12/14/12

Human Voice: It's Beautiful


I can play an electric piano with the setting on choir and hear the digital sound of synthesized voices. It’s a pretty fun way to liven up tedious practice exercises. But it’s not nearly as beautiful as the sound of a real human voice.  The real human voice depends upon airflow instead of electronics.   Two tiny vocal cords tucked safely within the larynx vibrate to create the human voice. 

I brushed up on the basics of voicing when a young lady e-mailed me seeking voice therapy. She was experiencing vocal fatigue and hoarseness. I recommended that an otolaryngologist examine her vocal cords and that she follow through with any referral to a speech language pathologist (SLP) specializing in voice therapy. However, I also suggested we meet for a voice screening and a consultation regarding normal voice production and good vocal hygiene. At our first meeting, we talked about her concerns and completed both the Voice Activity and Participation Profile[1] and the Consensus Auditory-Perceptual Evaluation of Voice[2]. In subsequent sessions, we talked over her vocal history, demands currently placed on her voice, and some thoughts on change. I enjoyed these conversations.

Updating my knowledge of voice and voice therapy was a welcome change of pace. The American Speech Language Hearing Association studies that caught my eye questioned the usefulness of vocal warm-up[3], studied the significance of speaker temperament[4], and recommended ‘motivational interviewing’ as a method to support change[5].  YouTube had several relevant videos.  There were animations of laryngeal and related anatomy and physiology[6]. There was a 4-part power point presentation narrated in detail by Stephen M. Tasko, Ph.D., CCC-SLP.[7] Miriam van Mersbergen, Ph.D., CCC-SLP talked about the “Basics of Voice Training” in a video produced by LinguaHealth.[8]  The National Center for Voice and Speech had a tutorial explaining how researchers have come to understand vocal fold function.[9] And, there were lots of videos of the vocal cords recorded using videostoboscopy. It was all so fascinating that I also purchased a 6-hour continuing education course![10]

Here’s a very short synopsis.  Air from the lungs pushes the vocal cords apart, increasing the space between them. A combination of aerodynamics and vocal cord elasticity causes them to move back toward one another, closing the airway. It is a continuous stream of air from the lungs that separates the vocal cords again and again and again, resulting in a “non-linear mucosal wave.”  Puffs of air explode through the opening between the vocal cords and breeze through the throat, mouth and nose before leaving the body.  This air is shaped into speech sounds along the way.

I was happy enough with that review.  Except the continuing education course placed such emphasis on diaphragmatic breathing, that I researched this too.  A careful search of YouTube uncovered videos about breathing that seemed useful for a wide range of clients. How the body works: breathing was a delightfully simple animation with the sound muted. The narration is a bit technical and bland for children.[11]  A white board presentation by a young woman offered more complex information with friendly enthusiasm.[12] An authoritative and quite professional looking animation was available for studious teens and adults.[13]  Finally, that priceless podcast series, Stutter Talk, had at least two episodes devoted to breathing and speech.[14],[15] I assembled a new webpage for voice almost instantly![16]

Some occupations demand a clear, professional sounding voice. People who depend on their voice to earn a living include singers, politicians, broadcasters, actors, salespersons, customer service workers and teachers.  For these workers, vocal pathology is an occupational hazard.  They need to take excellent care of their voices and actually, many of them do even more. They study articulation (including accent reduction), intonation, loudness, pausing/phrasing, vocabulary, and the difference between explicit and implied meaning. SLPs treat a variety of voice disorders due to medical conditions. However, they also train use and care of the professional voice.

I have a renewed appreciation for the role of breath support in communication. I almost never talk about breathing with my students because they usually respond with effortful thorasic or clavicular breathing.[17]  Observe yourself taking “a deep breath.” What do you do? Do your shoulders rise up and your chest expand? They shouldn’t, at least not by much. It’s your abdomen that should expand as your diaphragm presses downward to make extra space for the lungs. How many of us ever learned this? A newspaper advertisement for a local performing arts school shows a little girl being taught diaphragmatic breathing as she sings.  This seemed exceptional. My curiosity got the best of me and I purchased a how to sing DVD by an internationally known singer. It instructed me in a series of fast-paced vocal exercises with slight reference to diaphragmatic breathing. I had to wonder how many viewers of this DVD damaged their voices by trying to sing using the laryngeal muscles instead of adequate breath support.

The concept is simple. Physical work requires effort and that effort can be misplaced. For example, I am learning to play the piano. My fingers are uncomfortable at the piano keys. With every missed note, my arms and shoulders stiffen and I hold my breath. Why?! I’m not entirely sure, but it happens. With the wisdom of an adult, I pay close attention to gentle breathing and upper body relaxation as I struggle to match music notes and piano keys and finger movements. I stop. I slow down. I attend to the feeling of my muscles. I have the time to do that. When voicing is difficult, speakers may compensate with extra effort in the neck, mouth, and face. It happens.[18] Conversation is fast paced and demanding so there is no time to stop, slow down, attend to the feeling of muscle movement and prevent inappropriate motor memories. (It can also be that differences in motor abilities affect this process.) Finding the feeling of relaxation under a variety of circumstances comes in handy. [19]

There it is: a brief description of voicing, which necessarily includes a review of breathing.  I am looking forward to learning alot more about the voice and voice therapies in the future.








[1] This can be found in the Appendix of Estella P-M.Ma and Edwin M-L. Yiu (2001) Voice Activity and Participation Profile: Assessing the Impact of Voice Disorders on Daily Activities. Journal of Speech Language Hearing Research, 44, 511-524.
[2] This can be found as Appendix C in G.B. Kempster et. al. (2008) Consensus Auditory-Perceptual Evaluation of Voice: Development of a Standardized Clinical Protocol. American Journal of Speech Language Pathology, 18, 124-132. The authors give permission to photocopy it for clinical purposes. When I downloaded it, the lines used for severity ratings were only 95mm long, so I retyped the entire document and drew 100 mm lines as required.Appendix A and B describe the tool, administration, and scoring.
[3] Rochelle L. Milbrath and Nancy Pearl Solomon (2003) Do Vocal Warm-Up Exercises Alleviate Vocal Fatigue? Journal of Speech, Language, Hearing Research, 46, 422-436.
[4] M. Dietrich and K. Verdolini Abbott (2012) Vocal Function in Introverts and Extroverts during a Psychological Stress Reactivity Protocol. Journal of Speech, Language, and Hearing Research, 55, 973-987.
[5] Alison Behrman (2006) Facilitating Behavioral Change in Voice Therapy: the Relevance of Motivational Interviewing. American Journal of Speech Language Pathology, 15, 215-225.
[6] Cricoarytenoid Function AngleOne 4sec http://www.youtube.com/watch?v=nhVXgDEPu1E&feature=relmfu (this is one of them)
[7] Part 1 http://www.youtube.com/watch?v=A5uW4LcAemw (this is one of them)
[8] Speech Language Pathology: The Basics of Voice Training  http://www.youtube.com/watch?v=mC2b5PxGavM&feature=youtube_gdata_player
[10] Ellen N. Friedman (2012) Short - Term Voice Therapy. 6 hour CEU course, www.pesi.com
[12] 8.6 Respiratory System Structure and Function http://www.youtube.com/watch?v=12ddbrqpZiQ&feature=related
[14] Stutter Talk:  Episode 263 The Anatomy and Physiology of Normal Speech Breathing as It Relates to Costal Breathing and Stuttering, 2/27/11,  http://stuttertalk.com/?s=breathing
[15] Stutter Talk: Stuttering and Breathing with Doctor Phillip Shneider,  Nov 8, 2008   http://stuttertalk.com/tag/breathing/
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.