The aim of this study was to establish reliability and validity for self-ratings of vocal status obtained during the daily activities of patients with vocal hyperfunction (VH) and matched controls.
Eight-four patients with VH and 74 participants with normal voices answered 3 vocal status questions-difficulty producing soft, high-pitched phonation (D-SHP); discomfort; and fatigue-on an ambulatory voice monitor at the beginning, 5-hr intervals, and the end of each day (7 total days). Two subsets of the patient group answered the questions during a 2nd week after voice therapy (29 patients) or laryngeal surgery (16 patients).
High reliability resulted for patients (Cronbach's α = .88) and controls (α = .95). Patients reported higher D-SHP, discomfort, and fatigue (Cohen's d = 1.62-1.92) compared with controls. Patients posttherapy and postsurgery reported significantly improved self-ratings of vocal status relative to their pretreatment ratings (d = 0.70-1.13). Within-subject changes in self-ratings greater than 20 points were considered clinically meaningful.
Ratings of D-SHP, discomfort, and fatigue have adequate reliability and validity for tracking vocal status throughout daily lifein patients with VH and vocally healthy individuals. These questions could help investigate the relationship between vocal symptom variability and putative contributing factors (e.g., voice use/rest, emotions).
This article provides a summary of some recent innovations in voice assessment expected to have an impact in the next 5–10 years on how patients with voice disorders are clinically managed by speech-language pathologists. Specific innovations discussed are in the areas of laryngeal imaging, ambulatory voice monitoring, and “big data” analysis using machine learning to produce new metrics for vocal health. Also discussed is the potential for using voice analysis to detect and monitor other health conditions.
Purpose Ambulatory voice biofeedback has the potential to significantly improve voice therapy effectiveness by targeting carryover of desired behaviors outside the therapy session (i.e., retention). This study applies motor learning concepts (reduced frequency and delayed, summary feedback) that demonstrate increased retention to ambulatory voice monitoring for training nurses to talk softer during work hours.
Method Forty-eight nurses with normal voices wore the Voice Health Monitor (Mehta, Zañartu, Feng, Cheyne, & Hillman, 2012) for 6 days: 3 baseline days, 1 biofeedback day, 1 short-term retention day, and 1 long-term retention day. Participants were block-randomized into 3 different biofeedback groups: 100%, 25%, and Summary. Performance was measured in terms of compliance time below a participant-specific vocal intensity threshold.
Results All participants exhibited a significant increase in compliance time (Cohen's d = 4.5) during biofeedback days compared with baseline days. The Summary feedback group exhibited statistically smaller performance reduction during both short-term (d = 1.14) and long-term (d = 1.04) retention days compared with the 100% feedback group.
Conclusions These findings suggest that modifications in feedback frequency and timing affect retention of a modified vocal behavior in daily life. Future work calls for studying the potential beneficial impact of ambulatory voice biofeedback in participants with behaviorally based voice disorders.
Purpose Ambulatory voice biofeedback (AVB) has the potential to significantly improve voice therapy effectiveness by targeting one of the most challenging aspects of rehabilitation: carryover of desired behaviors outside of the therapy session. Although initial evidence indicates that AVB can alter vocal behavior in daily life, retention of the new behavior after biofeedback has not been demonstrated. Motor learning studies repeatedly have shown retention-related benefits when reducing feedback frequency or providing summary statistics. Therefore, novel AVB settings that are based on these concepts are developed and implemented.
Method The underlying theoretical framework and resultant implementation of innovative AVB settings on a smartphone-based voice monitor are described. A clinical case study demonstrates the functionality of the new relative frequency feedback capabilities.
Results With new technical capabilities, 2 aspects of feedback are directly modifiable for AVB: relative frequency and summary feedback. Although reduced-frequency AVB was associated with improved carryover of a therapeutic vocal behavior (i.e., reduced vocal intensity) in a patient post-excision of vocal fold nodules, causation cannot be assumed.
Conclusions Timing and frequency of AVB schedules can be manipulated to empirically assess generalization of motor learning principles to vocal behavior modification and test the clinical effectiveness of AVB with various feedback schedules.
Purpose The purpose of this study was to evaluate the potential for estimating subglottal air pressure using a neck-surface accelerometer and to compare the accuracy of predicting subglottal air pressure relative to predicting acoustic sound pressure level (SPL).
Method Indirect estimates of subglottal pressure (Psg′) were obtained from 10 vocally healthy speakers during loud-to-soft repetitions of 3 different /p/–vowel gestures (/pa/, /pi/, /pu/) at 3 pitch levels in the modal register. Intraoral air pressure, neck-surface acceleration, and radiated acoustic pressure were recorded, and the root-mean-square amplitude of the acceleration signal was correlated with Psg′ and SPL.
Results The coefficient of determination between accelerometer level and Psg′ was high when data were pooled from all vowel and pitch contexts for each participant (r 2 = .68–.93). These relationships were stronger than corresponding relationships between accelerometer level and SPL (r 2 = .46–.81). The average 95% prediction interval for estimating Psg′ using accelerometer level was ±2.53 cm H2O, ranging from ±1.70 to ±3.74 cm H2O across participants.
Conclusions Accelerometer signal amplitude correlated more strongly with Psg′ than with SPL. Future work is warranted to investigate the robustness of the relationship in nonmodal voice qualities, individuals with voice disorders, and accelerometer-based ambulatory monitoring of subglottal pressure.
Monitoring subglottal neck-surface acceleration has received renewed attention due to the ability of low-profile accelerometers to confidentially and noninvasively track properties related to normal and disordered voice characteristics and behavior. This study investigated the ability of subglottal necksurface acceleration to yield vocal function measures traditionally derived from the acoustic voice signal and help guide the development of clinically functional accelerometer-based measures from a physiological perspective. Results are reported for 82 adult speakers with voice disorders and 52 adult speakers with normal voices who produced the sustained vowels /A/, /i/, and /u/ at a comfortable pitch and loudness during the simultaneous recording of radiated acoustic pressure and subglottal necksurface acceleration. As expected, timing-related measures of jitter exhibited the strongest correlation between acoustic and necksurface acceleration waveforms (r 0:99), whereas amplitudebased measures of shimmer correlated less strongly (r 0:74). Additionally, weaker correlations were exhibited by spectral measures of harmonics-to-noise ratio (r 0:69) and tilt (r 0:57), whereas the cepstral peak prominence correlated more strongly (r 0:90). These empirical relationships provide evidence to support the use of accelerometers as effective complements to acoustic recordings in the assessment and monitoring of vocal function in the laboratory, clinic, and during an individual’s daily activities.