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Journal of Voice

Vol. 13. No. 1, pp. 43-50 1999 SingularPublishingGroup. lnc.

Effects of Systematized Vocal Warm-Up on Voices With Disorders of Various Etiologies


Thomas R. Blaylock
Northwest Institute of Voice, Beaverton, Oregon, U.S.A.

Summary: This investigation studied the effect of a systematized vocal warmup procedure on voices with disorders. There were 4 subjects with voice disorders. To optimize vocal function a systematized vocal warm-up system was developed by the author for singers and nonsingers alike. Subjects were asked to practice the vocal warm-up exercises daily, with weekly monitoring in the studio. Data from independent raters and subjects' self-ratings were compared to and corroborated with computer analysis of audio samples. Results indicated significant improvement in subjects' voices that were increasingly maintained over time. Key Words: Systematized vocal warm-up---Voice disorder-Singing voice--Sonogram--Wave form--Spectrogram--Computer analysis-Vocal function Vocal exercise.

Voice users, whether singers or speakers, use the same underlying process involved in voice production. t However, when voice users develop a voice disorder or difficulties, they may begin to experience a diminished quality of life that may include frustration and lowered self-esteem. Unfortunately, our level of understanding of practical suggestions for the management of various kinds of voice pathologies is not often as clear as one would like. 2 When the vocal mechanism is not functioning adequately, perceivable problems can arise in the speaking voice and artistic growth may be impeded in the singer's voice. In order to keep the mechanism functioning properly, several theories have been proposed. First, vocal
Accepted for publication August 4, 1998. Address correspondence and reprint requests toThomas R. Blaylock, M.A., Executive Director, Northwest Institute of Voice, 4645 S.W. 191st Avenue, Beaverton, OR 97007-2424, U.S.A. This paper was presented at the 25th Annual Symposium of The Voice Foundation: Care of the Professional Voice, Philadelphia, Pennsylvania, June 6, 1996, U.S.A.

warm-up is necessary to maintain a healthy speaking and singing voice) Second, an ability to interconnect the physiology with singing is necessary, in part, to obtain optimum skill. 4 Toward that end, using a systematized vocal warm-up procedure based on voice physiology should benefit voice users. 5 The positive effect of vocal warm-up on those with voice disorders of various etiologies has been suggested by Sataloff. 6 This investigation studied the effect of a systematized vocal warm-up procedure on voices with disorders. The systematized vocal warm-up system used was developed by the author to optimize vocal function with singers as well as nonsingers. Because of the lack of access to appropriate scientific instruments, objective analysis in the nonresearch voice studio has been difficult to obtain, thus leaving the actual effects of the vocal warm-up process to the intuitive, subjective experience of voice teachers, choral directors, and singers. With the advent of inexpensive computer technology and more sophisticated software programs, the nonresearch voice studio can now provide research to the field of voice. In this 43

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THOMAS R. BLAYLOCK

study, data were obtained through objective, computerized analysis as well as subjective ratings from voice teachers and subjects. This investigation compared the voice quality of 4 subjects with voice disorders over a period of 4~ months. Two hypotheses were tested. First, there would be an overall improvement in the quality of sound production proportional to the duration of experience with the systematized vocal warm-up exercises. Second, vocal improvement would be maintained for longer periods in correlation with the number of vocal exercise sessions.

METHOD Subjects Four subjects participated in this study: a professional singer, 2 recreational singers, and a nonsinger. Each had been referred by a primary care physician and/or a speech pathology clinic. The subjects had all received other treatments (medical and speech therapy) with no significant improvements. At the time of this investigation, the vocal waxm-up exercises were the only form of voice therapy these subjects were receiving. Subject 1 (S.A.) was a 38-year-old female with nodules. This disorder had been present for the past several years. As a classroom teacher, she had abused her voice for a number of years by speaking loudly. Subject 2 (M.W.) was a 36-year-old male, with a long-standing history of hoarseness. Five months before beginning work with the author, he had surgery for in situ squamous carcinoma of unknown origin. Subject 3 (N.S.) was a 47-year-old female with a voice disorder. An upper respiratory illness 4 months earlier left her barely able to whisper. Subject 4 (P.H.) was a 46-year-old female who had an upper respiratory illness 8 weeks before coming to this office. One vocal fold did not adduct adequately and the other vocal fold did not adduct at all. Procedure Subjects were instructed in the application of the systematized vocal warm-up procedures and asked to practice them at least once a day to support the positive change made in the weekly sessions with the voice teacher. By adjusting various elements of the
Journal of Voice, Vol. 13, No. 1, 1999

exercises--tempo, vowels, range, volume, intensity, etc.--the author used the systematized vocal warmup to make changes in voice function. The systematized vocal warm-up for subjects was a sequence of vocal exercises that covered the spectrum of the vocal range according to the given limits through the singing of specific vowels and consonants. The subjects were instructed to employ proper body alignment and breath support as they performed the exercises. Fifteen minutes was considered a vocal warm-up session. Three sources of data were collected. Approximately every 3 weeks post-vocal warm-up, subjects were asked to speak and sing---counting 1 to 5, free conversation, a sustained "ah" and "oh," the Rainbow Passage, and free conversation--into a microphone that was connected to a Macintosh Ilvx computer. These data were used in comparative voice analysis. Additional audio excerpts were transferred to the Macintosh from video recordings made on a Sony SLV-676UC VHS video cassette recorder. Six voice teachers served as independent raters. They were provided with 5 samples of each subject's voice. The samples reflected 5 separate sessions per subject, each approximately 3 weeks apart. The samples were provided on an audiotape in random order. The teachers were asked to rank order the samples to reflect what they considered an increase in overall voice quality. Subjects also reported how long the effects of the vocal warm-up exercises lasted after the studio sessions.

Data Collection There were 3 sets of data. First, voice analysis was performed using the computer program SoundEdit from Macromedia. Samples were compared by wave form, sonogram, and spectrogram. The second set of data was obtained to assess the effect of vocal warm-up on the voice over time. Six voice teachers independently listened to an audiotape with 5 voice samples from each subject. The raters subjectively rank ordered the 5 samples for voice quality. The voice teacher raters had from 4 to 16 years of teaching experience. Independent raters were used to control for experimenter bias. The teachers were not cognizant of each others' evaluations, but did know the purpose of their evaluations.

EFFECTS OF SYSTEMATIZED VOCAL WARM-UP ON VOICES The third set of data was obtained from subjects. Subsequent to each studio session, subjects were asked to record how long the effects of the vocal warm-up lasted before the speech quality degraded. This was a subjective report from each subject.

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RESULTS
Waveforms, sonograms, and spectrograms indicated that voice quality was positively affected by the systematized vocal warm-up exercises. The waveform was informative regarding the changes to note the increase in the levels of intensity and waveform consistency. When the sonogram and spectrogram were viewed, the improvements were obvious by the enhancement of the harmonic information. Examples are seen in Figures 1-5. The results of the vocal warm-up exercises on the 4 subjects with voice disorders demonstrated improvement in overall voice quality and level of intensity over time. Each subject's vocal warm-up rank correlated with the number of sessions of vocal warmup, such that more experience with vocal warm-up improved voice quality over time (Figure 6). The Friedman's Rank Test for Correlated Samples was applied to the data (Figure 7). Statistical significance was found at the P = .05 level, indicating that voice samples were indeed different. The final hypothesis tested whether each subject's perception of his or her voice quality post-vocal warm-up lasted for longer periods of time. Results again showed that this was the case, as illustrated in Figure 8.

cess of this system is not simply in the choice of vocal exercises, but also in the order of the melodic constructs, the order in which vowels are presented, the sequential vocal range that is expressed, and the positioning/alignment of the head, neck, and torso, which make the necessary and sufficient conditions for vocal growth and maintenance. The exercises and their systematized use are available in the author's book, Developing Your Vocal Instrument: A Systematized Process from Function to Artistry, which is due for publication in 1999. CONCLUSIONS This investigation studied the effect of a systematized vocal warm-up procedure on voices with disorders. This study of 4 subjects has indicated that using a systematized vocal warm-up process for voices with disorders of various etiologies makes a significant difference, objectively and subjectively, as measured by computer analysis, raters, and subjects. Voice users with certain voice disorders can benefit from a systematized vocal warm-up exercise process to improve and maintain voice quality. These results indicated a practical application for systematized vocal warm-up exercises and the role they could play in voice therapy. The systematized vocal warm-up system used was developed by the author to optimize vocal function with singers as well as nonsingers. This evidence was presented by this author at the 24th Symposium of The Voice Foundation, June 8, 1995. The paper, entitled "The Effects of Vocal Warm-Up on Singers and Voices With Disorders as Measured by Computer Analysis," used 3 groups of singers with varying degrees of systematized vocal warm-up experience, a control group of nonsingers with no such experience, and 4 voices with disorders who were learning to use the systematized vocal warm-up exercises. Research now in progress is investigating a comparison of 3 different vocal warmup systems and their effects on vocal function. While this study is a demonstration that this system of specific vocal warm-ups is responsible for the improvement and continued maintenance of the vocal subjects and others, the author acknowledges that using other systems and vocal warm-ups may be just as effective.
Journal of Voice, Vol. 13, No. 1, 1999

DISCUSSION
Regardless of the disorder and length of time from onset of voice trauma, all subjects had improved voice production after the vocal warm-up exercises, and over time the improvement lasted for longer periods. The combination of weekly studio sessions and daily practice of the systematized vocal warm-up exercises worked toward the enhancement of each subject's voice quality. The subjects all practiced the same prescribed set of exercises to elicit the coordination, flexibility, and increased strength of the muscle groups in the entire vocal mechanism. The suc-

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THOMAS R. BLAYLOCK

Waveform Subject 3

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~ ,~ll i q i l l , ~ l o .ir. ~ ~ i.., ~ r..,"it-~

1-31-96

3-8-96 (saying the word "one")

4-27-96

FIG. 1. The waveforms show an increase in the intensity of the harmonic information for each succeeding sample (a-c).

Sonogram/Waveform Subject 3

5K

4K

:K

2K

IK

OK

FIG. 2. The sonogram and waveforms show an increase in the intensity and distribution of the harmonic information for each succeeding sample (a-c).

Journal of Voice, Vol. 13, No. 1, 1999

EFFECTS OF SYSTEMATIZED VOCAL WARM-UP ON VOICES

47

Spectrogram Subject 3
(Session 1)

,<.f,.

~
/

t.

160 p.l:~

80dBl ['L'
60 dB

,.

/
20 dB 0

dB 0 hz

U 1000 hz

2000 hz 3000 hz 4000 hz 5000 hz

~lllllllllj[~IIlllllll I/II
3744Pts

1-31-96 (saying the word "one")


F I G . 3. The spectrogram shows a defining of the harmonic information.

Spectrogram Subject 3 (Session 2)

J, /

~'~i~iiili i: ili ii~iiii lliliii 4768 P't~

57

80 dB 60 dB
40

i i

,/
2000 hz 3000 hz

.,iiii iilii i g~! ! !i! 6 3 0 4 Pt~

~Li~...~ ~ ~o1~,~
7328 Pts

dB ~

20 dB
0 dB

0 P~s

0 hz

I 000 hz

4000 hz 5000 hz

3-8-96 (saying the word "one")


F I G . 4. The spectrogram shows an increase in the harmonic information from Figure 3.

Journal of Voice, Vol. 13, No. 1, 1999

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THOMAS R. BLAYLOCK

Spectrogram Subject 3 (Session 3)


: . . : : .

8 0 d B II
60 dB 40 dB 1 20 dB O dB
I 1 1

~0
i
.iiiiii!:!ii!iiii~ii!i[ii~iji'.iiiiii~ iiiililiii!,!ililiiii iliiii ~i iiiiiiii 12576 Pts

10016 Pts

528

0 hz

1000 hz 2000 hz :3000 hz 4000 hz 5000 hz

4-27-96 (saying the word "one")


FIG. 5. The spectrogram shows an increase in the hamaonic information from Figure 4.

30

25

+subjec, [ it
A ~-Subject Subject Subject

20

15

10

FIG. 6. To assess whether overall quality of vocal production of voice disordered subjects improved over time, 5 voice samples were obtained approximately 3 weeks apart. Six judges listened to a tape of the 5 samples and placed them in rank order. The samples were randomly placed on the tape to control for rater expectation The judges' ranks for each subject were then totaled, averaged, and graphed. All subjects improved over time.

Journal of Voice, Vol. 13, No. 1, 1999

EFFECTS OF SYSTEMATIZED VOCAL WARM-UP ON VOICES

49

X2 =

12R nk(k+l)

-3n(k + 1)

12(52 + 102 + 12.82 + 13.82 +18.22) -3(4)(5 + 1) 20(5 + 1) _ 12(25 + 100 + 163.8 + 190.4 + 331.2) -72
120

(9724.8) -72 120


X 2 = 81.04 -72 X 2 = 9.04 significance at P = .05
FIG. 7. The Friedman's Rank Test for Correlated Samples was used to determine if the ranking was statistically significant. It was significant at the P = .05 level.

--~---Subject 1 Z Subject z --A~Subject 3 ~Subject 4

/ / J
t 0 I 2 3 4 5

FIG. 8. The graph shows subjects' perception of how long, in days, their voices maintained improved voice quality after vocal warm-up.

Journal o[Voice, Vol. 13, No. 1, 1999

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THOMAS R. BLAYLOCK

Replication is needed. Certainly a study that incorporates more subjects, weekly samples of their voice quality, higher quality data collection tools, and better sound-controlled environment could yield more precise data. For example, a study of this nature may illuminate where a significant change in the post-vocal warm-up skill of the voice user begins and the point at which that skill is maintained week to week. Further research would look at other subject factors, for example other types of voice disorders, duration of disorder, and the validity of vocal warm-up as a presurgical treatment.

REFERENCES
1. Carroll LM, Sataloff RT. The singing voice. In: Sataloff RT, ed. Professional Voice: The Science and Art of Clinical Care. New York: Raven Press; 1991:381-383. 2. Boone DR. The Voice and Voice Therapy. 2nd ed. Englewood Cliffs, NJ: Prentice Hall; 1977:v. 3. Sundberg J. The Science of the Singing Voice. Dekalb: Northem Illinois University Press; 1987:192-194. 4. Miller R. The structure of singing. New York: Schirmer Books; 1986:xix-xxii. 5. McKinney JC. The Diagnosis and Correction of Vocal Faults. Nashville, TN: Broadman Press; 1982:181-182. 6. Sataloff RT. Introduction to treating voice abuse. In: Sataloff RT, ed. Professional Voice: The Science and Art of Clinical Care. New York: Raven Press; 1991:311-312.

Journal of Voice, Vol. 13, No. 1, 1999

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