What Do We Know About Normals?

RLN gets all the attention-2.png

What is Normal?

Voice Rehabilitation depends on knowing to what degree we deviate from the norm. This helps us better understand what constitutes a disorder. A recent descriptive analysis was completed by Daniel Croake, Richard Andreatta and Joe Stemple looking at how the subsystems of voice (respiration, phonation and resonance) all interact in healthy normals.



“And of note, the best part of Fall Voice Conference 2019 was getting to chat with Dan Croake about this very blog and study.”


The Study

Stemple and team wanted to look at how the three subsystems interact and what makes that interaction normal. Breath, vocal cord vibration and the space in the throat, mouth and nose are all complex, as are their interactions to manipulate sound production.

So two questions arose:

1) Can we look at the subsystem patterns in vocally normal individuals to measure them and describe them

2) Can we make any more specific findings to describe regarding differences of physiologic nature

What Was Observed?

We know there is not one specific vocal subsystem balance situation that fits every human. 29 vocally healthy young people 21 of whom were women were included in this study. (I find this balance for the study funny because it is true to what is increasingly a more common finding of more voice disorders in females than males.) All were strobed, had acoustics taken, and aerodynamic measures taken.

Take Away

Findings were that 7 of the 9 things they measured, were different in a significant way. This is important because even among “normal” or what we see as normal, there were very different representations of it.

What is stunning about this study, is that we may feel that normal is constant or even predictable, but we really don’t know much about variables within the range of what is normal. Parts of the breathing and sound production system were strongly correlated, relationships were found between breathing and resonance as well. All their findings truly show that I will likely need to edit my current handouts about our 3 system model of phonation in a few years, but it will benefit our understanding of the systems.










Stemple and team suggest the model should reflect a more flexible view of vocalization regarding subglottic pressure and average airflow rate. Hard work from all who put this study together, thank you for always asking questions so we know more about how effectively we can help others for voice rehabilitation.

Study Credit:

Descriptive Analysis of the Interactive Patterning of the Vocalization Subsystems in Healthy Participants: A Dynamic Systems Perspective Daniel J. Croake , Richard D. Andreatta and Joseph C. Stemple Journal of Speech, Language, and Hearing Research, Vol. 62, No. 2, February 2019: 215-228.

Abstract | Full Text | PDF (260.8 KB KB)

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on voice science nationally. She is part of the Professional Development Committee for ASHA Special Interest Group 3, Voice and Upper Airway Disorders, and a member of the National Association of Teachers of Singing and the Pan-American Vocology Association. Knickerbocker blogs on her website at  www.atempovoicecenter.com. She has developed a line of kid and adult-friendly therapy materials specifically for voice on TPT or her website. Follow her on Pinterest, on Twitter and Instagram or like her on Facebook.


Follow Us On

We use cookies to personalize out websites of offering to your interests and for meaasurement and analytics purposes. By using our website and products, you agree to our use of cookies