Effectiveness of a Voice Training Program for Student

Teachers on Vocal Health

Bernhard Richter, Manfred Nusseck, Claudia Spahn, and Matthias Echternach, Freiburg, Germany

Summary: Objectives. The effectiveness of a preventive training program on vocal health for German student
teachers was investigated on specific vocal parameters.
Methods. The voice quality as described by the Dysphonia Severity Index of 204 student teachers (training group:
n ¼ 123; control group: n ¼ 81) was measured at the beginning and at the end of the student teachers training period
(duration 1.5 years). Additionally, for investigating the voice-carrying capacity, a vocal loading test (VLT) was per-
formed. Finally, participants had to provide a subjective judgment of a possible Voice Handicap Index.
Results. The training program improved the voice quality of the trained group compared with that of the control
group, whose voice quality declined. The trained group was also able to better sustain their voice quality across the
VLT than the control group. Both groups, however, reported a similar increase in subjective vocal strain.
Conclusions. The presented training program clearly showed a positive impact on the voice quality and the vocal
capacity. The results maintain the importance of such a training program to be integrated in the education and occupa-
tional routine of teachers.
Key Words: Voice–Teachers–Vocal health–Vocal loading–Prevention.

INTRODUCTION methodologically divided into an ‘‘indirect’’ training (including

The voice is an essential tool in the teaching profession. It is not
only necessary to impart knowledge but also to communicate
emotions and personal characteristics. Hence, vocal problems
have direct consequences on the teaching abilities. Studies
showed that teachers with vocal disorders had a negative influ-
ence on the pupils’ learning outcome.1,2 It is therefore
important that teachers maintain a good vocal function during
their professional life.
Teachers, however, often experience voice disorders, and it
has been shown that they are at greater risk for developing voice
disorders compared with those in other professions.3–5 On
average, up to 50% of teachers complained about having
experienced a serious vocal problem at least once in their
teaching career.6–9 Furthermore, the onset of voice problems
is not only limited to older teachers with years of working
experience. Younger teachers may also experience voice
complaints within the first few years of teaching. Simberg10
showed that 39% of student teachers reported voice symptoms.
Nevertheless, prevalence of reported voice problems in teachers
largely ranges between 5% and 90%. This variety depends
mostly on different definitions of voice problem and how it
was reported.4
To prevent vocal problems, various voice training programs
have been developed. For example, on the basis of the concept
of the Schlaffhorst-Anderson method, Saatweber11 published
several practical exercises for teachers’ voices. Other voice
programs for teachers focused on group training and were
Accepted for publication May 6, 2015.
From the Freiburg Institute of Musicians’ Medicine, University of Music and University
Medical Center, Freiburg, Germany.
Address correspondence and reprint requests to Bernhard Richter, Freiburg Institute of
Musicians’ Medicine, University of Music and University Medical Center, Breisacher Str.
60, 79106 Freiburg, Germany. E-mail: bernhard.richter@uniklinik-freiburg.de
Journal of Voice, Vol. -, No. -, pp. 1-8
0892-1997/$36.00
Ó 2015 The Voice Foundation
http://dx.doi.org/10.1016/j.jvoice.2015.05.005
lectures about the functionality of and influences on the voice)
and a ‘‘direct’’ training (with personal coaching and practical
exercises).
Several studies investigated the effects of these training
methods on voice aspects. Timmermans et al12 found that stu-
dents (n ¼ 49) who participated in 9 months of voice training
(indirect and direct) showed a positive effect on the quality of
the voice described by the Dysphonia Severity Index (DSI13)
compared with a group without voice training (n ¼ 20). The
trained group obtained a significantly higher DSI of 4.3 than
the control group (DSI of 3.2). Additionally, they used the
self-assessment questionnaire for vocal symptoms, the Voice
Handicap Index (VHI14), and found that both groups scored
similarly.
In a follow-up study, Timmermans et al15 investigated
another short voice training program (6 hours) in future
teachers and found no significant effects of the DSI and
the VHI between the trained group (n ¼ 35) and the control
group (n ¼ 30). Even with an addition of 30 minutes of
individual voice counseling, no significant changes could
be observed.16
Duffy and Hazlett17 compared two groups of student teachers
with voice programs of either indirect (n ¼ 20) or direct
(n ¼ 12) voice training with a control group without training
(n ¼ 23). The results showed no differences in the mean values
of the VHI. Measuring the DSI, they found an increase for the
direct voice training group, no difference for the indirect group,
and a decrease for the control group. The results, however, did
not reach statistical significance.
Similarly, Bovo et al18 investigated kindergarten teachers
with indirect and direct training (n ¼ 21) compared with
matched untrained persons (n ¼ 20). They found large positive
effects in several acoustic voice parameters (such as maximum
phonation time (MPT), jitter, and shimmer) and in the VHI.
These effects still remained in a 12-month retest but were
slightly reduced.
2 Journal of Voice, Vol. -, No. -, 2015
TABLE 1.
Content of Each Session of the Voice Training Program
Session Topic
1 Voice hygiene and voice functioning
2 Movement and postural alignment
3 Breathing behavior
4 Finding the individual pitch during speaking
5 Vocal intensity
6 Resonance and cavities
7 Articulation
8 Prosodic elements
9 + 10 Recaps and presence
Always Care packet
As there are several more publications on this subject, two
literature reviews on the effectiveness of voice trainings have
been performed. Ruotsalainen et al19 selected, out of a body
of over 5000 references, only two studies that confirmed the
criteria required, such as homogenous population, study
design, and measurements performed. The amount increased
up to six studies in a later repeated review but they could not
find evidence for the effectiveness of voice training in
improving vocal function.20 Hazlett et al21 performed a similar
review with 10 studies included. They also found no clear
evidence for positive effects of voice training and concluded,
as there have been studies showing that voice training did
improve aspects of the quality of the voice, that more robust
research should be performed. Both reviews criticized that
the methodological quality in most of the studies was poor
mainly because of rather small sample sizes, nonrandomized
designs, the large diversity of training programs (content,
length in time, and amount of sessions), and the rather short
time between training and follow-up measurements, which
should be at least 1 year.20
Since these reviews, several studies addressing the topic
have been published. Nanjundeswaran et al,22 for instance,
investigated the effects of two different training programs (in-
direct and indirect combined with direct) in student teachers
(n ¼ 31) on the VHI value compared with a control group.
They found a decrease of the VHI in both trained groups.
For the subjects with low VHI values at the beginning, how-
ever, the VHI increased. Because of the small sample size,
they only described the positive effect of the training.
Pizolato et al23 measured acoustic parameters of the voice
FIGURE 1. Study design and number of participants at both evaluation times.
to analyze effects between a group of teachers with vocal
training (n ¼ 30) and a control group (n ¼ 43). They found
that the fundamental frequency (F0) of the trained male par-
ticipants decreased but increased in the trained female partic-
ipants. There were no significant differences of both groups
between the initial and final measurements after 3 months,
except that only the control group increased their mean voice
intensity.
Regarding all these studies, there is still no clear evidence of
the positive effects of voice training on vocal functioning.
The aim of this study was to analyze vocal outcome of a
prevention training program on vocal health in a homogenous
sample with a larger sample size (n ¼ 204 German student
teachers). It was hypothesized that vocal function was
improved for subjects getting vocal training within the preven-
tion program, where vocal function was impaired for those who
had no such voice training.
MATERIALS AND METHODS
Voice training protocol
The training program was integrated into the teaching educa-
tion period for student teachers (duration 1.5 years). It was
set to eight sessions of 90 minutes during the first half
year of the education period, two refreshing sessions of
90 minutes in the second half year, and an individual teacher
observation at school for all participants of the intervention
group by the voice teachers in the last half year. The individ-
ual voice topics of the training of all sessions are listed
in Table 1.
Each session included the so-called ‘‘care packet.’’ This is a
short program that can be performed in <10 minutes containing
selected exercises of all topics such as body stretching, jaw
massage, breathing, activating the articulation, and pronounc-
ing syllables. It was designed as a repeatable procedure across
the whole training program and to be used to activate the voice
and the body before a working day or a voice-demanding
situation.
The courses were given at the institutions where the seminars
for the teaching education period took place. They were orga-
nized in groups of 10–12 people and were led by professionally
educated voice teachers.
Participants
The sample of the study comprised a total of 266 vocally
healthy student teachers, who just started with their education
Bernhard Richter, et al Evaluation of a Voice Training Program 3

There were no significant differences between this database

TABLE 2.
Number of Participants and Gender Distribution for Each
and the dropped out participants for gender, age, or school
School Type type distribution.
The mean age of the student teachers was 27.1 years (stan-
Intervention Control Gender dard deviation [SD], 3.6 years) with 26.7 years (SD, 2.8 years)
School Type % Group Group (Female, %)
for the intervention group and 27.6 years (SD, 4.2 years) for
Primary school 30 37 25 87 the control group. Seventy-seven percent (n ¼ 156) were
Junior high 21 25 17 71 female student teachers. The gender distribution, however,
school differed between the school types (Table 2) but showed,
High school 35 42 29 63 respectively, representative distributions for each individual
School for 14 19 10 93
school type.
handicapped
children
Total 100 123 81 77
Evaluation instruments
All subjects were analyzed using a multidimensional voice
assessment protocol including videostroboscopy, VHI (the
short form of the German version with 12 items was used24),
period at that time. They came from four different school Roughness-Breathiness-Hoarseness scale, and acoustic mea-
types: primary school, junior high school, high school, and sures. The highest fundamental frequency (F0 max), the lowest
school for handicapped children. All subjects gave their intensity, the jitter (by use of the sustained vowel /a/), and the
agreed consent for participation, approved by the local ethical MPT (best of three attempts) were determined using the ling-
committee. WAVES software (WEVOSYS, Forchheim, Germany, sound
Before the measurement procedure, all subjects were exam- level meter at a distance of 30 cm). From these data, the
ined by an experienced otolaryngologist for exclusion because DSI13 was established.
of a vocal dysfunction. In this respect, six possible participants After that, a vocal loading test (VLT) was performed. Here,
at the pretest were thereby excluded from the sample because the subjects were asked to read a standardized text (German
of vocal fold pathologies. The assignment into the intervention Text: Das tapfere Schneiderlein, Grimm brothers) for 10
and control groups was different among the school types. The minutes louder than 80 dB at a distance of 30 cm on the basis
seminars of the primary and junior high school were organized of a recommendation by Echternach et al.25 The subjects
in classes of 10–12 student teachers. For easier realization of could see their intensity level on a computer screen, which
the intervention courses, whole classes were randomly allo- showed a red arrow when the sound pressure level was below
cated to the intervention group, and in the other classes, the the required 80 dB. The program calculates the mean values
student teachers were asked to participate for the control of the percentage <80 dB, the fundamental frequency, and
group. In the other seminars, student teachers were asked the sound pressure level averaged across the recorded 10
for voluntary participation and were afterward randomly minutes. This test was shown to be able to stress the voice
assigned into the two groups. After the first measurement at equally to a class teaching situation of 45 minutes.26 After
the beginning of the teacher training period, the sample con- the VLT, the DSI measurement was repeated. The measure-
sisted of n ¼ 153 in the intervention group and n ¼ 113 in ment procedure for the first and the second measurements is
the control group (Figure 1). The groups have uneven sizes shown in Figure 2.
because of the primary intention to fill up the intervention The report of the results is divided into two aspects: (1) the
courses. analysis of changes in the voice quality between the first and
The second measurement was at the end of the training the second measurements by using the values of the DSI before
period approximately 9 months after the end of the voice the VLT (pre-VLT) and (2) changes in the voice-carrying
training lessons, that is, half a year after the refreshing les- capacity, that is, the differences between the measurements
sons and a few weeks after the teaching observation of the before (pre-VLT) and after the VLT (post-VLT) at both
voice trainer. At the second measurement, 204 subjects measuring times.
were reevaluated (77%) with a distribution of n ¼ 123
(80%) in the intervention group and n ¼ 81 (72%) in the con- Statistics
trol group. As repeated-measures tests were used for the sta- Data were analyzed using the statistic software SPSS 21
tistics, these subjects constituted the database of analysis. (SPSS Inc., Armonk, NY). For the comparison of the

FIGURE 2. Measurement procedure at both the first and the second measurements.
4 Journal of Voice, Vol. -, No. -, 2015

TABLE 3.
Mean Values of the Different Voice Parameters and the VHI at Both Measurements Before the Vocal Loading Test
Intervention Group (n ¼ 123) Control Group (n ¼ 81)

Measurement First Second First Second

F0 max females (Hz) 718 (159) 742 (202) 739 (149) 732 (183)
F0 max males (Hz) 492 (183) 509 (185) 473 (146) 463 (150)
Lowest intensity (dB) 53.9 (4.4) 53.1 (3.9) 52.8 (4.6) 53.8 (3.7)
Jitter (%) 0.19 (0.2) 0.19 (0.2) 0.18 (0.1) 0.20 (0.2)
MPT (s) 15.9 (4.9) 16.7 (5.4) 17.1 (6.2) 17.7 (6.4)
DSI (diff. first/second) +0.25 (1.35) 0.22 (1.35)
VHI 5.7 (4.5) 6.5 (4.7) 6.2 (4.2) 6.7 (4.1)
Abbreviations: F0, fundamental frequency; MPT, maximum phonation time; DSI, Dysphonia Severity Index; VHI, Voice Handicap Index.
Note: Standard deviation values are given in brackets.

mean values between the intervention and the control groups
at the two measuring times, a two-way analysis of variance
repeated-measures test with factors of time and group was
used. Individual effects of time and group as well as the
interaction between both factors were reported. Tests for
individual group comparisons were investigated using inde-
pendent t tests. The level of significance was set on
P ¼ 0.05.
RESULTS
Vocal quality
To analyze the effectiveness of the training program on the gen-
eral voice quality, individual acoustic parameters and the
composed value of the DSI before the VLT (pre-VLT) were
compared between the first measurement at the beginning and
the second measurement at the end of the student teachers
training period. Mean values of the parameters are summarized
in Table 3. The statistical analyses of time, group, and interac-
tion effects are listed in Table 4.
The maximal fundamental frequency (F0 max) was analyzed
separately for each gender and yielded no significant effects of
time, group, or interaction. The lowest intensity showed a sig-
nificant interaction effect. There were no significant effects
for the jitter. The MPT showed a significant time effect with
an increase of the phonation time at the second measurement
for both groups. The DSI, however, yielded a clear significant
interaction effect between both groups with an increase of the
DSI in the intervention group and a decrease in the control
group (Figure 3).
The VHI showed a significant time effect with an increase
at the second measurement in both groups. In the first mea-
surement, 73% of the participants were below the threshold
of a mild voice handicap (<7) according to Nawka et al,24
and the mean value was significantly lower than the threshold
value [t(203) ¼ 3.623; P < 0.001]. The number of parti-
cipants below this threshold reduced to 66% in the second
measurement, and the mean value was not significantly
different to the threshold value anymore [t(203) ¼ 1.291;
P ¼ 0.198].
Voice-carrying capacity
The mean values of the outcome parameters of the VLT are
listed in Table 5, and the statistical analyses are summarized
in Table 6. All parameters showed significant effects between
the first and the second measurements without significant group
or interaction effects.
As the DSI was measured before (pre-VLT) and after the
VLT (post-VLT), for all acoustic parameters of the DSI, the

TABLE 4.
Statistical Analyses of the Voice Parameters at Both Measuring Times Before the Vocal Loading Test (Table 3) on Time,
Group (IG/CG), and Time 3 Group Interaction Effects
Time Effect (First/Second Time 3 Group Interaction
Measurement Measurement) Group Effect (IG/CG) Effect
F0 max females (Hz) F(1,154) ¼ 0.417; P ¼ 0.520 F(1,154) ¼ 0.046; P ¼ 0.830 F(1,154) ¼ 1.478; P ¼ 0.226
F0 max males (Hz) F(1,46) ¼ 0.049; P ¼ 0.825 F(1,46) ¼ 0.416; P ¼ 0.522 F(1,46) ¼ 0.668; P ¼ 0.418
Lowest Intensity (dB) F(1,202) ¼ 1.804; P ¼ 0.181 F(1,202) ¼ 0.132; P ¼ 0.717 F(1,202) ¼ 3.988; P ¼ 0.047
Jitter (%) F(1,202) ¼ 0.447; P ¼ 0.504 F(1,202) ¼ 0.000; P ¼ 0.990 F(1,202) ¼ 0.266; P ¼ 0.635
MPT (s) F(1,202) ¼ 4.879; P ¼ 0.028 F(1,202) ¼ 2.090; P ¼ 0.150 F(1,202) ¼ 0.088; P ¼ 0.767
DSI (diff. first/second) F(1,202) ¼ 0.023; P ¼ 0.880 F(1,202) ¼ 0.601; P ¼ 0.439 F(1,202) ¼ 5.782; P ¼ 0.017
VHI F(1,202) ¼ 7.651; P ¼ 0.006 F(1,202) ¼ 0.323; P ¼ 0.571 F(1,202) ¼ 0.196; P ¼ 0.658
Abbreviations: F0, fundamental frequency; MPT, maximum phonation time; DSI, Dysphonia Severity Index; VHI, Voice Handicap Index.
Note: Interaction effects (in bold: P < 0.05).
Bernhard Richter, et al Evaluation of a Voice Training Program
FIGURE 3. Dysphonia Severity Index (DSI) differences between
the first and second measurements of both groups (Error bars present
the standard error of the mean, *P < 0.05).
difference between these two tests was calculated at the first
and the second measurements (Table 7). The value of the
pre-VLT was subtracted from the value of the post-VLT.
Therefore, negative values indicate that the value after the
VLT was lower than the one before the VLT. The statistical
analyses of the time, group, and interaction effects are listed
in Table 8.
After the VLT, the participants increased the mean highest F0
except for the male participants in the intervention group who
showed lower values in F0 in the first measurement. Neverthe-
less, there were no significant effects of time, group, or interac-
tion on F0.
All participants showed an increase in the lowest intensity
after the VLT. The intervention group, however, was able to
significantly compensate this loss of soft phonation capacity
better in the second measurement than the control group.
There were no significant effects for the jitter. MPT was signif-
icantly different between the two groups and showed a signif-
icant time effect with larger difference values at the second
measurement.
For the DSI, both groups lost on average 0.5 in value after the
VLT in the first measurement. When the control group showed a
similar decrease at the second measurement, the intervention
group was able to rather keep the DSI level and significantly
reduced the difference value (Figure 4).
TABLE 5.
Mean Values of the Fundamental Frequencies (F0), the Percentage <80 dB, and the Sound Pressure Level (SPL) During the
Vocal Loading Test
Intervention Group (n ¼ 123)
Measurement First
F0 females (Hz) 254 (25.2)
F0 males (Hz) 165 (19.9)
SPL <80 dB (%) 31.4 (22.7)
Mean SPL (dB) 81.3 (2.4)
Note: Standard deviation values are given in brackets.
5
DISCUSSION
A prevention training program on vocal health for German
student teachers was evaluated for effects on parameters of
vocal functioning and self-perceived voice handicap. The
duration between the intervention program and the second
measurement was in the recommended range by Ruotsalainen
et al.20
The analysis of the vocal quality showed that the DSI
increased between the first and second measurements for the
trained group and decreased for the control group with signif-
icant interaction effect. This finding evidently determines that
the voice training had a clear positive effect on the voice
quality.
The DSI value differences between the first and second
measurements were lower compared with the findings of
Timmermans et al,12 whereas in their study, the control group
also increased in the DSI value. This could be due to the
fact that their DSI values in the initial evaluation were, in
both groups, notably lower compared with the values of
this study.
Regarding the different vocal acoustic parameters, there was
no effect of the intervention on the jitter, which is in agreement
with earlier findings.12,15,23 MPT, however, showed a
significant effect between the first and second measurements
in both groups with longer MPT in the second measurement.
Descriptively, a similar observation was also found by
Timmermans et al.12 It seems that the intensive use of the voice
and the frequent speaking during the student teacher education
period could be seen as a form of training. Because longer MPT
indicates a more effective transformation of subglottic pressure
to air pulses through the vibrating vocal folds, this might be
considered as criteria for enhanced vocal functioning. The
results of the VLT also showed that for both groups, the values
of the MPT were greater (except for the control group in the first
measurement) indicating longer phonation times after the vocal
stress.
The lowest vocal intensity describes the possibility to pro-
duce a noticeable sound at the lowest sound pressure level of
the voice. This needs a proper use of and connection between
respiratory and laryngeal system. The results showed that the
control group revealed a lowest intensity higher by 1 dB,
whereas the trained group was able to lower the intensity
Control Group (n ¼ 81)
Second First Second
259 (24.6) 257 (24.3) 259 (23.8)
167 (17.2) 163 (29.8) 170 (24.0)
19.1 (15.1) 29.6 (22.9) 19.2 (15.2)
82.5 (1.9) 81.6 (2.4) 82.6 (1.9)
6 Journal of Voice, Vol. -, No. -, 2015

TABLE 6.
Statistical Analyses of the Voice Parameters During the Vocal Loading Test (Table 5) on Time, Group (IG/CG), and
Time 3 Group Interaction Effects
Time Effect (First/Second Time 3 Group Interaction
Measurement Measurement) Group Effect (IG/CG) Effect
F0 females (Hz) F(1,149) ¼ 6.979; P ¼ 0.009 F(1,149) ¼ 0.125; P ¼ 0.724 F(1,149) ¼ 0.905; P ¼ 0.343
F0 males (Hz) F(1,45) ¼ 7.337; P ¼ 0.010 F(1,45) ¼ 0.009; P ¼ 0.927 F(1,45) ¼ 1.490, P ¼ 0.229
SPL <80 dB (%) F(1,196) ¼ 73.166; P < 0.001 F(1,196) ¼ 0.116; P ¼ 0.734 F(1,196) ¼ 0.501; P ¼ 0.480
Mean SPL (dB) F(1,196) ¼ 54.456; P < 0.001 F(1,196) ¼ 0.297; P ¼ 0.587 F(1,196) ¼ 1.954; P ¼ 0.395
Abbreviations: F0, fundamental frequency; SPL, sound pressure level.
Note: Interaction effects (in bold: P < 0.05).

by about 1 dB between the first and second measurements
with a significant interaction effect. As this parameter
showed to have a rather strong influence on the DSI,25 the
interaction effect of the DSI may be mainly caused by this
factor together with the small increase of the F0 in the
trained group.
The VHI showed that both groups reported more self-
perceived voice handicap indications at the end of the teacher
education period (second measurement). The presumptions
by Nanjundeswaran et al22 that the VHI would reduce in the
trained group and increase in the control group can therefore
not be supported by our data. Even more, Timmermans et al12
found that both the trained and the untrained groups signifi-
cantly reduced the VHI values without interaction effect instead
of increasing it.
Interestingly, the VHI values contrast with the findings of the
voice quality as measured by the DSI where the trained group
clearly improved their voice quality. Therefore, the training
program seems to have less impact on the impression of having
a vocal handicap that arose with teaching and speaking experi-
ences. Nevertheless, the mean values of both groups were still
below the threshold indicating a mild voice handicap (<7)
according to Nawka et al.24
The VLT was used to investigate the voice-carrying
capacity. The participants in both groups managed the
requirements of the VLT in the second measurement better
than in the first. They read louder and reduced the percent-
age of SPL <80 dB remarkably. They also increased the F0
during the VLT. These results lead to the assumption that
the student teachers of both groups experienced some
sort of vocal training probably through the teaching expe-
riences that improved the use and the behavior during
the VLT.
Nevertheless, the DSI differences between the pre-VLT
and the post-VLT showed a significant interaction effect.
The trained group was able to keep the vocal quality over
the VLT in the second measurement. Hence, the voice
training had a clear effect on the voice-carrying capacity to
stand certain vocal demands. In more detail, the most influ-
encing factor seemed to be again the lowest vocal intensity.
The trained group was able to perform phonations with
recognizable lower intensity than the control group after
the VLT.
The results of this study have therefore shown that the pre-
vention training program on vocal and mental health posi-
tively affected vocal functioning. To indicate the importance
of the components in the training program, future researches
should investigate effects of specific implements according
to the profession and the comparison with other training
programs.

TABLE 7.
Mean Values of the Acoustic Parameters as a Difference Between Before and After the Vocal Loading Test (VLT) at Both
Measurement Times
Intervention Group (n ¼ 123) Control Group (n ¼ 81)

Measurement First Second First Second

F0 Diff. females (Hz) 2.9 (108) 5.3 (100) 15.3 (119) 16.8 (128)
F0 Diff. males (Hz) 41.6 (92) 2.3 (103) 11.8 (109) 3.5 (103)
Low. Int. Diff. (dB) 2.12 (3.3) 1.39 (2.9) 1.99 (3.1) 2.56 (3.4)
Jitter Diff. (%) 0.06 (0.2) 0.01 (0.3) 0.02 (0.2) 0.01 (0.3)
MPT Diff. (s) 0.29 (3.1) 1.1 (4.1) 0.68 (3.4) 0.37 (3.9)
DSI Diff. 0.56 (1.0) 0.22 (1.0) 0.50 (.87) 0.60 (1.0)
Abbreviations: F0, fundamental frequency; MPT, maximum phonation time; DSI, Dysphonia Severity Index.
Note: Standard deviation values are given in brackets.
Bernhard Richter, et al Evaluation of a Voice Training Program 7

TABLE 8.
Statistical Analysis of the Voice Parameter Differences Before and After the Vocal Loading Test (Table 7) on Time, Group,
and Interaction Effects
Time Effect (First/Second Time 3 Group Interaction
Measurement Measurement) Group Effect (IG/CG) Effect
F0 Diff. females (Hz) F(1,154) ¼ 0.027; P ¼ 0.871 F(1,154) ¼ 0.760; P ¼ 0.385 F(1,154) ¼ 0.001; P ¼ 0.973
F0 Diff. males (Hz) F(1,46) ¼ 0.649; P ¼ 0.425 F(1,46) ¼ 1.573; P ¼ 0.216 F(1,46) ¼ 1.542; P ¼ 0.221
Low. Int. Diff. (dB) F(1,202) ¼ 0.063; P ¼ 0.802 F(1,202) ¼ 2.423; P ¼ 0.121 F(1,202) ¼ 4.364; P ¼ 0.038
Jitter Diff. (%) F(1,202) ¼ 2.734; P ¼ 0.100 F(1,202) ¼ 0.196; P ¼ 0.658 F(1,202) ¼ 0.972; P ¼ 0.325
MPT Diff. (s) F(1,202) ¼ 7.237; P ¼ 0.008 F(1,202) ¼ 4.164; P ¼ 0.043 F(1,202) ¼ 0.185; P ¼ 0.668
DSI Diff. F(1,202) ¼ 1.613; P ¼ 0.206 F(1,202) ¼ 2.172; P ¼ 0.142 F(1,202) ¼ 5.057; P ¼ 0.026
Abbreviations: F0, fundamental frequency; MPT, maximum phonation time; DSI, Dysphonia Severity Index.
Note: Interaction effects (in bold: P < 0.05).

CONCLUSIONS
In this study, the effectiveness of a prevention training pro-
gram on vocal health of German student teachers was investi-
gated. The results indicate that the teacher education period
for student teachers was experienced as a voice-demanding
time and that the participants developed certain voice strate-
gies through teaching practices. The trained group, however,
increased not only their voice quality over time but was also
able to withstand vocal loading and kept their vocal quality
with statistical significance. These results showed the poten-
tial of a prevention program for student teachers on their vocal
health.
The findings should lead to consequences to better inform
and train teachers and especially future teachers how to manage
with certain work-related voice demands and to provide preven-
tion programs for voice training. It is important to learn more
about one’s own voice and to understand its limitations and
vocal capacity. Furthermore, voice problems should be taken
more seriously, and on repeated appearance, speech experts
should be consulted.
FIGURE 4. Dysphonia Severity Index (DSI) differences between
pre-VLT and post-VLT at both measurements for both groups (Error
bars present the standard error of the mean, *P < 0.05).
Acknowledgments
The authors would like to thank Nisma Bux-Cherrat, Juliane
Stein-Vogel, Dr. Louisa Traser, and Dr. Sebastian Dippold for
providing the measuring procedure and the examinations.
Further special thanks go to the heads of the teacher education
seminars Prof. M. Frommhold, Ms. M. Neumann, Ms. N.
Kr€ankel-Schwarz, and Mr. T. Sachsenheimer for the support
in recruiting the student teachers. The study was funded by
the Ministry of Science and Arts and the Ministry of Culture,
Youth, and Sports in Baden-W€urttemberg.
The authors declare no conflict of interest.
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