in literature when discussing way that the speakers respond to communicative scenarios, most of the studies reviewed (both historical and recent) still use the term of vocal load and vocal loading. Although there is a broad variety of literature discussing a wide range of vocal demands and voice parameters used to characterize the vocal demand response, results show that there is consistency across the studies. While vocal demand response is unique and intrinsic to the talker, associated factors that contribute to this response include both internal talker and external talker factors. Internal factors include muscle stiffness, viscosity in the phonatory system, vocal fold tissue damage, elevated sound pressure levels during occupational voice demands, extended periods of voice use, suboptimal body posture, difficulties in breathing technique, and sleep disturbances. Associated external factors include the working environment (noise, acoustics, temperature, humidity). In conclusion, although vocal demand response is intrinsic to the speaker, the speaker's response is affected by external vocal demands. However, due to the wide methods to evaluate vocal demand response, it has been difficult to establish its contribution to voice disorders in the general population and, specifically, among occupational voice users. This literature review identified commonly reported parameters and factors that may help clinicians and researchers define vocal demand response.
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Affiliation(s)
- Carlos Alberto Calvache Mora
- Department of Communicative Sciences and Disorders, Corporación Universitaria Iberoamericana, Bogotá, Colombia
- Department of Mechatronics Engineering, Universidad Militar Nueva Granada, Bogotá, Colombia
- Vocology Center, Bogotá, Colombia
| | - Lady Catherine Cantor-Cutiva
- Vocology Center, Bogotá, Colombia
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan, USA
| | - Eric J Hunter
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan, USA
| | - Marco Guzmán
- Department of Communication Sciences and Disorders, Universidad de los Andes, Santiago, Chile
| | - Leonardo Soláque
- Department of Mechatronics Engineering, Universidad Militar Nueva Granada, Bogotá, Colombia
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Berardi ML, Hunter EJ. Self-Perception of Vocal Effort in Response to Modeled Communication Demands. J Voice 2022:S0892-1997(22)00154-0. [PMID: 35760632 PMCID: PMC10015702 DOI: 10.1016/j.jvoice.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The optimization of vocal effort given a response to a voice demand is a common clinical and vocal performance goal. Increases in vocal effort are often in response to communication limitations from both the interlocutors and the communication environment. This study investigates the relationship between vocal effort and vocal demands from changes and limitations imposed by the communication environment. METHODS Thirty-seven participants rated their vocal effort associated with a map description task in a range of communication demands. These demands included communication distance (from 1 m to 4 m), loudness goal (54 dB-66 dB), and excess background noise (53 dBA-71 dBA). The vocal effort ratings were compared across the different types and extents of vocal demand conditions. RESULTS As would be expected, there were significant increases in vocal effort levels from the control condition to the extremes of the distance and loudness goal vocal demands. Each increase in background noise resulted in distinct increases in vocal effort level. Participants were able to use the vocal effort scale to efficiently quantify expected increases in vocal demands. CONCLUSIONS Increases of vocal effort level accompany increases to vocal demands that exceed the habitual or expected communication. While voice training and vocal therapy are essential for reducing internal vocal demands, clients with a goal to reduce vocal effort should also consider external vocal demands such as communication distance and background noise.
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Affiliation(s)
- Mark L Berardi
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, North Rhine-Westphalia, Germany.
| | - Eric J Hunter
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan, USA
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