Question

As part of a study we are asking speech therapists what they think the purpose of some functional assessment tasks are. The two I am investigating are:

• Getting the client to sing a simple song such as Happy Birthday.

• Getting the client to sustain the vowel /a/ – (not the MPT task).

My response

When assessing voice without the aid of instrumental measures this is known as perceptual assessment of voice. When conducted formally the investigator will follow a published protocol. An example of this is my own Clinical Voice Evaluation 2 (CVE2). Published originally in 2003 this was a Windows^® based software program designed to assist in the perceptual assessment of voice difficulties in both adults and children.

You can download a copy of the cut-down CVE2 Screening Assessment here:

I updated this program in 2008 to run on an MS Access^® database. The following screenshot is from this updated Clinical Voice Evaluation 3 (CVE3), which incorporates both perceptual and instrumental measurement of voice:

CVE3: Standard Assessment Screen (click for an enlarged image)

Assessment protocols such as these will typically incorporate the sorts of “functional assessment tasks” you are studying. As you infer, it is necessary for the practitioner to be clear about what data can legitimately be gleaned from each task. With regard to this, here are my thoughts on the two tasks you are investigating.

With this task I would be primarily listening for the following:

1. Resonance
2. Pitch
3. Loudness
4. Suprasegmental features (intelligibility, rate, pitch variation)
5. Adduction (hard attack)

However, as Happy Birthday – sung at a moderate tempo – takes about 20 seconds to complete, this is sufficient time for an experienced therapist to make several additional observations (if not, the client could always be asked to ‘sing it twice’). These might include:

• Breathing (method, breath support, audible breathing, inhalation phonation, phrasing)
• Posture (jaw tension, neck tension, shoulder tension)
• Motor speech (dysarthria, dyspraxia)

Unless this activity is audio recorded it may be too brief to give many insights into voice quality.

Similarly, I don’t think this activity is suitable for endurance testing, as it is unlikely to be either long enough or sufficiently vigorous.

The purpose of this task would be straightforwardly to gather data on (particularly) resonance, pitch, loudness and suprasegmental features to help build a vocal profile. It’s important to remember that this (like so much of what voice therapists do in their assessment sessions) is a performance task that is likely to invoke a reactive effect. If we are concerned with improving the speaking voice in naturalistic settings then we must treat any observations/findings from this task with caution.

With this task I would be primarily listening for the following:

1. Voice quality (grade, roughness, breathiness, asthenia, strain)

It is likely to be a relatively brief task and so, unless it is audio recorded so that it can be repeatedly listened to, it may not be possible to determine much else in real time. However, an experienced therapist should perhaps also be listening for the following:

2. Resonance
3. Pitch
4. Loudness

In addition, an experience therapist should perhaps also be making a number of observations, particularly the following (which may be noticeable in the client’s preparation for vowel production (e.g. s/he may take a deep, audible, clavicular in-breath and set the jaw in a rigid posture before phonating):

• Breathing (method, breath support, audible breathing, inhalation phonation, phrasing)
• Posture (jaw tension, neck tension, shoulder tension)

The purpose of this task would be primarily to gain some insights into voice quality (sustaining the long open vowel /a/ is one of the best methods for detecting variations in voice quality when relying solely on perceptual assessment). Again, of course, the same cautions must apply as indicated above: this is not a real-world activity and it is most certainly not spontaneous conversation.