Revista de Investigación e Innovación en Ciencias de la Salud

Interdisciplinary work in the human voice professions: challenges, limits, and projections

Sat, 03 Feb 2024 00:00:00 -0500

This document summarizes the main contributions of the panel discussion titled "Interdisciplinary work in the human voice professions: challenges, limits and projections" organized by the Vocology Center on July 18, 2023. The event brought together leaders and representatives from various associations related to the human voice, including professionals from the clinical, artistic, vocal rehabilitation, occupational voice, vocal pedagogy, and other related disciplines. The purpose of this panel discussion was to promote a critical debate on the nature of interdisciplinary work in the study of the human voice. The discussion explored the challenges that emerge when teams that include professionals with different approaches and expertise address voice production, as well as the inherent boundaries of the various roles and functions performed by specialized professionals in this field, along with the emerging ethical issues in this process. With a focus on strengthening interdisciplinary collaborations, the event centered on seeking more effective communication and collaboration. This document represents a significant step forward in understanding and fostering interdisciplinary cooperation in the care of the human voice.

Voice Disorder, Job Stress, and COVID-19 in Teachers: Impacts in Times of Pandemic

Sat, 03 Feb 2024 00:00:00 -0500

Introduction. The conditions of teachers' work during the COVID-19 pandemic affected teachers' lives regarding voice disorder and stress, even in emergency remote classroom situation.

Objective. To analyze the relationship between the presence of voice disorder, job stress, and COVID-19 in teachers when in emergency remote classroom teaching situation at the time of the pandemic.

Method. This is a primary, exploratory, observational cross-sectional study with the use of survey forwarded online during the period of emergency classes after the arrival of COVID-19 pandemic in Brazil. The teachers answered the sociodemographic questions about the presence of COVID-19 and the following instruments: Condition of Vocal Production-Teacher [Condição de Produção Vocal - Professor (CPV-P)], Screening Index for Voice Disorder (SIVD), and Job Stress Scale (JSS).

Results. Of the 118 teachers analyzed, 94.1% were female; the average age was 44 years. The SIVD recorded the presence of voice disorder in 66.9% of the participants. Regarding the JSS, which are the findings related to stress at work in the demand domain, the teachers showed high levels, a fact which presupposes the existence of pressure of psychological nature to perform their work.

Conclusion. The teachers self-reported the presence of voice disorder even in remote class situation, on the occasion of COVID-19, which were more common in older teachers. When comparing the presence of voice disorders, coronavirus symptoms, and stress domains in relation to demand, control, and social support, there was no significance. It is hoped that this study will help to reflect on the need to improve teachers' working conditions, strengthening work-related voice disorder actions and guiding actions for vocal care and well-being.

Fine-Tuning of a Voice Production Model to Estimate Impact Stress Using a Metaheuristic Method

Carlos-Alberto Calvache-Mora, Leonardo Soláque, Alexandra Velasco, Lina Peñuela — Sat, 03 Feb 2024 00:00:00 -0500

Introduction. In vocal production models employing spring-mass-damper frameworks, precision in determining damping coefficients that align with physiological vocal fold characteristics is crucial, accounting for potential variations in the representation of viscosity-elasticity properties.

Objective. This study aims to conduct a parametric fitting of a vocal production model based on a mass-spring-damper system incorporating subglottic pressure interaction, with the purpose of accurately modeling the collision forces exerted by vocal folds during phonation.

Method. A metaheuristic search algorithm was employed for parametric synthesis. The algorithm was applied to elasticity coefficients c1 and c2, as well as damping coefficients ε1 and ε2, which directly correlate with the mass matrices of the model. This facilitates the adjustment of fold composition to achieve desired physiological behavior.

Results. The vocal system's behavior for each simulation cycle was compared to a predefined standard under normal conditions. The algorithm determined the simulation endpoint by evaluating discrepancies between key features of the obtained signals and the desired ones.

Conclusion. Parametric fitting enabled the approximation of physiological vocal production behavior, providing estimates of the impact forces experienced by vocal folds during phonation.

Behind the Headset: Predictive Accuracy of Patient-Reported Outcome Measures for Voice Symptoms in Call Centers

Sat, 03 Feb 2024 00:00:00 -0500

Objective. This study examines factors predicting self-reported voice symptoms in call center workers.

Methods. Multivariate analysis and predictive modeling assess personal, work-related, acoustic, and behavioral factors. Generalized Linear Models (GLMs) and Receiver Operating Characteristic (ROC) curves are employed.

Results. Age and sleep patterns impacted voice quality and effort, while workplace factors influenced symptom perception. Unhealthy vocal behaviors related to tense voice and increased effort, while hydration was protective. Voice acoustics showed diagnostic potential, supported by ROC data. These findings emphasize voice symptom complexity in call center professionals, necessitating comprehensive assessment.

Limitations. This study recognizes its limitations, including a moderate-sized convenience sample and reliance on PROM metrics. Future research should incorporate more objective measures in addition to self-reports and acoustic analysis.

Value. This research provides novel insights into the interplay of personal, occupational, and voice-related factors in developing voice symptoms among call center workers. Predictive modeling enhances risk assessment and understanding of individual susceptibility to voice disorders.

Conclusion. Results show associations between various factors and self-reported voice symptoms. Protective factors include sleeping more than six hours and consistent hydration, whereas risk factors include working conditions, such as location and behaviors like smoking. Diagnostic models indicate good accuracy for some voice symptom PROMs, emphasizing the need for comprehensive models considering work factors, vocal behaviors, and acoustic parameters to understand voice issues complexity.

Vocal Load of University Professors: Preliminary Results

Sat, 03 Feb 2024 00:00:00 -0500

Purpose. To describe the acoustic characteristics of a classroom, voice quality, fatigue, and vocal load of university professors.

Methods. Exploratory, observational, longitudinal, and descriptive study with a single group of participants, including vocal monitoring data over two weeks. Acoustic characterization of the classroom, perceptual-auditory evaluation, and acoustic analysis of voice samples were conducted before and after classes. Vocal dosimetry was performed during classes, and the Vocal Fatigue Index (VFI) was assessed at the beginning of each week. Descriptive analysis of the findings was conducted, and randomization test was performed to verify the internal reliability of the judge.

Results. All participants reported speaking loudly in the classroom, with the majority reporting vocal changes in the past six months, and only one participant reported a current vocal change. The classroom had acoustical measures and estimations that deviated from established standards. The professors used high vocal intensities during classes. After the classes, an increase in the absolute values of the aggregated data for CAPE-V, jitter, and fundamental frequency was found, varying within the range of normality. Furthermore, there was an observed increase in both post-lesson intensity and VFI when comparing the two-week period.

Conclusions. Vocal intensities and VFI were possibly impacted by the acoustics of the classroom. The increase in average VFI between the weeks may be attributed to a cumulative fatigue sensation. Further research with a larger number of participants and in acoustically conditioned classrooms is suggested in order to evaluate collective intervention proposals aimed at reducing the vocal load on teachers.

Outcomes of a Community of Practice on Quebec Speech Language Pathologists’ Voice Assessment Practices and Professional Identity

Ingrid Verduyckt, Lyne Defoy, Imane Hocine, Vincent Martel-Sauvageau — Sat, 03 Feb 2024 00:00:00 -0500

In a context where different protocols for recommended practices in clinical voice assessment exist, while there are gaps in the literature regarding the evidence base supporting assessment procedures and measures, clinicians from regions where a strong community holding expertise in clinical and scientific voice practices lack can struggle to confidently develop their voice assessment practices. In an effort to improve voice assessment practices and strengthen professional identity among speech-language pathologists in Quebec, Canada, a community of practice (CoP) was established, with the aim of promoting knowledge sharing, implementing change in clinical practice, and improving professional identity. Thirty-nine participants took part in the CoP activities conducted over a four-month period, including virtual meetings and in-person workshops. Participants had a high rate of attendance (> 74% participation rate in virtual meetings), and were highly satisfied with their participation and intended to remain involved after the project’s end. Statistically significant changes in voice assessment practices were observed post-CoP, regarding probability of performing assessments (p < .001), and perceived importance of assessment for evaluative purposes (p <.001), as well as improvements in assessment specific confidence, specifically for procedure of auditory-perceptual assessment (p < .001) and purpose of aerodynamic assessment (p = .05). Moreover, there was an increase in professional identity post-CoP (p < .001) and participants felt they made significant learnings. The present study highlighted the need to involve SLPs in future research to identify assessments that are relevant to the specific evaluative objectives of SLPs working with voice, and suggests CoPs are an efficient tool for that purpose.

Adaptation and Validation of the Voice Handicap Index and its Abbreviated Version to Rioplatense Spanish of Argentina

Juana Román-Zubeldia, Patricia Guadalupe Farias — Sat, 03 Feb 2024 00:00:00 -0500

Aim. This study aimed to validate the Voice Handicap Index (VHI) and its abbreviated version (VHI-10) adapted into Rioplatense Spanish from Argentina, with specific goals centered on assessing their reliability and validity.

Methods. Cultural adaptation involved direct translation, synthesis and back-translation techniques, followed by an assessment of semantic equivalence and application to a pilot group. For the validation process, the reliability of both adapted indices was assessed through measures of internal consistency (Cronbach's alpha coefficient) and test-retest stability (Bland-Altman test, ICC and Spearman's correlation coefficient). Additionally, we conducted analyses to asses criterion and construct validity. 213 subjects participated in the validation of the adapted 30-items index, (123 with dysphonia; 90 from control group); 113, in the abbreviated version (63 with dysphonia; 50 from control group).

Results. The "Índice de Desventaja Vocal" (IDV) was established as the adapted version of the VHI into Rioplatense Spanish from Argentina. Both indeces exhibited excellent internal consistency (IDV-30 α = 0,96; IDV-10 α = 0,92) and satisfactory stability and agreement (IDV-30 CCI = 0,95; IDV-10 CCI = 0,96). Regarding validity, a strong correlation was observed between the scores of both indeces and the participant’s self-assessment of dysphonia degree (r = 0,85). Both indices effectively differentiated between individuals with dysphonia and healthy subjects (p< 0,001). Factor analysis revealed three factors for the IDV-30 and one factor for the IDV-10.

Conclusion. The IDV-30 and IDV-10 demonstrate satisfactory levels of reliability and validity. Both indices can be incorporated into the assessment protocols for evaluating the vocal function by professionals in Argentina.

Surveying Colombian Speech-Language Pathologists on their Reported Training & Practices of Auditory-Perceptual Evaluation of Voice

Martha Peña Sanchez, Fernando Delprado-Aguirre — Sat, 03 Feb 2024 00:00:00 -0500

Objective. To explore the training and use of auditory perceptual evaluation of the voice reported by Colombian speech-language pathologists.

Study Design. Cross-sectional observational research with a quantitative approach.

Methods. A digital questionnaire was designed and distributed to gather information regarding professionals' training process and implementation of auditory-perceptual evaluation procedures. Descriptive statistics were applied, and several generalized linear models were adjusted to determine the influence of certain variables on others.

Results. The survey received responses from 40 speech-language pathologists, revealing that the most used scales for training and evaluating vocal quality within this group are direct magnitude estimations (82.5% and 77.5%). Similarly, in this group, the tasks most frequently used to train and use as an evaluation strategy are vowel assessments (38%) followed by spontaneous speech (30%). Practitioners of this group were mostly trained using a conceptual framework involving multiple exposures to rating (42.5%). The use of direct magnitude estimation in training with a normal voice showed significance (p = 0.015), as did the use of the vowel /i/ in training with an equal-appearing interval (p = 0.013). The statistical models relating the scale used to the scale on which participants were trained were also significant (p < 0.05).

Conclusions. The GRBAS scale is the training tool most used by the group of speech-language pathologists of the study group in Colombia. Future efforts should focus on improving training practices for auditory-perceptual evaluation, exploring alternative conceptual frameworks, and incorporating external references to enhance validity and reliability.

Presentation of the ATLETAS DA VOZ™ Conditioning Program

Flávia Badaró, Thays Vaiano, Mara Behlau — Sat, 03 Feb 2024 00:00:00 -0500

Objectives. To present a simple form of vocal and breathing conditioning for voice professionals based on concepts from vocal science. The vocal conditioning program called Voice Athletes Conditioning uses the principles of exercise physiology to gradually improve vocal and respiratory overload to achieve endurance, power, and flexibility.

Methods. Due to our personal experience with high voice users, we synthesized a vocal conditioning program (AVCP) that combines voice science, exercise physiology, sports science and physical therapy principles. This is an 8-week program of daily vocal and breathing exercises with overload enhancement each week using different types of breathing devices and semi-occluded vocal tract exercises, designed and developed according to the specific requirements and performance of the voice professional.

Reflections. Professional voice users often experience episodes of vocal fatigue that can directly affect their performance and vocal health. As with physical training for athletes, voice exercises can also contribute to improving vocal conditioning, preventing voice disorders, as well as helping to obtain better performance, greater tolerance to fatigue and shorter recovery time.

Conclusions. AVCP is an approach that considers the principles of muscle training aimed objectively at the respiratory and vocal muscles, carried out with a variety of breathing devices and specific vocal exercises in search of greater performance time, less physiological stress, and shorter recovery time in the professional use of the voice.

Exercise Physiology and Vocal Pedagogy: Calisthenics Reflections

Ariel Coelho — Sat, 03 Feb 2024 00:00:00 -0500

Introduction. The gymnastic calisthenics method is configured as a specific form of exercises involving the adoption of artificial postures through specific movements. These movements are designed to produce clearly defined hygienic and educational effects. This mode of exercise bears notable similarities to the modus operandi of vocalises in vocal pedagogy.

Objective. The objective of this work is to investigate the potential relationships between the technical-scientific principles that guide the gymnastic calisthenics system and the technical-pedagogical principles governing vocal exercises practiced by singers during their teaching and learning process. Additionally, it aims to explore the connections between the objectives and purposes of the gymnastic calisthenics system and those of vocal exercises in this process.

Method. To address this objective, a bibliographic research was conducted, involving a detailed analysis of relevant sources. Academic publications and specialized literature related to gymnastic calisthenics and vocal pedagogy were examined.

Reflection. Gymnastic calisthenics and vocal exercises share a fundamental structure of specific exercises involving artificial postures and specific movements. Both seek refinement in hygiene and education, enabling individuals, either in the physical or vocal realm, to develop appropriately and healthily.

Conclusion. Based on the bibliographic research, it is concluded that vocal exercises in the teaching and learning process of singers can be considered a form of vocal calisthenics. This conclusion is based on the intrinsic relationships observed between the principles and objectives of the gymnastic calisthenics system and the modus operandi of vocal exercises. This reflection provides valuable insights into vocal pedagogy, aiming to offer a more specifically physiological and biomechanical understanding of vocal exercises. This effectively guides the application of vocalizations in the process of vocal education and training.

In-office Laryngeal Procedures: a Modern Perspective for Vocal Fold Interventions

Fermin M Zubiaur Gomar, Valeria Lagunes Costales — Sat, 03 Feb 2024 00:00:00 -0500

Introduction. The purpose of this article is to discuss in-office laryngeal procedures as an alternative to surgical intervention under general anesthesia. In-office procedures have become more common due to technological advancements. As a result, these approaches are less invasive and more patient-friendly, with increased pain tolerance and reduced procedure time and cost.

Methods. We conducted a thematic analysis of published reports regarding the best known and performed in-office laryngeal interventions. Three questions guided our analysis: What laryngological procedures can be performed in the office setting? What are the advantages of in-office laryngology procedures compared to operating room surgical procedures? Why aren't more in-office procedures performed in some Latin American countries?

Discussion. Despite being performed more frequently, there is still controversy whether in-office procedures should be performed as often due to the risk of complications. Furthermore, procedures that are done in the office setting are more popular in some countries than in others, even though their benefit has been well demonstrated. This article describes various in-office procedures, including biopsy, vocal fold injections, and laser surgery. We also discuss what factors might contribute to having office-procedures being performed more frequently in some countries than others.

Conclusion. Awake interventions offer numerous benefits, including shorter procedure time, reduced costs, and lower patient morbidity. These advantages have significantly transformed the treatment of laryngeal diseases in modern laryngology practice in a global manner.

Vocal Approach to Transgender Individuals: The Journey Taken in Chile and Argentina

Maria Celina Malebrán Bezerra de Mello, Virginia Zangroniz — Sat, 03 Feb 2024 00:00:00 -0500

In recent years, there have been international references to the vocal approach for the specific group of transgender individuals, although the Latin American literature is still very timid on this matter. The purpose of this article is to identify the current norms, statistics, and vocal approach towards transgender individuals in Chile and Argentina, considering the experience of two speech and language pathologists with more than twenty years of experience on voice therapy. Reflections were made on the transgender reality in these countries, the limitations in the implementation of the depathologization of the transgender group were outlined, some current and unreliable statistics were presented, some innovative actions in the public system were highlighted, and the lack of knowledge about the benefits of vocal work for transgender men and women was discussed. The identified aspects could benefit from multicenter research that strengthens speech therapy actions with this group, contributing to depathologization and positive approach.

Bioethical Considerations in the Management of Amyotrophic Lateral Slerosis: An Approach to Speech Therapy

Jorge Sepúlveda — Sat, 03 Feb 2024 00:00:00 -0500

Introduction. Amyotrophic lateral sclerosis (ALS) is the most common form of degenerative motor neuron disease in adulthood and is considered a terminal disease. For this reason, the actions of the speech therapist must consider respect for basic bioethical principles to guarantee adequate assistance.

Objective. To know those bioethical considerations related to the management and study of people with ALS to then provide an approach to speech therapy.

Methodology. A bibliographic search was carried out in the PubMed, Scopus, and SciELO databases. Articles published from 2000 to June 2023 were filtered and those that addressed a bioethical component in the population with ALS were selected.

Results. Aspects related to the use of informed consent and shared decision-making stood out as essential elements to support people's autonomy.

Conclusion. Proper communication and shared decision-making are key to respecting people's autonomy. In turn, the standardization of procedures through clinical research will contribute to compliance with the bioethical principles of beneficence and non-maleficence, essential for professional practice.

Post-COVID-19 Laryngeal Dystonia: Report of Two Cases and Potential Pathophysiological Explanation

Liliana Sigal, Gabriela Beatriz Raina — Sat, 03 Feb 2024 00:00:00 -0500

Laryngeal dystonia (LD), also known as spasmodic dysphonia, is a task-specific focal movement disorder, primarily affecting voice production. The dystonic movements of the vocal folds result in a varied phenomenology, typically hard vocal breaks and strain in the adductor-type laryngeal dystonia (ADLD), and breathy breaks or aphonia in the abductor-type laryngeal dystonia (ABLD). More than 80% of patients have suffered from ADLD.

Two female patients developed LD a month after presenting an upper respiratory tract infection by COVID-19. They had the adductor-type laryngeal dystonia. Through the acoustic study of the vowel /a/ breaks, frequency changes and aperiodicity were observed. Speech was studied using the phonetogram, and the range of speech is altered in both patients.

The inflammation of the peripheral nerves of the larynx by COVID-19 produced a sensory alteration, with a maladaptive response in these patients, who perhaps had predisposing genetic basis, or the immunological activation or the invasion of the germ by retrograde pathway altered the neuronal networks involved in the genesis of LD.