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Apfelbach CS, Guzmán M. Acoustic, Aerodynamic, Morphometric, and Perceptual Changes During and After Semi-Occluded Vocal Tract Exercise: An Integrative Review. J Voice 2024; 38:404-425. [PMID: 34774370 DOI: 10.1016/j.jvoice.2021.09.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The body of literature discussing the acoustic, aerodynamic, perceptual, and morphometric changes that occur during and after semi-occluded vocal tract exercise (SOVTE) has dramatically expanded within the past 20 years. The current study integrates the literature on SOVTE from the 1990s onward, reviewing the technique's clinically relevant effects in vocally untrained adults both with and without dysphonia. The study aims to give clinicians actionable information on how SOVTEs alter vocal function in both normal and pathological states. METHODS The author queried the MEDLINE database for combinations of search terms related to semi-occluded vocal tract exercise. To improve article identification, the author also performed iterative citation webbing in which the reference lists of each article selected for full-text screening were cross-referenced against the articles returned in the initial MEDLINE search. Articles identified by iterative citation webbing that did not appear in the initial MEDLINE search were then screened individually. The second author independently verified adherence to the review's inclusion and exclusion criteria in both the initial search and data extraction phases. RESULTS The initial MEDLINE search returned 869 articles, 111 of which passed the title and abstract screening phase. Iterative citation webbing returned an additional 20 studies, resulting in a total of 131 articles that qualified for full-text screening. 53 articles passed full-text screening and were included in the current review. DISCUSSION Semi-occluded vocal tract exercise increases the inertive reactance of the glottis, vocal tract, and air column, as well as introducing flow resistance at the level of the lips or velopharyngeal port. Each of these mechanisms yields downstream acoustic, aerodynamic, morphometric, and perceptual changes, including reductions in phonation threshold pressure and perceived phonatory effort, improved spectral characteristics of the acoustic signal, attenuation of vocal fold impact stress as indexed by various metrics such as maximum area declination rate, and alterations to the physical dimensions of the vocal tract. Although few studies examined the duration of these changes post exercise, several RCTs support the assertion that SOVTE's effects can be sustained with regular practice over weeks or months, regardless of current vocal health status.
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Affiliation(s)
- Christopher S Apfelbach
- Department of Communication Sciences and Disorders, University of Delaware, Newark, Delaware.
| | - Marco Guzmán
- Department of Communication Sciences and Disorders, Universidad de los Andes, Santiago, Chile
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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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Cortez-Aoyagi M, Gufstason E, Murphy A, van Mersbergen M. A Measure of Swallow Effort Using the Borg Category Ratio 10 Perceived Exertion Scale. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2846-2857. [PMID: 37713539 DOI: 10.1044/2023_ajslp-23-00090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
PURPOSE With the emphasis on patient-centered care, tools to adequately measure the experience of swallowing are an important part of clinical care. Swallowing effort is one such experience. However, few measurement tools capture swallowing effort in the moment of swallowing to quantify effort. The Borg Category Ratio 10 Perceived Exertion Scale (Borg CR 10), designed to track effort in a variety of tasks from lifting, breathing, and running, appears to be a likely candidate to measure swallowing effort in the moment of swallowing. METHOD In a quasi-random design, 32 healthy individuals, ages 40-80 years (average age: 63 years), consumed seven bolus consistencies in both small and large quantities, three times. Following each individual swallow, they rated the amount of effort it took to swallow each bolus using an adapted Borg CR 10 for swallowing effort. RESULTS Results showed significantly greater reports of swallowing effort on the Borg CR 10 for more adhesive consistencies, larger quantities, and increased number of swallows. CONCLUSION Results suggest that the Borg CR 10 is a reasonable measurement tool to capture patient-perceived effort in swallowing.
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Affiliation(s)
| | - Erin Gufstason
- Northern Illinois University, DeKalb
- UW Health in Northern Illinois, Rockford
| | - Amanda Murphy
- Northern Illinois University, DeKalb
- Chicago Public Schools, IL
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Li DX, Ye W, Yang YL, Zhang L, Qian XJ, Jiang PH. Enhanced recovery nursing and mental health education on postoperative recovery and mental health of laparoscopic liver resection. World J Gastrointest Surg 2023; 15:1728-1738. [PMID: 37701692 PMCID: PMC10494595 DOI: 10.4240/wjgs.v15.i8.1728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/09/2023] [Accepted: 07/11/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Patients undergoing laparoscopic resection of liver metastases of colorectal cancer are prone to negative emotions and decrease of digestive function. Early nursing and psychological intervention are necessary. AIM To observe the effect of enhanced recovery nursing combined with mental health education on postoperative recovery and mental health of patients undergoing laparoscopic resection of liver metastases of colorectal cancer. METHODS One hundred and twenty patients who underwent laparoscopic resection of liver metastases of colorectal cancer at our hospital between March 2021 and March 2023, were selected as participants. The patients admitted from March 1, 2021 to February 28, 2022 were set as the control group, and they were given routine nursing combined with mental health education intervention. While the patients admitted from March 1, 2022 to March 31, 2023 were set as the observation group, they were given accelerated rehabilitation surgical nursing combined with mental health education intervention. The differences in postoperative recovery-related indices, complications and pain degrees, and mental health-related scores were compared between groups. The T lymphocyte subset levels of the two groups were also compared. RESULTS The postoperative exhaust, defecation, eating and drainage time of the observation group were shorter than those of the control group. The pain scores of the observation group were lower than those of the control group at 6, 12, 24, 48, and 72 h after surgery. The cumulative complication rate of the observation group was lower than that of the control group (P < 0.05). The CD4+/CD8+ in the observation group was higher than that in the control group 3 d after surgery (P < 0.05). After intervention, the self-rating depression scale, self-rating anxiety scale, avoidance dimension, and yielding dimension in Medical coping style (MCMQ) scores of the two groups were lower than those prior to intervention, and the scores in the observation group were lower than those in the control group (P < 0.05). The face dimension score in the MCMQ score was higher than that before intervention, and that of the observation group was higher than that of the control group (P < 0.05). After intervention, the total scores of the life function index scale (FLIC) and psychological well-being scores of cancer patients in the two groups, and the physical and social well-being scores in the observation group, were higher than those before intervention. The nursing satisfaction of the observation group was higher than that of the control group (P < 0.05). The physical, psychological, and social well-being, and the total FLIC scores of the observation group were higher than those in the control group after surgery (P < 0.05). CONCLUSION Enhanced recovery nursing combined with mental health education can promote the recovery of gastrointestinal function, improve the mental health and quality of life of patients after laparoscopic resection of colorectal cancer liver metastases, and reduce the incidence of complications.
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Affiliation(s)
- Dong-Xia Li
- Department of Pancreatic Hepatobiliary Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Wei Ye
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Department of Orthopedics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Yi-Lu Yang
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Department of Orthopedics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Lei Zhang
- Department of Pancreatic Hepatobiliary Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Xiang-Jun Qian
- Department of Pancreatic Hepatobiliary Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Ping-Hua Jiang
- Department of Pancreatic Hepatobiliary Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
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Vinney LA, Tripp R, Shelly S, Gillespie A. Indexing Cognitive Resource Usage for Acquisition of Initial Voice Therapy Targets. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:717-732. [PMID: 36701805 DOI: 10.1044/2022_ajslp-22-00197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE The purpose of this study was to index cognitive resource usage for acquisition of initial targets of two common voice therapy techniques (resonant voice therapy [RVT] and conversation training therapy [CTT]) based on the theorized depletion effect (i.e., when an initial task requiring high cognitive load leads to poorer performance on a subsequent task). METHOD Eleven vocally healthy participants, ages 23-41 years, read aloud the Rainbow Passage and produced consonant-vowel resonant targets (/mi, ma, mu/) followed by a baseline computerized Stroop task and a 15-min washout. Following this baseline period, participants watched and interacted with two videos instructing them in RVT or CTT initial targets. After viewing each video and practicing the associated vocal skills, participants rated the degree of mental effort required to engage in the target vocal technique on a modified Borg scale. Participants recorded their attempts at RVT on /mi, ma, mu/ and CTT on the Rainbow Passage, which were later rated by three voice-specialized speech-language pathologists as to how representative they were of each respective target technique. Changes in fundamental frequency and average auditory-perceptual ratings from baseline were examined to determine if participants adjusted their technique from RVT and CTT baseline to acquisition. RESULTS Performance on the Stroop task was, on average, worse post CTT than post RVT, but both post-CTT and post-RVT Stroop scores were poorer than baseline. These results suggest that both treatment techniques taxed cognitive resources but that CTT was more cognitively taxing than RVT. However, despite differences in raw averages, no statistically significant differences were found between the baseline, post-CTT, and post-RVT Stroop scores, likely due to the small sample size. Participant ratings of mental effort for CTT and RVT were statistically similar. Likewise, poorer post-RVT Stroop scores were associated with participants' greater perceived mental effort with RVT acquisition, but there was no significant association between mental effort ratings for CTT acquisition and post-CTT Stroop scores. Significantly higher fundamental frequency and perceived ratings of the accuracy of technique from baseline to acquisition for both CTT and RVT were found, providing evidence of vocal behavior changes as a result of each technique. CONCLUSIONS Brief exposure to initial treatment tasks in CTT is more cognitively depleting than initial RVT tasks. Results also indicate that vocally healthy participants are able to make a voice change in response to a brief therapy prompt. Finally, participant-rated measures of mental effort and secondary measures of cognitive depletion do not always correlate.
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Affiliation(s)
| | - Raquel Tripp
- Department of Communicative Sciences and Disorders, New York University, NY
| | - Sandeep Shelly
- Emory Voice Center, Department of Otolarynngology-Head and Neck Surgery, Emory University, Atlanta, GA
| | - Amanda Gillespie
- Emory Voice Center, Department of Otolarynngology-Head and Neck Surgery, Emory University, Atlanta, GA
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Shembel AC, Nanjundeswaran C. Potential Biophysiological Mechanisms Underlying Vocal Demands and Vocal Fatigue. J Voice 2022:S0892-1997(22)00220-X. [PMID: 36008185 PMCID: PMC9943805 DOI: 10.1016/j.jvoice.2022.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 10/15/2022]
Abstract
Patients with complaint of vocal fatigue have perceptual, acoustic, and aerodynamic outcomes that are heterogeneous in nature. One reason may be due to different underlying biophysiological mechanisms that lead to these heterogeneous clinical presentations. Five potential mechanisms are proposed: neuromuscular, metabolic, vocal tissue, afferent, and central neural. Analytical frameworks and study designs to study these mechanisms are also addressed. A better understanding of biophysiological mechanisms of vocal fatigue can improve precision of therapeutic approaches. It can also help shift management from symptom-based to etiology-focused approaches for vocal fatigue.
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Affiliation(s)
- Adrianna C Shembel
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Dallas, Texas; Department of Otolaryngology-Head and Neck, Voice Center, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Chaya Nanjundeswaran
- Department of Audiology & Speech Language Pathology, East Tennessee State University, Johnson City, Tennessee
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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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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 2022:S0892-1997(22)00004-2. [PMID: 35168867 PMCID: PMC9372227 DOI: 10.1016/j.jvoice.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [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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Tuomainen O, Taschenberger L, Rosen S, Hazan V. Speech modifications in interactive speech: effects of age, sex and noise type. Philos Trans R Soc Lond B Biol Sci 2022; 377:20200398. [PMID: 34775827 PMCID: PMC8591383 DOI: 10.1098/rstb.2020.0398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
When attempting to maintain conversations in noisy communicative settings, talkers typically modify their speech to make themselves understood by the listener. In this study, we investigated the impact of background interference type and talker age on speech adaptations, vocal effort and communicative success. We measured speech acoustics (articulation rate, mid-frequency energy, fundamental frequency), vocal effort (correlation between mid-frequency energy and fundamental frequency) and task completion time in 114 participants aged 8-80 years carrying out an interactive problem-solving task in good and noisy listening conditions (quiet, non-speech noise, background speech). We found greater changes in fundamental frequency and mid-frequency energy in non-speech noise than in background speech and similar reductions in articulation rate in both. However, older participants (50+ years) increased vocal effort in both background interference types, whereas younger children (less than 13 years) increased vocal effort only in background speech. The presence of background interference did not lead to longer task completion times. These results suggest that when the background interference involves a higher cognitive load, as in the case of other speech of other talkers, children and older talkers need to exert more vocal effort to ensure successful communication. We discuss these findings within the communication effort framework. This article is part of the theme issue 'Voice modulation: from origin and mechanism to social impact (Part II)'.
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Affiliation(s)
- Outi Tuomainen
- Speech Hearing and Phonetic Sciences, University College London, 2 Wakefield Street, London WC1N 1PF, UK,Department of Linguistics, University of Potsdam, Haus 14, Karl-Liebknecht-Straße 24-25, 14476 Potsdam, Germany
| | - Linda Taschenberger
- Speech Hearing and Phonetic Sciences, University College London, 2 Wakefield Street, London WC1N 1PF, UK
| | - Stuart Rosen
- Speech Hearing and Phonetic Sciences, University College London, 2 Wakefield Street, London WC1N 1PF, UK
| | - Valerie Hazan
- Speech Hearing and Phonetic Sciences, University College London, 2 Wakefield Street, London WC1N 1PF, UK
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Hunter EJ, Berardi ML, van Mersbergen M. Relationship Between Tasked Vocal Effort Levels and Measures of Vocal Intensity. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:1829-1840. [PMID: 34057833 PMCID: PMC8740752 DOI: 10.1044/2021_jslhr-20-00465] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/04/2021] [Accepted: 02/19/2021] [Indexed: 06/12/2023]
Abstract
Purpose Patients with voice problems commonly report increased vocal effort, regardless of the underlying pathophysiology. Previous studies investigating vocal effort and voice production have used a range of methods to quantify vocal effort. The goals of the current study were to use the Borg CR100 effort scale to (a) demonstrate the relation between vocal intensity or vocal level (dB) and tasked vocal effort goals and (b) investigate the repeated measure reliability of vocal level at tasked effort level goals. Method Three types of speech (automatic, read, and structured spontaneous) were elicited at four vocal effort level goals on the Borg CR100 scale (2, 13, 25, and 50) from 20 participants (10 females and 10 males). Results Participants' vocal level reliably changed approximately 5 dB between the elicited effort level goals; this difference was statistically significant and repeatable. Biological females produced a voice with consistently less intensity for a vocal effort level goal compared to biological males. Conclusions The results indicate the utility of the Borg CR100 in tracking effort in voice production that is repeatable with respect to vocal level (dB). Future research will investigate other metrics of voice production with the goal of understanding the mechanisms underlying vocal effort and the external environmental influences on the perception of vocal effort.
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Affiliation(s)
- Eric J. Hunter
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Mark L. Berardi
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
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Hunter EJ, Cantor-Cutiva LC, van Leer E, van Mersbergen M, Nanjundeswaran CD, Bottalico P, Sandage MJ, Whitling S. Toward a Consensus Description of Vocal Effort, Vocal Load, Vocal Loading, and Vocal Fatigue. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:509-532. [PMID: 32078404 PMCID: PMC7210446 DOI: 10.1044/2019_jslhr-19-00057] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Purpose The purpose of this document is threefold: (a) review the uses of the terms "vocal fatigue," "vocal effort," "vocal load," and "vocal loading" (as found in the literature) in order to track the occurrence and the related evolution of research; (b) present a "linguistically modeled" definition of the same from the review of literature on the terms; and (c) propose conceptualized definitions of the concepts. Method A comprehensive literature search was conducted using PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scientific Electronic Library Online. Four terms ("vocal fatigue," "vocal effort," "vocal load," and "vocal loading"), as well as possible variants, were included in the search, and their usages were compiled into conceptual definitions. Finally, a focus group of eight experts in the field (current authors) worked together to make conceptual connections and proposed consensus definitions. Results The occurrence and frequency of "vocal load," "vocal loading," "vocal effort," and "vocal fatigue" in the literature are presented, and summary definitions are developed. The results indicate that these terms appear to be often interchanged with blurred distinctions. Therefore, the focus group proposes the use of two new terms, "vocal demand" and "vocal demand response," in place of the terms "vocal load" and "vocal loading." We also propose standardized definitions for all four concepts. Conclusion Through a comprehensive literature search, the terms "vocal fatigue," "vocal effort," "vocal load," and "vocal loading" were explored, new terms were proposed, and standardized definitions were presented. Future work should refine these proposed definitions as research continues to address vocal health concerns.
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Affiliation(s)
- Eric J. Hunter
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Lady Catherine Cantor-Cutiva
- Department of Collective Health, Universidad Nacional de Colombia, Bogotá
- Department of Speech and Language Pathology, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Eva van Leer
- Department of Communication Sciences and Disorders, Georgia State University, Atlanta
| | | | - Chaya Devie Nanjundeswaran
- Department of Audiology and Speech-Language Pathology, East Tennessee State University, Johnson City, TN
| | - Pasquale Bottalico
- Department of Speech and Hearing Science, University of Illinois at Urbana–Champaign
| | - Mary J. Sandage
- Department of Communication Disorders, Auburn University, AL
| | - Susanna Whitling
- Department of Logopedics, Phoniatrics and Audiology, Lund University, Sweden
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