Perceptual Analysis

The GRBAS scale⁹ was completed, which gives scores from 0 to 3 for hoarseness (dysphonia grade), roughness, breathiness, asthenia, and vocal strain.¹⁰ Because parents, choir conductors, and school teachers would likely not be familiar with the GRBAS scale, we ensured that they understood the scale adequately through training and precise instructions. During the training, 2 speech pathologists (A.C.-P. and C.P.) explained the terms used in the GRBAS scale and provided special recordings presenting the examples of rough voice, hoarse voice, breathiness, asthenia, and vocal strain. Then the speech pathologists, together with parents and the choir conductors or school teachers, completed the GRBAS scale.