| Our History
The National Center for Voice and Speech (NCVS), conceived
as a "center
without walls," was formally organized in 1990 with the assistance
of a grant from the National Institute on Deafness and Other Communication
Disorders. The grant proposal was initiated in response to a request
for applications for National Multi-Purpose Research and Training Centers
for the newly-established Institute. The NCVS was organized on the
premise that a consortium of institutions is better able to acquire
and maintain resources to fulfill the global mission of the sponsors
than a single organization. NCVS members, although geographically separate,
were linked by a common desire to fully understand the characteristics,
limitations and enhancement of human voice and speech. They maintained
cohesiveness by exploiting contemporary communications technology,
inter-site training responsibilities, periodic conferences, and shared
resources.
In 1999, the Institute rescinded the Multi-Purpose Research and Training
Center funding mechanism. In a July 2000 meeting, however, NCVS investigators
voted unanimously to continue the concept of a national resource center
for voice and speech, to be driven by a variety of single-project research
awards (R01's), as well as health communication, core, and training
grants.
Our Mission
Please see our Strategic
Plan to learn about our mission,
values and milestones.
Current Research
Research Toward Occupational Safety
in Vocalization
Ingo Titze, Ph.D. , Principal Investigator.
This research addresses an
important public need, the protection of an estimated 10 million
workers in the U.S. who rely heavily on their voice as a primary
tool of trade. Evidence has been growing that occupational voice
users, such a s teachers, telephone workers, ministers, counselors,
interviewers, are at risk for vocal injury because they get inadequate
recovery times from prolonged speaking. The underlying hypothesis
is that there is a limited vibration dose that vocal fold tissues
can withstand. As for hand-transmitted vibration in power tools
use, a safe dose is governed by frequency, amplitude, and duration
of vibration exposure. Microphone use solves the overdose problem
related to vocal loudness, but does not address the problem of excessive
duration. A voice dosimeter has been designed, tested, and is currently
in use by teachers in the Denver area public school system to measure
vocal dose. The teachers also self-monitor their vocal fatigue levels.
In this renewal application, the primary focus will be on the molecular
underpinnings of tissue response to excessive vibration. Specific
aims are to (1) determine the ideal geometric and viscoelastic properties
of the lamina propria, (2) quantify voice recovery times and relate
them to auto-perceptive ratings, (3) culture distinct cell types
at various states of differentiation, (4) determine the relative
merits of co-culture for in vitro monolayer systems, (5) engineer
a 3D in vitro model of the lamina propria in a bioreactor, (6) identify
and functionally characterize candidate vibration-responsive genes,
(7) develop a theoretical model of economic voice production, and
(8) explore two types of economy-based vocal therapy. The ultimate
goal is to provided heavy voice users with safety criteria based
on genetic disposition to vocal injury, degree of training in economic
voice use, accumulated dose of vibration in a typical work day,
and the amount of recovery available at night and on weekends. A
multi-disciplinary research team has been assembled to address this
public health concern at physical, biochemical, molecular, and behavioral
levels of investigation.
A Computational Tool for Simulation of Phonosurgical Procedures
Eric Hunter, Principal Investigator
The goal of this project is to predict outcomes of laryngeal phonosurgery
with physiologically based voice simulation. The research will move towards
this goal by developing a model of vocal fold posturing. Vocal fold posturing,
a fundamental aspect of phonation control, is defined as adduction, abduction
or elongation of the vocal folds. Because posturing is based on laryngeal
joint mechanics and soft tissue deformation, fundamental theories of continuum
mechanics are used to formulate this model. The application of continuum
mechanics to laryngeal posturing requires an accurate geometric and mechanical
description of various tissues in the larynx, such as the vocal ligament
and intrinsic laryngeal muscles. Furthermore, because many of these tissues
are fibrous and thus have distinct lines of action, a portrayal of passive
and contractile stress contributions and fiber direction is needed. The
specific aims of the current project are:
- To mathematically represent the orientation of differentiated
laryngeal muscle bundles, allowing for distributed muscle forces
over various cartilages.
- To create, with the distribution of intrinsic muscle
bundles, a three-dimensional finite element model of vocal fold
mechanics that can predict both the speed
and the range of vocal fold medialization and lateralization.
- To simulate a Type I Thyroplasty phonosurgery and
predict the resultant glottal configuration as well as the resultant
stress distribution in the
repaired vocal fold.
It is expected that the posturing model will have a significant impact on
surgically based voice therapies, as well as on vocal fold modeling in general.
Efficacy of Voice Treatment for Parkinson’s
Disease
Lorraine Ramig, Ph.D., Principal Investigator;
DCPA subcontract through CU-Boulder
At least 89% of individuals with Parkinson’s Disease have
speech and voice disorders which affect communication; yet, only
3-4% receive treatment. The work proposed here builds upon 10 years
of previous research into the effectiveness of the Lee Silverman
Voice Treatment®, an efficacious and widely studied speech treatment
for Parkinson’s Disease. Over the next 5 years, we will continue
to examine the positive impacts of LSVT® on speech and voice,
swallowing, facial expression and gesture in PD, in order to gain
greater insight into the neural mechanisms underlying this disease
and help improve the quality of life for individuals with PD.
Applying the Lee Silverman Voice Treatment
(LSVT®) to children with Down Syndrome
Lorraine Ramig, Ph.D., Principal Investigator
Through research funded by the Coleman Institute for Cognitive Disabilities,
the NCVS Down syndrome research team is studying methods of improving
the quality of voice and speech of children with Down syndrome.
This research is currently focused on applying an intensive voice
treatment (LSVT®) to this population with hopes of improving
overall speech intelligibility.
Additionally, the Coleman Institute for Cognitive
Disabilities is funding research examining the use of computers
during speech treatment with children with Down syndrome. Through
this funding, an animated computer software program has been designed
and is currently being studied for its effectiveness in the Down
syndrome population.
Engineering the Vocal Fold Extracellular Matrix
Kim Davis, Ph.D., Principal Investigator, Univ. of Utah; Ingo Titze, Ph.D.,
DCPA subcontractor
Cell growth and gene expression in natural and engineered vocal fold
tissues is being explored in light of vibrational forces that simulate those
in phonation. This work investigates areas that will potentially lead to three
future clinical treatments: l) specific speech therapy exercises; 2) the injection
of materials into the vocal folds; 3) removal and/or replacement of the extracellular
matrix; or 4) a combination of these.
Imaging and Modeling Therapeutic Mechanisms
of Action
Peter T. Fox, M.D., Principal Investigator,
Univ. of Texas at San Antonio; Lorraine Ramig, Ph.D., DCPA subcontractor
The immediate goal is to study mechanisms of action
of treatment in Idiopathic Parkinson’s Disease. The long-range
vision of this project is to develop therapeutic interventions for
brain disorders, e.g. neurological, psychiatric and developmental.
PDA-Enhanced Speech Treatment for
Parkinson’s Disease
Lorraine Ramig, Ph.D., Principal Investigator;
DCPA subcontract through CU-Boulder
“Real world” treatment of speech remains
an unmet need for the vast majority of individuals with Parkinson’s
Disease. Recent advances in information technology now offer an
opportunity to examine the use of a personal data assistant (PDA)
to adapt clinician-directed treatment, including the Lee Silverman
Voice Treatment ® (LSVT), in a home care, self-training mode
while preserving clinician feedback and monitoring. This would allow
increased patient access to treatment as well as information to
clinicians about the effectiveness of treatment, e.g. outcomes.
The Voice Academy
Julie Ostrem, M.B.A., Principal Investigator,
Univ. of Iowa; DCPA consultant: Kate Emerich, M.S., CCC-SLP.
This project will develop a web site providing teachers
across the country with information about keeping their voices healthy.
Biomechanics of the Larynx
From data gathered in laboratory studies, Dr. Titze
and investigators at The University of Iowa and The Denver Center for
the Performing Arts have developed a computerized model of the complex movements
of air and tissue through the larynx. Physical laws describing air
flow and lung pressure are combined with information such as larynx
size and vocal tract shape. These data are programmed on powerful
computer systems and can be converted from digital to analog form
and played back over loudspeaker systems, producing simulated voice.
It
is anticipated in the near future, the model will be sufficiently
refined to serve as a valuable resource to clinicians. Just as pilots
train on flight simulators, speech-language pathologists, voice teachers
and otolaryngologists can use voice simulators to improve their professional
skills. Cellular Structure of the Lamina Propria
In this study, investigators at The University
of Utah, led by Dr. Steven Gray, take a microscopic view of the
layered tissue covering
the vocal fold muscle: the lamina propria. Tissues are removed from
cadavers and biomechanical characteristics such as elasticity ("springiness")
and viscosity ("stickiness") are measured. Investigators
are particularly interested in any differences related to age, gender
and race, or to injury.
As an outgrowth of these investigations, clinicians may soon be able
to guide their clients to a safe level of daily wear and tear on vocal
fold tissue. Secondly, a better understanding of natural tissue structures
will allow surgeons to develop substitutes for patients with severe
lamina propria damage, either from diseases such as cancer or traumatic
injuries.
Laryngeal Muscle Changes with Age and
Treatment
The elderly often experience stability problems with
their voices: tremor, quaver, pitch change or loss of volume. Moreover,
one in every hundred individuals over the age of 60 develops Parkinson
disease; many suffer from breathy and weak voices. Earlier studies,
led by Dr. Lorraine Ramig at the Denver Center for the Performing Arts,
proved the effectiveness of a behavioral therapy - LSVT® - on patients
with Parkinson disease.
The current investigation compares laryngeal muscle
activity in the elderly with that of young subjects and explores
the effectiveness of the LSVT® method on elderly patients with
voice problems not caused by Parkinson disease.
Phonation of Vocal Performers
Like star athletes or elite dancers, vocal artists must possess exceptional
skills and endurance beyond normal expectations. In this inquiry,
investigators at the Denver Center for the Performing Arts study
singers and actors to create a theory of the interrelationships among
lung pressure; vocal fold adduction, length, and motion; airflow
through the larynx; sound pressure level; and vocal tract shape and
resonance.
The study of performers reveals information important
to trainers of potentially-outstanding singers and actors. Just
as valuable, however, are discoveries for speech-language pathologists
who treat patients seeking rehabilitation of abnormal voice conditions.
Completed Projects
Exploring
Healthy Vocalization Levels in Musical Performers
John Nix, Project Coordinator; funding
from The National Academy of Recording Arts and Sciences
This project will explore the factors that cause
musical theater performers, opera singers and chorus members to
fatigue vocally. Objective measurements will be taken with a voice
dosimeter designed to collect and process in real-time the fundamental
frequency, intensity and voicing time of subjects from each of the
above groups during the pre-performance rehearsal period. Clinical
examinations will be provided at no cost and case studies will be
performed on a larger sampling of performers at the Denver Center
for the Performing Arts.
Physiology and Acoustics of Singing
II: New Directions
John Nix, Principal Investigator
The National Center for Voice and Speech is hosting the 2nd International
Conference on the Physiology and Acoustics of Singing, October 7-9,
2004. The conference is a unique scientific meeting where issues
of importance to researchers, clinicians, educators and practitioners
are presented and discussed. The presentations, poster papers and
discussion sessions address the most timely and important developments
in research and the application of research to educational, therapeutic
and performance settings. Cross disciplinary sharing is a hallmark
of this meeting, which seeks to close the gaps which may exist between
those who study the singing voice, those who treat the injured singer,
those who use singing as a therapeutic tool, those who teach singing
as an art, and those who do artistic singing. This grant includes
support for bringing six international experts in the field of voice
(Ingo Titze, Johan Sundberg, Thomas Cleveland, Harm Schutte, Sten
Ternström and Garyth Nair) to the conference, supporting the
attendance and participation of students, minorities and the disabled
at the conference, providing funds for documenting and disseminating
the proceedings of the conference, and gives partial support for
the costs of organizing the sessions.
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