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ABSTRACT
THE EFFECTIVENESS OF VOCAL FUNCTION EXERCISES (VFES)
ON VOCAL MEASURES WITH HEALTHY ADULT MALE
TRAINED SINGERS
Dr. Joseph Stemple created Vocal Function Exercises (VFEs) to help strengthen and stabilize the vocal musculature. The exercises were designed as a therapy technique to assist those with voice disorders. There is little research on the study of VFEs in normal healthy individuals and even less research on the effects of VFEs on healthy adult trained singers. Trained singers have the technical foundation to perform VFEs properly and could possibly benefit and improve upon their strength and muscle tone due to their established skills. The purpose of this study is to determine if Dr. Stemple’s VFEs are a technique that could be used by healthy adult male trained singers to increase their maximum phonation frequency range and maximum phonation time, and to decrease jitter and shimmer. The study consisted of 3 male participants who were healthy adult trained singers from the Fresno State Music Department who were enrolled in voice lessons with a professor from the Music Department. The study utilized a single-subject, multiple baseline across participants research design. The study consisted of baseline, treatment, and maintenance phases. During the treatment phase, participants were required to perform VFEs at home twice a day, two times each, and to meet with the researcher once a week for probe measurements. The results from this study are anticipated to enhance the vocal quality of established trained singers. Maelyn Danielle De Fede December 2018
APPROVED
For the Department of Communicative Sciences and Deaf Studies: We, the undersigned, certify that the thesis of the following student meets the required standards of scholarship, format, and style of the university and the student's graduate degree program for the awarding of the master's degree. Maelyn Danielle De Fede Thesis Author Fran Pomaville (Chair) Communicative Sciences and Deaf Studies Don Freed Communicative Sciences and Deaf Studies Anthony Radford Music Ericka Olsen Communicative Sciences and Deaf Studies For the University Graduate Committee: Dean, Division of Graduate Studies
AUTHORIZATION FOR REPRODUCTION
OF MASTER’S THESIS
X I grant permission for the reproduction of this thesis in part or in its entirety without further authorization from me, on the condition that the person or agency requesting reproduction absorbs the cost and provides proper acknowledgment of authorship. Permission to reproduce this thesis in part or in its entirety must be obtained from me. Signature of thesis author:
TABLE OF CONTENTS
Page LIST OF TABLES ............................................................................................................ vii
- CHAPTER 1: INTRODUCTION LIST OF FIGURES viii
- CHAPTER 2: LITERATURE REVIEW
- VFEs as Holistic Voice Therapy.................................................................................
- Singing Exercises
- Vocal Function Exercises
- Summary
- CHAPTER 3: METHODS
- Research Design........................................................................................................
- Participants
- Setting
- Procedures
- CHAPTER 4: RESULTS
- Maximum Phonation Frequency Range
- Maximum Phonation Time
- Jitter
- Shimmer
- CHAPTER 5: DISCUSSION............................................................................................
- Limitations
- Recommendations
- Conclusion
- REFERENCES
Page
vi
APPENDICES .................................................................................................................. 67
APPENDIX A: QUESTIONNAIRE ................................................................................ 68
APPENDIX B: HEARING SCREENING FORM ........................................................... 70
APPENDIX C: RECRUITMENT FLIER ........................................................................ 72
APPENDIX D: CONSENT FORM .................................................................................. 74
APPENDIX E: DAILY PRACTICE CHART .................................................................. 76
LIST OF FIGURES
Page Figure 1. Maximum phonation frequency range across participants ............................... 43 Figure 2. Maximum phonation time across participants .................................................. 45 Figure 3. Jitter across participants .................................................................................... 48 Figure 4. Shimmer across participants ............................................................................. 50
CHAPTER 1: INTRODUCTION
The purpose of the present research study was to determine the efficacy of Dr. Joseph Stemple’s Vocal Function Exercises (VFEs) in increasing maximum phonation frequency range and maximum phonation time, and in decreasing jitter and shimmer in normal adult male-trained singers through the use of a multiple baseline across participants design. Singing involves a complex manipulation of laryngeal functions to produce musical sounds. This is achieved through the coordination and balance of several subsystems, including respiration, phonation, resonation, and articulation. Stemple’s VFEs are classified as a form of physiologic voice therapy. Physiologic voice therapy includes programs and techniques that are designed to directly modify or alter the physiology of the vocal mechanism (Stemple, Roy, & Klaben, 2014). The goal of physiologic voice therapy techniques is to restore balance among the subsystems of airflow: laryngeal muscle strength, balance, and coordination. Stemple’s VFEs are designed to improve the balance between these subsystems of voice production. For this study, the independent variable was treatment utilizing Stemple’s VFEs program. The dependent variables were maximum phonation frequency range, maximum phonation time, jitter, and shimmer. Maximum phonation frequency range is the measurement determined by subtracting the lowest pitch produced from the highest pitch produced, excluding the production of glottal fry or falsetto. Maximum phonation time is determined by measuring the longest duration of a single note held on a single syllable (Stemple et al., 2014). Maximum phonation frequency range and maximum phonation time are important aspects of singing that are often targeted for improvement (Stemple, Lee, D’Amico, & Pickup, 1994). Jitter is a measurement of cycle-to-cycle variations in the frequency of vocal fold vibrations, and is therefore a reflection of pitch stability in the voice. Shimmer is a
with a normal healthy voice and improve upon an individual with a voice disorder. Holistic health focuses on the body as a whole and the interdependent parts that help create a healthy individual. Stemple’s VFEs assist in balancing and strengthening the laryngeal musculature and balancing the three subsystems or interdependent parts (respiration, phonation, and resonance) (Stemple et al., 2014). The VFEs are thought to enhance the overall sound quality of the normal voice and trained singing voice when one maintains a healthy lifestyle (Stemple, 2005). Previous research studies have been conducted on VFEs with a variety of populations (individuals with disordered voices, individuals with normal voices, and trained singers). Researchers found a significant improvement in acoustic measures (fundamental frequency, jitter, and frequency range) and aerodynamic measures (phonation volume, flow rate, and maximum phonation time) for the participants’ overall speaking voices (Croake, Andreatta, & Stemple, 2017; Elliot et al., 1992; Ellis & Beltyukova, 2011; Gish et al., 2012; Gorman, Weinrich, Lee, & Stemple, 2008; Guzman, Angulo, Muñoz, & Mayerhoff, 2013; Sabol, Lee, & Stemple, 1995; Stemple et al., 1994; Tay, Phyland, & Oates, 2012; Van Lierde et al., 2011). These studies focused on improving voices in various populations, but the proposed study expanded upon the reviewed studies regarding the population of normal adult-trained singers.
CHAPTER 2: LITERATURE REVIEW
A comprehensive review of literature concerning the effectiveness of vocal exercises was completed. The literature involved normal voices, trained singing voices, and disordered voices as well as vocal warm-up exercises and VFEs. Subject populations included in the research review consisted of both singers and non-singers and represented those with typical voices as well as disordered voices. The VFEs are an evidence-based treatment for individuals with disordered voices and are suspected to improve upon the skills of those with a normal voice or a professional voice. The review also evaluated literature on singing and vocal warm-up exercises and the effectiveness of these exercises. Stemple’s VFEs “are a series of voice manipulations that were designed to strengthen and balance the laryngeal musculature and to balance airflow to the muscular effort” (Stemple et al., 1994, p. 271). VFEs are intended to build upon and improve the skills currently present in an individual. Trained singers often wish to learn more technique to enhance their vocal skills. Therefore, these exercises could benefit the participants by providing them with a tool for improving their singing voices. This study has the potential to contribute to the limited research on VFEs, especially with trained singers. This literature review examines the effects of general vocal exercises and VFEs on singers, non-singers, and disordered voices. VFEs as Holistic Voice Therapy Voice therapy goals were built upon the ideas of speaking with adequate loudness, a clear tone, age and gender appropriate pitch, natural vibrato, and prosody which accurately relays the meaning of the message perceived (Stemple, 2005). To obtain a healthy voice, one must possess an overall healthy body and healthy lifestyle. According to Stemple (2005), “holistic health is based on the concept that a whole is
believing these exercises could be used for treatment of both vocal hyperfunction and vocal hypofunction. According to Stemple (2005), “normal voice production depends on a relative balance among three subsystems: airflow, supplied by the respiratory system; laryngeal muscle strength, balance, coordination, and stamina; and coordination among these and the supraglottic resonators (pharynx, oral cavity, nasal cavity)” (p. 133). When teaching the exercises, it is important to teach abdominal breathing, or diaphragmatic breathing, to posture the vowel prior to voicing, and activate voicing with an easy onset of the vocal folds. All three of these points are addressed through the VFEs, and therefore they are considered a holistic voice treatment approach. Many people do not think of the laryngeal mechanism as being similar to other muscles or structures in the body. However, Stemple (2005) compared rehabilitation of the laryngeal mechanism to rehabilitation of the knee. He described the process of rehabilitation of the knee as first a period of rest to help lessen anymore harm from the acute injury. Following the resting period, the knee is walked on and exercises are recommended to begin to strengthen and stabilize the musculature. This rehabilitative process for the knee is similar to what might be done for the voice. After an acute vocal fold injury, vocal rest may be required, followed by allowing the person to speak, and then introducing treatment exercises designed to return the voice to as normal of a state as possible. In summary, VFEs are considered to encompass principles of holistic therapy because they focus on improving not only the disordered voice, but also the normal voice. VFEs achieve this by focusing on the three subsystems of respiration, phonation, and resonance. Additionally, VFEs help balance the three subsystems to establish a physiological system for the normal voice to be integrated into other forms of effective communication. Therefore, VFEs are also classified as a form of physiologic voice therapy.
Singing Exercises Singing exercises have been studied by many researchers as a treatment technique for individuals with disordered voices, individuals with normal voices, and trained singers. Singing exercises are also known to be used as vocal warm-ups for singers prior to performances and rehearsals. The following studies evaluated singing exercises or warm ups as they pertained to the anatomy and physiology of the vocal mechanism, prevention of vocal fold injury, and overall vocal quality after performance of the exercises. Gish et al. (2012) surveyed 117 participants who were trained singers regarding vocal warm-up practices and their opinions concerning vocal warm-ups. Warm-ups are vital to singers and other professional voice users, just as stretching and warming up are to an athlete. It is believed that vocal warm-up exercises contribute to the prevention of vocal fold injury in professional voice users. The purpose of this study was to explore how often and how long singers utilize warm-ups, evaluate the differences between warm-up sessions in singers of varying skill levels, establish which warm-up exercises are used the most, gain perspective on singers’ opinions of warm-ups and prevention of injury, and finally to gather data regarding the amount of injury experienced by singers. Gish et al. (2012) targeted undergraduate and graduate singers as well as trained professionals. The survey contained 69 questions which included open-ended responses as well as yes/no questions. The survey questionnaire focused on topics such as, how often they used warm-ups, whether these sessions were consistent, how long they warmed-up, and what exercises they used for their warm-ups. The researchers listed many types of warm-up exercises found in the literature, and the participants were required to select which one(s) they used from the multiple-choice list. In the questionnaire, the researcher required information regarding the participants’ age, gender, current academic level, and number of years they had taken voice lessons. Additionally,
Furthermore, he explained that singers could demonstrate the following vocal behaviors that could lead to vocal pathologies:
- Excessive vibration in the higher register.
- Consistent discrepancy of the singer’s Fach , or voice part.
- Persistent vocal intensity or voce piena , and lack of awareness when fatigued and requiring rest.
- Disregard for early signs of vocal injury, such as: a. Compensatory strain due to lack of easy phonation; b. Disturbed tonal onset; c. Lessened breath control; d. Decreased intensity, or lack to differ intensity; e. Change in voice part, or loss of pitch range; f. Break in the passagio , or transition between registers; g. Diplophonia, voice breaks, burring; and h. Longer period of vocal recovery following a performance.
- No warm-up prior to performance.
- Inadequate amplitude.
- Poor vocal hygiene and behaviors (Spencer, 2009). These characteristics of vocal pathologies have been observed throughout considerable amounts of research. Spencer (2009) stated that singers were at higher risk for vocal pathologies if there was a lack of warm-up prior to singing. Considering few singers in the study conducted by Gish et al. (2012) believed in the importance of warm- ups, further education is required for singers regarding vocal exercises in enhancing vocal quality and preventing injury. Additionally, it is imperative that the vocal mechanism is aligned properly for precise execution of the singing exercises to create the foundation for proper singing
technique. For singing, the ideal position is described as upright and low. It is suggested that this particular position helps eliminate poor vocal technique, such as forced adduction of the vocal folds while singing. Many vocal exercises aim to achieve this position for training (Elliot et al., 1992 ). Elliot et al. (1992) examined whether this positioning of the larynx was successful in facilitating proper technique while performing a specific vocal exercise created for disordered voices. The study included seven participants. Two participants had hyperfunctional dysphonia phonasthenia, a functional audible voice disorder; three participants were trained singers; and two participants were untrained individuals with healthy voices. The researchers used a tracking multichannel electroglottograph system (TMEGG), presented by Rothenberg (1992), which contained electrodes that were placed on the participants’ necks in order to obtain positioning of the larynx at rest and during exercises. Prior to taking data, the TMEGG was calibrated, while the larynx was at rest and during a sustained single note on nonsense syllables that contained a prolonged /b/ sound with a vowel. These syllables began as consonant vowel (CV) and gradually increased in variation. Elliot et al. (1992) discovered that when subglottic air built up below the vocal folds, the larynx was at a higher upright position. However, if a balance was established between the subglottic pressure and the intraoral pressure, the larynx relaxed into a lower position that was required for proper singing technique. They found that this positioning came from a change in air pressure throughout the different cavities. It has been observed that hyperfunctional voices typically produce sound with an elevated larynx; therefore, this research could be beneficial for understanding the disordered voice. However, the research could also provide further information to professional voice users, such as singers, in educating them regarding the anatomy and physiology of the larynx and what changes might occur while singing. The researchers concluded that lowering the position
