Voice Activity Limitation and Participation Restriction in the Teaching Profession: The Need for Preventive Voice Care
Yiu, Edwin M-L, Ma, Estella P-M, Journal of Medical Speech - Language Pathology
Teachers are prone to developing voice problems because of the specific occupational demand of teaching. Voice problems impose difficulties or limitations not only on their teaching activities but also on other daily voice activities. Activity limitation and participation restriction are two separate dimensions introduced in the International Classification of Impairments, Disabilities, and Handicaps by the World Health Organization (1997). Teachers with voice problems may face difficulties or limitations in their teaching activities. However, they may have little choice but to continue participating in these teaching activities. This study reports the extent of voice problems and their impact on 30 self-selected teachers enrolled for a workshop to improve their teaching voice. The findings show that job, daily communication, social communication, and emotion were all affected in the majority of the teachers. It also points to the need of implementing preventive voice care for the teaching profession.
Teachers are among the most common occupational groups that have a high demand on vocal use (Simberg, Laine, Sala, & Ronnemaa, 2000). They, therefore, are often placed at the high-risk group for voice problems (Fritzell, 1996; Russell, Oates, & Greenwood, 1998; Smith, Gray, Dove, Kirchner, & Heras, 1997; Smith, Lemeke, Taylor, Kirchner, & Hoffman, 1998). The prevalence rates of voice disorders in teachers reported vary from 2.7% (Brindle & Morris, 1979) to 13% (Urrutikoetxea, Ispizua, Matellanes, & Aurrekoetxea, 1995). These figures rose sharply to 73% (Sapir, Keidar, & Mathers-Schmidt, 1993) and 81% (Gotaas & Starr, 1993) when self-reported surveys were used. This range of figures suggests that the prevalence of voice problems is often underestimated or overestimated in the majority of studies in the teaching profession. The teaching profession reported in different countries constitutes between 16% and 34% of all the voice cases of speech pathologists: 16% in a Swedish report (Fritzell, 1996); 18% in a Hong Kong report (Yiu & Ho, 1991); 34% in a report from England (Comins, 1992). Information on these prevalence figures is abundant in the literature but little is known on how voice problems in the teaching profession impact on their quality of life. Although some researchers have investigated the impact of voice problems on quality of life (Smith et al., 1996) and particularly, work-related issues in teachers (Smith et al., 1997), there are no empirical data yet on how the teachers perceive the voice problems and how they react to these impacts. Such information is useful because health care workers can plan their services appropriately for this professional group in response to what and how different communicative activities are being affected by voice disorders.
Voice disorders can have significant negative impacts on occupational, social, psychological, physical, and communicative aspects (Smith et al., 1996). In fact, the extent of impact has been reported to be similar to that found in subjects with life-threatening problems, such as stroke and cancer (Smith et al., 1996). The most common consequences of voice problems reported were missing job (Smith et al., 1997; Smith et al., 1998); affecting job performance (Sapir et al., 1993; Smith, Lemke, Taylor, Kirchner, & Hoffman, 1998); affecting daily and social communication; and impacting on emotion (Ma & Yiu, 2001). These consequences are not merely determined by the severity of the voice problem; they are related to how an individual perceives, reacts, and adjusts to the voice problem (Ma & Yiu, 2001).
VOICE IMPAIRMENT, ACTIVITY LIMITATION, AND PARTICIPATION RESTRICTION IN THE TEACHING PROFESSION
The International Classification of Impairments, Disabilities, and Handicaps (ICIDH) (World Health Organization, 1980) defined impairment as the impact of bodily dysfunction. …