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Hockey K, Kennedy E. Clinical Characteristics of Individuals Presenting to Physiotherapy for Voice and Throat Care: A Retrospective Case Notes Review. J Voice 2024:S0892-1997(24)00009-2. [PMID: 38429117 DOI: 10.1016/j.jvoice.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Currently, little is known about the characteristics of individuals presenting for physiotherapy care with voice and throat problems. PURPOSE The aim of this study is to describe the demographic and clinical characteristics of individuals presenting to physiotherapy for voice and throat-related problems, and to use this information to clarify the role of physiotherapy in the management of people with voice and throat problems. METHODS A retrospective clinical case notes review was conducted of all clients who accessed physiotherapy for voice and throat problems at a private practice based in Christchurch within a 12-month period from 1st October 2020 to 1st October 2021. RESULTS Data were analyzed from 53 patient charts. The typical profile of an individual accessing physiotherapy for voice and throat problems were female (n = 37), NZ European (n = 26), singer (n = 43), with chronic problems (n = 20), of a nontraumatic origin (n = 45). Voice problems were present in 39 cases and muscle-related problems were present in 42 cases. Treatment primarily included manual therapy and various modes of exercise therapy. CONCLUSIONS The clinical characteristics described offer insight into the demographic and clinical characteristics of individuals accessing physiotherapy services for voice and throat problems. A high prevalence of muscle-related problems and wider issues were identified, consistent with the physiotherapy skill set. Physiotherapy appears to complement existing ENT or SLT services by identifying and managing muscle-related voice problems and addressing wider factors contributing to voice and throat problems.
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Picciotti PM, Marchese MR, Longobardi Y, Oliveto G, Calò L, D'Alatri L. Combined treatment of muscle tension dysphonia: voice therapy with instrumental postural rehabilitation. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023:1-7. [PMID: 37224171 PMCID: PMC10366564 DOI: 10.14639/0392-100x-n2287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/22/2023] [Indexed: 05/26/2023]
Abstract
Objectives This investigation aimed to propose a new rehabilitation technique that combines voice exercises and instrumental postural rehabilitation for patients with muscle tension dysphonia (MTD). Methods We enrolled nine dysphonic patients (8 women and 1 man, aged 22-55 years). Voice assessment included strobovideolaryngoscopy, Maximum Phonation Time (MPT), perceptual evaluation by GRBAS scale and patient's self-rating by Italian version of the Voice Handicap Index (VHI). Vestibular function was evaluated by the Bed Side Examination and Video Head Impulse test (VHIT). Postural control was evaluated by Dynamic Posturography (DP) using the Sensory Organization Test (SOT) and analysing the Equilibrium Score (ES) and balance subsystems (somatosensorial, visual, vestibular). Results All cases underwent different types of voice exercises combined with balance training based on NeuroCom Balance Master Protocols, once a week for six 35-minutes sessions. After therapy, an improvement in MPT, VHI, GRBAS scores and endoscopic laryngeal features was obtained. DP results at baseline were normal and after therapy we showed a slight improvement of ES (somatosensorial and visual components). Conclusions A combined rehabilitation technique for MTD, by improving the attention to postural control, allows for significant improvement in vocal symptoms.
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Affiliation(s)
- Pasqualina Maria Picciotti
- Complex Unit of Otolaryngology, Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, "Agostino Gemelli" IRCCS, Rome, Italy
- Section of Otorhinolaryngology, University Department Head-Neck and Sense Organs, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Raffaella Marchese
- Complex Unit of Otolaryngology, Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, "Agostino Gemelli" IRCCS, Rome, Italy
| | - Ylenia Longobardi
- Complex Unit of Otolaryngology, Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, "Agostino Gemelli" IRCCS, Rome, Italy
| | - Giuseppe Oliveto
- Complex Unit of Otolaryngology, Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, "Agostino Gemelli" IRCCS, Rome, Italy
| | - Lea Calò
- Complex Unit of Otolaryngology, Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, "Agostino Gemelli" IRCCS, Rome, Italy
- Section of Otorhinolaryngology, University Department Head-Neck and Sense Organs, Catholic University of the Sacred Heart, Rome, Italy
| | - Lucia D'Alatri
- Complex Unit of Otolaryngology, Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, "Agostino Gemelli" IRCCS, Rome, Italy
- Section of Otorhinolaryngology, University Department Head-Neck and Sense Organs, Catholic University of the Sacred Heart, Rome, Italy
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Andriollo DB, Frigo LF, Cielo CA. Effect of Pompage on Vocal and Respiratory Measurements from Female Teachers: A Randomized Clinical Trial. Folia Phoniatr Logop 2023; 75:295-305. [PMID: 36812904 DOI: 10.1159/000529832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Teachers stand out among occupational groups due to their contribution to modern societies, and their voice is the main form of interaction. OBJECTIVE The aim of the study was to verify the changes in vocal and respiratory measurements from teachers with vocal and musculoskeletal complaints and with normal larynx after applying a musculoskeletal manipulation protocol of myofascial release using pompage. METHODS Controlled and randomized clinical trial with 56 participants: 28 teachers in the study group and 28 teachers in the control group. Anamnesis, videolaryngoscopy, hearing screening, sound pressure and maximum phonation time measurements, and manovacuometry were performed. The musculoskeletal manipulation protocol of myofascial release using pompage consisted of a total of 24 sessions, 40 min for each session, three times a week, for 8 weeks. RESULTS There was a significant improvement in the maximum respiratory pressure in the study group after the intervention. The sound pressure level and the maximum phonation time did not change significantly. DISCUSSION AND CONCLUSION Musculoskeletal manipulation protocol of myofascial release using pompage had a direct effect on the respiratory measurements from female teachers, significantly increasing the maximum respiratory pressure but without affecting sound pressure level and the /a/ maximum phonation time.
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Affiliation(s)
- Débora Bonesso Andriollo
- Programa de Pós-graduação em Fonoaudiologia, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Universidade Federal de Santa Maria, Santa Maria, Brazil
| | | | - Carla Aparecida Cielo
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Fonoaudiologia, Laboratório de Voz, Universidade Federal de Santa Maria, Santa Maria, Brazil
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Castillo-Allendes A, Delgado-Bravo M, Ponce AR, Hunter EJ. Muscle Activity and Aerodynamic Voice Changes at Different Body Postures: A Pilot Study. J Voice 2022:S0892-1997(22)00300-9. [PMID: 36273960 PMCID: PMC10924224 DOI: 10.1016/j.jvoice.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Body posture is a commonly discussed component of voice training and therapy. However, body postures, postural changes, related posturing muscle monitoring, and the potential changes in voice production (eg, glottal aerodynamic changes, acoustic differences) have been inconsistently described in the literature, leaving room for free interpretation and possible misunderstandings. The primary purpose of this pilot study was to compare the magnitude of electromyographical activation of muscles involved in phonation-breathing functions and their changes due to four standardized body postures in experienced singers. Secondly, to identify which body posture produces greater changes in aerodynamic parameters, vocal pitch, and loudness. METHODS Eight healthy adults with experience in singing voice performed a vocal task during different body postures commonly used in both voice training and therapy. A 3D-capture system was used to control and quantify the alignment of each posture. During the performances, surface electromyography (sEMG) was used to measure the muscular activity involved in the breathing/phonation and posture processes. A nonparametric Kruskal-Wallis test was used to compare the sEMG activity of phonatory muscles and aerodynamic voice variables between postures. RESULTS Our study did not reveal significant differences in sEMG activity, aerodynamic parameters, vocal pitch, and loudness among body postures during vocal task productions. However, the vocal pitch (in semitones) revealed significant differences in the unstable surface when compared to the upright posture, modified upright, and leaning postures. CONCLUSION The body postures selected did not generate voice aerodynamic modifications of the voice nor in the levels of activation of muscles involved in the phonation-breathing process in individuals with experience in singing voice. Modifications of body posture as a tool for voice therapy should be further investigated, considering the population with voice problems and no voice training experience.
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Affiliation(s)
- Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Mauricio Delgado-Bravo
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
| | - Alvaro Reyes Ponce
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago de Chile, Chile
| | - Eric J Hunter
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
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Colla CN, Andriollo DB, Cielo CA. Self-assessment of teachers with normal larynges and vocal and osteomuscular complaints. J Voice 2022:S0892-1997(22)00105-9. [PMID: 35570174 DOI: 10.1016/j.jvoice.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Teachers face vocal problems related to long periods of speech and increased sound pressure, as well as environmental noise, inadequate posture and tension of the cervical muscles. OBJECTIVE To verify the results of self-assessment of teachers with normal larynges and vocal and musculoskeletal complaints, and compare them with the reference values. METHODS Fifty-seven teachers, aged between 21 and 60 years (average 40.14 years) participated in the study. Anamnesis, otorhinolaryngological examination, hearing screening and self-assessment protocols were performed. RESULTS In the Nordic musculoskeletal questionnaire, the majority of teachers had discomfort in most parts of the body and in the situations evaluated; on the voice-related quality of life, the total and physical subscores were lower than the normative values while the emotional subscore was higher; regarding voice symptoms scale and vocal tract discomfort scale, the scores were higher than the normative values; in the hospital anxiety and depression scale, there was alteration in the total score; in the Vocal Activity and Participation Profile, the effects on work and emotion were above the normative values; on the University of Rhode Island change assessment-voice and on the voice handicap index there were no significant differences. CONCLUSION Most of the teachers presented vocal, musculoskeletal, and emotional complaints on the self-assessment results, what suggests excessive voice use as well as overload on the body muscles, including the larynx and vocal tract, and that they presented emotional changes. These aspects had an impact on their quality of life, but they showed no action in coping with the condition.
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Affiliation(s)
- Carla Nolasco Colla
- Speech Therapy Department, Voice Laboratory, Federal University of Santa Maria, Building 26E, Av. Roraima, 1000, Camobi, Santa Maria, Rio Grande do Sul 97105-900, Brazil.
| | | | - Carla Aparecida Cielo
- Department of Speech Therapy and at the Postgraduate Program in Human Communication Disorders, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
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Desjardins M, Apfelbach C, Rubino M, Verdolini Abbott K. Integrative Review and Framework of Suggested Mechanisms in Primary Muscle Tension Dysphonia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1867-1893. [PMID: 35446683 PMCID: PMC9559660 DOI: 10.1044/2022_jslhr-21-00575] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 05/26/2023]
Abstract
PURPOSE Despite the high prevalence of primary muscle tension dysphonia (MTD-1), its underlying mechanisms and their interrelationships have yet to be fully identified. The objectives of this integrative review were (a) to describe and classify the suggested underlying mechanisms for MTD-1, (b) to appraise the empirical evidence supporting each of the proposed mechanisms, and (c) to summarize the information in an integrative model. METHOD PubMed, Scopus, and CINAHL were searched for all publications pertaining to muscle tension dysphonia. Papers were retained if they included theoretical or empirical data pertaining to underlying mechanisms of MTD-1. A total of 921 papers initially qualified for screening, of which 100 remained for consideration in this review. Underlying mechanisms of MTD-1 were extracted using a consensus approach. RESULTS Seven broad categories of putative mechanisms involved in MTD-1 were identified: psychosocial, autonomic, sensorimotor, respiratory, postural, inflammatory, and neuromuscular. These categories were further divided into 19 subcategories detailed in the body of this review article. Based on the reviewed evidence, our proposed integrative model presents MTD-1 as an idiosyncratic motor adaptation to physiological perturbation or perceived threat. Under this model, physiologically or psychologically aversive stimuli can instigate a series of motor adaptations at multiple levels of the nervous system, ultimately disturbing muscle activation patterns and their biomechanical outcomes. Importantly, these adaptations appear to have the potential to become chronic even after threatening stimuli are withdrawn. CONCLUSIONS The proposed model highlights the importance of personalized rehabilitation in MTD-1 treatment. Limitations of the literature are discussed to provide guidance for future research aimed at improving our understanding of MTD-1. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19586065.
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Affiliation(s)
- Maude Desjardins
- Department of Communication Sciences & Disorders, University of Delaware, Newark
| | | | - Marianna Rubino
- Department of Communication Sciences & Disorders, University of Delaware, Newark
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Andriollo DB, Frigo LF, Cielo CA. Effect of pompage on pain, disability and craniocervical position of female teachers - Randomized clinical trial. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Education professionals are one of the most important occupational groups and represents one of the main parts of the economy of modern society. The vocal demands most mentioned by the teachers are talking while standing up, talking a lot and in a closed environment, which corresponds to the most frequent situations encountered in teaching. In addition, remaining in the standing position for a prolonged period may have repercussions on other systems and generate postural deviations, pain and reduced functionality. Objective: To verify changes in pressure pain threshold, in disability index and in craniocervical posture of female teachers with vocal and musculoskeletal complaints, and with normal larynx, after myofascial release - pompage. Methods: This study was a controlled and randomized clinical trial. The following procedures were performed: anamnesis, videolaryngoscopy, hearing screening, clinical and photogrammetric postural assessment using the SAPo® protocol, completion of the neck pain self-assessment protocol Neck Disability Index, and pain threshold in the cervical muscles using the Pain Pressure Threshold. Myofascial therapy with pompage had a total of 24 sessions of 40 min each, three times a week, in 28 teachers assigned to the study group (SG), and 28 to the control group (CG). Afterwards, the groups were reassessed. Results: The SG presented a significant improvement in the pain threshold of all the muscles evaluated, in the posture of most of the body segments evaluated, and in the cervical disability. In the CG there was a significant improvement in angle A2 after therapy. Conclusion: After myofascial release therapy with pompage, the subjects presented a reduction in cervical pain and in functional disability, an increase in pain threshold, and posture improvement.
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Associations between Teachers' Posture, Muscle Tension and Voice Complaints. J Voice 2020; 35:933.e23-933.e31. [PMID: 32178916 DOI: 10.1016/j.jvoice.2020.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The interaction between muscle tension, posture, and vocal use is very complex as clinical research suggests that abnormal laryngeal posture can be associated with muscle adaptive changes, although specific evidence concerning body posture and voice disorders has been lacking. Thus, the aim of this study was to verify if there were differences in posture, muscle tension and voice between teachers with and without voice complaints. STUDY DESIGN Cross-sectional study. METHODS Twenty-four teachers, 6 males and 18 females, were submitted to photogrammetry, muscle tension assessed trough palpation and algometry assessment. Aerodynamic assessment of voice, acoustic and auditory-perceptual analysis of voice were done. Participants were divided into without voice complaints group (WVCG; n = 11) and voice complaints group (VCG; n = 13) based on Sociodemographic and Clinical Questionnaire completion. RESULTS For auditory-perceptual analysis, VCG showed a significant higher values on GRBASH subscales Grade (p < 0.001) and Roughness (p = 0.011). The VCG showed statistically significant higher values on muscle tension of suprahyoids (p = 0.001), thyrohyoids (P = 0009) and cricothyroids muscles (p = 0.040) and statistically significant lower values on algometry of the cricothyroid (p = 0.023 left and p = 0.026 right), suprahyoids (p = 0.017 left & p = 0.018 right), thyrohyoids (p = 0.006 left and p = 0.007 right) and pharyngolaryngeal (p = 0.016 left and p = 0.021 right) muscles of both sides. Concerning the aerodynamic assessment of voice and acoustic analysis of voice, no statistically significant differences between the groups were found. CONCLUSIONS Findings indicated statistically significant differences in muscle tension in laryngeal intrinsic muscles and auditory-perceptual analysis between teachers with and without voice complaints.
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Forsyth AL, Joshi RY, Canning CG, Allen NE, Paul SS. Flexed Posture in Parkinson Disease: Associations With Nonmotor Impairments and Activity Limitations. Phys Ther 2019; 99:893-903. [PMID: 30830153 DOI: 10.1093/ptj/pzz033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/18/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND People with Parkinson disease (PD) are twice as likely to develop flexed truncal posture as the general older population. Little is known about the mechanisms responsible beyond associations with age, axial motor impairments, and disease severity. OBJECTIVE The objective was to explore: (1) the associations of the nonmotor impairments of PD with flexed posture, and (2) the relationships of flexed posture with activity limitations. DESIGN This was a cross-sectional study. METHODS Seventy people with PD participated. Posture was measured in standing as the distance between the seventh cervical vertebra and a wall. Nonmotor impairments (cognition, depression, pain, fatigue, and proprioception) and activity performance (upper limb activity, bed transfers, respiratory function, and speech volume) were variously assessed using objective measures and self-report questionnaires. Univariate and multivariate regression analyses were performed to ascertain relationships between nonmotor impairments and truncal posture, and between truncal posture and activities. RESULTS Greater disease severity, greater axial impairment, poorer spinal proprioception, greater postural fatigue, and male sex were significantly associated with flexed truncal posture. The multivariate model containing these factors in addition to age explained 30% of the variability in flexed truncal posture, with male sex and axial motor impairment continuing to make independent contributions. A significant association was found between greater flexed truncal posture and poorer upper limb activity performance and respiratory function. LIMITATIONS A limitation to this study was that participants had mild-to-moderate disease severity. CONCLUSIONS Spinal proprioception and postural fatigue were the only nonmotor impairments to make significant contributions to flexed posture. Given the negative influence of flexed posture on upper limb activity and respiratory function, interventions targeting spinal proprioception and postural awareness should be considered for people with PD who might develop flexed posture.
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Affiliation(s)
- Aimi L Forsyth
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney; and Lady Davidson Private Hospital, Sydney, Australia
| | - Riddhi Y Joshi
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Australia
| | - Natalie E Allen
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Australia
| | - Serene S Paul
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney NSW 2141, Australia
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Cardoso R, Lumini-Oliveira J, Meneses RF. Associations between Posture, Voice, and Dysphonia: A Systematic Review. J Voice 2019; 33:124.e1-124.e12. [DOI: 10.1016/j.jvoice.2017.08.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 11/28/2022]
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Franco D, Fragoso I, Andrea M, Teles J, Martins F. Somatotype and Body Composition of Normal and Dysphonic Adult Speakers. J Voice 2017; 31:132.e9-132.e21. [DOI: 10.1016/j.jvoice.2015.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
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