Royal Conservatory of Brussels

The purpose of this study was to examine the short- and longer-term effects (3-month follow-up) of a 1-month intensive straw phonation (SP) therapy on the voice quality and voice-related quality of life of female speech-language pathology (SLP) students with mild dysphonia. Thirty-two female SLP students (mean age: 18.5 years, range: 17.8-19.8 years) with mild dysphonia were included in this study. A randomized controlled trial was used with three experimental groups and a control group. The experimental groups received a short-term intensive voice therapy of one month with SP in air (n=8), SP in 2cm water (n=8) or SP in 5cm water (n=8). The control group (n=8) received a comparable voice therapy by using [u] phonation with similar soft onset and slightly pursed lips as in SP but without a straw. Three maintenance sessions were provided via telepractice in the next month. A multidimensional voice assessment was performed immediately before therapy (pre), immediately after therapy (post 1) and at 1 month (after the maintenance therapy=post 2) and 3 months follow-up (post 3) by an assessor blinded to the group assignment and study phase. No significant time-by-group interactions were found for any of the outcome measures, indicating no significant differences in evolution over time among the four groups. Within-group analyses showed a significant increase (improvement) in Dysphonia Severity Index (DSI) between post 1 and post 2 in the SP in 2cm water group. Trends of improvement were visible in DSI between pre and post 1 in the SP in air group, and between pre/post 1 and post 2 in the SP in 5cm water group. A clinically relevant decrease (improvement) in Acoustic Voice Quality Index (AVQI) was found between pre and post 1 in the SP in 2cm water group. Within-group analyses further showed a significant increase in the SP in 2cm water group in the highest intensity between pre and post 1/post 2, a significant decrease in the lowest frequency between pre and post 3, and a significant decrease in Vocal Fatigue Index between pre and post 1/post 2. The SP in the air group showed an increase in the highest frequency between pre and post 2. The SP in 5cm water group showed improvements in the auditory-perceptual parameters, roughness, and strain between pre and post 1. Positive effects were found for the three SP interventions. The most promising results were found for SP in 2cm water, suggesting an optimal impedance match between the glottis and the vocal tract in this specific population of female SLP students with mild dysphonia. What is already known on the subject Straw phonation (SP) exercises have shown positive effective for patients with dysphonia. However, to date, there remains a lack of clarity regarding the training conditions generating the most optimal effects, emphasizing the need for further research. For example, there is still uncertainty about a potential additional benefit of submerging the straw in water, creating extra resistance to airflow and a potential massage-like effect. To date, most studies investigated the immediate effects of SP. Consequently, there is limited evidence regarding whether a SP intervention results in a more economical and efficient voice production in the longer term. What this paper adds to existing knowledge The purpose of this study was to examine the short- and longer-term effects (3 months follow-up) of a one-month intensive SP intervention on the voice quality and voice-related quality of life of female speech-language pathology (SLP) students diagnosed with mild dysphonia, using a randomized controlled trial. The effects of SP in air, SP in 2cm water and SP in 5cm water were compared. Positive effects were found for the three SP interventions. However, the most promising results were found for SP in 2cm water, suggesting an optimal impedance match between the glottis and the vocal tract in this specific population. What are the potential or actual clinical implications of this work? In line with the current state of the art, an intervention using straw phonation (with stirring straws) demonstrated positive effects on the phonation of the investigated female SLP students with mild dysphonia. Among the three conditions tested, a stirring straw submerged 2 cm in water appeared to be the most effective for this population. Further research is needed to determine whether these findings extend to other voice users. The ultimate clinical goal of such efficacy studies is to refine and individualize the selection of SP types for specific populations in clinical practice. To achieve this, future large-scale randomized controlled trials focusing on specific patient subgroups are warranted.

Jan Fabre (Antwerp, 1958) is one of the creative minds of the so-called ‘Flemish Wave’ in the performing arts of the 1980s, a generation of directors, choreographers, actors and dancers who have developed a highly individual language on stage, breaking through the purist boundaries of theatre, opera, dance and performance art. Fabre, who started his career as a performance artist (1976–1981), was especially interested in working with and from ‘the harsh reality’ of his own body, thereby exploring what he has termed physiological performing. From his desire to create a performative language that takes the body and its physical sensory apparatus as the main instrument, he has developed a practice-based method through which to train his company of performers. This articles underscores how his physiological training method can be a relevant and enriching addendum to the training of contemporary actors, dancers and performers of various educational backgrounds. This claim is supported by going in depth into the specificity of Fabre’s training method and analysing how it reformulates the classic paradox of acting (as described amongst others by Aristotle and Diderot) via the introduction of a ‘performance art quality’, or what Fabre calls the transition between act and acting. A selection of exercises is also illustrated by means of the underlying performative principles, such as ‘spacing’, ‘anatomical awareness’, ‘transformation’ and ‘duration’. The article concludes by formulating some arguments in order to pinpoint the relevance of Fabre’s training method within the broad field of contemporary performance training.

The purpose of this study was to investigate the impact of a single session of manual circumlaryngeal therapy on the vocal characteristics of future elite vocal performers (music students). A pretest/post-test control group design was used. Sixteen music students were randomly divided in an experimental and control group. The experimental group received manual circumlaryngeal therapy for 20 minutes, whereas the control group was instructed to have complete vocal rest for 20 minutes. Immediately before and after the therapy or vocal rest, an identical objective voice assessment protocol (aerodynamic measurement, acoustic analysis, voice range profile, and Dysphonia Severity Index [DSI]) was performed. Vocal parameters were compared before and after manual circumlaryngeal therapy in the experimental group, and before and after vocal rest in the control group using the Wilcoxon signed rank test. In the experimental group a significant difference in DSI was found between the measurement before and after manual circumlaryngeal therapy. The median DSI increased from 6.3 before to 7.2 after manual circumlaryngeal therapy. No differences in DSI were found in the control group between the two measurements. The results of this pilot study prudently suggest that manual circumlaryngeal therapy can also improve vocal capacities in the healthy trained voices of future elite vocal performers.