Proper control of respiration is necessary
for optimal vocalization in singing devised by
singers and voice teachers may be useful also in
a clinical setting for treating patients with
vocal problems. We have adopted the diaphragm
breath support method developed by singing
teachers. We call this method the "yawning
breath pattern" (YBP) method, because
patients seem to understand this term better
than the original term in treating patients
suffering from singer's nodules (N),
recurrent laryngeal nerve paralysis (RNP), and
incomplete glottal closure (IGQ associated with
chronic laryngitis and sulcus vocalis.
They were taught to correct their breathing by
using this breath pattern.
When yawning, during the exhalation
stage, the diaphragm and the lower part of the
chest are kept in a sustained extended state.
This situation may justly be regarded as an
important part of breath technique not only in
singing vocalization, but also in voice therapy
practice.
In this report, we describe the details of
this method in our clinical trial and its
efficacy by evaluating the results for 91
patients who were treated with the YBP method.
The evaluations included a voice test, a
laryngoscopie examination, an evaluation of the
patient's subjective improvement, and the
patient's ability to master the YBP technique as
evaluated by the therapist.
The results showed an extension of the
patient's voice range, an increase of voice
intensity, and a decrease in the air flow rate
compared to pre-treatment. The laryngoscopie
examination, the patients' subjective evaluation
of their symptom showed the same improvement.
This clinical attempt indicated that most
patients can master this special breath
technique when vocalizing and that their
symptoms can be removed or improved distinctly
after this therapy. It also tended to show a
relationship between clinical efficacy and the
patients' ability to practice this breath
pattern as evaluated from the YBP curves.
[...]
Discussion : Background of the clinical
study jor YBP wice therapy. There have been many
significant basic studies on the relation
between hurnan voice and respiration using EMG.
There have shown that respiration is one of the
most important factors in good voice
production.
Brodnitz (1971), Lin (1960), And Hixon,
Goldman, and Mead (1973) observed the kinematics
of the chest and abdominal wall, and emphasized
that respiratory movement plays an important
role in improving voice efficiency. Their
significant experiments have demonstrated
emphatically that a strong relationship exists
between respiratory disorders and organic
changes or dysfunctions of the vocal folds. Many
reports from voice clinics have indicated
similar results about this close correlationship
between voice and respiration.
However, typically in voice work, the
examination, and analysis of the respiratory
mechanism has usually not been given sufficient
attention. Clinical studies on the improvement
of respiratory function in voice production is
still insufficient in voice clinical work. There
have been great advances in the field of
phoniatrie surgery of late, but there are still
not many adequate treatment for those dysphonic
patients who are not suitable for phono-surgery.
The necessity for the scientific examination and
investigation on the respiratory mechanism in
voice has not been recognized sufficiently. To
fill this need, we developed a conservative
method which employs a technique used to teach
voice students, to aid and teach patients with
voice problem and diseases to use their breath
and voice correctiv. To develop an effective
conservative treatment for voice dysfunctions,
it is necessary and important to check and
adjust the patients' breath pattern during
respiration and vocalization.
The use of biofeedback to shape behavior
and to classify the ability to practice the YBP
method. This is an attempt to use
instrumental bio-feedback to learn a special
respiratory technique. The technique makes it
casier for patients to learn to adjust their
breath pattern effectively. The latter is
normally very difficult work both for the
learner and for the therapist without
bio-feedback. Also it offers the therapist a
technique for observing objectively the
kinematics of the patient's rib cage, and for
evaluating the patient's performance. According
to their ability to practice the YBP, the shape
of curves shown on the monitor can be classified
into 3 types depending on the ability of the
diaphragm and the other inhalation muscles to
support or control the breath during phonation.
This clinical experiment showed that most of the
patients, after an average of about three
months' outpatient treatment, improved from
their original production curve ("d") to a
better one. The results of voice examinations
and the subjective improvement evaluations both
significantly agree with the therapists'
evaluation of the patients' ability to perform
the YBP vocalization from the kinematic
curves.
The relationship behveen the patients'
ability to master the YBP and the results of
voice examination. As shown in Figs. 3 and 5
(also Tables 3 and 5), the statistical results
were divided into Group A (best), Group B
(better), and Group C (normal). The results
indicated that the better the patients' ability
to master the YBP were the better the results of
voice examination, Comparing Group A to Group I,
B to II, and C to III, one notes a
correspondence between the voice examination and
YBP curve classification. This is especially
true for patients with nodules. However, for
cases of recurrent laryngeal nerve paralysis
(RNP) and incomplete glottal closure (IGC), the
results were somewhat incongruous. For those
patients with IGC and RNP, it seems that an
improvement of the symptom appeared before they
were able to master the YBP technique
perfectly.
The relationship between achieved YBP
curves and subjective improvment. As shown
in Figs. 3 and 5 (also Tables 3 and 5), each
suitable data pair shows a a strong correlation.
These results indicates that the patients'
ability to master the yawning breath pattern is
related to their subjective improvement.
Therefore, the greater the effort which is made
to master the YBP, the more improvement is seen
in the respiratory curve, and the greater is the
degree of subjective improvement felt by the
patients.
The YBP method in voice therapy. At
present, western opera singers are taught a
method of vocalization using the YBP. This
pattern is usually used only when yawning. As a
technique for effect singing, it permits the
maximum expression of the human voice. If
dysphonia originates from attempting to
phonation beyond the individual's ability, the
YBP will be very useful for expanding their
vocal ability. Eventhough there is no ultimately
difference between patients' ability to master
the YBP, a sustained effort on the part of the
patients is needed in the first 2-3 weeks to
master this technique. They have to practice the
YBP as much as possible, at least 30 min every
day. The clinical findings indicate that much
practice causes a remarkable improvement in the
symptoms. This YBP method requires no medication
and no voice rest, and is shown to be an
effective therapy in our clinics.
Directions for the future study of voice
therapy. The YBP was used as the breath
technique of Bel Canto. It is somewhat difficult
to give a definition of this great singing
technique, however it is a fact that this
special breath technique which permits great
expression in the human voice, has been proved,
further, this technique is being utilized
skillfully by present singers and their
teachers. But in the field of phoniatries, the
relationship between breath and voice
phonophysiology has not been investigated
sufficiently. Hence our laboratory has been
interested in investigating aerodynarnics and
the observation of breath patterns. For
scientific effect of continuously maintaining
the constrictive pulling state of the
diaphragm and the low position of larynx when
vocalizing by the YBP. By studying the basic
relationship between breathing and voice, and
the quantitative analysis between breath curve's
change and breath pattern further, and the
methods of voice therapy will progress and
become much more effective.
CONCLUSION
Details concerning the application of the
YBP method as a clinical voice therapy are
presented.
Voice therapy applying the YBP method was
used on 91 patients with dysphonia of vocal
nodules, recurrent laryngeal nerve paralysis,
and incomplete glottal closure. The clinical
results shows that there was no difference in
the patients' ability to master YBP
respiration.
The YBP method was effective in our clinical
voice trial. About 1/3 of the patients roastered
the YBP perfectly, and their symptoms improved
satisfactorily.
The results for the mastering of the YBP
curve shows a correlationship between the
results for laryngoscopy and voice evaluation,
and the patients' improvement. The results
indicated that it is necessary to check the
breath pattern for dysphonia patients.
Bio-feedback enables them to do this
effectively.
.
