Elsevier

Journal of Voice

Volume 30, Issue 6, November 2016, Pages 771.e17-771.e25
Journal of Voice

Effect of Two Isolated Vocal-facilitating Techniques Chant Talk and Pitch Inflections on the Phonation of Female Speech-language Pathology Students: A Pilot Study

https://doi.org/10.1016/j.jvoice.2015.11.007Get rights and content

Summary

Objective

The purpose of this study was to determine the effect of the isolated vocal-facilitating techniques Chant Talk and Pitch Inflections on the phonation of healthy female speech-language pathology (SLP) students.

Study design

A multigroup pretest-posttest design was used.

Methods

A homogenous group of 40 healthy female SLP students with a mean age of 18.7 years were randomly assigned into 3 groups: a Chant Talk group (practicing Chant Talk across 18 weeks), a Pitch Inflections group (practicing Pitch Inflections across 18 weeks), and a control group (practicing no facilitating techniques). To compare vocal measures before and after this time span, an identical objective voice assessment protocol (aerodynamic measurement, acoustic analysis, voice range profile, and Dysphonia Severity Index) was performed in the 3 groups.

Results

Both Chant Talk and Pitch Inflections groups resulted in a significant decrease of the acoustic measure noise-to-harmonics ratio compared with the control group. The Chant Talk group resulted in a significant increase in the acoustic measure fundamental frequency compared with the control group.

Conclusions

The results of this pilot study suggest that the facilitating techniques Chant Talk and Pitch Inflections may improve the objective measure of breathiness (noise-to-harmonics ratio) in healthy female SLP students.

Introduction

Chant Talk and Pitch Inflections are listed by Boone and McFarlane1 as techniques that may facilitate a more optimal vocal response in patients with dysphonia. Chant Talk is produced by reciting syllables in one continuous tone, creating a “singing monotone” (cfr. legato in singing). It is characterized by an elevation of pitch, prolongation of vowels, lack of syllable stress, and an obvious softening of glottal attack. The Pitch Inflections technique is used to stimulate pitch variability during phonation.2 Both facilitating techniques were described by Boone et al2 as being particularly beneficial for patients with hyperfunctional dysphonia. Nevertheless, a broader application can be found in the literature, more specifically in treating organic dysphonia and training professional voices.3, 4, 5, 6, 7, 8, 9, 10, 11

The existing literature is limited to defining the techniques and describing their potential benefit. Studies that investigate the underlying mechanisms and the exact reason for a possible effect are missing. Boone et al2 and Bovo et al5 mentioned obtaining relaxed voicing and elimination of hard glottal attacks, although these findings were based on clinical experience rather than evidence-based practice. Moreover, the techniques have been used for more than 20 years2 and yet effectiveness studies are rare. A summary of these studies can be found in Table 1. A first observation of the table indicates that almost all studies had a positive outcome. A less favorable result was found by De Bodt et al,12 who used fiberoptic laryngovideoendoscopy to assess the impact of vocal techniques on vocal-fold closure in young females with normal vocal quality. Remarkably, Chant Talk resulted in significantly decreased vocal-fold closure. However, an unexpected laryngeal tension or breath holding during phonation due to the use of a flexible videoendoscopic system could possibly have influenced the results.12 A second observation of the table indicates that Chant Talk and/or Pitch Inflections have nearly always been investigated as part of a broader therapy program,4, 5, 6, 7, 8, 9, 10, 11 wherefore the results cannot be attributed solely to the techniques. One exception is a study of McCabe and Titze,3 which examined the exclusive effect of Chant Talk on self-perceptive symptoms of vocal fatigue in four public school teachers. Group data on one particular vocal technique are difficult to gather because voice therapy is individualized and usually includes several techniques.2 Nevertheless, the need for effectiveness studies that exclusively investigate the facilitating techniques Chant Talk and Pitch Inflections becomes clear.

This pilot study aimed to make a first contribution to the research gap and focused on Chant Talk and Pitch Inflections as techniques that could facilitate and train the healthy voice. Previous studies investigating healthy subjects show conflicting results. Bovo et al5 and Oliveira et al11 both investigated the effect of a training program including Chant Talk and Pitchinflections in healthy professional voice users. Bovo et al5 found a positive effect, whereas Oliveira et al11 found no effect. These conflicting results are probably due to various reasons such as variations in assessment methods and training frequency, although the main reason probably remains a difference in therapy content: the techniques were never investigated in isolation and were always presented in different combinations.

The purpose of this study was to determine the effect of the isolated vocal-facilitating techniques Chant Talk and Pitch Inflections on the phonation of healthy female speech-language pathology (SLP) students. A positive effect on the SLP students' vocal capacities was hypothesized because Chant Talk and Pitch Inflections may facilitate relaxed voicing with elimination of hard glottal attacks,2, 5 and most studies that investigated the techniques as part of a broader therapy program were promising.4, 5, 6, 7, 8, 9, 10, 11

Section snippets

Material and Methods

This study was approved by the Human Subjects Committee of Ghent University Hospital.

Voice questionnaire

At the beginning of the study, each subject filled in a questionnaire based on the voice assessment protocol of the European Study Group on Voice Disorders12 to describe vocal complaints and risk factors.

Objective vocal measures

The three groups completed pre- and postobjective voice assessment measures. Data were collected by two SLPs (S.D. and L.T.) in a sound-treated room at Ghent University Hospital.

Voice questionnaire

The results of the questionnaire concerning vocal complaints and vocal risk factors are presented in Table 3. No significant differences were found between the three groups at precondition (chi-square test, P > 0.05).

Comparison of the precondition objective vocal measures

The results of the precondition voice assessment are presented in Table 4. No significant differences in precondition vocal measures were found between the three groups (One-way ANOVA, p > 0.05).

Comparison of the differences in pre- and postobjective vocal measures

Comparison of the differences in pre- and postobjective vocal measures between the

Discussion

The purpose of this study was to determine the effect of the isolated vocal-facilitating techniques Chant Talk and Pitch Inflections on the phonation of healthy females enrolled in an SLP program. A positive effect on the SLP students' vocal capacities was hypothesized because Chant Talk and Pitch Inflections may facilitate relaxed voicing with elimination of hard glottal attacks,2, 5 and most studies that investigated the techniques as part of a broader therapy program were promising.4, 5, 6, 7

Conclusions

The results of this pilot study suggest that the facilitating techniques Chant Talk and Pitch Inflections may improve the objective measure of breathiness (NHR) in healthy female SLP students. An investigation of the underlying mechanisms together with their potential effect in subjects with vocal pathology is recommended in future.

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