Toward Enhanced Voice-Related Self-Reports: Translation, Cross-Cultural Adaptation, and Validity.

PURPOSE: This article provides a commentary on voice-related self-reports and presents various shortcomings endemic in the development and validation of these measures. Emphasis is placed on issues of construct validity, translation, and cross-cultural adaptation. Finally, a demonstration is provided to elucidate the importance of cross-cultural adaptation. METHODS: An example of a voice-related self-report that lacks cross-cultural adaptation is provided, and a linguistic translation and cross-cultural adaptation process is outlined and demonstrated. A bilingual voice scientist, a bilingual speech-language pathologist (SLP), and two experts in voice-related self-reports completed a multistep linguistic translation and cross-cultural adaptation process and obtained back-translations from five SLPs native to the self-report's source culture. RESULTS: Analyses of the back-translations demonstrated that the mean BiLingual Evaluation Understudy (BLEU) scores of the adapted items were higher overall than the back-translations of the original English items. CONCLUSIONS: Unvalidated translations of voice-related self-reports are commonly used as a baseline to further translate the measure, and this deteriorates cross-cultural health equity. Cross-cultural adaptation is a crucial, but often overlooked process when translating and adapting self-reports. The present article calls for standardized methodologies with an emphasis on the necessity of careful translation methods and cultural adaptation processes.

Adaptação transcultural para o português Brasileiro do Vocal Congruence Scale e Transgender Congruence Scale / Cross-cultural adaptation to Brazilian Portuguese of the Vocal Congruence Scale and Transgender Congruence Scale

RESUMO Objetivo realizar a adaptação transcultural dos instrumentos Vocal Congruence Scale (VCS) e o Transgender Scale Congruence (TSC) para o português brasileiro. Método o estudo foi desenvolvido em duas etapas: adaptação transcultural e pré-teste. 1. Adaptação transcultural: foi composta por uma equipe de dois fonoaudiólogos e dois não-fonoaudiólogos, sendo responsáveis pela tradução para o português (um fonoaudiólogo e um não-fonoaudiólogo nativos do português brasileiro - PB e falantes do inglês), de modo independente, com posterior consenso realizado pelos pesquisadores; retrotradução para o inglês (um fonoaudiólogo e um não-fonoaudiólogo nativos do inglês e falantes do PB); análise da versão final por um comitê (um tradutor, um metodologista, e três fonoaudiólogos). 2. Etapa de pré-teste: os instrumentos foram aplicados em 38 indivíduos transgêneros (29 mulheres trans, 2 travestis e 7 homens trans), sendo acrescido na chave de resposta a opção "não aplicável". Os dados foram analisados de forma descritiva e inferencial. Resultados No processo de adaptação transcultural do VCS houve ajustes em cinco itens do questionário, quatro deles quanto à forma e um quanto ao conteúdo. Para o TSC também foram necessários ajustes quanto a forma em cinco itens. No pré-teste, para todos os itens dos instrumentos, a opção não aplicável apresentou proporção significativamente menor que as opções da chave de resposta dos instrumentos. Por fim, foi obtida uma versão traduzida e adaptada para o português dos dois instrumentos. Conclusão Os instrumentos foram transculturalmente adaptados para o português brasileiro e nomeados como Escala de Congruência Vocal e Escala de Congruência da Pessoa Transgênero.

ABSTRACT Purpose to carry out the cross-cultural adaptation of the Vocal Congruence Scale (VCS) and the Transgender Scale Congruence (TSC) instruments into Brazilian Portuguese. Methods the study was developed in two stages: cross-cultural adaptation and pre-test. 1. Cross-cultural adaptation: it was composed of a team of two speech therapists and two non-speech therapists, being responsible for the translation of the instruments into Portuguese (a speech therapist and a non-speech therapist native to Brazilian Portuguese - BP and English speakers, independently, with subsequent consensus achieved by the researchers; back-translation of the instruments into English (a speech therapist and a non-speech therapist who are native speakers of English and speakers of BP); analysis of the final version by a committee (a translator, a methodologist, and three speech therapists). Data were analyzed descriptively and inferentially. Results In the cross-cultural adaptation process of the VCS there were adjustments in five items of the questionnaire, four of them in terms of form and one in terms of content. necessary adjustments regarding form in five items. In the pre-test, for all VCS and TSC items, the non-applicable option had a significantly lower proportion than the instrument response key options (p<0.001, for all). Finally, a translated and adapted version for Brazilian Portuguese of the Vocal Congruence Scale (VCS) and the Transgender Scale Congruence (TSC) instruments was obtained. Conclusion The VCS and TSC were transculturally adapted to Brazilian Portuguese and named as Vocal Congruence Scale and Transgender Person Congruence Scale.

Cross-cultural adaptation to Brazilian Portuguese of the Vocal Congruence Scale and Transgender Congruence Scale. / Adaptação transcultural para o português Brasileiro do Vocal Congruence Scale e Transgender Congruence Scale.

PURPOSE: to carry out the cross-cultural adaptation of the Vocal Congruence Scale (VCS) and the Transgender Scale Congruence (TSC) instruments into Brazilian Portuguese. METHODS: the study was developed in two stages: cross-cultural adaptation and pre-test. 1. Cross-cultural adaptation: it was composed of a team of two speech therapists and two non-speech therapists, being responsible for the translation of the instruments into Portuguese (a speech therapist and a non-speech therapist native to Brazilian Portuguese - BP and English speakers, independently, with subsequent consensus achieved by the researchers; back-translation of the instruments into English (a speech therapist and a non-speech therapist who are native speakers of English and speakers of BP); analysis of the final version by a committee (a translator, a methodologist, and three speech therapists). Data were analyzed descriptively and inferentially. RESULTS: In the cross-cultural adaptation process of the VCS there were adjustments in five items of the questionnaire, four of them in terms of form and one in terms of content. necessary adjustments regarding form in five items. In the pre-test, for all VCS and TSC items, the non-applicable option had a significantly lower proportion than the instrument response key options (p<0.001, for all). Finally, a translated and adapted version for Brazilian Portuguese of the Vocal Congruence Scale (VCS) and the Transgender Scale Congruence (TSC) instruments was obtained. CONCLUSION: The VCS and TSC were transculturally adapted to Brazilian Portuguese and named as Vocal Congruence Scale and Transgender Person Congruence Scale.

OBJETIVO: realizar a adaptação transcultural dos instrumentos Vocal Congruence Scale (VCS) e o Transgender Scale Congruence (TSC) para o português brasileiro. MÉTODO: o estudo foi desenvolvido em duas etapas: adaptação transcultural e pré-teste. 1. Adaptação transcultural: foi composta por uma equipe de dois fonoaudiólogos e dois não-fonoaudiólogos, sendo responsáveis pela tradução para o português (um fonoaudiólogo e um não-fonoaudiólogo nativos do português brasileiro - PB e falantes do inglês), de modo independente, com posterior consenso realizado pelos pesquisadores; retrotradução para o inglês (um fonoaudiólogo e um não-fonoaudiólogo nativos do inglês e falantes do PB); análise da versão final por um comitê (um tradutor, um metodologista, e três fonoaudiólogos). 2. Etapa de pré-teste: os instrumentos foram aplicados em 38 indivíduos transgêneros (29 mulheres trans, 2 travestis e 7 homens trans), sendo acrescido na chave de resposta a opção "não aplicável". Os dados foram analisados de forma descritiva e inferencial. RESULTADOS: No processo de adaptação transcultural do VCS houve ajustes em cinco itens do questionário, quatro deles quanto à forma e um quanto ao conteúdo. Para o TSC também foram necessários ajustes quanto a forma em cinco itens. No pré-teste, para todos os itens dos instrumentos, a opção não aplicável apresentou proporção significativamente menor que as opções da chave de resposta dos instrumentos. Por fim, foi obtida uma versão traduzida e adaptada para o português dos dois instrumentos. CONCLUSÃO: Os instrumentos foram transculturalmente adaptados para o português brasileiro e nomeados como Escala de Congruência Vocal e Escala de Congruência da Pessoa Transgênero.

A Measure of Swallow Effort Using the Borg Category Ratio 10 Perceived Exertion Scale.

PURPOSE: With the emphasis on patient-centered care, tools to adequately measure the experience of swallowing are an important part of clinical care. Swallowing effort is one such experience. However, few measurement tools capture swallowing effort in the moment of swallowing to quantify effort. The Borg Category Ratio 10 Perceived Exertion Scale (Borg CR 10), designed to track effort in a variety of tasks from lifting, breathing, and running, appears to be a likely candidate to measure swallowing effort in the moment of swallowing. METHOD: In a quasi-random design, 32 healthy individuals, ages 40-80 years (average age: 63 years), consumed seven bolus consistencies in both small and large quantities, three times. Following each individual swallow, they rated the amount of effort it took to swallow each bolus using an adapted Borg CR 10 for swallowing effort. RESULTS: Results showed significantly greater reports of swallowing effort on the Borg CR 10 for more adhesive consistencies, larger quantities, and increased number of swallows. CONCLUSION: Results suggest that the Borg CR 10 is a reasonable measurement tool to capture patient-perceived effort in swallowing.

Comparison of Aerosol Emissions during Specific Speech Tasks.

OBJECTIVES/HYPOTHESIS: Recent investigations into the behavior of aerosolized emissions from the oral cavity have shown that particulate emissions do indeed occur during speech. To date, there is little information about the relative contribution of different speech sounds in producing particle emissions in a free field. This study compares airborne aerosol generation in participants producing isolated speech sounds: fricative consonants, plosive consonants, and vowel sounds. STUDY DESIGN: Prospective, reversal experimental design, where each participant served as their own control and all participants were exposed to all stimuli. METHODS: While participants produced isolated speech tasks, a planar beam of laser light, a high-speed camera, and image software calculated the number of particulates detected over time. This study compared airborne aerosols emitted by human participants at a distance of 2.54 cm between the laser sheet and the mouth. RESULTS: Statistically significant increases in particulate count over ambient dust distribution for all speech sounds. When collapsed across loudness levels, emitted particles in vowel sounds were statistically greater than consonants, suggesting that mouth opening, as opposed to the place of vocal tract constriction or manner of sound production, might also be influential in the degree to which particulates become aerosolized during speech. CONCLUSIONS: The results of this research will inform boundary conditions for computational models of aerosolized particulates during speech.

Degree of Breathiness in a Synthesized Voice Signal as it Differentiates Masculine versus Feminine Voices.

INTRODUCTION: Most studies determining speakers' perceived gender as binarily female or male are reliant on F0 perception, although other vocal parameters may also contribute to the perception of gender. The current study focused on the impact of breathiness on the perception of speakers' gender as a biological variable (feminine or masculine). METHODS: n = 31 normal hearing, native English speakers, 18 female, 13 male, mean age 23 (SD = 3.54), were auditorily and visually trained in and then took part in a categorical perception task. A continuum of nine samples of the word "hello", was created in an airway modulation model of speech and voice production. Resting vocal fold length, resting vocal fold thickness, F0, and vocal tract length were fixed. Glottal width at the vocal process, posterior glottal gap, and bronchial pressure were continually modified for all stimuli. Each stimulus was randomly presented 30 times within each of the five blocks (150 presentations in total). Participants rated stimuli as binarily female or male. RESULTS: Showed a sigmoidal shift in breathiness along the continuum between perceived feminine or masculine voicing. This shift was evident at stimuli four and five, indicating a nonlinear, discrete perception of breathiness among participants. Response times were also significantly slower in these two stimuli, suggesting a categorical perception of breathiness among participants. CONCLUSION: Breathiness created by the change in glottal width of at least 0.21 cm may influence the perception of a speaker's perceived gender.

The Voice Range Profile-A Shortened Protocol Pilot Study.

INTRODUCTION: Voice production is a complex process involving the coordination of various anatomical structures and physiologic systems. The Voice Range Profile (VRP) is an established acoustic measure for evaluating voice production that examines minimum and maximum intensity across the frequency range. This pilot study sought to establish a consistent, efficient, and accessible VRP elicitation method. One primary research question was addressed: Does the proposed Short method provide at least as much information as a full, discrete-steps method, which is generally accepted in the literature? METHODS: In this quasi-repeated measures design, twenty-four singers completed a full VRP based on accepted methods from the literature, and the same participants returned within one to three weeks to complete the proposed Short VRP protocol. The full VRP consisted of steady state productions at every semitone within a participant's range for both minimum and maximum intensities. The Short VRP consisted of steady state productions at every octave and perfect fifth across the semitone range for both minimum and maximum intensities. Additional sampling was completed between points when a 7 dB or greater difference was found between consecutive points. Analysis compared each protocol's average elicitation time differences, average semitone range differences, visual examination of the average VRP graph, and examination of average intensity differences between protocols at specific semitone points. Male and female results were analyzed separately. RESULTS: The proposed Short protocol produced similar or better intensity ranges when compared with the accepted full elicitation method. The Short protocol produced intensities with 95% or greater similarity to the Full Protocol for male maximum intensity curve, female minimum intensity curve, and female maximum intensity curve. CONCLUSIONS: When compared with a Full VRP, a Short VRP protocol appears to generate similar minimum and maximum intensity curves allowing for a time-efficient substitute.

Vocal Fatigue Index in Teachers Using Mokken Analysis.

PURPOSE: Vocal fatigue (VF) is a primary vocal symptom experienced by professional voice users, such as teachers, whose voice is an occupational tool. The study determines the utilization of the Vocal Fatigue Index (VFI), a 19-item scale in identifying symptoms of VF and its severity in teachers. METHODS: Using responses of 695 teachers who completed the VFI, Mokken scaling was conducted on the items to identify the experiences of VF and its associated hierarchical nature of VF symptoms in teachers. Mokken scaling was completed on a total of four groups: (a) Total teachers group, (b) No VF group, (c) Low VF group, and (d) High VF group. RESULTS: Results revealed differences in item hierarchies between total teachers and across the separate groups of VF severity. Item hierarchy for teachers highlighted items from physical discomfort at the mild end of the hierarchy to items from symptom improvement with rest at the severe end of the hierarchy. Items related to avoidance presented as a separate scale for teachers presenting with high VF. DISCUSSION: Mokken scaling in teachers provides insight into the underlying complexity of the experience of VF symptoms and reliance on differential behavioral strategies in its management, suggesting the heterogenous nature of latent trait for VF in this specific population.

Listeners' Attitudes Towards Young Women With Glottal Fry.

PURPOSE: Glottal fry is an increasingly prevalent voice type in young female speakers. The purpose of this study was to identify employers' perceptions toward young female speakers presenting with glottal fry and the impact on hirability. METHODS: Sixty employers responsible for hiring at their business in the Southeast region of the United States completed a survey developed to capture employers' perceptions toward young women using glottal fry. Employers listened to three voice samples of young women with varying levels of glottal fry and rated the voice on 14 semantic differential items. The semantic differential items were derived from the hiring constructs literature to capture perceptions related to mental capability, personality tendencies, and applied social skills. Additionally, questions related to hirability were captured at the end of the survey. RESULTS: Employers were able to identify continuous glottal fry compared to nonglottal fry voice samples. Employers rated voice samples with glottal fry more negatively (eg, less trustworthy, less competent, less educated) compared to nonglottal fry voice samples and were less likely to hire female speakers with continuous glottal fry. CONCLUSION: This study highlights the impact of negative perceptions toward glottal fry on hirability of young female speakers. Such information can provide insight to increase awareness of the impact of a voice type on listener perceptions and communication among young female speakers.

Pregnancy and the Singing Voice: A Survey of What Singers Report.

Pregnancy has profound effects on a variety of body systems by way of hormonal and physical changes. Many of these changes directly affect body systems involved in singing. Assumptions exist about what can happen to a person's voice during pregnancy, but these assumptions are based on theoretical predictions leaving little knowledge of the lived experiences of voice changes during pregnancy. An anonymous mixed-method survey was given to 321 professional singers to gain insights on the lived experiences of pregnant singers. This investigation explored what people were told about the effects of pregnancy on the voice in comparison to what they actually experienced. Results show that about half of the respondents' experience matched what they were told for respiration. For phonation and vocal quality less than 25% respondent's experience matched what they were told. In addition, most of the information respondents received came from friends, colleagues, and teachers compared to medical professionals suggesting a need for more interdisciplinary education to best prepare vocalists who are contemplating becoming pregnant.

Listeners' Perceptions of Speaker Personality Traits Based on Speech.

PURPOSE: Voice and speech are rich with information about a speaker's personality and other features of identity. This study seeks to determine the extent to which listeners agree about speakers' social, physical, and personality attributes. METHOD: Two experiments were conducted. In the first experiment, listeners rated a group of speakers who were unbalanced for sex and personality traits. The second experiment elaborated on the first by ensuring the speaker set was balanced for sex and personality traits. Both experiments played standard speech samples from speakers who provided personality information via the Multidimensional Personality Questionnaire-Brief Form. Groups of listeners rated each speaker on the same personality traits and other features of identity. Responses were analyzed for listener agreement. RESULTS: For both experiments, listeners showed consistently high levels of agreement on the personality attributes of a speaker. For certain speakers, listener agreement on some personality traits was as high as 92% and 97% in Experiments 1 and 2, respectively. Furthermore, a range of agreement across personality subscales was observed across speakers such that some were agreed-upon across all personality ratings and others were agreed-upon only for a few personality traits. CONCLUSIONS: When it comes to judging personality traits and other features of identity, most listeners might not be "correct" about speakers' traits and attributes, but they broadly agree about how the listener sounds. Some speakers send more salient voice and speech cues that drive agreement about their personality, whereas others speak in a manner that precludes consensus. Supplemental Material https://doi.org/10.23641/asha.16906990.

The Patient Experience: The Relationship Between Vocal Handicap, Congruency, Perceived Present Control, and Mood Across Four Voice Disorders.

The potential for negative sequalae in psychosocial well-being presents clinical importance to the assessment of voice disorders. Despite the impairment voice disorders cause in the psychosocial domain, the clinical assessment of these disorders relies heavily on visual perceptual judgments of the larynx, audio-perceptual, as well as acoustic and aerodynamic measures. While these measures aid in accurate diagnosis and are necessary for standard of care, they present little insight into the patient experience of having a voice disorder. DESIGN: Retrospective between-subject, non-experimental design. METHODS: Data from 335 patients from the University of Pittsburgh Voice Center were collected from scores of the Voice Handicap Index-10 (VHI-10) and two recent questionnaires, the Voice Present Perceived Control scale (VPPC), and the Vocal Congruency Scale (VCS). Examining how these voice-specific scales related to three mental health screeners for stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7) and depression (Patient Health Questionnaire-9) were also examined. Patient diagnoses included primary muscle tension dysphonia (pMTD), unilateral vocal fold paralysis (UVFP), vocal fold atrophy, and mid membranous vocal fold lesions. RESULTS: There were significant differences in scores from the voice-specific scales between diagnostic groups with UVFP being the highest (worst) in VHI-10 and UVFP being the lowest (worst) in VCS compared to healthy controls. There was no significant difference in VPPC scores between diagnostic groups. Results showed statistically significant inverse relationships between the VHI-10 and the VPPC and between the VHI-10 and VCS for all diagnostic groups. A significant direct relationship was found between the VPPC and the VCS for patients diagnosed with MTD, UVFP and Lesions. In sum, patients with UVFP presented with the most frequent and sometimes strongest relationships between voice and mental health measures. DISCUSSION: This study marks an initial investigation into the nuanced patient experience of having a voice disorder. Three theoretically unrelated voice constructs: handicap, perceived control, and sense of self, were measured via self-report. Results from this study describe the patient experience correlating to these constructs with weak correlations to stress, anxiety, and depression. Findings also clearly suggest that patient experience varies among diagnostic groups, as well as varying constructs. Measures of multiple constructs of patient perception provide valuable insight into a patient's experience of their voice disorder, guidance on the direction of voice treatment, and justification for such treatments.

Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy.

Communication problems (eg, dysphonia, dysfluency and language and articulation disorders), swallowing disorders (dysphagia and globus), cough and upper airway symptoms, resulting from functional neurological disorder (FND), are commonly encountered by speech and language professionals. However, there are few descriptions in the literature of the most effective practical management approaches. This consensus document aims to provide recommendations for assessment and intervention that are relevant to both adults and young people. An international panel of speech and language professionals with expertise in FND were approached to take part. Participants responded individually by email to a set of key questions regarding best practice for assessment and interventions. Next, a video conference was held in which participants discussed and debated the answers to these key questions, aiming to achieve consensus on each issue. Drafts of the collated consensus recommendations were circulated until consensus was achieved. FND should be diagnosed on the basis of positive clinical features. Speech and language therapy for FND should address illness beliefs, self-directed attention and abnormal movement patterns through a process of education, symptomatic treatment and cognitive behavioural therapy within a supportive therapeutic environment. We provide specific examples of these strategies for different symptoms. Speech and language professionals have a key role in the management of people with communication and related symptoms of FND. It is intended that these expert recommendations serve as both a practical toolkit and a starting point for further research into evidence-based treatments.

Relationship Between Tasked Vocal Effort Levels and Measures of Vocal Intensity.

Purpose Patients with voice problems commonly report increased vocal effort, regardless of the underlying pathophysiology. Previous studies investigating vocal effort and voice production have used a range of methods to quantify vocal effort. The goals of the current study were to use the Borg CR100 effort scale to (a) demonstrate the relation between vocal intensity or vocal level (dB) and tasked vocal effort goals and (b) investigate the repeated measure reliability of vocal level at tasked effort level goals. Method Three types of speech (automatic, read, and structured spontaneous) were elicited at four vocal effort level goals on the Borg CR100 scale (2, 13, 25, and 50) from 20 participants (10 females and 10 males). Results Participants' vocal level reliably changed approximately 5 dB between the elicited effort level goals; this difference was statistically significant and repeatable. Biological females produced a voice with consistently less intensity for a vocal effort level goal compared to biological males. Conclusions The results indicate the utility of the Borg CR100 in tracking effort in voice production that is repeatable with respect to vocal level (dB). Future research will investigate other metrics of voice production with the goal of understanding the mechanisms underlying vocal effort and the external environmental influences on the perception of vocal effort.

The Relation Between Eating Disorders and Voice Disorders.

OBJECTIVE: The purpose of this study is to determine the relation between specific eating disorder diagnoses/purging behaviors and voice disorders. METHOD: One hundred-nine participants with eating disorders completed a survey inquiring about eating disorder symptoms, purging behaviors, and voice disorder symptoms. Participants also completed the Eating Disorders Examination Questionnaire, Voice Handicap Index, and the Reflux Symptom Index. RESULTS: The prevalence of voice disorders among the group with eating disorders was 21.88%. Of those with both eating disorders and voice disorders, anorexia nervosa appeared to be more prevalent in this group than bulimia nervosa. In addition, purging behaviors of exercise presented with a higher prevalence of voice problems than vomiting. CONCLUSION: Individuals with eating disorders seem to be at a higher risk for voice disorders than the general population. Anorexia nervosa and exercise as a purging method were identified as the highest risk factors for voice disorders.

Vocal Congruence: The Voice and the Self Measured by Interoceptive Awareness.

Voices are, by nature, idiosyncratic representations of individuals because they possess anatomical, physiological, and psychological characteristics that are unique to them, which contribute to vocal output, and thus, establish the voice as a salient marker of their individuality. The areas of experimental psychology and cognitive neuroscience have examined the psychological and neurological constructs that form one's sense of self and have employed measures of interoceptive and exteroceptive abilities to discover the underlying constructs of the sense of self. This study employed measures of interoceptive awareness to assess level of vocal congruence. Forty-one participants analyzed in this study underwent a heartbeat detection task designed to assess the level of interoceptive awareness and were placed into two groups: those high in interoceptive awareness and those low in interoceptive awareness. They completed two tasks, a speaking task, which included structured passages and conversation, and a listening task, where they listened to themselves in the speaking task. Following each task, they completed a Vocal Congruence Scale designed to assess the level of identification they have within themselves related to the sound of their voice. Individuals scoring high in interoceptive awareness scored significantly higher in vocal congruence than those scoring lower in interoceptive awareness. Additionally, when analyzed with other measures of personality, anxiety, mood, and voice handicap, the Vocal Congruence Scale appears to measure a unique aspect of vocal identity with one's self that encompasses interoceptive awareness.

Cognitive, Emotional, and Social Influences on Voice Production Elicited by Three Different Stroop Tasks.

INTRODUCTION: The effects of emotion and cognition have been of interest to voice clinicians and research given the known correlations between psychological states and voice disorders. However, most voice research techniques investigate one psychological state at a time and do not necessarily consider other psychological states or the combination of two or more states occurring simultaneously. The purpose of this study is to employ three Stroop tasks, all known to elicit different psychological states, during a voice study to determine whether separate psychological states have a variable effect on vocalizations. METHODS: Fifteen female participants were instructed to view a word on a computer screen and say the name of the color of the font of that word. Words were part of a Color Stroop, Emotional Stroop, or Taboo Stroop paradigm and designed to elicit cognitive, emotional, or the combination of cognitive/emotional interference. Behavioral measures of response time and acoustic measures of frequency, intensity, and noise ratio were extracted from each stimulus. RESULTS: Participants had significantly greater response times for all experimental conditions compared to baseline. Additionally, intensity range was significantly less, and average fundamental frequency and cepstral peak prominence were significantly greater than baseline. However, there was no distinct pattern of response for any condition. DISCUSSION/CONCLUSION: Although there are definite changes in vocalizations when participants were engaged in higher cognitive or emotional processing, no acoustic signatures for these separate conditions exist. These findings suggest that more specific acoustic measures or additional measures such as physiological or self-report may be necessary to parse out the differential effect on the voice in these three conditions.

Do We Need a Measure of Vocal Effort? Clinician's report of vocal effort in voice patients.

Purpose: Vocal effort has been of increasing interest to voice clinicians and researchers. However, little is known about the prevalence of vocal effort in voice patients presenting to voice clinics. The purpose of this study was to better understand how vocal effort is perceived and used in a clinical setting, including the current opinions on this symptom and experiences of voice clinicians regarding vocal effort measurement and management. Method: Speech language pathologists who regularly treat voice patients were queried about their years of voice experience, number of voice patients treated yearly, percentage of voice patients who complain of vocal effort, methods of clinically measuring vocal effort, and treatment strategies that address vocal effort in therapy. Results: Survey results revealed that vocal effort is a commonly presented complaint in the voice clinic with over two-thirds of clinicians reporting that the majority of their patients complain of vocal effort and approximately 25% of clinicians reporting that vocal effort is the main complaint in their patients. Although most clinicians measure vocal effort in the clinic, very few use a dedicated vocal effort measure. About half of the clinicians reported that they specifically address vocal effort reduction as a therapy goal. Conclusion: Despite the high prevalence of observed vocal effort complaints in patients and the focus of vocal effort reduction in therapy, there is no standardized measure of vocal effort widely utilized in the clinic. Future research should address clinically tractable methods to measure vocal effort validly and reliably.

Toward a Consensus Description of Vocal Effort, Vocal Load, Vocal Loading, and Vocal Fatigue.

Purpose The purpose of this document is threefold: (a) review the uses of the terms "vocal fatigue," "vocal effort," "vocal load," and "vocal loading" (as found in the literature) in order to track the occurrence and the related evolution of research; (b) present a "linguistically modeled" definition of the same from the review of literature on the terms; and (c) propose conceptualized definitions of the concepts. Method A comprehensive literature search was conducted using PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scientific Electronic Library Online. Four terms ("vocal fatigue," "vocal effort," "vocal load," and "vocal loading"), as well as possible variants, were included in the search, and their usages were compiled into conceptual definitions. Finally, a focus group of eight experts in the field (current authors) worked together to make conceptual connections and proposed consensus definitions. Results The occurrence and frequency of "vocal load," "vocal loading," "vocal effort," and "vocal fatigue" in the literature are presented, and summary definitions are developed. The results indicate that these terms appear to be often interchanged with blurred distinctions. Therefore, the focus group proposes the use of two new terms, "vocal demand" and "vocal demand response," in place of the terms "vocal load" and "vocal loading." We also propose standardized definitions for all four concepts. Conclusion Through a comprehensive literature search, the terms "vocal fatigue," "vocal effort," "vocal load," and "vocal loading" were explored, new terms were proposed, and standardized definitions were presented. Future work should refine these proposed definitions as research continues to address vocal health concerns.

Cognitive influences on perceived phonatory exertion using the Borg CR10.

Objectives: The purpose of the present study was to examine the nature of the relationship between perceptions of vocal and mental (cognitive) effort during reading and speaking tasks.Methods: One hundred and four young, healthy adult participants were randomized into one of three groups. Each group performed a writing task meant to elicit low mental effort, high mental effort, or high mental effort followed by a period of relaxation. Participants then engaged in reading and speaking tasks, meant to elicit high (suppression of a prepotent desire to speak louder) or low (no suppression of a prepotent desire to speak louder) mental effort, and completed ratings of mental effort and vocal effort via adapted versions of the Borg CR10.Results: Findings indicate that ratings of perceived mental and vocal effort are related to one another, evidenced by strong correlations, and additional analyses reveal that mental effort might drive this relationship.Conclusions: Perceptions of vocal effort appear to mirror ratings of mental effort during tasks for which vocal activity is relatively stable but cognitive demands fluctuate. The possibility that perceptions of mental effort might influence perceptions of vocal effort should be considered when creating reliable and valid measures of vocal effort as well as when interpreting currently adapted measures of vocal effort in the clinical context.