Lucie Šebková & Kateřina Vitásková
1Palacký University in Olomouc, Faculty of Education (Czech Republic)
Abstract
Research Aim: Educators and students of education programmes constitute a high-risk group of individuals where the existence of a problem with voice, or voice disorders, can possibly impact the complex performance of their profession. The incidence of voice disorders is high in these groups of voice users. Therefore, we need to emphasize the necessity of implementing preventive measures for voice disorders within the pre-gradual preparation, as well as the need for combining specific speech and language therapy techniques and technology assessing the quality of voice professionals preparing for their educational or special educational career. The principal aim of the partial research was to map students’ interest in utilizing the method of measuring voice field and, concurrently, suggest the possibility of preventive therapeutic utilization of voice assessment technology in the students of the Faculty of Education. A partial aim was to detect the knowledge of prevention of voice disorders and to analyze the basic awareness of the strategies applied in case of voice disorders.
Keywords: technology, education, university students, voice disorders, speech and language therapy
1. Introduction
The ability to create (more or less naturally) voice representing a tool for creating speech is a very important characteristic feature of humans (Qian, Xudong, Mittal, & Bielamowicz, 2014). In professional terms, however, the ability to use voice adequately is much more important and serious, and especially not obvious. All professionals using voice as their main professional tool, therefore, face relatively strong pressure on the quality of their vocal expression, although they often realize this fact only in situations where their voice is weakened or affected by a significant disorder, the so- called dysphonia (cf. e.g. Jardim, Barreto & Assunção, 2007). The most serious problem that can possibly befall a voice professional is then the so-called aphonia, leading to complete loss of voice. In this case, aphonia de facto represents a professional failure because it prevents or severely restricts the direct exercising of the profession; in educators, it affects their natural impingement upon children, pupils or students, their communication with colleagues or parents. Voice professional (or professional voice user) is defined as
“...an individual who depends on a consistent and appealing voice quality as the main tool in their employment” (Hazlett, Duffy, & Moorhead, 2011, p. 181).
From the viewpoint of education or special-education workers’ impingement upon children, pupils or students, the specific characteristics of their voice (the so-called timbre or sonority, purity, etc.) are also important as they transmit information about the so-called nonverbal or melodic components of speech or components accompanying verbal expression. Sonorous, adequately strong, clear and pure voice of education workers satisfies the perfect idea about the basic professional preparedness for the vocally challenging teaching profession. Therefore, in some countries, many faculties of education also require a confirmation from doctors (specialists–phoniatricians) recommending or not recommending the prospective students of primarily teaching fields (but also non-teaching, e.g. speech therapy) as a mandatory part of the entry admission requirements (Vydrová, 2014). The ability of laying accent in speech, the descending or ascending melodic curve of sentences, the strength of voice during speech, i.e.
the so-called prosodic speech factors, are the basis of the main information about the pragmatic importance of speech expression, including the mediation of communication emotional component. These are the speech components that refine, enhance or negate the content of statements, and their implementation would not be possible without adequate voice participation and functionality (Patel, Scherer, Björkner, & Sundberg, 2011). The presence of voice disorders in teachers may also negatively affect the performance of children in language tasks as it distracts them from the task content, disrupts their selective acoustic perception and subsequently their understanding of the content (cf. e.g.
Lyberg-Ahlander, Haake, Brännström, Schötz, Sahlén, 2015). Pedagogical workers should be able to actively control their voice and adapt to different learning environments and acoustic conditions; above all, however, they should be aware of the possible signs of voice disorders. Even better, the students of education fields should have the opportunity of identifying their voice difficulties and prevent the continuation or even worsening of such difficulties on the basis of being maximally objective as well as relatively affordable.
The incidence of voice disorders in the general population fluctuates between 6-15%, being up to 46% in the group of voice professionals (Martins, Pereira, Hidalgo, & Tavares, 2014; Vydrová, 2014).
Data on the prevalence and incidence of voice disorders may be different. For example, this can be due to the concept of their definitions; these may determine the minimum number of experts-specialists needed to congruously (objectively) identify a specific voice disorder in the given individual based on sound perception and perceptual analysis of the client’s voice. If it be to the contrary, it can relate to individual perception and self-identification of own voice problems in voice professionals (e.g. teachers) that may subsequently relate to a significantly lower prevalence based on the identification of voice difficulties by experts compared to nearly double the data on voice disorders perceived by the voice users themselves (cf. e.g. Scalco, Pimentel, & Pilz, 1996). Regarding the incidence of voice disorders in voice professionals- teachers, Higgins & Smith (2012) point to new data of a retrospective control study compared with a similar research by Roy, Merrill, Thibeault, Parsa, et al. (2004), evaluating the incidence of voice disorders among university teachers. In their opinion, the compared results refute the significant influence of behavioural and demographic factors on the development of voice problems. On the contrary, they think that the main determinant consists in educational requirements for using voice. From the perspective of differentiated voice demands on teaching workers, it is worth noting that the incidence of voice disorders in this group of voice professionals is above average compared to the typical population or non-teaching university staff; on the other hand, however, it is nearly twice lower than in teachers working in pre-school up to middle-school education institutions. The majority of teachers had difficulties, not serious but persistent and long-standing, in a degree that significantly interferes with their daily communication. Significant correlation between voice disorders or their symptoms in teachers, secondarily mildly to moderately restricting their continuous work performance, and incapacity to work was currently also confirmed by Giannini, Latorre, Fischer, Ghirardi & Ferreira (2015). Their study also points to the negative impact of poor acoustic conditions in the working environment of teachers, increasing the incidence of voice problems in this group of voice professionals (see also Cutiva Cantor &
Burdorf, 2015 and others). At the same time, these authors also did not confirm the dependence of their voice disorders on demographic factors. In contrast to these predominantly Latin American research studies, the authors of a Swedish study, Ohlsson, Andersson, Södersten, Simberg & Barregård (2012), arrived at results pointing to the significant relationship of higher incidence of voice disorders (about 17%) in the group of students-future teachers, especially women, to certain factors that included organic voice problems in childhood or adolescence, frequent inflammatory diseases of the larynx, allergies associated with breathing difficulties, smoking, hearing difficulties, and, regarding functional influences, the previous practice of the teaching profession or leadership position, participation in leisure activities demanding voice use and previously undergone speech therapy or speech training.
The issue of prevention, diagnosis and treatment of voice disorders involves not only doctors but also speech therapists who, within the modern concept of implementing their profession, apply also advanced technology in the perceptual evaluation of voice quality, allowing visualization of individual vocal expression and subsequent analysis of voice characteristics (more in the American Speech-Language-Hearing Association, 2007, for example). Therefore, the respective contribution to enhancing the professional quality of future teachers and special education teachers also became the subject of our interest and the reason for initiating the verification of benefits that result from direct involvement of experts in voice disorders in their undergraduate university training. We would also like to point out the necessity of strengthening the competencies of future speech therapists in matters of objective assessment of voice quality and symptoms of voice disorders in confrontation with their subjective perceptual evaluation in relation to various study fields representing different future demands on the use of voice and professional voice load. At the same time, we proceed from the results of analyses and recommendations evaluating the current status of that preparedness of speech therapists to exercise their profession, which is part of that education or special education training in some countries (more in Georgieva, Woźniak, Topbaş, Vitaskova, Vukovic, Zemva, & Duranovic, 2015; Scharff Rethfeldt, W., &
Heinzelmann, B., 2014, for example).
2. Methodology
The fundamental research method was chosen as a questionnaire, primarily aimed at verifying knowledge about the prevention of voice disorders in students of the teaching programmes at the Faculty of Education.
The items of the questionnaire (n = 13) assessed the knowledge of students about the risk factors of voice disorders, about the symptoms of voice disorders, the principles of vocal hygiene and harmful habits. Furthermore, the questionnaire examined what importance is attached to the prevention of voice disorders in relation to future occupation and whether the students would be interested in introducing oriented voice education in their training using visualization of the vocal expression.
The distribution of questionnaires was conducted electronically in the months of December 2014 to February 2015. Overall, the survey involved 143 students of the teaching programmes, 5 men and 138 women, with the mean age as 26.12 years.
3. Results and discussion of results
The first questionnaire item identified the risk factors of voice disorders that the students consider as the most (5) and the least (1) hazardous. Table 1 clearly shows that the most hazardous factors include smoking, frequent inflammation of the upper and lower airways, and shouting down. Allergies, stress, family problems and chalk dust are ranked among the significant factors influencing the emergence of voice disorders and elementary knowledge about the risk factors is essential for preventing voice disorders; the respondents, however, are less aware of them.
Table 1. Risk factors for voice disorders
Risk factors 1 2 3 4 5 Average
Allergies 21 54 49 17 2 2.48
Smoking 1 9 24 57 52 4.05
Upper respiratory
tract infections 3 6 29 50 55 4.03
Hearing disorders 21 29 32 30 31 3.15
Noisy and dusty
environment 3 20 22 49 49 3.85
Teaching profession 4 13 31 47 48 3.94
Shouting down 3 8 24 38 70 4.15
Poor acoustics 10 24 46 46 17 3.25
Stress 10 41 48 36 8 2.94
Family problems 35 47 46 14 1 2.28
Dust of chalk 24 49 40 21 9 2.59
Table 2 presents respondents' awareness of the symptoms of voice disorders. Underestimated symptoms of voice disorders include feeling of dryness in the throat, burning in the throat and reduced vocal range. Voice fatigue as a symptom of voice disorders should be more realized as it leads to congestion of the edges of the vocal cords, which can result in asymmetrical movement of the vocal cords, increase in phonation pressure and ultimately the formation of vocal cord nodules.
Table 2. Symptoms of voice disorders
Symptoms Yes I am not sure No
Hoarseness 125 8 10
Voice fatigue 99 28 16
Aphonia 123 14 6
Burning in the throat 51 55 37
Reduced vocal range 59 36 48
Voice formed with strain 107 25 11
Breaks in the voice pitch 78 47 18
Feeling of dryness in the throat 35 39 69
The following two tables summarize the answers of the students (Table 3 and Table 4.) concerning harmful habits. The results show that the addressed students have less awareness about the harmful effects of whispering (when whispering, air leaks from between the vocal cords, engorging them), monotonous speech and breath-holding. Ignorance of the harmfulness of whispering for voice is
also evidenced by the results of answers to the following question: “What should I do instead of trying to shout down pupils in the class?” The most frequent answers of the students were: “I will drop my voice to a whisper.”
Although most students (n = 104) chose addictive cough as a harmful habit, the possibility of hawking (“I will hawk”) as a strategy for the so-called voice purification is used very often (n = 63).
Conversely, yawning, which is recommended, is almost unused (n = 9).
Table 3. Harmful habits Table 4. Strategies for the so-called voice purification
Harmful habits Answers
Strategies for the so-called voice purification
Answers
Addictive caughing 104 I will hawk 63
Whisper 54 I will yawn 9
Monotonous speech 12 I will swallow
several times 34
Breath-holding 18 I will drink water 117
Loud speech 100
Another questionnaire item assessed the significance the students attach to preventing voice disorders in relation to future profession. More than half of the students, 66%, consider the prevention of voice disorders in relation to future profession as very important, only 4% of the students consider the prevention as unimportant. When looking at the results of the answers to items related to the knowledge of and compliance with the principles of vocal hygiene, which is the primary factor in the prevention of voice disorders, we find that the students observe the principles of vocal hygiene only occasionally or minimally although they consider the prevention of voice disorders as very important (Table 5 and Table 6).
Table 5. Knowledge of the principles of vocal hygiene Table 6. Compliance with the principles of vocal hygiene Knowledge of the
principles of vocal hygiene
Answers Percentage
Compliance with the principles
Answers Percenta ge
Yes 72 50 % Minimally 30 21 %
I am not sure 49 34 % On a long-term
basis 22 15 %
No 22 16 % Sometimes 79 55 %
I fail to comply 12 9 % The last questionnaire item focused on the interest in using Voice Range Profile in training.
91% (n = 130) of the respondents were interested in active participation in the prevention of voice disorders within their university study. Due to the fact that the students are motivated to learn how to prevent voice disorders, the introduction of voice education in teaching future voice professionals can contribute to reduction in the prevalence of voice disorders in voice professionals, which is two to three times higher than in the general population. Voice education represents a low-cost but highly effective strategy of preventing voice disorders. The effect of voice education in students was investigated in the study titled The Effect of Short Voice Training Programme in Future Teachers (Timmermans, Coveliers, 2011). After implementing the training, the pursued students were able to extend their vocal range and vary their vocal expression, which is important for healthy future work with the voice apparatus.
4. Conclusion
Prevention of voice disorders requires the implementation of preventive measures before the problem arises. Emphasis should be placed on eliminating risk factors, recognizing the initial symptoms, avoiding underestimation of these symptoms, and seeking professional help. The results of the survey, which was attended by 143 students of the Faculty of Education, Palacky University in Olomouc, clearly show that the addressed students are aware of the significance of preventing voice disorders but their knowledge regarding the proper formation of voice, voice disorders and the principles of vocal hygiene acts interferentially with respect to the future occupation as a voice professional. It is important for the
students to be aware of the consequences of voice disorders that can have a negative impact on the quality of life as well as the economic impact in terms of job loss. Through this paper, we would like to highlight not only the negative impact of voice disorders for voice professionals but also the essentiality of primary prevention. We believe that the introduction of theoretically and practically oriented voice education into the training of future voice professionals, together with visualization of voice expression using the Voice Range Profile, is a very effective strategy for preventing voice disorders; we would like to use this strategy to innovate the training of students in the teaching courses at the Faculty of Education, Palacky University in Olomouc.
Acknowledgments
The research results constitute partial results of the specific research ‘Research on selected communication disorders and deviations focusing on the specifics of speech therapy and hearing impairment assessment and intervention’ (IGA_PdF_2015_024, principal researcher: Kateřina Vitásková).
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