Optimizing Your Online Services for Voice

Contributed to the 2020 InFormant from Pan American Vocology Association (PAVA)

Kristie Knickerbocker, MS, Cara Bryan, MA, and Aaron Ziegler, PhD Founding Members, Confident Clinician Cooperative

We are under considerable pressure to deliver effective voice care as we distance physically and connect virtually. In 2018, Grillo published evidence in support of telepractice to successfully prevent and manage voice disorders.

Though use of telepractice may at first seem to be a road-block to quality voice care, it does not have to be. Consider these recommendations to optimize your delivery of telepractice services for voice. Exploring creative options to gather acoustic data can facilitate outcomes measurement when evaluating the voice during telepractice. Acoustic analysis software is available, however, real-time acquisition of the patient’s voice signal through videoconferencing is not readily available. Instead, have the patient make voice recordings on their computer using free recording software (e.g., Audacity or Praat). Patients can email or upload their voice recordings as .wav files for analysis in Praat with Phonanium plugins. Patients also can send voice recordings for free through smartphone and tablet applications such as VoiceEvalu8, which provides its paid clinician subscribers with multidimensional voice outcomes data. Other free or paid Android or iPhone apps such as Vocal Pitch Monitor and Voice Analyst are available for limited acoustic analysis. Ensuring everyone hears a clear vocal signal can improve cohesiveness when treating the voice during telepractice.

According to Maryn & Weenick (2014), lowering external/environmental noise and optimizing the signal-to-noise ratio is ideal. The vocal signal your patient hears as you demonstrate will improve with a USB or headset cardiod condenser microphone with audio interface. The microphone should have a flat frequency response curve within a 2dB variation and be sensitive to between 50- 8,000Hz with a 3% dynamic range. Encouraging your patient or client to get an external microphone will improve your ability to listen critically to their voice. During telepractice for voice, providing visual cues in addition to verbal cues is key. Enabling “original sound” in software like Zoom can optimize singing training during telepractice. Due to time lags in videoconferencing apps and device software, completing real-time accompaniment on one end while singing on the other is challenging. Issues also may occur with the patient playing a track on their computer while singing along. A solution is to play a starting note and have the patient sing entirely a cappella or have the patient play tracks in headphones that only they can hear and sing ‘a cappella.’

Alternatively, the patient can sing while playing their accompaniment track on a device other than their computer and placed away from their microphone.
Indeed we can help our patients with their voice through telepractice, and patience is key.