Vocal Training in Healthy Individuals: A Scoping Review


      Objective: This study aimed to map the characteristics and effects of vocal training approaches in individuals with healthy voice. Methods: This is a scoping review based on three research questions: What are the interventions used for vocal training of individuals with healthy voice? What are their prescription parameters? What are their effects? The search was conducted electronically in the databases of Embase, Lilacs, Medline, Scopus, and Web of Science. The study selection was based on the reading of titles, abstracts, and full text, applying the eligibility criteria. Data related to the characteristics of the publication, sample, and intervention were extracted. Measures/outcomes and results were also extracted. Quantitative synthesis was performed, and the results were presented in descriptive format. Results: In total, 221 studies were identified during the search, of which 23 were selected. The most frequently used approach in the vocal training of individuals with healthy voice was the Semi-Occluded Vocal Tract Exercise (SOVTE), mainly with tube and straw phonation. Many studies have focused on the immediate effect, with varying dosages. The main outcome measures were acoustic analysis, aerodynamic evaluation, electroglotography, and vocal self-assessment. Positive effects were mainly observed on aerodynamic and acoustic parameters. Only one study reported negative results in the self-assessment. Conclusions: The SOVTE is most frequently performed to provide an immediate effect in the acoustic analysis and has also demonstrated positive effects on vocal self-assessment. Medium and long-term effects and dosages are rarely reported and should be also investigated.

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        • Behlau M
        • Madazio G
        • Feijó D
        Terapia breve intensiva nos diferentes distúrbios da voz.
        in: Lopes L Moreti F Ribeiro LL Pereira EC Fundamentos e Atualidades em Voz Clínica. Revinter, Rio de Janeiro2019
        • Gartner-Schimidt JL
        • Roth DF
        • Zullo TG
        • et al.
        Quantifying component parts of indirect and direct voice therapy related to different voice disorders.
        J Voice. 2013; 27: 210-216
        • Desjardins M
        • Halstead L
        • Cooke M
        • et al.
        A systematic review of voice therapy: what “effectiveness” really implies.
        J Voice. 2017; 31: 13-32
        • Sandage MJ
        • Hoch M
        Exercise physiology: perspective for vocal training.
        J Sing. 2018; 74: 419-425
        • Vaiano T
        • Badaró F
        Fisiologia do exercício na clínica vocal.
        in: Lopes L Moreti F Ribeiro LL Pereira EC Fundamentos e Atualidades em Voz Clínica. Revinter, Rio de Janeiro2019
        • Guida HL
        • Zorzetto NL
        Morphometric and histochemical study of the human vocal muscle.
        Ann Otol Rhinol Laryngol. 2000; 109: 67-71
        • Silva E
        • Freitas WZ
        • Ferrão MLD
        • et al.
        Níveis de flexibilidade em função do tipo de fibra muscular.
        Fitness Performance J. 2003; (v.2, n.3): 157-164
      1. Powers, SK, Howley ET, Ikeda M, Barbanti VR. Fisiologia do exercicio: teoria e aplicação ao condicionamento e ao desempenho/Scott K. [Tradução Marcos Ikeda]. 5th ed. Barueri: Manole 2005.

        • Boff SR
        A fibra muscular e fatores que interferem no seu fenótipo.
        Acta Fisiátrica. 2016; 15: 111-116
        • Azevedo LL
        • Passaglio KT
        • Rosseti MB
        • et al.
        Avaliação da performance vocal antes e após a vibração sonorizada de língua.
        Rev Soc Bras Fonoaudiol. 2010; 15: 343-348
        • Sandage MJ
        • Smith AG
        Muscle bioenergetic considerations for intrinsic laryngeal skeletal muscle physiology.
        J Speech Lang Hear Res. 2017; 60: 1254-1263
        • Bane M
        • Angadi V
        • Dressler E
        • et al.
        Vocal function exercises for normal voice: the effects of varying dosage.
        Int J Speech Lang Pathol. 2019; : 37-45
        • Mills R
        • Hays C
        • Al-Ramahi J
        • et al.
        Validation and evaluation of the effects of semi-occluded face mask straw phonation therapy methods on aerodynamic parameters in comparison to traditional methods.
        J Voice. 2017; 31: 323-328
        • Paes SM
        • Zambon F
        • Yamasaki R
        • et al.
        Immediate effects of the Finnish resonance tube method on behavioral dysphonia.
        J Voice. 2013; 27: 717-722
        • Titze IR
        Voice training and therapy with a semi-occluded vocal tract: rational and scientific underpinnings.
        J Speech Lang Hear Res. 2016; 49: 448-459
        • Croake DJ
        • Andreatta RD
        • Stemple JC
        Immediate effects of the vocal function exercises semi-occluded mouth posture on glottal airflow parameters: a preliminary study.
        J Voice. 2017; 31 (245.e9-245.e14)
        • Peterson J
        • Pearce PF
        • Ferguson LA
        • et al.
        Understanding scoping reviews: Definition, purpose, and process.
        J. Am. Assoc. Nurse Pract. 2017; 29: 12-16
        • Aromataris E
        • Munn Z
        Chapter 1: JBI systematic reviews.
        JBI Manual for Evidence Synthesis. JBI, 2020
        • Galvão TF
        • Pansani TS
        • Harrad D
        Reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Epidemiol Serv Saúde. 2015; 24: 3342
        • Medronho RA
        Atheneu, 2006
        • Page MJ
        • McKenzie JE
        • Bossuyt PM
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        BMJ. 2021; 372: n71
        • Behlau M
        • Moreti F
        • Pecoraro G
        Condicionamento vocal individualizado para profissionais da voz cantada - relato de casos.
        Revista CEFAC. 2014; 16: 1713-1722
        • De Bodt M
        • Patteeuw T
        • Versele A
        Temporal variables in voice therapy.
        J Voice. 2015; 29: 611-617
        • Araújo ALL
        • Santos TMM
        • Giannini SPP
        • et al.
        Aquecimento vocal para o canto erudito: teoria e Prática.
        Revista Música Hodie. 2014; 14 (Goiânia): 122-137
        • Vieira VP
        • De Biase N
        • Peccin MS
        • et al.
        The research questions and methodological adequacy of clinical studies of the voice and larynx published in Brazilian and international journals.
        J Eval Clin Pract. 2009; 15: 473-477
        • Collet N
        • Rozendo CA
        Questões metodológicas da pesquisa no campo da saúde.
        Revista Latino-Americana de Enfermagem. 2001; 9: 106-111
        • Johnson AM
        • Sandage MJ
        Exercise science and the vocalist.
        J Voice. 2021; 35: 668-677
        • Hoch M
        • Sandage MJ
        Exercise science principles and the vocal warm-up: implications for singing voice pedagogy.
        J Voice. 2018; 32: 79-84
        • Kang J
        • Xue C
        • Piotrowski D
        • et al.
        Lingering effects of straw phonation exercises on aerodynamic, electroglottographic, and acoustic parameters.
        J Voice. 2019; 33 (810.e5-810.e11)
        • Titze IR
        Voice training and therapy with a semi-occluded vocal tract: rationale and scientific underpinnings.
        J Speech Lang Hear Res. 2006; 49 (1092-4388/06/4902-0448): 448-459
        • Cielo CA
        • Lima JPDM
        • Christmann MK
        • et al.
        Exercícios de trato vocal semiocluído: revisão de literatura.
        Rev CEFAC. 2013; 15: 1679-1689
        • Fadel CB
        • Dassie-Leite AP
        • Santos RS
        • et al.
        Immediate effects of the semi-occluded vocal tract exercise with LaxVox® tube in singers.
        Codas. 2016; 28 (9-10Portuguese, English): 618-624
        • Paes SM
        • Behlau M
        Dosage dependent effect of high-resistance straw exercise in dysphonic and non-dysphonic women.
        Codas. 2017; 29e20160048
        • Mailänder E
        • Mühre L
        • Barsties B
        Lax Vox as a voice training program for teachers: a pilot study.
        J Voice. 2017; 31 (262.e13-262.e22)
        • da Silva Antonetti AE
        • Ribeiro VV
        • Moreira PAM
        Voiced high-frequency oscillation and laxvox: analysis of their immediate effects in subjects with healthy voice.
        J Voice. 2019; 33 (808.e7-808.e14)
        • Bonette MC
        • Ribeiro VV
        • Xavier-Fadel CB
        • et al.
        Immediate effect of semioccluded vocal tract exercises using resonance tube phonation in water on women without vocal complaints.
        J Voice. 2020; 34 (962.e19-962.e25)
        • Andrade PA
        • Wood G
        • Ratcliffe P
        • et al.
        Electroglottographic study of seven semi-occluded exercises: LaxVox, straw, lip-trill, tongue-trill, humming, hand-over-mouth, and tongue-trill combined with hand-over-mouth.
        J Voice. 2014; 28: 589-595
        • Enflo L
        • Sundberg J
        • Romedahl C
        • et al.
        Effects on vocal fold collision and phonation threshold pressure of resonance tube phonation with tube end in water.
        J Speech Lang Hear Res. 2013; 56: 15308
        • Laukkanen AM
        • Titze IR
        • Hoffman HH
        • Finnegan E.
        Effects of a semioccluded vocal tract on laryngeal muscle activity and glottal adduction in a single female subject.
        Folia Phoniatr Logop. 2008; 60: 298-311
        • Meerschman I
        • Bettens K
        • Dejagere S
        • et al.
        Effect of two isolated vocal-facilitating techniques chant talk and pitch inflections on the phonation of female speech-language pathology students: a pilot study.
        J Voice. 2016; 30 (771.e17-771.e25)
        • Saxon KG
        • Berry SL
        Vocal exercise physiology: same principles, new training paradigms.
        J Sing. 2009; 66: 51-57
        • Roy N
        Optimal dose-response relationships in voice therapy.
        Int J Speech Lang Pathol. 2012; 14: 419-423
        • Moreira FS
        • Gama ACC
        Efeito do tempo de execução do exercício vocal sopro e som agudo na voz de mulheres.
        CoDAS. 2017; 29
        • Bassetto MR
        • Constantini AC
        Is there an ideal performance time for the latex tube exercise?.
        J Voice. 2021; (S0892-1997(21)00257-5)
        • Lopes LW
        • da Silva JD
        • Simões LB
        • et al.
        Relação entre medidas acústicas e autoavaliação em pacientes com distúrbios vocais.
        J Voice. 2017; 31 (119-e1)
      2. Ortiz KZ, Carrillo L Comparação entre as análises auditiva e acústica nas disartrias. Revista da Sociedade Brasileira de Fonoaudiologia [online]. 2008, 13, 325-331. doi: 10.1590/S1516-80342008000400005

        • Zhang Y
        • Jiang JJ
        Acoustic analyses of sustained and running voice from patients with laryngeal pathologies.
        J Voice. 2008; 22: 1-9
        • Lopes LW
        • Batista Simões L
        • Delfino da Silva J
        • et al.
        Accuracy of acoustic analysis measurements in the evaluation of patients with different laryngeal diagnoses.
        J Voice. 2017; 31 (382.e15-382.e26)
        • Uloza V
        • Vegieré A
        • Ṧaferis V
        Correlation between the basic videolaryngostroboscopic parameters and multidimensional voice measurements.
        J Voice. 2013; 27: 744-752
        • McHenry M
        • Johnson J
        • Foshea B
        The effect of specific versus combined warm-up strategies on the voice.
        J Voice. 2009; 23: 572-576
        • Meerschman I
        • D'haeseleer E
        • De Cock E
        • et al.
        effectiveness of chewing technique on the phonation of female speech-language pathology students: a pilot study.
        J Voice. 2016; 30: 574-578
        • Patel RR
        • Shaheen NA
        • Barkmeier-Kraemer J
        • et al.
        Recommended protocols for instrumental assessment of voice: American speech-lan- guage-hearing association expert panel to develop a protocol for instrumental assessment of vocal function.
        Am J Speech Lang Pathol. 2018; 27: 887-905
        • Joshi A
        A comparison of the s/z ratio to instrumental aerodynamic measures of phonation.
        J Voice. 2020; 34: 533-538
        • Genilhú PFL
        • Gama ACC
        Acoustic and aerodynamic measures in singers: a comparison between genders.
        Codas. 2018; 30 (e20170240. Portuguese, English)
        • Dastolfo C
        • Gartner-Schmidt J
        • Yu L
        • et al.
        Aerodynamic outcomes of four common voice disorders: moving toward disorder-specific assessment.
        J Voice. 2016; 30: 301-307
        • Carding PN
        • Wilson JA
        • MacKenzie K
        • et al.
        Measuring voice outcomes: state of the science review.
        J Laryngol Otol. 2009; 123: 823-829
        • Portillo MP
        • Rojas S
        • Guzman M
        • et al.
        Comparison of effects produced by physiological versus traditional vocal warm-up in contemporary commercial music singers.
        J Voice. 2018; 32: 200-208
        • Tyrmi J
        • Laukkanen AM
        How stressful is "deep bubbling"?.
        J Voice. 2017; 31 (262.e1-262.e6)
        • Laukkanen AM
        • Lindholm P
        • Vilkman E
        Phonation into a tube as a voice training method: acoustic and physiologic observations.
        Folia Phoniatr Logop. 1995; 47: 331-338
        • Story BH
        • Laukkanen AM
        • Titze IR
        Acoustic impedance of an artificially lengthened and constricted vocal tract.
        J Voice. 2000; 14: 455-469
        • Andrade PA
        • Wood G
        • Ratcliffe P
        • et al.
        Electroglottographic study of seven semi-occluded exercises: LaxVox, straw, lip-trill, tongue-trill, humming, hand-over-mouth, and tongue-trill combined with hand-over-mouth.
        J Voice. 2014; 28: 589-595
        • Ugulino AC
        • Oliveira G
        • Behlau M
        Disfonia na percepção do clínico e do paciente.
        J Soc Bras Fonoaudiol. 2012; 24: 113-118
        • Behlau M
        • Madazio G
        • Moreti F
        Efficiency and cutoff values of self-assessment instruments on the impact of a voice problem.
        J Voice. 2016; 30 (506.e9-506.e18)