Voice Stress Analysis: A New Framework for Voice and Effort in Human Performance

Effects of trace element dietary supplements on voice parameters and some physiological and psychological parameters related to stress

Trace elements, often used as dietary supplements, are widely accessible without prescription at pharmacies. Pronutri has pioneered Nutripuncture®, a methodology that utilizes orally consumed trace elements to elicit a physiological response akin to that of acupuncture. Pronutri has empirically observed that the user's voice becomes deeper following an exclusive ingestion procedure. Given that alterations in vocal characteristics are often linked to stress, the Pronutri researchers postulated that the pills have the capacity to promptly alleviate stress upon ingestion. Nevertheless, there is a lack of scientific substantiation about the impact of these supplements on voice (or stress) indicators. The aim of this research was to determine whether there is a consistent impact of trace element ingestion on vocal characteristics, namely the fundamental frequency of the voice, as well as other physiological and psychological stress measurements. In order to achieve this objective, we have devised a unique methodology to examine this hypothesis. This involves conducting a monocentric crossover, randomized, triple-blind, placebo-controlled trial with a sample size of 43 healthy individuals. This study demonstrates that compared to placebo tablets, consuming 10 metal traces containing tablets at once is enough to cause noticeable changes in the vocal spectrum in the direction of an improvement of the voice timbre "richness", and a decrease in the occurrence of spontaneous electrodermal activity, suggesting a stress reduction. However, there were no significant changes observed in the other parameters that were tested. These parameters include vocal measures such as voice frequency F0, standard deviation from this frequency, jitter, and shimmer. Additionally, physiological measures such as respiratory rate, oxygenation and heart rate variability parameters, as well as psychological measures such as self-assessment analogic scales of anxiety, stress, muscle tension, and nervous tension, did not show any significant changes. Ultimately, our research revealed that the ingestion of 10 trace elements pills may promptly elicit a targeted impact on both vocal spectrum and electrodermal activity. Despite the limited impact, these findings warrant more research to explore the long-term effects of trace elements on voice and stress reduction.

Acoustic and prosodic speech features reflect physiological stress but not isolated negative affect: a multi-paradigm study on psychosocial stressors

Heterogeneity in speech under stress has been a recurring issue in stress research, potentially due to varied stress induction paradigms. This study investigated speech features in semi-guided speech following two distinct psychosocial stress paradigms (Cyberball and MIST) and their respective control conditions. Only negative affect increased during Cyberball, while self-reported stress, skin conductance response rate, and negative affect increased during MIST. Fundamental frequency (F0), speech rate, and jitter significantly changed during MIST, but not Cyberball; HNR and shimmer showed no expected changes. The results indicate that observed speech features are robust in semi-guided speech and sensitive to stressors eliciting additional physiological stress responses, not solely decreases in negative affect. These differences between stressors may explain literature heterogeneity. Our findings support the potential of speech as a stress level biomarker, especially when stress elicits physiological reactions, similar to other biomarkers. This highlights its promise as a tool for measuring stress in everyday settings, considering its affordability, non-intrusiveness, and ease of collection. Future research should test these results' robustness and specificity in naturalistic settings, such as freely spoken speech and noisy environments while exploring and validating a broader range of informative speech features in the context of stress.

Analysis of the relationship between emotion intensity and electrophysiology parameters during a voice examination of opera singers

OBJECTIVES

Emotions and stress affect voice production. There are only a few reports in the literature on how changes in the autonomic nervous system affect voice production. The aim of this study was to examine emotions and measure stress reactions during a voice examination procedure, particularly changes in the muscles surrounding the larynx.

MATERIAL AND METHODS

The study material included 50 healthy volunteers (26 voice workers - opera singers, 24 control subjects), all without vocal complaints. All subjects had good voice quality in a perceptual assessment. The research procedure consisted of 4 parts: an ear, nose, and throat (ENT)‑phoniatric examination, surface electromyography, recording physiological indicators (heart rate and skin resistance) using a wearable wristband, and a psychological profile based on questionnaires.

RESULTS

The results of the study demonstrated that there was a relationship between positive and negative emotions and stress reactions related to the voice examination procedure, as well as to the tone of the vocal tract muscles. There were significant correlations between measures describing the intensity of experienced emotions and vocal tract muscle maximum amplitude of the cricothyroid (CT) and sternocleidomastoid (SCM) muscles during phonation and non-phonation tasks. Subjects experiencing eustress (favorable stress response) had increased amplitude of submandibular and CT at rest and phonation. Subjects with high levels of negative emotions, revealed positive correlations with SCMmax during the glissando. The perception of positive and negative emotions caused different responses not only in the vocal tract but also in the vegetative system. Correlations were found between emotions and physiological parameters, most markedly in heart rate variability. A higher incidence of extreme emotions was observed in the professional group.

CONCLUSIONS

The activity of the vocal tract muscles depends on the type and intensity of the emotions and stress reactions. The perception of positive and negative emotions causes different responses in the vegetative system and the vocal tract. Int J Occup Med Environ Health. 2024;37(1):84-97.

Effects of Cognitive Load on Vocal Fold Vibratory Patterns in Bilingual Speakers of Low and High German

OBJECTIVES

Increased cognitive load has been observed to correlate with decreased vocal fold perturbation, reduced additive noise, increased periodicity, and a higher rate of vocal fold vibration. The aim of this study was to explore whether vocal fold vibratory patterns can serve as indicators of increased cognitive load in nonbalanced bilingual speakers when they use their weaker language.

STUDY DESIGN

This is a comparative experimental study with a within-speaker design.

METHODS

We recorded a total of 95 bilingual speakers of Low German (LG), which is an endangered language spoken in Northern Germany, and Standard High German (HG). Participants completed four tasks in both languages: engaging in free narration, describing a picture story, giving directions, and reading a narrative passage. For the last three tasks, the difficulty levels were varied. Measurements included jitter, shimmer, harmonics-to-noise ratio (HNR), cepstral peak prominence (CPP), the proportion of creak, pitch level, and pitch span. Changes in voice characteristics were examined both in terms of the participants' age and their language dominance. For the latter, we calculated a dominance score derived from age of acquisition, frequency of use, and self-perceived linguistic competence in the two languages.

RESULTS

Younger speakers showed a higher dominance of HG over LG, which decreased with age. Younger and more HG-dominant speakers exhibited lower jitter and shimmer, along with a higher HNR and a lower creak proportion in LG compared to HG. CPP and pitch level were higher in LG but showed little variation with age or language dominance. No clear effects on pitch span were observed. Overall, age was a slightly more reliable predictor than language dominance. Acoustic differences in voice quality were about equally detectable across the different speech tasks while varying difficulty levels had minimal impact.

CONCLUSIONS

The variation in vocal fold vibratory patterns suggests that younger and more HG-dominant speakers experienced greater cognitive load when speaking LG. Given that increased cognitive load may negatively impact language usage, voice analysis opens up new possibilities for evaluating the future prospects of endangered languages.

Influence of Cognitive Load on Voice Production: A Scoping Review

Cognitive-motor interactions in speech production have a strong theoretical basis. However, majority of the existing literature has primarily focused on subjective and objective measures related to speech and not voice. This systematic review gathered evidence on the potential relationship between cognitive load and voice production. A search of five databases, website, citation review, and author search were completed in a sequential order to find published and unpublished literature from 1992 to 2022 using a combination of search terms including voice, cognitive load/demand/effort/flexibility, dual task, and speech production/motor. Studies for which the primary dependent variables were linguistic, or speech measures were included if voice acoustics was also measured and described. A final sample of nine articles were identified as meeting inclusion criteria: completed between 1992 and 2022, healthy adults (18+), and American English speakers. The review indicated that existing literature on the influence of cognitive load on voice production is limited. Acoustic measures, such as fundamental frequency, sound pressure level, and cepstral peak prominence, do not show consistent patterns of change with an increase in cognitive load. It is likely that the inconsistencies in the speech or cognitive task type and measurement of individual reaction to cognitive load changes may have led to these varied results. Further research using a range/continuum of cognitive tasks varying in load/difficulty level and physiological measurements is warranted to understand the underlying mechanisms of behavioral performance with implications for clinical voice assessment and rehabilitation.

Interventions That Target or Affect Voice or Speech Production During Public Speaking: A Scoping Review

OBJECTIVES

Public speaking (PS) is frequently necessary in many professional, educational, and personal settings. Mastering this communication skill is particularly important in today's society. Training techniques for PS have been described in the literature. Given that PS anxiety affects performance, especially voice characteristics and speech fluency, the purpose of this scoping review is to examine, map, and narratively summarize the available evidence on PS interventions that target or affect voice or speech.

METHODS

An extensive literature search was conducted in three bibliographic databases: Medline ALL/Ovid, PsycINFO/Ovid, and Eric/Ovid. Of the 850 studies identified, 22 met the eligibility criteria, and one was added from the reference lists of the included studies.

RESULTS

A total of 23 studies were included. The interventions identified aim to improve speaking skills either by explicitly targeting the voice or speech (direct intervention, n = 15) or by targeting the cognitive, behavioral, psychological, or physical environment impacting the speaker's production (indirect intervention, n = 8).

CONCLUSIONS

This scoping review provides the first published methodological summary of the characteristics of existing PS interventions that target or affect voice and speech. Heterogeneous characteristics were observed. Further studies are needed to determine which interventions are most effective.

The honest sound of physical effort

Acoustic correlates of physical effort are still poorly understood, even though effort is vocally communicated in a variety of contexts with crucial fitness consequences, including both confrontational and reproductive social interactions. In this study 33 lay participants spoke during a brief, but intense isometric hold (L-sit), first without any voice-related instructions, and then asked either to conceal their effort or to imitate it without actually performing the exercise. Listeners in two perceptual experiments then rated 383 recordings on perceived level of effort (n = 39 listeners) or categorized them as relaxed speech, actual effort, pretended effort, or concealed effort (n = 102 listeners). As expected, vocal effort increased compared to baseline, but the accompanying acoustic changes (increased loudness, pitch, and tense voice quality) were under voluntary control, so that they could be largely suppressed or imitated at will. In contrast, vocal tremor at approximately 10 Hz was most pronounced under actual load, and its experimental addition to relaxed baseline recordings created the impression of concealed effort. In sum, a brief episode of intense physical effort causes pronounced vocal changes, some of which are difficult to control. Listeners can thus estimate the true level of exertion, whether to judge the condition of their opponent in a fight or to monitor a partner’s investment into cooperative physical activities.

Stress and Workload Assessment in Aviation-A Narrative Review

In aviation, any detail can have massive consequences. Among the potential sources of failure, human error is still the most troublesome to handle. Therefore, research concerning the management of mental workload, attention, and stress is of special interest in aviation. Recognizing conditions in which a pilot is over-challenged or cannot act lucidly could avoid serious outcomes. Furthermore, knowing in depth a pilot's neurophysiological and cognitive-behavioral responses could allow for the optimization of equipment and procedures to minimize risk and increase safety. In addition, it could translate into a general enhancement of both the physical and mental well-being of pilots, producing a healthier and more ergonomic work environment. This review brings together literature on the study of stress and workload in the specific case of pilots of both civil and military aircraft. The most common approaches for studying these phenomena in the avionic context are explored in this review, with a focus on objective methodologies (e.g., the collection and analysis of neurophysiological signals). This review aims to identify the pros, cons, and applicability of the various approaches, to enable the design of an optimal protocol for a comprehensive study of these issues.

Speech as a Promising Biosignal in Precision Psychiatry

Health research and health care alike are presently based on infrequent assessments that provide an incomplete picture of clinical functioning. Consequently, opportunities to identify and prevent health events before they occur are missed. New health technologies are addressing these critical issues by enabling the continual monitoring of health-related processes using speech. These technologies are a great match for the healthcare environment because they make high-frequency assessments non-invasive and highly scalable. Indeed, existing tools can now extract a wide variety of health-relevant biosignals from smartphones by analyzing a person's voice and speech. These biosignals are linked to health-relevant biological pathways and have shown promise in detecting several disorders, including depression and schizophrenia. However, more research is needed to identify the speech signals that matter most, validate these signals against ground-truth outcomes, and translate these data into biomarkers and just-in-time adaptive interventions. We discuss these issues herein by describing how assessing everyday psychological stress through speech can help both researchers and health care providers monitor the impact that stress has on a wide variety of mental and physical health outcomes, such as self-harm, suicide, substance abuse, depression, and disease recurrence. If done appropriately and securely, speech is a novel digital biosignal that could play a key role in predicting high-priority clinical outcomes and delivering tailored interventions that help people when they need it most.

Acoustic speech features in social comparison: how stress impacts the way you sound

The use of speech as a digital biomarker to detect stress levels is increasingly gaining attention. Yet, heterogeneous effects of stress on specific acoustic speech features have been observed, possibly due to previous studies' use of different stress labels/categories and the lack of solid stress induction paradigms or validation of experienced stress. Here, we deployed a controlled, within-subject psychosocial stress induction experiment in which participants received both neutral (control condition) and negative (negative condition) comparative feedback after solving a challenging cognitive task. This study is the first to use a (non-actor) within-participant design that verifies a successful stress induction using both self-report (i.e., decreased reported valence) and physiological measures (i.e., increased heart rate acceleration using event-related cardiac responses during feedback exposure). Analyses of acoustic speech features showed a significant increase in Fundamental Frequency (F0) and Harmonics-to-Noise Ratio (HNR), and a significant decrease in shimmer during the negative feedback condition. Our results using read-out-loud speech comply with earlier research, yet we are the first to validate these results in a well-controlled but ecologically-valid setting to guarantee the generalization of our findings to real-life settings. Further research should aim to replicate these results in a free speech setting to test the robustness of our findings for real-world settings and should include semantics to also take into account what you say and not only how you say it.

Machine Learning Based on Event-Related EEG of Sustained Attention Differentiates Adults with Chronic High-Altitude Exposure from Healthy Controls

(1) Objective: The aim of this study was to examine the effect of high altitude on inhibitory control processes that underlie sustained attention in the neural correlates of EEG data, and explore whether the EEG data reflecting inhibitory control contain valuable information to classify high-altitude chronic hypoxia and plain controls. (2) Methods: 35 chronic high-altitude hypoxic adults and 32 matched controls were recruited. They were required to perform the go/no-go sustained attention task (GSAT) using event-related potentials. Three machine learning algorithms, namely a support vector machine (SVM), logistic regression (LR), and a decision tree (DT), were trained based on the related ERP components and neural oscillations to build a dichotomous classification model. (3) Results: Behaviorally, we found that the high altitude (HA) group had lower omission error rates during all observation periods than the low altitude (LA) group. Meanwhile, the ERP results showed that the HA participants had significantly shorter latency than the LAs for sustained potential (SP), indicating vigilance to response-related conflict. Meanwhile, event-related spectral perturbation (ERSP) analysis suggested that lowlander immigrants exposed to high altitudes may have compensatory activated prefrontal cortexes (PFC), as reflected by slow alpha, beta, and theta frequency-band neural oscillations. Finally, the machine learning results showed that the SVM achieved the optimal classification F1 score in the later stage of sustained attention, with an F1 score of 0.93, accuracy of 92.54%, sensitivity of 91.43%, specificity of 93.75%, and area under ROC curve (AUC) of 0.97. The results proved that SVM classification algorithms could be applied to identify chronic high-altitude hypoxia. (4) Conclusions: Compared with other methods, the SVM leads to a good overall performance that increases with the time spent on task, illustrating that the ERPs and neural oscillations may provide neuroelectrophysiological markers for identifying chronic plateau hypoxia.

Voice Analysis for Neurological Disorder Recognition–A Systematic Review and Perspective on Emerging Trends

Quantifying neurological disorders from voice is a rapidly growing field of research and holds promise for unobtrusive and large-scale disorder monitoring. The data recording setup and data analysis pipelines are both crucial aspects to effectively obtain relevant information from participants. Therefore, we performed a systematic review to provide a high-level overview of practices across various neurological disorders and highlight emerging trends. PRISMA-based literature searches were conducted through PubMed, Web of Science, and IEEE Xplore to identify publications in which original (i.e., newly recorded) datasets were collected. Disorders of interest were psychiatric as well as neurodegenerative disorders, such as bipolar disorder, depression, and stress, as well as amyotrophic lateral sclerosis amyotrophic lateral sclerosis, Alzheimer's, and Parkinson's disease, and speech impairments (aphasia, dysarthria, and dysphonia). Of the 43 retrieved studies, Parkinson's disease is represented most prominently with 19 discovered datasets. Free speech and read speech tasks are most commonly used across disorders. Besides popular feature extraction toolkits, many studies utilise custom-built feature sets. Correlations of acoustic features with psychiatric and neurodegenerative disorders are presented. In terms of analysis, statistical analysis for significance of individual features is commonly used, as well as predictive modeling approaches, especially with support vector machines and a small number of artificial neural networks. An emerging trend and recommendation for future studies is to collect data in everyday life to facilitate longitudinal data collection and to capture the behavior of participants more naturally. Another emerging trend is to record additional modalities to voice, which can potentially increase analytical performance.

Using IoT devices for sensor-based monitoring of employees' mental workload: Investigating managers' expectations and concerns

Although the objective assessment of mental workload has been a focus of human factors research, few studies have investigated stakeholders' attitudes towards its implementation in real workplaces. The present study addresses this research gap by surveying N = 702 managers in three European countries (Germany, United Kingdom, Spain) about their expectations and concerns regarding sensor-based monitoring of employee mental workload. The data confirm the relevance of expectations regarding improvements of workplace design and employee well-being, as well as concerns about restrictions of employees' privacy and sovereignty, for the implementation of workload monitoring. Furthermore, Bayesian regression models show that the examined expectations have a substantial positive association with managers' willingness to support workload monitoring in their company. Privacy concerns are identified as a significant barrier to the acceptance of workload monitoring, both in terms of their prevalence among managers and their strong negative relationship with monitoring support.

The submariners' sleep study. A field investigation of sleep and circadian hormones during a 67-days submarine mission with a strict 6h-on/6h-off watch routine

The submarine working and living environment is an isolated, confined, and extreme (ICE) environment where a continuous on-watch is required to fulfill the tactical objectives. The current study examined whether a physiological and behavioral adjustment to an operational watch standing scheme occurred in terms of hormonal secretion (i.e., melatonin and cortisol) and sleep during a 67-days undersea mission. The crew followed a strict scheme of watch-on blocks at 0:00-06:00 h and at 12:00-18:00 h (group 1, diurnal sleep group) or watch-on blocks at 06:00-12:00 h and 18:00-24:00 h (group 2, nocturnal sleep group). We sampled saliva during the operational blocks over a 24h period at day 55 of the mission and collected sleep actigraphy data during the entire mission in 10 participants. Sleep showed a biphasic split pattern with significantly unequal distributions of total sleep time (TST) and sleep efficiency (SE) between the two sleeping blocks, i.e., one long and one short sleep bout. Melatonin secretion showed no adjustment at the end of the mission to the watch standing blocks, following an endogenous circadian rhythm independent from the social zeitgebers with indications of a phase shift. Cortisol secretion however matched the biphasic work-sleep shift routine. Human physiology does not fully obey operational needs and there are differences in adjustment between melatonin and cortisol. A watch standing schedule that provides a balance between physiology and operationality still needs to be established. The potential adaptation effects of bright light therapy and melatonin supplementation should be investigated in future research.

Speech as an indicator for psychosocial stress: A network analytic approach

Recently, the possibilities of detecting psychosocial stress from speech have been discussed. Yet, there are mixed effects and a current lack of clarity in relations and directions for parameters derived from stressed speech. The aim of the current study is – in a controlled psychosocial stress induction experiment – to apply network modeling to (1) look into the unique associations between specific speech parameters, comparing speech networks containing fundamental frequency (F0), jitter, mean voiced segment length, and Harmonics-to-Noise Ratio (HNR) pre- and post-stress induction, and (2) examine how changes pre- versus post-stress induction (i.e., change network) in each of the parameters are related to changes in self-reported negative affect. Results show that the network of speech parameters is similar after versus before the stress induction, with a central role of HNR, which shows that the complex interplay and unique associations between each of the used speech parameters is not impacted by psychosocial stress (aim 1). Moreover, we found a change network (consisting of pre-post stress difference values) with changes in jitter being positively related to changes in self-reported negative affect (aim 2). These findings illustrate – for the first time in a well-controlled but ecologically valid setting – the complex relations between different speech parameters in the context of psychosocial stress. Longitudinal and experimental studies are required to further investigate these relationships and to test whether the identified paths in the networks are indicative of causal relationships.

The Concept of Advanced Multi-Sensor Monitoring of Human Stress

Many people live under stressful conditions which has an adverse effect on their health. Human stress, especially long-term one, can lead to a serious illness. Therefore, monitoring of human stress influence can be very useful. We can monitor stress in strictly controlled laboratory conditions, but it is time-consuming and does not capture reactions, on everyday stressors or in natural environment using wearable sensors, but with limited accuracy. Therefore, we began to analyze the current state of promising wearable stress-meters and the latest advances in the record of related physiological variables. Based on these results, we present the concept of an accurate, reliable and easier to use telemedicine device for long-term monitoring of people in a real life. In our concept, we ratify with two synchronized devices, one on the finger and the second on the chest. The results will be obtained from several physiological variables including electrodermal activity, heart rate and respiration, body temperature, blood pressure and others. All these variables will be measured using a coherent multi-sensors device. Our goal is to show possibilities and trends towards the production of new telemedicine equipment and thus, opening the door to a widespread application of human stress-meters.

Measuring Stress in Health Professionals Over the Phone Using Automatic Speech Analysis During the COVID-19 Pandemic: Observational Pilot Study

Background

During the COVID-19 pandemic, health professionals have been directly confronted with the suffering of patients and their families. By making them main actors in the management of this health crisis, they have been exposed to various psychosocial risks (stress, trauma, fatigue, etc). Paradoxically, stress-related symptoms are often underreported in this vulnerable population but are potentially detectable through passive monitoring of changes in speech behavior.

Objective

This study aims to investigate the use of rapid and remote measures of stress levels in health professionals working during the COVID-19 outbreak. This was done through the analysis of participants’ speech behavior during a short phone call conversation and, in particular, via positive, negative, and neutral storytelling tasks.

Methods

Speech samples from 89 health care professionals were collected over the phone during positive, negative, and neutral storytelling tasks; various voice features were extracted and compared with classical stress measures via standard questionnaires. Additionally, a regression analysis was performed.

Results

Certain speech characteristics correlated with stress levels in both genders; mainly, spectral (ie, formant) features, such as the mel-frequency cepstral coefficient, and prosodic characteristics, such as the fundamental frequency, appeared to be sensitive to stress. Overall, for both male and female participants, using vocal features from the positive tasks for regression yielded the most accurate prediction results of stress scores (mean absolute error 5.31).

Conclusions

Automatic speech analysis could help with early detection of subtle signs of stress in vulnerable populations over the phone. By combining the use of this technology with timely intervention strategies, it could contribute to the prevention of burnout and the development of comorbidities, such as depression or anxiety.

Investigating Group-Specific Models of Hospital Workers’ Well-Being: Implications for Algorithmic Bias

Hospital workers often experience burnout due to the demanding job responsibilities and long work hours. Data yielding from ambulatory monitoring combined with machine learning algorithms can afford us a better understanding of the naturalistic processes that contribute to this burnout. Motivated by the challenges related to the accurate tracking of well-being in real-life, prior work has investigated group-specific machine learning (GS-ML) models that are tailored to groups of participants. We examine a novel GS-ML for estimating well-being from real-life multimodal measures collected in situ from hospital workers. In contrast to the majority of prior work that uses pre-determined clustering criteria, we propose an iterative procedure that refines participant clusters based on the representations learned by the GS-ML models. Motivated by prior work that highlights the differential impact of job demands on well-being, we further explore the participant clusters in terms of demography and job-related attributes. Results indicate that the GS-ML models mostly outperform general models in estimating well-being constructs. The GS-ML models further depict different degrees of predictive power for each participant cluster, as distinguished upon age, education, occupational role, and number of supervisees. The observed discrepancies with respect to the GS-ML model decisions are discussed in association with algorithmic bias.

Does the Acoustic Voice Quality Index (AVQI) Correlate with Perceived Creak and Strain in Normophonic Young Adult Finnish Females?

BACKGROUND

The Acoustic Voice Quality Index (AVQI) is a correlate of dysphonia. It has been found to differentiate between dysphonic and normophonic speakers and to indicate the effects of voice therapy. This study investigates how the AVQI reacts towards creak and strain, which are common in normophonic speakers.

METHODS

The material was obtained from an earlier study on 104 Finnish female university students (mean age 24.3 years, SD 6.3 years) with no known pathology of voice or hearing and a perceptually normal voice (G = 0 in GRBAS), who were recorded while reading aloud a standard text and sustaining the vowel [a:]. Perceptual analysis for the amount of creak and strain was carried out by 2 expert listeners. In this study, the AVQI v03.01 was analyzed and correlated with perceptual evaluations. Samples with low and high amounts of creak and strain were compared with t tests.

RESULTS

On average, the AVQI was below the threshold value of dysphonia in the Finnish population. The AVQI (ρ = 0.35, p = 0.000) and its subparameters, smoothed cepstral peak prominence (CPPS; ρ = -0.35, p = 0.000) and harmonics-to-noise ratio (HNR; ρ = -0.30, p = 0.002) showed low but significant correlations with creak. Strain had low but significant correlations with spectral Slope (ρ = 0.38, p = 0.000) and Tilt (ρ = -0.40, p = 0.009). The AVQI was lower (better) in samples that were evaluated as having a high amount of strain, but the difference was not significant. Only CPPS differentiated significantly between low and high amounts of creak.

CONCLUSION

The AVQI does not seem to differentiate between high and low amounts of creak and strain in normophonic speakers.

Which teachers are most at risk for voice disorders? Individual factors predicting vocal acoustic parameters monitored in situ during a workweek

PURPOSE

To identify the factors affecting teachers' vocal acoustic parameters, with the aim of detecting individuals at risk of phonotrauma.

METHOD

The voicing time, voice sound pressure level [SPL] and fundamental frequency [f_o] of 87 teachers were measured during one workweek using a voice dosimeter. We retrospectively investigated the impact of 10 factors (gender, age, teaching experience, teaching level, tobacco, gastro-esophageal problems, nonoccupational voice activity, voice education, past voice problems, and biopsychosocial impact of voice problems measured using the Voice Handicap Index [VHI]) on each voice parameter.

RESULTS

None of the above factors affected voicing time or SPL. f_o depended significantly on gender, teaching level, nonoccupational voice activity and VHI score. Specifically, f_o was higher in women (Δ = 69 Hz), in individuals without nonoccupational voice activities (Δ = 11 Hz), and in individuals with a lower VHI score (increase of 0.7 Hz for each additional point). For females, post hoc comparisons revealed a substantial impact of teaching level on f_o: university instructors had deeper voices than kindergarten (Δ = 66 Hz), elementary (Δ = 52 Hz), or secondary teachers (Δ = 41 Hz).

CONCLUSIONS

Since higher f_o increases the mechanical stress related to vocal fold vibration, the screening and prevention of phonotrauma should focus primarily on women, particularly those who teach at lower levels, and teachers with more self-rated voice problems. The lower f_o of teachers who engage in nonprofessional voice activities may suggest acute inflammation or muscle fatigue due to voice overload.

Voice perturbations under the stress overload in young individuals: phenotyping and suboptimal health as predictors for cascading pathologies

Verbal communication is one of the most sophisticated human motor skills reflecting both-the mental and physical health of an individual. Voice parameters and quality changes are usually secondary towards functional and/or structural laryngological alterations under specific systemic processes, syndrome and pathologies. These include but are not restricted to dry mouth and Sicca syndromes, body dehydration, hormonal alterations linked to pubertal, menopausal, and andropausal status, respiratory disorders, gastrointestinal reflux, autoimmune diseases, endocrinologic disorders, underweight versus overweight and obesity, and diabetes mellitus. On the other hand, it is well-established that stress overload is a significant risk factor of cascading pathologies, including but not restricted to neurodegenerative and psychiatric disorders, diabetes mellitus, cardiovascular disease, stroke, and cancers. Our current study revealed voice perturbations under the stress overload as a potentially useful biomarker to identify individuals in suboptimal health conditions who might be strongly predisposed to associated pathologies. Contextually, extended surveys applied in the population might be useful to identify, for example, persons at high risk for respiratory complications under pandemic conditions such as COVID-19. Symptoms of dry mouth syndrome, disturbed microcirculation, altered sense regulation, shifted circadian rhythm, and low BMI were positively associated with voice perturbations under the stress overload. Their functional interrelationships and relevance for cascading associated pathologies are presented in the article. Automated analysis of voice recordings via artificial intelligence (AI) has a potential to derive digital biomarkers. Further, predictive machine learning models should be developed that allows for detecting a suboptimal health condition based on voice recordings, ideally in an automated manner using derived digital biomarkers. Follow-up stratification and monitoring of individuals in suboptimal health conditions are recommended using disease-specific cell-free nucleic acids (ccfDNA, ctDNA, mtDNA, miRNA) combined with metabolic patterns detected in body fluids. Application of the cost-effective targeted prevention within the phase of reversible health damage is recommended based on the individualised patient profiling.

Sense of Coherence and Coping Strategies in Patients With Dysphonia

AIM

To analyze sense of coherence (SOC) of dysphonic individuals considering the type and degree of dysphonia, coping strategies, and sociodemographic variables.

METHODS

This cross-sectional study was performed with 50 dysphonic individuals under follow-up at a Brazilian Speech-Language Pathology Clinic. They answered a questionnaire with sociodemographic information, the PEED-10 (Brazilian Voice Disability Coping Questionnaire) and the Brazilian version of Sense of Coherence scale. The SOC was categorized as high or low using Cluster analysis. After descriptive analysis, data were analyzed through both the bivariate and multivariate logistic regression model method and the Spearman's correlation test (P< 0.05).

RESULTS

Most individuals presented a high SOC (60%). Individuals with mild dysphonia were 7.00 times more likely to present high SOC (95% CI = 1.24-39.38).  Individuals between 45 and 70 years old were 5.03 times more likely to present high SOC (95% CI = 1.25-20.28). In addition, the higher SOC, as well as the scores of manageability domain, the lower the use of strategies focused on emotion.

CONCLUSION

Patients with mild dysphonia are more likely to have a high SOC. The same goes for individuals over the fourth decade of life. Also, the greater the SOC, the fewer emotional strategies are used to cope with dysphonia.

Effects of Physiological Arousal on Speech Motor Control and Speech Motor Practice in Preschool-Age Children Who Do and Do Not Stutter

Purpose We examined the effects of physiological arousal on speech motor control and speech motor practice effects in preschool-age children who do (CWS) and do not stutter (CWNS). Method Participants included 18 CWS (M _age = 4 years 5 months) and 18 age- and gender-matched CWNS. The participants repeated a phrase "buy bobby a puppy" interspersed with viewing pictures from the International Affective Picture System under two experimental conditions speaking after viewing pictures with (a) negative and (b) neutral valence. Participants' lip movements were tracked using Optotrak system. The spatiotemporal index and mean utterance duration were calculated to examine speech motor control and speech motor practice effects. Skin conductance level was measured during the experimental conditions to assess participants' physiological level of arousal. Results Preschool-age CWS demonstrated greater speech movement variability across all conditions and trials than CWNS. Furthermore, the younger participants produced more variable articulatory movements than the older participants. Participants' speech movement variability did not significantly differ between the negative and neutral experimental conditions, and the level of physiological arousal did not have a significant effect on it. There was a nonsignificant trend of decrease in speech movement variability across the repeated trials in both groups. Last, CWS and CWNS did not differ in their mean utterance duration, suggesting that their articulation rate was similar across all conditions and trials. Conclusions Our findings indicate that, compared to preschool-age CWNS, CWS demonstrate less mature speech motor control. However, present findings do not support the hypothesis that CWS benefit less from motor practice relative to CWNS. Given that our conditions elicited similar levels of arousal in the participants, future research is needed to examine whether physiological arousal disrupts speech motor control in preschool-age children potentially contributing to disruptions of speech fluency and the development of stuttering.

Stimulus Parameters Underlying Sound-Symbolic Mapping of Auditory Pseudowords to Visual Shapes

Sound symbolism refers to non-arbitrary mappings between the sounds of words and their meanings and is often studied by pairing auditory pseudowords such as "maluma" and "takete" with rounded and pointed visual shapes, respectively. However, it is unclear what auditory properties of pseudowords contribute to their perception as rounded or pointed. Here, we compared perceptual ratings of the roundedness/pointedness of large sets of pseudowords and shapes to their acoustic and visual properties using a novel application of representational similarity analysis (RSA). Representational dissimilarity matrices (RDMs) of the auditory and visual ratings of roundedness/pointedness were significantly correlated crossmodally. The auditory perceptual RDM correlated significantly with RDMs of spectral tilt, the temporal fast Fourier transform (FFT), and the speech envelope. Conventional correlational analyses showed that ratings of pseudowords transitioned from rounded to pointed as vocal roughness (as measured by the harmonics-to-noise ratio, pulse number, fraction of unvoiced frames, mean autocorrelation, shimmer, and jitter) increased. The visual perceptual RDM correlated significantly with RDMs of global indices of visual shape (the simple matching coefficient, image silhouette, image outlines, and Jaccard distance). Crossmodally, the RDMs of the auditory spectral parameters correlated weakly but significantly with those of the global indices of visual shape. Our work establishes the utility of RSA for analysis of large stimulus sets and offers novel insights into the stimulus parameters underlying sound symbolism, showing that sound-to-shape mapping is driven by acoustic properties of pseudowords and suggesting audiovisual cross-modal correspondence as a basis for language users' sensitivity to this type of sound symbolism.

Stress measurement using speech: Recent advancements, validation issues, and ethical and privacy considerations

Life stress is a well-established risk factor for a variety of mental and physical health problems, including anxiety disorders, depression, chronic pain, heart disease, asthma, autoimmune diseases, and neurodegenerative disorders. The purpose of this article is to describe emerging approaches for assessing stress using speech, which we do by reviewing the methodological advantages of these digital health tools, and the validation, ethical, and privacy issues raised by these technologies. As we describe, it is now possible to assess stress via the speech signal using smartphones and smart speakers that employ software programs and artificial intelligence to analyze several features of speech and speech acoustics, including pitch, jitter, energy, rate, and length and number of pauses. Because these digital devices are ubiquitous, we can now assess individuals' stress levels in real time in almost any natural environment in which people speak. These technologies thus have great potential for advancing digital health initiatives that involve continuously monitoring changes in psychosocial functioning and disease risk over time. However, speech-based indices of stress have yet to be well-validated against stress biomarkers (e.g., cortisol, cytokines) that predict disease risk. In addition, acquiring speech samples raises the possibility that conversations intended to be private could one day be made public; moreover, obtaining real-time psychosocial risk information prompts ethical questions regarding how these data should be used for medical, commercial, and personal purposes. Although assessing stress using speech thus has enormous potential, there are critical validation, privacy, and ethical issues that must be addressed.