Pi is 089219971000055 x

8
The Effect of a Short Voice Training Program in Future Teachers *Bernadette Timmermans, *Yannick Coveliers, Wil Meeus, Frits Vandenabeele, *Linda Van Looy, and §Floris Wuyts, *Brussels, yxAntwerp, and zMechelen, Belgium Summary: The purpose of this study was to investigate if a module consisting of 6 hours of voice training is effective in future teachers. Sixty-five students, enrolled in the academic teaching program at the Vrije Universiteit Brussel, partic- ipated in this study. The trained group (n ¼ 35) received 6 hours of voice training, whereas the control group (n ¼ 30) received no voice training. A multidimensional test battery containing subjective judgments and objective measure- ments was applied in both groups at the study onset and after 4 months to evaluate the training outcome. No significant differences were observed for the subjective judgments. For the objective measurements, by contrast, several significant differences between the trained and the control groups were found. This outcome favors the systematic introduction of voice training during the schooling of future teachers. Key Words: Teacher education–Voice training–Voice problems. INTRODUCTION Research indicates that at least 50% of teachers are regularly confronted with voice problems. The voice sounds hoarse or harsh, and sometimes, speaking is painful. 1 In addition, 31% of teachers miss working days as a result of a voice problem. 2 Sometimes, the voice problem even causes a loss of income, as teaching becomes impossible. 3,4 It is known that future teachers encounter voice problems as well: 17.2% of them have problems during their education. 5 Furthermore, 90% of fu- ture teachers who were confronted with voice problems during their education experience voice problems in their teaching ca- reer. 2 This high prevalence can be explained by the heavy vocal load, as teachers are often full-time speakers for relatively large groups of students. Worryingly, few prevention programs are designed for teachers and future teachers. Literature reveals three studies in which a rather short voice training program for future teachers resulted in objectively obtained voice improvements (Table 1). However, the results of Simberg et al, 6 Duffy and Hazlett, 7 and Schneider and Bigenzahn 8 are difficult to compare, as their methodologies differ too much. There is no correspon- dence in timing (training hours ranging from 1.5 to 10 hours), the number of participants (individual training and small- and large-group training), or assessment strategy (subjective evalu- ations and/or objective measurements). This study is the first part of a multifaceted study where time (¼number of training sessions) and group size are ques- tioned with respect to training effect. The aim of this multifac- eted study is to set up a cost-effective voice training module for the academic teacher training program of the Vrije Universi- teit Brussel (Free University of Brussels [VUB]). In this first study, 6 hours of voice training is given (Table 2). In the second part of the study, a 30-minute individual coaching is added to the 6 hours of voice training. In the third part of the study, 9 hours of voice training will be given. The parameter ‘‘group size’’ is im- portant as well. Because voice training is mostly a matter of an individual approach, the authors wondered if group training is also effective (compared with individual training). In the first and the second studies, the training sessions were conducted in large groups (ie, 30–50 subjects); in the third study, the train- ing will be given in several small groups (ie, 20 subjects). In the present study, the effectiveness of a 6-hour voice train- ing program in a large group was measured by means of a mul- tidimensional test battery 9 and the voice loading test. 10 We decided to give 6 hours of voice training, because former stud- ies indicated that a combination of direct and indirect training would be the best guarantee for a successful outcome. Next to this, students were trained in a large group. Because there is hardly any research material available on voice training in large groups, we were unable to determine if this was the right course of action. Students of the academic teaching program at the VUB participated in this study and were assigned to a trained or a control group. The multidimensional test battery and the voice loading test were applied in both groups at the study onset and after 4 months. Two main questions needed to be answered: Is 6 hours of voice training sufficient to obtain a significant improvement in vocal behavior and voice quality? Does voice training prove effective in large groups as well? SUBJECTS Sixty-five students of the academic teacher education program at the VUB were engaged in this study (43 females and 22 males) (Table 3). Students with a deviated voice quality were inspected by an ear, nose, and throat specialist (four students with a G1 and one student with a G2 voice quality). Two stu- dents with an organic voice disorder were excluded from the study. The participants were randomly assigned to the trained (n ¼ 35) or control group (n ¼ 30). Students were tested at the study onset (pretest) and again after 4 months (posttest). The Accepted for publication April 8, 2010. From the *Department IDLO, Vrije Universiteit Brussel, Brussels, Belgium; yDepartment IOIW, Universiteit Antwerpen, Antwerp, Belgium; zCVO-Meviza, Meche- len, Belgium; and the xDepartment Fysica, Universiteit Antwerpen, Antwerp, Belgium. Address correspondence and reprint requests to Bernadette Timmermans, Department IDLO, Vrije Universiteit Brussel, Pleinlaan 2—lokaal 3B210, B-1050, Brussels, Belgium. E-mail: [email protected] Journal of Voice, Vol. 25, No. 4, pp. e191-e198 0892-1997/$36.00 Ó 2011 The Voice Foundation doi:10.1016/j.jvoice.2010.04.005

Transcript of Pi is 089219971000055 x

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The Effect of a Short Voice Training Program

in Future Teachers

*Bernadette Timmermans, *Yannick Coveliers, †Wil Meeus, ‡Frits Vandenabeele, *Linda Van Looy,

and §Floris Wuyts, *Brussels, yxAntwerp, and zMechelen, Belgium

Summary: The purpose of this study was to investigate if a module consisting of 6 hours of voice training is effective in

AccepFromyDepartmlen, Belg

AddreIDLO, VE-mail: b

Journa0892-1� 201doi:10

future teachers. Sixty-five students, enrolled in the academic teaching program at the Vrije Universiteit Brussel, partic-ipated in this study. The trained group (n¼ 35) received 6 hours of voice training, whereas the control group (n¼ 30)received no voice training. A multidimensional test battery containing subjective judgments and objective measure-ments was applied in both groups at the study onset and after 4 months to evaluate the training outcome. No significantdifferences were observed for the subjective judgments. For the objective measurements, by contrast, several significantdifferences between the trained and the control groups were found. This outcome favors the systematic introduction ofvoice training during the schooling of future teachers.Key Words: Teacher education–Voice training–Voice problems.

INTRODUCTION

Research indicates that at least 50% of teachers are regularlyconfronted with voice problems. The voice sounds hoarse orharsh, and sometimes, speaking is painful.1 In addition, 31%of teachers miss working days as a result of a voice problem.2

Sometimes, the voice problem even causes a loss of income,as teaching becomes impossible.3,4 It is known that futureteachers encounter voice problems as well: 17.2% of themhave problems during their education.5 Furthermore, 90% of fu-ture teachers who were confronted with voice problems duringtheir education experience voice problems in their teaching ca-reer.2 This high prevalence can be explained by the heavy vocalload, as teachers are often full-time speakers for relatively largegroups of students.

Worryingly, few prevention programs are designed forteachers and future teachers. Literature reveals three studiesin which a rather short voice training program for futureteachers resulted in objectively obtained voice improvements(Table 1). However, the results of Simberg et al,6 Duffy andHazlett,7 and Schneider and Bigenzahn8 are difficult to compare,as their methodologies differ too much. There is no correspon-dence in timing (training hours ranging from 1.5 to 10 hours),the number of participants (individual training and small- andlarge-group training), or assessment strategy (subjective evalu-ations and/or objective measurements).

This study is the first part of a multifaceted study wheretime (¼number of training sessions) and group size are ques-tioned with respect to training effect. The aim of this multifac-eted study is to set up a cost-effective voice training modulefor the academic teacher training program of the Vrije Universi-teit Brussel (Free University of Brussels [VUB]). In this firststudy, 6 hours of voice training is given (Table 2). In the second

ted for publication April 8, 2010.the *Department IDLO, Vrije Universiteit Brussel, Brussels, Belgium;ent IOIW, Universiteit Antwerpen, Antwerp, Belgium; zCVO-Meviza, Meche-

ium; and the xDepartment Fysica, Universiteit Antwerpen, Antwerp, Belgium.ss correspondence and reprint requests to Bernadette Timmermans, Departmentrije Universiteit Brussel, Pleinlaan 2—lokaal 3B210, B-1050, Brussels, [email protected] of Voice, Vol. 25, No. 4, pp. e191-e198997/$36.00

1 The Voice Foundation.1016/j.jvoice.2010.04.005

part of the study, a 30-minute individual coaching is added to the6 hours of voice training. In the third part of the study, 9 hours ofvoice training will be given. The parameter ‘‘group size’’ is im-portant as well. Because voice training is mostly a matter of anindividual approach, the authors wondered if group training isalso effective (compared with individual training). In the firstand the second studies, the training sessions were conductedin large groups (ie, 30–50 subjects); in the third study, the train-ing will be given in several small groups (ie, 20 subjects).

In the present study, the effectiveness of a 6-hour voice train-ing program in a large group was measured by means of a mul-tidimensional test battery9 and the voice loading test.10 Wedecided to give 6 hours of voice training, because former stud-ies indicated that a combination of direct and indirect trainingwould be the best guarantee for a successful outcome. Next tothis, students were trained in a large group. Because there ishardly any research material available on voice training in largegroups, we were unable to determine if this was the right courseof action. Students of the academic teaching program at theVUB participated in this study and were assigned to a trainedor a control group. The multidimensional test battery and thevoice loading test were applied in both groups at the study onsetand after 4 months.

Two main questions needed to be answered:

� Is 6 hours of voice training sufficient to obtain a significantimprovement in vocal behavior and voice quality?

� Does voice training prove effective in large groups aswell?

SUBJECTS

Sixty-five students of the academic teacher education programat the VUB were engaged in this study (43 females and 22males) (Table 3). Students with a deviated voice quality wereinspected by an ear, nose, and throat specialist (four studentswith a G1 and one student with a G2 voice quality). Two stu-dents with an organic voice disorder were excluded from thestudy. The participants were randomly assigned to the trained(n¼ 35) or control group (n¼ 30). Students were tested at thestudy onset (pretest) and again after 4 months (posttest). The

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TABLE 1.

Three Studies in Future Teachers

Year Author Population Group Size Assessment Method Duration Results

2004 Simberg Future

teachers

Combination of

large groups

and individual

training

(n¼ 75–226)

Subjective

evaluation

Indirect and

direct training

1.30 direct

30 indirect

3-mo

self-training

Significant

improvements

2004 Duffy and

Hazlett

Future

teachers

small groups

(n¼ 20)

Subjective

evaluation

and objective

measurements

Indirect and

direct training

4 mo Subjective and

objective progress

2005 Schneider and

Bigenzahn

Future

teachers

small groups

(n¼ 11)

Subjective

evaluation

and objective

measurements

Indirect and

direct training

10 sessions,

1 h a week

Significantly

higher sound

pressure levels

Journal of Voice, Vol. 25, No. 4, 2011e192

trained group received 3 hours of indirect and 3 hours of directvoice training. The control group (n¼ 30) received no trainingat all.

TABLE 2.

An Overview of the Multifaceted Study With Number of

Training Sessions and Group Size

Study Training Sessions Group Size

Study 1

(2007–2008)

3-h indirect training Large group size

3-h direct training Large group size

Study 2

(2008–2009)

3-h indirect training Large group size

3-h direct training Large group size

30-min coaching Individual

Study 3 Individual intake Individual

VOICE TRAINING PROTOCOL

The voice training protocol consisted of 3 hours of indirect and3 hours of direct training, and there were no multiple sessions(Table 2). Both direct and indirect training sessions were orga-nized for the trained group (n¼ 35) after the pretest and tookplace in the evening. Voice training sessions were given bya speech therapist who was not involved in the assessments.

A PowerPoint presentation was distributed before indirectand direct training sessions began. These presentations couldbe used as a guide to the exercises that needed to be performedafter the lessons.

The indirect training concentrated on eliminating the factorsthat contribute to or maintain a voice problem. This educationalapproach helps individuals to identify the factors that add toa voice problem, to alter and avoid these factors, and to modifyvocal behavior before any voice damage occurs.7 Therefore, therules of proper vocal care (ie, vocal hygiene) were discussed indetail. An explanation of how the voice functions was given aswell (Appendix). The authors believe in a short-term improve-ment following a proper dissemination of information related toefficient and healthy vocal behavior.

Direct training, on the other hand, focused on the componentsof voice production, such as a healthy posture, a good breathingtechnique and breath support, the establishment of optimalpitch, the control of pitch consistence, a projected voice, reso-nance, and articulation. Exercises for these components wereclarified and demonstrated. Small groups of students (six oreight students) were asked to perform the exercises in front ofthe classroom. For several exercises, little feedback was givento each student. The training was structured and scripted(Appendix).

(2010–2011) 1 3 3-h indirect training Large group size

1 3 3-h direct training Small groups

1 3 3-h call-back Small groups

Individual coaching Individual

VOICE ASSESSMENT PROTOCOL

Data collection was based on the guidelines of the multidimen-sional voice assessment protocol, as proposed by the European

Laryngological Society.9 The first assessment, the pretest, wascarried out in November 2007 (Table 3). The second assess-ment, the posttest, was organized in March 2008. The followingset of data was collected for each subject: perceptual evaluation,acoustic analysis, and phonatory measurement. The voice load-ing test (LingWaves, 2007; LingCom GmbH, Forchheim,Germany) was used to measure pitch and pitch deviation. Thepre- and posttests were carried out by three speech therapistswho were not involved in the training sessions. The three speechand language pathologists (SLPs) had different tasks pre- andposttest: one was responsible for the perceptual evaluation, an-other for the voice loading test, and the third for the measure-ment of the parameters of the dysphonia severity index (DSI).It was impossible to compare the results pre- and posttest, asthey were not available for them. Both tests were carried outin the evening.

The perceptual evaluation was performed using the GRBASscale as designed by Hirano,11 where G stands for grade of over-all hoarseness, R for roughness, B for breathiness, A for asthenicquality, and S for strain. Each scale is rated as 0 (normal), 1(mild), 2 (moderate), and 3 (severe). The voices were judgedby an experienced SLP and were rated when subjects werereading aloud.

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TABLE 3.

The Number of Subjects of the Trained and Control

Groups

Males Females Total

Pretest, November 2007 65

Trained group 9 26 35

Control group 13 17 30

Posttest, March 2008 63

Trained group 9 25 34

Control group 13 16 29

Bernadette Timmermans, et al Short Voice Training Program in Future Teachers e193

The acoustic parameters were determined by means of theLingWaves Phonetogram Pro software (LingCom GmbH,Forchheim, Germany).10 Students were asked to produce theirloudest and softest intensities and their highest and lowestfrequencies, sliding mid-up and mid-down until their highest/lowest frequency or intensity. This enabled us to measure thevoice range of each student. A segment of a sustained vowel/a/ was used to obtain the jitter.

The phonatory measurement was determined by the maxi-mum phonation time (MPT). After a maximal inhalation, sub-jects were asked to sustain the vowel /a/ at habitual loudnessand pitch. The LingWaves software registered the length oftime in seconds.

For each subject, the DSI was calculated to obtain an overallmeasure of voice quality. The DSI is based on the weightedcombination of the following selected set of voice measure-ments: highest frequency (FoH [Hz]), lowest intensity (IL[dB]), MPT (seconds), and jitter (%). The DSI is the most opti-mal combination of independently measured variables that bestreflects the degree of hoarseness. It is constructed as follows:DSI¼ (0.13 3 MPT) + (0.0053 3 FoH)� (0.26 3 IL) + (1.18 3

jitter) + 12.4. The DSI for perceptually normal voices equals+5, whereas for severely dysphonic voices, it equals �5. Themore negative the subject’s index, the worse is his or her voicequality. A DSI of 1.6 is the cutoff score for perceptually normalvoices.12

The LingWaves voice loading test was carried out to test thepredisposition of the subjects to vocal fatigue. The voice load-ing test module offers automated real-time data processingduring the test run. The test parameters, including required levelof vocal loading and test duration, can be set freely by an exam-iner. When the test is finished, a statistic report provides infor-mation on the subject’s vocal ability.

Subjects were asked to count aloud for 1 minute above a levelof 70 dBA and for another minute above a level of 75 dBA. Thesoftware continuously updates the intensity and the fundamen-tal frequency estimates of the voice; they are immediately mea-sured and displayed during the test run. A red line indicated therequired loudness levels (70 and 75 dBA), whereas a green linevisualized pitch. A blue arrow pointing upward flashed whenthe required loudness levels of 70 or 75 dBA were not obtained.

The difference in mean pitch and pitch deviation was calcu-lated. Because the task is to raise the voice from 70 dBA inthe first minute to 75 dBA in the second minute, a small or

nonexistent pitch deviation throughout the entire task indicatesa stability of pitch and pitch control at both loudness levels.A large pitch deviation indicates poor stability of pitch.

STATISTICS

The purpose of this investigation was to determine the effect ofthe voice training. Data were analyzed with the Statistical Pack-age For Social Sciences (SPSS V16.0, SPSS Inc., Chicago, IL).The probability level (P value) was set on P¼ 0.05. The vari-ables jitter, highest frequency (FoH), lowest intensity (LI),MPT, DSI, average pitch, and pitch deviation were investigatedby means of a two-way analysis of variance repeated-measurestest. The influence of the time effect was assessed comparing theresults within the subjects from pre- to posttest. To studywhether the evolution in time was influenced by the training,the interaction effect was investigated. Gender was includedas a factor in this analysis. The perceptual evaluation (GRBASscore) was examined using the Mann-Whitney U test to comparethe results of the trained and control groups. Wilcoxon matched-pair signed-rank test was used for pre- and posttest evaluation.

RESULTS AND DISCUSSION

The results of the perceptual evaluation were obtained by com-paring the scores obtained pre- and posttest for both trained andcontrol groups. There were no significant differences for theparameters G, R, B, A, and I. For the parameter S (strain), a sig-nificant difference was found (P¼ 0.046), indicating that therewas more strain in the posttest for the control group. This resultis clinically insignificant, as this was true for just four subjects.An analysis of the objectively obtained data, that is, the param-eters of the DSI and the DSI scores, are presented in Table 4 and5. The results of FoH (P < 0.001) and LI (P¼ 0.009) revealedsignificant gender effects (Table 4). Therefore, males andfemales were studied separately to find out whether time, group,or training effects occurred without the influence of gender.Further analysis of the results of the highest frequency indicatedthat only the females of the trained group showed a significantimprovement (P¼ 0.022) after training (interaction:P¼ 0.032). For the males of both the trained and the controlgroups, no significant differences were observed. With regardto LI, the male subjects scored significantly better (significantinteraction: P¼ 0.033; significant time effect: P¼ 0.005). Forthe males of the trained group only, a significantly differinggroup effect (P¼ 0.009) occurred as well. As regards the resultsof jitter, MPT, and DSI, however, no significant differenceswere found. At present, there is no explanation for these results.

It is not clear why female subjects improved significantly forhighest frequency and male subjects for lowest intensity, but itseems that this short training package has induced a change insense of mastery of their own vocal capacities. Because studentswere subjected to these kinds of tests for the first time in theirlives, this new experience clearly encouraged them to dare toexperiment and to improve their vocal competence. Thus, weshould refer to a test effect.

Because of the large size of the group, the (direct) trainingsession was limited to an explanation, a demonstration, and

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TABLE 4.

Influence of Gender, Time, Group, and Interaction Effect, Pre- and Posttest, of the DSI and Its Parameters for the Trained and

Control Groups

Parameters of DSI and DSI

Gender Effect Time Effect Group Effect Interaction Effect

P Value P Value P Value P Value

Highest frequency <0.001 0.020

\ 0.291 CG: 0.400

TG: 0.022

0.032

_ 0.912 0.288 0.192

Lowest intensity 0.009 0.004

\ 0.310 0.076 0.097

_ 0.005 CG: 0.500

TG: 0.009

0.033

Jitter 0.495 0.984 0.279

MPT 0.430 0.561 0.501

DSI 0.408 0.689 0.108

Abbreviations: CG, control group; TG, trained group.

Journal of Voice, Vol. 25, No. 4, 2011e194

a brief performance. There was barely time for feedback afterthe group exercises, and there was also no guarantee thatstudents would continue to train their voices after this trainingsession. This might explain the restricted results in the changeof voice quality (DSI).

To detect whether subjects were able to control pitch (ie, theability to increase loudness with the capacity to produce a stablepitch level), we searched for significant differences for averagepitch and pitch deviation.

For the parameter average pitch, a gender effect was found(P < 0.001), with an interaction of P < 0.001 (Table 6). Againmales and females were studied separately. Further analysisshowed a significant change of average pitch during the pre-and posttest for females of the control group only (P¼ 0.027).Thus, the females of the control group scored equally in both

TABLE 5.

Mean and SD, Pre- and Posttest, of the DSI and Its Parameters

Pre- and Posttest–Trained

and Control Group

DSI (�5 to +5) MPT (Seco

Mean (SD) Mean (SD

Pretest

Control group

Males 4.8 (2) 20.3 (7)

Females 4.1 (2) 17.3 (5)

Trained group

Males 2.9 (2) 18.6 (7)

Females 3.8 (2) 16.0 (6)

Posttest

Control group

Males 3.9 (2) 18.9 (6)

Females 4.6 (2) 16.9 (6)

Trained group

Males 3.9 (3) 17.8 (6)

Females 5.0 (2) 16.8 (7)

Abbreviation: SD, standard deviation.

pre- and posttest. For the females of the trained group, onthe other hand, no significant difference for average pitch inthe posttest was observed. This indicates that the females ofthe trained group were able to count at a rather stable averagepitch level when they had to switch from 70 to 75 dBA. It ap-pears that they were applying what they had learned. For themales, on the other hand, there was only a significant time effect(P¼ 0.003) and no group or interaction effect.

Analyzing the results of pitch deviation, no significant gendereffect was found, meaning that males and females scoredequally well. However, a strong significant interaction effect(P < 0.001) was observed. This clarifies that training effectedthe results. Again, studying males and females separately, statis-tics revealed a significant interaction (P¼ 0.047), a significanttime effect (P¼ 0.015), and a significant difference pre- and

for the Trained and the Control Groups

nds) Jitter (%) FoH (Hz) IL (dB)

n) Mean (SD) Mean (SD) Mean (SD)

1.1 (1) 529 (150) 49 (4) 13

0.7 (1) 654 (156) 48 (3) 17

0.7 (1) 575 (239) 54 (5) 9

0.8 (1) 627 (156) 50 (3) 26

0.8 (1) 486 (216) 48 (3) 13

0.8 (1) 640 (168) 48 (3) 16

1.3 (3) 626 (250) 49 (4) 9

0.8 (1) 726 (183) 48 (3) 25

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TABLE 6.

Influence of Gender, Time, Group, and Interaction Effect, Pre- and Posttest, of the Parameters Average Pitch and Pitch

Deviation, for the Trained and Control Groups

Parameters

Gender Effect Time Effect Group Effect Interaction Effect

P Value P Value P Value P Value

Average pitch <0.001 <0.001

\ 0.576 CG: 0.027

TG: 0.130

0.011

_ 0.003 0.074 0.518

Pitch deviation 0.075 <0.001

\ 0.015 CG: 0.660

TG: 0.021

0.047

_ <0.001 0.016 0.097

Abbreviations: CG, control group; TG, trained group.

Bernadette Timmermans, et al Short Voice Training Program in Future Teachers e195

posttest (P¼ 0.021) for the females of the trained group only.The significant differences between the females of the trainedand those of the control group show that the results are causedby training. It was emphasized in the voice training sessionsthat the pitch should not be raised during teaching, as this coulddamage the vocal folds and generate vocal fatigue. Untrainedfemale subjects showed a significant pitch shift when theywere asked to speak louder, whereas trained females were capa-ble of stabilizing the pitch level. This could indicate that subjectswere able to adapt vocal behavior after training.

For the male subjects, on the other hand, the results were dif-ferent, although they received the same training as the females.A strong significant time effect (P < 0.001), a significant groupeffect (P¼ 0.016), and a nonsignificant interaction (P¼ 0.097)were observed. Thus, the results of the male subjects of bothtrained and control groups ameliorated and were influencedby time. Because the results of the trained group were superior(Table 7), it could indicate that the trained group learned from

TABLE 7.

Mean and SD, Pre- and Posttest, of the Average Pitch and

Pitch Deviation for the Trained and the Control Group

Pre- and

Posttest–Trained

and Control Group

Average

Pitch (Hz)

Pitch

Deviation (Hz)

nMean (SD) Mean (SD)

Pretest

Control group

Males 179 (31) 21 (19) 13

Females 248 (20) 19 (6) 17

Trained group

Males 207 (32) 36 (15) 9

Females 264 (31) 25 (12) 26

Posttest

Control group

Males 161 (29) 11 (5) 13

Females 261 (21) 20 (5) 16

Trained group

Males 179 (37) 12 (9) 9

Females 256 (36) 18 (7) 25

Abbreviation: SD, standard deviation.

the training. Probably, again a test effect could have influencedthese results.

CONCLUSION

In this study, the outcome of a short voice training program ina large group of future teachers was explored by objective mea-surements (ie, the parameters of the DSI and the DSI itself, andthe voice loading test) and subjective judgments (ie, perceptualevaluation). As the authors were looking for a cost-effectivevoice training program, a multifaceted study was set up. The au-thors needed to know if voice training in large group was effec-tive with a minimum of training hours. It should be clear thatostentatious results were not expected and that a long-term im-plementation of the new and healthier vocal behavior is subjectfor a long-term study. With respect to the perceptual evaluation,no clinically significant results were observed. For the objectivemeasurements, however, several significant differences be-tween the trained and control groups were found. Trained sub-jects were able to expand their voice range and to alter theirvocal behavior. As the control of pitch is a prerequisite fora strong and healthy voice, these results are important. Evenwith significant results at the level of 5%, it is now clear thatthese training sessions make the difference. The fact that the fu-ture teachers are clearly explained what is good for the voiceand what is not good for the voice, how the voice should beused, and which techniques needed to be used, has impact, how-ever small it is. It is not clear to what extent a more extensivetraining program, given in a large or small group, wouldshow a more promising outcome.

REFERENCES1. Mattiske JA, Oates JM, Greenwood KM. Vocal problems among teachers:

a review of prevalence, causes, prevention, and treatment. J Voice. 1998;12:

489–499.

2. de Jong FICRS, Kooijman PGC, Thomas G, Huinck WJ, Graamans K,

Schutte HK. Epidemiology of voice problems in Dutch teachers. Folia Pho-

niatr Logop. 2006;58:186–198.

3. Russel A, Oates J, Greenwood KM. Prevalence of voice problems in

teachers. J Voice. 1998;12:467–479.

4. Smith E, Lemke J, Taylor M, Krichner HL, Hoffman H. Frequency of voice

problems among teachers and other occupations. J Voice. 1998;12:

480–488.

Page 6: Pi is 089219971000055 x

Journal of Voice, Vol. 25, No. 4, 2011e196

5. Thomas G, Kooijman PGC, Donders ART, Cremer CWRJ, de Jong FICRS.

The voice handicap of student-teachers and risk factors perceived to have

a negative influence on the voice. J Voice. 2007;21:325–336.

6. Simberg S, Sala E, Ronnemaa AM. A comparison of the prevalence of vo-

cal symptoms among teacher students and other university students. J

Voice. 2004;18:363–368.

7. Duffy OM, Hazlett DE. The impact of preventive voice care programs for

training teachers: a longitudinal study. J Voice. 2004;18:63–70.

8. Schneider B, Bigenzahn W. Vocal risk factors for occupational voice disor-

ders in female teaching students. Eur Arch Otorhinolaryngol. 2005;262:

272–276.

9. Dejonckere PH, Bradley P, Clemente P, et al. A basic protocol for functional

assessment of voice pathology, especially for investigating the efficacy of

(phonosurgical) treatments and evaluating new assessment techniques.

Eur Arch Otorhinolaryngol. 2001;258:77–82.

10. LingWaves (Version 2.5) [Computer software]. Germany: LingCom GmbH;

2007. Available at: www.wevosys.com. Last accessed May 2008.

11. Hirano M. Clinical Examination of Voice. Wien, NY: Springer–Verlag; 1981.

12. Wuyts FL, De Bodt MS, Molenberghs G, et al. The dysphonia severity

index: an objective measure of vocal quality based on a multiparameter

approach. J Speech Lang Hear Res. 2000;43:796–809.

13. Timmermans B. Klink Klaar. De eerste uitspraak- en intonatiegids. Davids-

fonds, Leuven 2005.

14. Coblenzer H, Muhar F. Atem und Stimme. Anleitung zum guten sprechten.

Wien, Austria: Obv&Hpt; 2002.

15. Lessac A. The Use and Training of the Human Voice. A Bio-dynamic

Approach to Vocal Life. Mountain View, CA/London/Toronto: Mayfield

Publishing Company; 1997.

16. Le Huche F, Allali A. La voix-therapeutique des troubles vocaux. Paris,

France: Maffon; 1989.

APPENDIX

Vocal hygiene (indirect training)

Vocal hygiene was discussed in detail, examples were givenwhenever possible. The illustrative software of Blue Tree Publish-ing was projected (www.bluetreepublishing.com). Students were,thus, able to see the inhalation of smoke and its contact with thevocal folds, the strong muscle contraction when yelling, thehard glottal attack, . Vocal abuse, overuse, and misuse was dem-onstrated by the teacher. Vocal warm up and cool down andcorrect loud speaking were demonstrated and afterward—inthe direct training session—exercises were performed with thestudents.

- Vocal abuse

B Shouting, yelling, .

- Vocal overuseB When does one talk too much?B When does one speak with too much effort to produce

voice?- Vocal misuse

B Correct loud speaking: how? (see also exercise 5)B Use of pitch: mind difference between habitual pitch

and natural pitch- Voice care

B Reflux: what to do to prevent this?

- Timing: eat and drink at least two hours before going

to sleep- Food: not too spicy- Avoid food with a high fat content- Beverages: avoid soft drinks

B Warm up and cool down (see also resonance exercises)B Voice rest: how and whenB Mind good humidity in room(s) where you live, work,

and sleepB Avoid dairy products before voice work (chocolate,

milk, .)

Exercises (direct training)

To be able to repeat this study, the exercises are explained later.It must be clear that the exercises were performed in Dutch. En-glish examples are used to illustrate the exercises.

First, the exercises are demonstrated by the teacher, and sec-ond, the students are asked to perform the exercises. Some-times, feedback was given to few students or each one ofthem, depending on the kind of exercise.

Order of exercises:. 1. Good posture

- First, demonstration, second, exercise with the whole

group together (n¼ 20)- Feedback was given to students with a bad posture; they

were asked to perform the exercise in front of the class-room. Their posture was corrected.

B Feet firmly on the floor and see that your body isgrounded

B Pretend that your head is connected to the sealingB Shoulders lowB Speak through your students, not over your students:

thus, chin not too high

2. Awareness of respiration

- First, demonstration, second, exercise in small groups

(n¼ 5) in front of the classroom- Feedback was given to each student- After each exercise, students are able to ask questions

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B Feel your respiration—what happens when youbreathe?

B Sit on your chair and feel your respiration: in and out.B Check it out: what happens when the air gets into

your lungs?B Check it out: what happens with the air if you speak?B What happens when you pretend to smell a rose? Is

your respiration low? Check it out.B Do the same exercise as you stand.B Check it out: what happens when the air gets into

your lungs?B Check it out: what happens with the air if you speak?B What happens when you pretend to smell a rose? Is

your respiration low? Check it out.

3. Breath control

- First, demonstration, second, exercise in small groups(n¼ 5) in front of the classroom

- Feedback is given to each student.- After each exercise, students are able to ask questions

B Demonstration: the teacher and a student are stand-ing in front of each other. The teacher firmly pressesthe sternum of the student. The teacher asks the stu-dent to repeat the short sentences while pressing thesternum. The student feels what happens. It is impos-sible for the student to use the shoulders to inhale.The student feels a good and low respiration.

B Exercise small group: pretend to lift a heavy stone;what do you feel when you do this?

B Do you feel the breath control? Do you feel the ten-sion of the muscles?

B Check it out: what happens when you lift the stone?Is this correct?

B Say the words ‘‘hop hop hop’’—see that the lips closeand open firmly when you articulate each /p/. Putyour hand on your belly.

B What happens when you suddenly lose the tension ofyour lips? Do you feel the movement in your belly?This is a reaction of your diaphragm.

B Do this again and feel that your diaphragm returns toits natural position. This is important.

B Exercise whole group: first, demonstration, second,exercises in small group.

B Feel the diaphragm when you say: FFF ZZZ FFFZZZ

B Feel the diaphragm when you say: SSS VVV ZZZB Count aloud and seek a good rhythm 121 122 123

124 .

4. Resonance exercises- First, demonstration, second, exercise in whole group

(n¼ 20)- Feedback is given to few students.- After each exercise, students are able to ask questions.

There is time for discussion, as this topic is not easy tounderstand.

B Explanation and demonstration. When the ‘‘belly’’of a guitar is filled with paper, there will be no reso-nance when you hit a string. You will hear a muffled

sound, barely audible. The resonance will return asyou remove the paper out of the belly of the guitar.The same happens when your resonance fails.When you speak without resonance, a tiny voice oc-curs and the sound of you voice is barely audible inyou classroom. Feel the resonance in your nose, fore-head and sternum when you say ‘‘MMMMM’’ or‘‘NNNNN.’’ Feel the vibrations. Relax the musclesof you face, mouth, and neck: it is easier to do this‘‘with a stupid face.’’ Listen to the sound of yourvoice and feel what happens.

B Use your voice box and feel the vibration.

B First, demonstration, second, exercise in whole group.There is no feedback.

MMMoo MMMaa MMMeeMMMoo MMMaa MMMeeMMMoo MMMaa MMMee

This is also a warming-up and cool-down exercise. Nottoo loud and nice and easy to do. Students are asked andmotivated to do this exercise every morning and everyevening.

B First, demonstration, second, exercise in whole group: re-peat the words and short sentences and feel the resonance.This exercise lasts for 3 minutes. Small words or shortsentences are presented and repeated together with theteacher. Students are asked to feel and concentrate onthe vibration as the exercise continues. The teacher walksthe classroom and helps some students when necessary.

man mom donewon long .Many men on the moonMama makes mayonnaise.

B First, demonstration, second, exercise in whole group.The teacher walks the classroom and helps studentswhen necessary.

Students are asked to perform small pitch changes onMMMo, MMMa, MMMe, .

Second, students are asked to raise the voice in pitch—justa little bit—on MMMo, MMMa, MMMe, .

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Third, students are asked to go louder and then softer:

5. Pitch control- Whole group together

B Students are asked to count louder each time theteacher gives a sign to do so. When they carry outthis exercise the first time, they will raise their voicein pitch as well. In their second attempt—after theteacher told them not to raise in pitch—they are ca-pable of controling pitch as well.Count 1, 2, 3Louder 1, 2, 3And louder 1, 2, 3And louder 1, 2, 3

B Exercise in small groups (n¼ 5) in front of the class-room: once students understand what they need todo, the teacher asks them to perform the exerciseagain and to manage their breath control as well.Feedback is given to each student.

5. Avoiding glottal attacks- Small groups in front of the classroom- Feedback is given when possible and necessary

B Demonstration: put your hand around your larynx.Say ‘‘AA’’ firmly and feel the hard glottal attack;now say ‘‘haa’’ and you will feel just the vibrationof your vocal folds. Several exercises are done ina strict order.

B ‘‘Freeze’’ exercise. Say a word and stop in the middleof it, ‘‘freeze’’ your movements and also the movementof your vocal folds, e.g., ‘‘ha—and’’. Put your handaround your larynx and feel the correct glottal attack.ha – and da – ance fee – eetsta –ay de– esk ..

B Do the same exercise with two different vowels: e.g.,‘‘Hi – Angel.’’ This might be difficult for some stu-dents. The teacher gives feedback and listens to ev-ery student.Go on go away see Anna Hi AngelTry out ..

B In case the student is not able to perform this exercisein a proper way, the teacher asks the student to pro-nounce a W of J between the two vowels.

Go /W/ on Go /W/ awaySee /J/ Anna Hi /J/ Angel

6. Voice exercises:- Whole group together- No feedback is given

B An exercise of Le Huche is demonstrated by theteacher and performed by the students. Scale singingon 1,2,3,4,5. The arrows symbolize the inhalation.After ‘‘5,’’ a long and round ‘‘oooooh’’ is produced.

7. Shouting exercises with proper breath control- First, demonstration, second, exercises in small groups

in front of the classroom- Feedback is given to each student.

B In the first ‘‘shouting’’ exercise, students are askedto raise the voice in loudness only and repeat theshort sentences of the teacher. These exerciseswere repeated until the teacher was able to controlevery student.Come to me! No, I’ will not!You have to! I really can’t!.

8. Articulation drill- First, demonstration, second, exercise in whole group- Feedback is given to few students

B To activate their articulation and pronunciation, severaldrill exercises were given. Students needed to open theirmouth and round their lips in a proper way. The produc-tion of several kinds of vowels are explained (openvowel, round vowel, etc.).

B Second, consonants are drilled. The teacher explainsthat proper lip and tongue tension is necessary to acti-vate the diaphragm (cfr. Horst Coblenzer). These drillexercises need to be performed in a fast and repetitiveway. Words with multiple consonants are repeatedtwice. The breath control is an important issue as wellin these exercises.

The exercises are entirely provided by Timmermans.13

In Belgium, the exercises of Coblenzer,14 Lessac,15 and LeHuche16 are often used, as they are well known.