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Background Voice training has been proposed as an intervention to improve swallowing function in patients with dysphagia. However, little is known about the effects of voice training on swallowing physiology. Objectives This systematic review investigates the effect of voice training on the swallowing function of patients with oropharyngeal dysphagia and provides the theoretical basis for improving the swallowing function and life quality of patients with oropharyngeal dysphagia. Data sources A systematic review using a narrative synthesis approach of all published studies was sought with no date restrictions. Five electronic databases (EMBASE, PubMed, CINAHL, Web of Science, and The Cochrane Library) were searched from inception to April 2022. Study selection Eight studies were included. Two researchers screened the literature according to inclusion and exclusion criteria, extracted data, and carried out quality control according to the Cochrane handbook5.1.0. Data were analyzed narratively and descriptively. Conclusions In general, statistically significant positive therapy effects were found. Voice training improves the oral and pharyngeal stages of swallowing in patients with neurological causes of dysphagia, such as stroke, and in patients with non-neurological causes of dysphagia, such as head and neck cancer. However, the current literature is limited and further primary research is required to provide more evidence to support voice training intervention in dysphagia.  Future studies could  further refine the content of voice training interventions, increase the number of patients enrolled, assess the long-term effects of voice training interventions and add associated assessments of the quality of life after treatment.

Background Schizophrenia patients exhibit sensory and behavioral abnormalities, and the current common intervention treatment mainly uses drugs to block dopamine receptors in the brain. However, the cognitive function of patients with schizophrenia cannot be cured through medication. In current interventions for schizophrenia, vocal training therapy can regulate the patient’s breathing rhythm, maintain their heart rate and emotions, relax their mood and body, thereby increasing their resistance to stressful situations. Therefore, the study explored the positive effects of vocal training on cognitive function training in patients with schizophrenia. Methods A study was conducted on 150 patients with schizophrenia, who were evenly divided into a control group and an experimental group, with 75 patients in each group. The control group received routine nursing methods and the nursing time was maintained for 6 months. The experimental group added soothing vocal training activities on the basis of routine care, twice a week for 30 minutes each time. The same intervention lasted for 6 months in the experimental group. After intervention, Stroop color word test was used to evaluate patients’ cognitive function. Results The study will evaluate the cognitive function level of patients with schizophrenia based on the Stroop color word test results before and after intervention in the experimental and control groups. The specific results are shown in Table 1. From the table, it can be seen that the control group scored 97.32±1.27 and 97.87±1.40 before and after intervention in the A card test, respectively. The scores of the experimental group before and after intervention were 97.65±1.27 and 99.70±0.46, respectively. In the detection of the B card, the scores of the control group before and after intervention were 94.75±1.77 and 95.18±2.22, respectively, while the detection scores of the experimental group were 95.10±1.66 and 98.73±1.04, respectively. In the C card, the scores of the control group before and after intervention were 87.20±3.83 and 88.08±3.76, respectively. The scores of the experimental group before and after intervention were 86.53±3.55 and 95.60±2.12, respectively. From the data results, it can be seen that the experimental group showed a greater increase in Stroop color word test scores after intervention, indicating that vocal training can effectively improve cognitive function in patients with schizophrenia. Discussion The experimental results indicate that the intervention method of vocal training can improve patients’ thinking expression ability and memory by soothing their physical and mental health, and through vocal music. Through vocal training, patients with schizophrenia can enhance their self-identity through beautiful musical works and singing behavior, thereby improving their psychological state and cognitive function, enhancing their self-management level and quality of life.

The elements and the functional areas are displayed in a drawing of Eastern European nesting doll called a babushka. The graphic, which serves as a representation of the connection between the aspects of voice training, is used as a signpost on each page, with shading to indicate the element under discussion. Each of the first three chapters is devoted to the functional areas, while the final chapter addresses the balance among these areas. In the discussion of synergy (which is the seventh element), the author explains that when the three functional areas are balanced and working together in synergy, the hallmarks of good vocal technique (such as accurate intonation, vibrato, agility, and legato) are attainable.

Amaç: Disfoni şikâyeti ile başvuran organik ve fonksiyonel disfonili hastalarda uygulanan ses terapisi yöntemlerinin etkinliğini objektif ve subjektif parametreler kullanarak değerlendirmek amaçlanmıştır. Gereç ve Yöntemler: Kriterlere uyan 110 hasta çalışmaya dâhil edildi. Tüm hastaların genel kulak-burun-boğaz muayeneleri yapılıp videolaringostroboskopik ve fleksibl nazofaringolaringoskopik larinks incelemeleri yapılıp görüntü kayıtları alındı. Hastaların akustik ve aerodinamik ses analizleri yapıldı. Temel frekans (F0-Hz), jitter (%), shimmer (desibel-dB), harmonik gürültü oranı [harmonic noise ratio (HNR-dB)] ve maksimum fonasyon zamanı (MFZ-sn) ölçüldü. Subjektif ses değerlendirmesinde Sesle İlişkili Yaşam Kalitesi Ölçeği (SİYKÖ) kullanıldı. Hastalara ses terapisi, araştırma yürütücüsü tarafınca verildi. Terapi sonunda tüm ölçümler tekrarlanıp aradaki fark analiz edildi. Bulgular: 110 hastanın 76’sı kadın, 34’ü erkekti. Ortalama yaş 43,17±13,67 idi. Ortanca ses bozukluğu süresi 7 (minimum: 1-maksimum: 180) aydı. Hastaların 70’inde organik disfoni saptanırken; 53’ünde fonksiyonel disfoni mevcuttu. Organik disfonilerin dağılımı %38,57 vokal fold nodülü, %48,57 vokal fold paralizisi, %12,85 sulkus vokalis şeklindeydi. Fonksiyonel disfonilerin ise %42,5’ini kas gerilim disfonisi, %57,5’ini psikojen disfoni oluşturmaktaydı. Vokal fold paralizilerinde ve nodüllerde ses terapisine yanıt pertürbasyon parametrelerinde düşme, MFZ’de uzama, HNR’de artış, SİYKÖ skorlarında yükselme yönünde olmuştur. Sulkus vokaliste akustik, aerodinamik ölçümlerde ve SİYKÖ skorlarında terapi sonrası anlamlı değişiklik saptanmamıştır. Fonksiyonel disfonilerde tüm hasta gruplarında ses terapisi ile incelenen parametrelerde olumlu yönde değişiklikler olduğu görülmüştür. Özellikle yaşam kalitesi skorlarında belirgin iyileşme olmuştur. Sonuç: Ses terapisi uygun hasta gruplarında etkili bir tedavi yöntemidir. Hem ses kalitesini hem de yaşam kalitesini artırmaktadır. Disfonili hastalara yaklaşımda maliyeti düşük, uygulanabilirliği kolay ve yakın hasta takibine olanak sağlayan bir tedavi yöntemi olarak öncelikli olarak değerlendirilmelidir.

Abnormal speech function caused by radiotherapy will affect the normal communication of patients with head and neck cancer (HNC) and even interrupt their social life. Rehabilitation Training is widely used to improve articulatory abnormalities in patients with HNC. However, the effectiveness of these rehabilitation measures in restoring the voice function of HNC patients is still unknown. This study aimed to systematically examine the effects of rehabilitation training on radiotherapy-related voice function and quality of life in patients with HNC. The databases PubMed, Web of Science, EMBASE, Cochrane Library, CINAHL, CNKI, Wan Fang, and SinoMed were searched for studies published from inception through October 2024. Randomized controlled trials of rehabilitation training to improve voice function abnormalities associated with radiotherapy for HNC were included, and two investigators independently performed the literature review. Meta-analysis was performed using RevMan 5.4 software to determine statistical heterogeneity based on P-values and I2 values. 13 randomized controlled trials involving 710 participants were included. Meta-analysis showed that rehabilitation training significantly affected the patients' maximum phonation time(MD=1.53, 95%CI=[0.83, 2.23], P<0.0001, Grade Moderate), smoothed cepstral peak prominence(MD=-0.59, 95%CI=[-0.89, -0.29], P=0.0001, Grade Moderate), social communication abilities(MD=-2.60, 95%CI=[-5.14, -0.07], P=0.04, Grade Moderate), and quality of life(MD=8.49, 95%CI=[3.06, 13.92], P=0.002, Grade Moderate). Rehabilitation training is an effective approach for ameliorating abnormal voice functions after radiotherapy for HNC. However, there is no consensus on the optimal frequency, periodicity, and follow-up of interventions for rehabilitation training. More studies are still required to determine the optimal intervention effect for ameliorating speech function abnormalities in patients with HNC after radiotherapy.

Contact author: Ingo R. Titze, 1101 13th Street, Denver, CO 80204-5319. Email: ititze{at}dcpa.org PURPOSE: Voice therapy with a semi-occluded vocal tract has a long history. The use of lip trills, tongue trills, bilabial fricatives, humming, and phonation into tubes or straws has been hailed by clinicians, singing teachers, and voice coaches as efficacious for training and rehabilitation. Little has been done, however, to provide the scientific underpinnings. The purpose of the study was to investigate the underlying physical principles behind the training and therapy approaches that use semi-occluded vocal tract shapes. METHOD: Computer simulation, with a self-oscillating vocal fold model and a 44 section vocal tract, was used to elucidate source–filter interactions for lip and epilarynx tube semi-occlusions. RESULTS: A semi-occlusion in the front of the vocal tract (at the lips) heightens source–tract interaction by raising the mean supraglottal and intraglottal pressures. Impedance matching by vocal fold adduction and epilarynx tube narrowing can then make the voice more efficient and more economic (in terms of tissue collision). CONCLUSION: The efficacious effects of a lip semi-occlusion can also be realized for nonoccluded vocal tracts by a combination of vocal fold adduction and epilarynx tube adjustments. It is reasoned that therapy approaches are designed to match the glottal impedance to the input impedance of the vocal tract. KEY WORDS: voice therapy, voice training, singing, resonant voice, voice efficiency CiteULike     Connotea     Del.icio.us     Digg     Facebook     Reddit     Technorati     Twitter     What's this?

The objective of this study was to examine whether different types of mental-imagery training focused on the vocal apparatus can enhance awareness of the vocal tract and diaphragm (vocal awareness) in non-professional singers.Sixty participants with no singing education received one of three training conditions: following instructions based on 1) a description of the physiological changes that take place during phonation (physiological description), 2) imitating an action using the vocal apparatus (imitative action), and 3) a metaphorical narration. Imitative action and metaphorical narration were conceptualized as more imaginative forms of training. Vocal awareness was assessed with a questionnaire that participants completed before and after the training. The questionnaire measured three indices: vocal apparatus representation, vocal apparatus interoceptive awareness, and vocal self-regulation. Results showed that all three types of training program significantly enhanced vocal awareness, but imitative action and metaphorical narration were more effective for interoceptive awareness, and metaphorical narration was more effective for self-regulation. In conclusion, the two imaginative forms of training were more effective than physiological description for improving vocal awareness.

Up to 75% of patients with Parkinson disease (PD) experience voice and speech impairments, such as breathy phonation and low speech volume, which worsen over time and negatively impact the quality of life. However, given their increasingly limited mobility, face-to-face speech therapy is often inaccessible. Mobile health (mHealth) apps offer accessible and cost-effective alternatives; yet, their application in PD-specific, self-delivered voice therapy remains underexplored. This study aimed to evaluate the feasibility, adherence, and satisfaction of a self-delivered smartphone app for voice therapy in patients with PD, designed to minimize speech-language pathologist involvement while promoting patient independence. In addition, it seeks to assess the preliminary therapeutic effectiveness of the app in addressing voice and speech problems in this population. A single-arm, rater-blinded, and pretest and posttest study was conducted between September to November 2023. Patients with PD with voice and speech problems who have no problem with using Android (Google) smartphones were recruited. Participants downloaded the researcher-developed mHealth app on their smartphone and participated in a patient-tailored 5-week home-based speech training program. Each session included 5 stages: breathing, oral motor exercises, loudness, prosody, and functional speaking. The training program consisted of 20 sessions, with participants completing 1 session per day, 4 days per week. Each session lasted approximately 20-30 minutes. Adherence was monitored through app logs, satisfaction was assessed through a phone survey, and therapeutic effectiveness was evaluated using acoustic analysis and auditory-perceptual assessments. Out of 30 patients were initially recruited, but 2 of them withdrew. Out of 25 participants completed all the training sessions while 3 dropped out. The adherence was above 90% in 20 participants (80%, 20/25), 70% to 90% in 4 (16%, 4/25), and below 70% in 4 (16%, 4/25). Satisfaction was 75% (18/24) among the 24 people who participated in the survey. Significant improvements were observed in all acoustic measures: the maximum phonation time increased from 11.15 (SD 5.38) seconds to 14.01 (SD 5.64) seconds (P=.003), and vocal intensity increased from 71.59 (SD 4.39) dB to 73.81 (SD 3.48) dB (P<.001) across both sustained phonation and reading tasks. Voice quality scores on the GRBAS (grade, roughness, breathiness, asthenia, and strain) scale improved significantly (all components P<.001). Furthermore, 58.3% (14/24) of participants reported subjective improvements in their voice. This study demonstrates that home-based, self-training speech therapy delivered through a mHealth app is a feasible solution for patients with PD, suggesting that mHealth apps can serve as a convenient and effective alternative to face-to-face therapy by enhancing accessibility and empowering patients to actively manage their condition.

This article provides a four-part model for effective practice based on “The Four Rs”: Resolve, Repeat, Refine, and Reinforce. Each term in this memorable mnemonic represents a useful component of systematic practice, providing an outline for exploration of the voice. By understanding each step, singers will have an identifiable process to follow that, while specific, can also be tailored to fit individual goals.