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Batista DDJ, Duarte JMDT, Siqueira LTD, Almeida AA, Lopes LW, Ribeiro VV. Volitional and Non-volitional Devices Used in Voice Therapy and Training: A Scoping Review-Part A. J Voice 2023:S0892-1997(23)00348-X. [PMID: 38155057 DOI: 10.1016/j.jvoice.2023.10.027] [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: 07/31/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To map the volitional and non-volitional devices used by speech and language pathologists (SLPs) in voice training and therapy and characterize their use in research on voice interventions. METHODS This scoping review is the first part of a larger study. The electronic search was carried out by mapping the references in PubMed/Medline, LILACS/BVS, Scopus, Web of Science, EMBASE, and the Cochrane Library, and the manual search was carried out in the grey literature. Two blind independent reviewers selected and extracted data; divergences were solved by consensus. The data extracted in this part of the study were the authorship and year of publication, country, study design, sample characteristics, intervention modality, ingredient, target, mechanism of action, dosage, and outcome measures. They were addressed with descriptive analysis. RESULTS Publications that use devices as ingredients are mostly from the last two decades, mainly carried out in the United States of America and Brazil, in adults of both sexes with behavioral dysphonia. Forty-two types of devices were used, many of them with similar approaches but different nomenclatures. Most devices were used voluntarily, focusing on vocal function, and aiming to increase source and filter interaction. Most studies used silicone tubes. The most reported technical specification to apply the ingredient was surface electrodes on the neck. Device dosage was time-controlled, and the most used outcomes were self-assessment and acoustic analysis. CONCLUSION Devices are currently used as ingredients in vocal interventions, with a greater focus on increasing the source and filter interaction, associated with silicone tubes (the most used devices in these studies), which have been dosed with performance time. Outcomes were measured with self-assessment instruments.
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Affiliation(s)
- Denis de Jesus Batista
- Center for Exact and Natural Sciences, Postgraduate program in Decision Models and Health of Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil; Health Sciences Center, Associated Postgraduate Program in Speech-Language Pathology and Audiology at the Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte, and Universidade Estadual de Ciências da Saúde de Alagoas, João Pessoa, Paraíba, Brazil
| | - João M da Trindade Duarte
- Center for Human Sciences, Letters and Arts, Postgraduate program in Linguistics of Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | - Larissa T D Siqueira
- Department of Speech-Language Pathology and Audiology of the Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Anna A Almeida
- Health Sciences Center, Associated Postgraduate Program in Speech-Language Pathology and Audiology at the Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte, and Universidade Estadual de Ciências da Saúde de Alagoas, João Pessoa, Paraíba, Brazil; Department of Speech-Language Pathology and Audiology, Graduate Program in Linguistics, and Graduate Program in Decision Models and Health of the Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | - Leonardo W Lopes
- Health Sciences Center, Associated Postgraduate Program in Speech-Language Pathology and Audiology at the Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte, and Universidade Estadual de Ciências da Saúde de Alagoas, João Pessoa, Paraíba, Brazil; Department of Speech-Language Pathology and Audiology, Graduate Program in Linguistics, and Graduate Program in Decision Models and Health of the Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | - Vanessa V Ribeiro
- Health Sciences Center, Associated Postgraduate Program in Speech-Language Pathology and Audiology at the Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte, and Universidade Estadual de Ciências da Saúde de Alagoas, João Pessoa, Paraíba, Brazil; Faculty of Medicine, Speech-Language Pathology and Audiology course and the Postgraduate Program in Medical Sciences of the Universidade de Brasília, Brasília, Distrito Federal, Brazil.
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Bane M, Angadi V, Andreatta R, Stemple J. Effect of Clinical Expertise on Efficacy of Vocal Function Exercises in Individuals With Typical Voice. J Voice 2023:S0892-1997(23)00361-2. [PMID: 37996344 PMCID: PMC11111589 DOI: 10.1016/j.jvoice.2023.11.002] [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: 06/16/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES/HYPOTHESIS To determine the effect of clinical expertise on efficacy of Vocal Function Exercises (VFEs) as measured by change in percent of maximum phonation time goal attained. The hypothesis was that clinical expertise would result in greater increases in percent of maximum phonation time goal attained. STUDY DESIGN Randomized controlled trial. METHODS A convenience sample of 19 individuals with typical voice was recruited in a university academic clinic setting. All participants completed baseline assessment and 17 completed all study procedures. Participants were randomized to receive VFEs from an expert voice clinician with more than 40 years' experience (expert group (EG)) or from a master's student in Communication Sciences and Disorders trained in VFEs (novice group (NG)). The primary outcome measure was change in percent of maximum phonation time goal attained during VFE tasks 1 and 4. RESULTS Mean change scores for maximum phonation time were 27.71 (P = 0.001) and 25.31 (P = 0.003) for EG and NG, respectively. Both groups improved significantly on the primary outcome measure, but the difference between groups was not statistically significant (P = 0.759). A Hedges'-g effect size of -0.14 [-1.10, 0.81] was obtained comparing EG and NG groups, indicating a small negative effect of limited clinical expertise on VFE outcomes in individuals with typical voice. CONCLUSIONS Speech-language pathologists with varied levels of expertise are capable of efficaciously administering VFEs in individuals with typical voice.
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Affiliation(s)
- Maria Bane
- University of Kentucky Department of Communication Sciences and Disorders, 900 South Limestone, Lexington, Kentucky 40536.
| | - Vrushali Angadi
- University of Kentucky Department of Communication Sciences and Disorders, 900 South Limestone, Lexington, Kentucky 40536
| | - Richard Andreatta
- University of Kentucky Department of Communication Sciences and Disorders, 900 South Limestone, Lexington, Kentucky 40536
| | - Joseph Stemple
- University of Kentucky Department of Communication Sciences and Disorders, 900 South Limestone, Lexington, Kentucky 40536
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Boominathan P, Mahalingam S, Arunachalam R, Venkatesh L. An eclectic Voice Therapy Program for the Treatment of Hyperfunctional Voice Disorders (HFVD). J Voice 2023; 37:969.e1-969.e21. [PMID: 34261583 DOI: 10.1016/j.jvoice.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE An eclectic voice therapy program includes sequenced and structured set of exercises combining direct and indirect intervention methods. Tailor-made exercise prescription with specific cultural adaptations are needed to provide a holistic change to voice quality.1 This study detailed the construction of an exercise prescription for participants with hyperfunctional voice disorder [HFVD] in the Indian context. METHOD The exercise program was developed based on literature related to vocal therapy approaches and delivery methods. Adaptations were introduced to a selected set of exercises. Five voice experts verified the exercises and their prescription for content and feasibility of use in the Indian context. Modification suggested by the experts were included for framing the final version of the exercise program. This structured therapy program was planned for 6 weeks (30 minutes duration/session offered individually twice per week, with a gap of two days between sessions in a week) with the goals to improve voice quality, flexibility, and endurance while speaking. Five participants with HFVD partook in the study for pilot testing. Stroboscopy, perceptual voice analysis, Dysphonia Severity Index (DSI) and Vocal Fatigue Index in Tamil (VFI-T) were used to report the therapy outcomes. Participants' report on the learning process and generalization of the program were documented. Wilcoxon-signed rank test was used to test the pre-post outcome measures. RESULTS An eclectic voice therapy program, i.e., Comprehensive Voice Habilitation Program [CVHP] was constructed and it included vocal hygiene instructions, warm-up & cool-down, easy onset, resonant voice, and carry over exercises. Participants completed the program in 14-18 sessions (over 7 to 9 weeks of therapy). All participants showed significant changes in vocal fold movement patterns, reduction in ventricular hyperadduction, overall grade of voice quality, DSI and VFI-T. Participants reported that pictorial illustrations, feedback, and monitoring sheets were useful in learning the exercises. CONCLUSION CVHP showed significant change in the voice-related outcome measures and was a viable program for treating HFVD.
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Affiliation(s)
- Prakash Boominathan
- Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India.
| | - Shenbagavalli Mahalingam
- Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
| | - Ravikumar Arunachalam
- SRM Institute of Science & Technology, Kattankulathur, Chengalpattu, Tamil Nadu, India
| | - Lakshmi Venkatesh
- Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
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Bane M, Angadi V, Andreatta R, Stemple J. The Effect of Maximum Phonation Time Goal on Efficacy of Vocal Function Exercises. J Voice 2023:S0892-1997(23)00098-X. [PMID: 37105793 PMCID: PMC10598240 DOI: 10.1016/j.jvoice.2023.03.009] [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: 01/06/2023] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES/ HYPOTHESIS To determine the effect of maximum phonation time goal on efficacy of Vocal Function Exercises (VFEs) as measured by percent of maximum phonation time goal attained. The hypothesis was that provision of a maximum phonation time goal would result in greater increases in percent of maximum phonation time goal attained. STUDY DESIGN Randomized controlled trial. METHODS A convenience sample of individuals with normal voice were recruited in a university academic clinic setting. Of 34 participants who volunteered for the study, 28 completed baseline assessment and 19 completed all study procedures. Participants were randomized to complete VFEs with knowledge of their maximum phonation time goal (standard goal, SG), with knowledge of their maximum phonation time goal after three weeks (delayed goal, DG), or without knowledge of their maximum phonation time goal (no goal, NG). The primary outcome measure was percent of maximum phonation time goal obtained during VFE tasks one and four. RESULTS Mean change scores for maximum phonation time were 32.50 (SG), 34.55 (DG), and 21.02 (NG). Hedges' g effect sizes of -0.10 (-1.19, 0.99) and 0.56 (-0.55, 1.67) were obtained comparing DG and SG groups, and NG and SG groups, respectively. CONCLUSIONS Absence of maximum phonation time goal attenuates VFE efficacy; maximum phonation time goal is an active ingredient within VFEs.
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Affiliation(s)
- Maria Bane
- Department of Communication Sciences and Disorders, University of Kentucky, 900 South Limestone, Lexington, KY 40536.
| | - Vrushali Angadi
- Department of Communication Sciences and Disorders, University of Kentucky, 900 South Limestone, Lexington, KY 40536
| | - Richard Andreatta
- Department of Communication Sciences and Disorders, University of Kentucky, 900 South Limestone, Lexington, KY 40536
| | - Joseph Stemple
- Department of Communication Sciences and Disorders, University of Kentucky, 900 South Limestone, Lexington, KY 40536
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Nascimento A, Korn GP, Sacaloski M, Azevedo RR. Effects of Mechanical Vibration Stimulation of the Larynx on Voice Production. J Voice 2023; 37:291.e11-291.e19. [PMID: 33495035 DOI: 10.1016/j.jvoice.2020.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Combining mechanical vibration stimulation with resistance training to improve neuromuscular performance is a method that has gained popularity in the field of sports sciences. PURPOSE To evaluate the immediate and mid-term effects of mechanical vibration stimulation (G-Life NL3000) of the larynx associated to vocal exercises. METHOD Fourteen professional voice users divided into: Experimental Group - Seven participants who performed a 20-minute exercise protocol with humming applying mechanical vibration stimulation (G-Life NL3000) of the larynx once a day for 30 days; Control Group - Seven participants who performed only the 20-minute exercise protocol with humming. For comparison purposes, the evaluation was carried out pre-stimulation, immediately after simulation (post) and 30 days after stimulation (late-post). RESULTS The Experimental Group showed a statistically significant progress in the post-immediate evaluation and in the post-treatment evaluation for maximum phonation time (*P = < 0.001), Jitter (*P = 0.008), Shimmer (*P = 0.005), noise-to-harmonics ratio (*P = 0.005). In the GRBASI scale, the Experimental Group showed significant results in the post-treatment evaluation for Grade (*P = 0.005), Roughness (*P = 0.008), Breathiness (*P = 0.018) and Instability (*P = 0.018). A self-perception voice questionnaire showed better voice quality (*P= 0.031) and easier phonation (*P = 0.005) in the Experimental Group. CONCLUSION Mechanical vibration stimulation of the larynx associated to humming produced positive changes in the vocal pattern and significantly improvement in short and mid-term vocal quality for participants in this study.
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Affiliation(s)
- Anderson Nascimento
- Department of Speech Therapy - Faculdades Metropolitanas Unidas (FMU) - Campus Santo Amaro - Av. Santo Amaro, 1239 - Vila Nova Conceição - 04505-002, São Paulo-SP, Brasil.
| | - Gustavo Polacow Korn
- Department of Otorhinolaryngology and Head and Neck Surgery - Universidade Federal de São Paulo (UNIFESP) - Rua Pedro de Toledo, 947 - Térreo - Vila Clementino - CEP 04039-032, São Paulo, Brasil
| | - Marisa Sacaloski
- Department of Speech Therapy - Faculdades Metropolitanas Unidas (FMU) - Campus Santo Amaro - Av. Santo Amaro, 1239 - Vila Nova Conceição - 04505-002, São Paulo-SP, Brasil; Campus Santo Amaro -, São Paulo -SP, Brasil
| | - Renata Rangel Azevedo
- Department of Speech Therapy - Universidade Federal de São Paulo (UNIFESP) - Rua Botucatu, 802 - Vila Clementino - CEP 4023900 - São Paulo- SP, Brasil
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Antonetti AEDS, Vitor JDS, Guzmán M, Calvache C, Brasolotto AG, Silverio KCA. Efficacy of a Semi-Occluded Vocal Tract Exercises-Therapeutic Program in Behavioral Dysphonia: A Randomized and Blinded Clinical Trial. J Voice 2023; 37:215-225. [PMID: 33413982 DOI: 10.1016/j.jvoice.2020.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE Semi-occluded vocal tract exercises (SOVTE) may improve the source and filter interaction by changing the acoustic characteristics and the impedance of the vocal tract, both in dysphonic and vocally healthy populations. However, there are a few studies that verify the effects of these exercises in a clinical trial. Thus, this study's purpose was to analyze the effectiveness of the SOVTE-Therapeutic Program (SOVTE-TP) in vocal quality and self-assessment, comparing it with Vocal Function Exercises. METHOD Eighteen (eight men; 10 women), ages 18-50, with behavioral dysphonia participated in this randomized and blinded clinical trial. The participants were equally randomized into two groups: Experimental Group and Vocal Function Exercises Group. They were assessed at three moments: before the treatment, after finishing it, and one month after finishing the treatment--follow up. Acoustic measures (ie, fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, cepstral peak-smoothed, alpha ratio, and L1-L0), auditory-perceptual analysis, vocal fatigue index (VFI), self-perceived resonant voice, and vocal handicap index-30 (VHI-30) were measured at all assessment moments. For the two groups, the interventions happened twice per week (four weeks) and lasted 35 minutes. It was applied the repeated-measures ANOVA test (P< 0.05) and Tukey Test. RESULTS The acoustic measures and auditory-perceptual had no differences between the groups and moments, respectively, which means that SOVTE-TP did not cause any harm. The auditory-perceptual analysis showed a mild deviation of participants' vocal quality. All groups reduced the VFI and VHI-30 scores in M2 and kept these results at M3 also, the vocal economy sensation increased in M2, decreasing slightly in M3. CONCLUSION SOVTE-TP has positive effects regarding self-assessment (VFI, VHI, and resonant voice quality) on patients with mild behavioral dysphonia, and it provides the same effects as VFE.
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Affiliation(s)
- Angélica Emygdio da Silva Antonetti
- Speech-Language Pathology and Audiology Department at Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brazil.
| | | | - Marco Guzmán
- Department of Communication Sciences and Disorders at Universidad de los Andes, Santiago, Chile
| | - Carlos Calvache
- Master, professor at the Department fo Communication Sciences and Disorders at Corporación Universitária Iberoamericana and Vocology Center, Bogotá, Colombia
| | - Alcione Ghedini Brasolotto
- Speech-Language Pathology and Audiology Department at Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brazil
| | - Kelly Cristina Alves Silverio
- Speech-Language Pathology and Audiology Department at Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brazil
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Bane M, Morton M, Angadi V, Andreatta R, Stemple J. Vocal Function Exercises With and Without Maximally Sustained Phonation: A Randomized Controlled Trial of Individuals With Normal Voice. J Voice 2022:S0892-1997(22)00317-4. [PMID: 36379827 PMCID: PMC10175512 DOI: 10.1016/j.jvoice.2022.10.012] [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: 08/19/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine the effect of maximally sustained phonation on efficacy of Vocal Function Exercises as measured by percent of maximum phonation time goal attained. The hypothesis was that maximally sustained phonation would result in greater improvements in percent of maximum phonation time goal attained. STUDY DESIGN Randomized controlled trial. METHODS A convenience sample of individuals with normal voice were recruited in a university academic clinic setting. Of 34 participants who volunteered for the study, 31 completed baseline assessment and 23 completed all study procedures. Participants were randomized to complete Vocal Function Exercises (traditional group TG), modified Vocal Function Exercises with reduced requirement for maximally sustained phonation (midpoint group MG), or modified Vocal Function Exercises with removed requirement for maximally sustained phonation (baseline group BG). The primary outcome measure was percent of maximum phonation time goal obtained during Vocal Function Exercises. RESULTS The MG (p = 0.008) and TG (p = 0.001) groups significantly improved percent of maximum phonation time goal attained after six weeks of exercise, while the BG group (p = 0.0202) did not (ɑ = 0.0125). Difference among groups was not statistically significant (p = 0.67, ɑ = 0.0125). Hedges' g effect sizes of 0.29 (-0.66, 1.25) and 0.51 (-0.57, 1.58) were obtained comparing MG and TG groups, and BG and TG groups, respectively. CONCLUSIONS Greater requirements for maximally sustained phonation improved efficacy of Vocal Function Exercises in enhancing normal voice as measured by percent of maximum phonation time goal attained. Maximally sustained phonation may be modified to some extent while preserving efficacy of Vocal Function Exercises, however complete elimination of maximally sustained phonation may attenuate improvement. Additional research in a clinical population is warranted.
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Affiliation(s)
- Maria Bane
- University of Kentucky Department of Communication Sciences and Disorders, Lexington, Kentucky.
| | - Mariah Morton
- University of Kentucky Department of Communication Sciences and Disorders, Lexington, Kentucky
| | - Vrushali Angadi
- University of Kentucky Department of Communication Sciences and Disorders, Lexington, Kentucky
| | - Richard Andreatta
- University of Kentucky Department of Communication Sciences and Disorders, Lexington, Kentucky
| | - Joseph Stemple
- University of Kentucky Department of Communication Sciences and Disorders, Lexington, Kentucky
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Santana ÉR, Lopes L, de Moraes RM. Recognition of the Effect of Vocal Exercises by Fuzzy Triangular Naive Bayes, a Machine Learning Classifier: A Preliminary Analysis. J Voice 2022:S0892-1997(22)00307-1. [PMID: 36376192 DOI: 10.1016/j.jvoice.2022.10.001] [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: 06/21/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Machine learning (ML) methods allow the development of expert systems for pattern recognition and predictive analysis of intervention outcomes. It has been used in Voice Sciences, mainly to discriminate between healthy and dysphonic voices. Parameter patterns of vocal acoustic analysis and vocal perceptual assessment can be evaluated by ML classifiers, such as the Fuzzy Triangular Naive Bayes (FTriangNB), after using techniques that improve the vocal quality of individuals with healthy or dysphonic voices. Thus, the goal of this study was to analyze the performance of the FTriangNB to detect patterns in the acoustic parameters and the auditory-perceptual assessment of 12 women with dysphonia and 12 vocally healthy women, after performing three vocal exercises (tongue trills, semi-occluded vocal tract exercise with a high-resistance straw - SOVTE, and over-articulation). METHODS The FTriangNB classifier contained in the Fuzzy Class package was implemented in the data analysis software R Studio version 1.4.1106 for Macintosh. The confusion matrix was extracted, as well as the accuracy, the Kappa coefficient, and the class statistics. The final result was compared with those generated by FTriangNB with the same variables from the preapplication database of the exercises. RESULTS The FTriangNB presented good accuracy (87.5%) and Kappa coefficient (81.3%), and showed almost perfect agreement after application of the exercises, while the results before the application of the exercises demonstrated accuracy without acceptable discrimination capacity (33.3%) and Kappa coefficient with a poor agreement (-6.67%). The Semioccluded Vocal Tract Exercises (SOVTE) with high strength straw presented with a sensitivity and Negative Predictive Value (NPV) of value 1 (one), and the over-articulation's specificity and Positive Predictive Value (PPV) also showed a value of 1 (one). CONCLUSIONS The FTriangNB showed great accuracy in recognizing the effect of vocal exercises. Exploratory studies with larger samples using FTriangNB, as well as other Machine Learning classifiers should be further carried out for this purpose in the Voice Science to enable inferences.
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Affiliation(s)
- Émile Rocha Santana
- Department of Life Sciences, Collegiate of Speech Language and Hearing Sciences, State University of Bahia, UNEB, Departamento de Ciências da Vida I, Colegiado de Fonoaudiologia. Salvador 41150-000, Bahia, Brazil; Department of Statistics, Graduate Program in Decision Models and Health of the Federal University of Paraíba (UFPB), Campus I, Centro de Ciências Exatas e da Natureza, Departamento de Ciências Exatas. João Pessoa 58051-900, Paraíba, Brazil.
| | - Leonardo Lopes
- Department of Speech Therapy, Federal University of Paraíba, UFPB, Campus I, Centro de Ciências da Saúde, Departamento de Fonoaudiologia, Cidade Universitária, João Pessoa 58051-900, Paraíba, Brazil.
| | - Ronei Marcos de Moraes
- Department of Statistics, Graduate Program in Decision Models and Health of the Federal University of Paraíba (UFPB), Campus I, Centro de Ciências Exatas e da Natureza, Departamento de Ciências Exatas. João Pessoa 58051-900, Paraíba, Brazil.
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Siqueira LTD, Vitor JDS, Brasolotto AG, de Andrade EC, Silverio KCA. Can Vocal Therapy With Transcutaneous Electrical Nerve Stimulation (TENS) Followed by Vocal Exercises Reduce Benign Laryngeal Lesions in Dysphonic Women?: Randomized, Blind Clinical Trial. J Voice 2022:S0892-1997(22)00238-7. [PMID: 36068131 DOI: 10.1016/j.jvoice.2022.08.006] [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: 05/24/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the effectiveness of vocal therapy with the use of low-frequency transcutaneous electrical nerve stimulation (TENS) followed by voice exercises on vocal fold lesion size, vocal quality and quality of life in dysphonic women. METHODS 27 women with vocal nodules participated, randomized into to: experimental group (EG)-13 women who received vocal therapy with 12 sessions of 20 min of TENS application (pulse:200μs, frequency:10Hz, motor threshold intensity, electrodes positioned in the trapezius muscle [descending fibers and submandibular region, bilaterally]). Each TENS session was followed by 30 min of vocal exercises; and the Control Group (CG)- 14 women who received 12 sessions with 20 min of application of placebo TENS (same conditions EG, but without receiving the stimulus electric), followed by 30 min of vocal exercise. Before, immediately after and one month after vocal therapy, participants underwent vocal recording for acoustic analysis, vocal self-assessment, laryngological examination and answered voice-related quality of life (V-RQOL) protocol. RESULTS There was reduction in the size of vocal fold lesions only in the EG, immediately after treatment and one month after treatment. Acoustic analysis showed decreases in SPI values immediately after and one month after treatment in both groups. There was improvement in voice self-perception in both groups after treatment and one month after, but no significant difference in V-RQOL values. CONCLUSION TENS followed by vocal exercises produced results similar to vocal therapy without TENS regarding voice quality, self-perception and quality of life in voice. However, vocal therapy with low-frequency TENS followed by vocal exercise was effective in reducing vocal fold lesion size in dysphonic women.
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Affiliation(s)
- Larissa Thaís Donalonso Siqueira
- Speech-Language Pathology and Audiology Department, Universidade Federal do Rio Grande do Norte, Rua General Cordeiro de Faria, s/n - Petrópolis, Natal, Rio Grande do Norte 59012-570, Brazil.
| | - Jhonatan da Silva Vitor
- Speech Language-Pathologist, Bauru School of Dentistry, São Paulo College, São Paulo, Brazil
| | - Alcione Ghedini Brasolotto
- Speech-Language Pathology and Audiology Department, Bauru School of Dentistry, São Paulo College, Bauru, São Paulo, Brazil
| | | | - Kelly Cristina Alves Silverio
- Speech-Language Pathology and Audiology Department, Bauru School of Dentistry, São Paulo College, Bauru, São Paulo, Brazil
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10
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Behlau M, Almeida AA, Amorim G, Balata P, Bastos S, Cassol M, Constantini AC, Eckley C, Englert M, Gama ACC, Gielow I, Guimarães B, Lima LR, Lopes L, Madazio G, Moreti F, Mouffron V, Nemr K, Oliveira P, Padovani M, Ribeiro VV, Silverio K, Vaiano T, Yamasaki R. Reducing the gap between science and clinic: lessons from academia and professional practice - part B: traditional vocal therapy techniques and modern electrostimulation and photobiomodulation techniques applied to vocal rehabilitation. Codas 2022; 34:e20210241. [PMID: 36000681 PMCID: PMC9886189 DOI: 10.1590/2317-1782/20212021241pt] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023] Open
Abstract
This text is the continuation of the XVIII SBFa Congress publication. In part "A" we presented the analyses on clinical vocal evaluation. Part "B" focuses on vocal rehabilitation: 4. Traditional techniques of vocal therapy; 5. Modern techniques of electrostimulation and photobiomodulation applied to vocal rehabilitation. The numerous studies on the various programs, methods, and techniques of traditional rehabilitation techniques, and many with high quality of evidence, allow us to consider such procedures relatively well described, safe, and with known effects, accounting for the treatment of various vocal disorders. The scientific evidence with traditional techniques is recognized worldwide. New fronts of evolution, with electrostimulation or photobiomodulation used to handle voice problems, seem to be promising as coadjutant approaches. There are more studies on electrostimulation in vocal rehabilitation than with photobiomodulation; however, scientific evidence for these two modern techniques is still limited. Knowledge and caution are required for the application of either technique.
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Affiliation(s)
- Mara Behlau
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.,Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP - São Paulo (SP), Brasil.
| | - Anna Alice Almeida
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.,Universidade Federal da Paraíba – UFPB - João Pessoa (PB), Brasil.
| | - Geová Amorim
- Universidade Federal de Alagoas – UFAL - Maceió (AL), Brasil.
| | - Patrícia Balata
- Apta Comunicação, Recife (PE), Brasil.,Universidade Federal de Pernambuco – UFPE - Recife (PE), Brasil.
| | - Sávio Bastos
- Centro de Fotobiomodulação e Saúde – CFOTOBIOS - Belém (PA), Brasil.
| | - Mauriceia Cassol
- Universidade Federal de Ciências da Saúde de Porto Alegre – UFCSPA - Porto Alegre (RS), Brasil.
| | | | - Claudia Eckley
- Faculdade de Ciências Médicas da Santa Casa de São Paulo – FCMSCSP - São Paulo (SP), Brasil.
| | - Marina Englert
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
| | | | - Ingrid Gielow
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
| | - Bruno Guimarães
- Clínica Bruno Guimarães Serviços de Fonoaudiologia e Fisioterapia, Fortaleza (CE), Brasil.
| | | | - Leonardo Lopes
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.,Universidade Federal da Paraíba – UFPB - João Pessoa (PB), Brasil.
| | | | - Felipe Moreti
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.,Centro Universitário da Faculdade de Medicina do ABC – FMABC - Santo André (SP), Brasil.,Complexo Hospitalar Municipal de São Bernardo do Campo – CHMSBC - São Bernardo do Campo (SP), Brasil.
| | - Vanessa Mouffron
- Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
| | - Katia Nemr
- Universidade de São Paulo – USP - São Paulo (SP), Brasil.
| | | | - Marina Padovani
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.,Faculdade de Ciências Médicas da Santa Casa de São Paulo – FCMSCSP - São Paulo (SP), Brasil.
| | - Vanessa Veis Ribeiro
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.,Universidade Federal da Paraíba – UFPB - João Pessoa (PB), Brasil.
| | - Kelly Silverio
- Faculdade de Odontologia de Bauru, Universidade de São Paulo – USP - Bauru (SP), Brasil.
| | - Thays Vaiano
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
| | - Rosiane Yamasaki
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.,Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP - São Paulo (SP), Brasil.
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11
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Behlau M, Almeida AA, Amorim G, Balata P, Bastos S, Cassol M, Constantini AC, Eckley C, Englert M, Gama ACC, Gielow I, Guimarães B, Lima LR, Lopes L, Madazio G, Moreti F, Mouffron V, Nemr K, Oliveira P, Padovani M, Ribeiro VV, Silverio K, Vaiano T, Yamasaki R. Reducing the gap between science and clinic: lessons from academia and professional practice - part B: traditional vocal therapy techniques and modern electrostimulation and photobiomodulation techniques applied to vocal rehabilitation. Codas 2022. [DOI: 10.1590/2317-1782/20212021241en] [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 This text is the continuation of the XVIII SBFa Congress publication. In part “A” we presented the analyses on clinical vocal evaluation. Part “B” focuses on vocal rehabilitation: 4. Traditional techniques of vocal therapy; 5. Modern techniques of electrostimulation and photobiomodulation applied to vocal rehabilitation. The numerous studies on the various programs, methods, and techniques of traditional rehabilitation techniques, and many with high quality of evidence, allow us to consider such procedures relatively well described, safe, and with known effects, accounting for the treatment of various vocal disorders. The scientific evidence with traditional techniques is recognized worldwide. New fronts of evolution, with electrostimulation or photobiomodulation used to handle voice problems, seem to be promising as coadjutant approaches. There are more studies on electrostimulation in vocal rehabilitation than with photobiomodulation; however, scientific evidence for these two modern techniques is still limited. Knowledge and caution are required for the application of either technique.
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Affiliation(s)
- Mara Behlau
- Centro de Estudos da Voz, Brasil; Universidade Federal de São Paulo, Brasil
| | - Anna Alice Almeida
- Centro de Estudos da Voz, Brasil; Universidade Federal da Paraíba, Brasil
| | | | - Patrícia Balata
- Apta Comunicação, Brasil; Universidade Federal de Pernambuco, Brasil
| | | | - Mauriceia Cassol
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil
| | | | - Claudia Eckley
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brasil
| | | | | | | | - Bruno Guimarães
- Clínica Bruno Guimarães Serviços de Fonoaudiologia e Fisioterapia, Brasil
| | | | - Leonardo Lopes
- Centro de Estudos da Voz, Brasil; Universidade Federal da Paraíba, Brasil
| | | | - Felipe Moreti
- Centro de Estudos da Voz, Brasil; Centro Universitário da Faculdade de Medicina do ABC, Brasil; Complexo Hospitalar Municipal de São Bernardo do Campo, Brasil
| | | | | | | | - Marina Padovani
- Centro de Estudos da Voz, Brasil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brasil
| | | | | | | | - Rosiane Yamasaki
- Centro de Estudos da Voz, Brasil; Universidade Federal de São Paulo, Brasil
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12
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Souza EVS, Bassi IB, Gama ACC. Voice amplifier: effects on dose and vocal intensity of teachers without dysphonia. Codas 2021; 33:e20200091. [PMID: 34431858 DOI: 10.1590/2317-1782/20202020091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/06/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Analyze the interference of using the voice amplifier in vocal dose of non-dysphonic teachers. METHODS This is an experimental study comparing people from the same ambience compound for 20 teachers from municipal elementary school in Belo Horizonte/MG. After consent, the participants were requested to answer the vocal symptom scale questionnaire (ESV) and later participated in two different moments of the study, for which they randomly selected. In the first moment, the participants used only the vocal dosimeter and in the second, they used the vocal dosimeter and the voice amplifier. The measurements were recorded by the device for 1h40m, in the classroom that the teachers taught. The time between the two measurements was one week, with the same room, the same time and the same discipline being taught, at both times. RESULTS The intensity parameter was the only one that showed difference with the use of the voice amplifier. CONCLUSION Use voice amplification while non-dysphonic teachers are teaching doesn't affect the fundamental frequency and vocal dose measure in the acoustics parameters. The vocal intensity is smaller when teacher uses the vocal amplification.
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Affiliation(s)
- Evelyn Vanessa Silva Souza
- Programa de Pós-graduação em Ciências Fonoaudiológicas, Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
| | | | - Ana Cristina Côrtes Gama
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte, MG, Brasil
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13
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Cardoso R, Meneses RF, Lumini-Oliveira J, Pestana P. Myofascial Release Effects in Teachers' Posture, Muscle Tension and Voice Quality: A Randomized Controlled Trial. J Voice 2021:S0892-1997(21)00119-3. [PMID: 34024696 DOI: 10.1016/j.jvoice.2021.03.029] [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: 12/07/2020] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Myofascial release (MFR) comprises a set of manual therapeutic techniques applied to many conditions, but specific evidence concerning its effects on body posture, muscle tension and voice has been lacking. Thus, the aim of this study was to verify the effects of MFR in teachers' posture, muscular tension and voice quality. STUDY DESIGN Randomized controlled trial - crossover. METHODS Twenty-four teachers, after completing a Sociodemographic and Clinical Questionnaire and providing written informed consent, were randomly distributed into two groups designated Group 1 (G1; n = 12; received MFR first) and Group 2 (G2; n = 12; belong to control group first). All participants received treatment and were into control group, since, after a 14 day period, procedures were switched between groups. Photogrammetry, muscle tension assessed through palpation, algometry, aerodynamic assessment of voice, acoustic and auditory-perceptual analysis of voice were performed before and after interventions. RESULTS Regarding voice, statistically significant differences were found when intervention was applied to both groups for maximum phonation time (MPT) (G1 P = 0.019; G2 P = 0.004). The acoustic variables did not differ. Concerning the auditory-perceptual analysis of voice statistically significant differences were found when intervention was applied in both groups for Grade in G2 (P = 0.046) and for Roughness in G1 (P = 0.025). Regarding the photogrammetry assessment statistically significant differences were found when intervention was applied to both groups in many parameters while as control group they did not. Concerning the algometry and muscle tension assessed through palpation statistically significant differences were found when intervention was applied in all muscles. CONCLUSIONS Findings indicated that MFR seems to be an effective therapy in improving MPT, two subscales (Grade and Roughness) of the GRABASH scale, muscle tension assessed through palpation and algometry. Regarding photogrammetry, MFR had an immediately effect in improvement of the posture, especially related with head.
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Affiliation(s)
- Ricardo Cardoso
- Fernando Pessoa University, Porto, Portugal; Transdisciplinary Center of Consciousness Studies of Fernando Pessoa University, Porto, Portugal.
| | - Rute F Meneses
- Fernando Pessoa University, Porto, Portugal; Transdisciplinary Center of Consciousness Studies of Fernando Pessoa University, Porto, Portugal; Longevity and Development Observatory of Fernando Pessoa University, Porto, Portugal
| | - José Lumini-Oliveira
- Fernando Pessoa University, Porto, Portugal; CIAFEL - Research Centre in Physical Activity, Health and Leisure, Porto University, Porto, Portugal; LABIOMEP - Porto Biomechanics Laboratory, Porto University, Porto
| | - Pedro Pestana
- Fernando Pessoa University, Porto, Portugal; PMP terapia, Esposende, Portugal
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14
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Van Stan JH, Whyte J, Duffy JR, Barkmeier-Kraemer JM, Doyle PB, Gherson S, Kelchner L, Muise J, Petty B, Roy N, Stemple J, Thibeault S, Tolejano CJ. Rehabilitation Treatment Specification System: Methodology to Identify and Describe Unique Targets and Ingredients. Arch Phys Med Rehabil 2021; 102:521-531. [PMID: 33065124 PMCID: PMC7934085 DOI: 10.1016/j.apmr.2020.09.383] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/01/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
Although significant advances have been made in measuring the outcomes of rehabilitation interventions, comparably less progress has been made in measuring the treatment processes that lead to improved outcomes. A recently developed framework called the Rehabilitation Treatment Specification System (RTSS) has potential to identify which clinician actions (ie, ingredients) actively improve specific patient functions (ie, targets). However, the RTSS does not provide methodology for standardly identifying specific unique targets or ingredients. Without a method to evaluate the uniqueness of an individual target or ingredient, it is difficult to know whether variations in treatment descriptions are synonymous (ie, different words describing the same treatment) or meaningfully different (eg, different words describing different treatments or variations of the same treatment). A recent project used vocal rehabilitation ingredients and targets to create RTSS-based lists of unique overarching target and ingredient categories with underlying dimensions describing how individual ingredients and targets vary within those categories. The primary purpose of this article is to describe the challenges encountered during the project and the methodology developed to address those challenges. Because the methodology was based on the RTSS's broadly applicable framework, it can be used across all areas of rehabilitation regardless of the discipline (speech-language pathology, physical therapy, occupational therapy, psychology, etc) or impairment domain (language, cognition, ambulation, upper extremity training, etc). The resulting standard operationalized lists of targets and ingredients have high face and content validity. The lists may also facilitate implementation of the RTSS in research, education, interdisciplinary communication, and everyday treatment.
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Affiliation(s)
- Jarrad H Van Stan
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston, Massachusetts; MGH Institute of Health Professions, Charlestown, Massachusetts.
| | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
| | | | | | - Patricia B Doyle
- University of Connecticut Medical School, Farmington, Connecticut
| | | | | | - Jason Muise
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston, Massachusetts; MGH Institute of Health Professions, Charlestown, Massachusetts
| | | | - Nelson Roy
- University of Utah, Salt Lake City, Utah
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15
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Van Stan JH, Park SW, Jarvis M, Stemple J, Hillman RE, Sternad D. Quantitative Assessment of Learning and Retention in Virtual Vocal Function Exercises. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:1-15. [PMID: 33285082 PMCID: PMC8608156 DOI: 10.1044/2020_jslhr-20-00357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/03/2020] [Accepted: 09/17/2020] [Indexed: 05/30/2023]
Abstract
Purpose Successful voice therapy requires the patient to learn new vocal behaviors, but little is currently known regarding how vocal motor skills are improved and retained. To quantitatively characterize the motor learning process in a clinically meaningful context, a virtual task was developed based on the Vocal Function Exercises. In the virtual task, subjects control a computational model of a ball floating on a column of airflow via modifications to mean airflow (L/s) and intensity (dB-C) to keep the ball within a target range representing a normative ratio (dB × s/L). Method One vocally healthy female and one female with nonphonotraumatic vocal hyperfunction practiced the task for 11 days and completed retention testing 1 and 6 months later. The mapping between the two execution variables (airflow and intensity) and one error measure (proximity to the normative ratio) was evaluated by quantifying distributional variability (tolerance cost and noise cost) and temporal variability (scaling index of detrended fluctuation analysis). Results Both subjects reduced their error over practice and retained their performance 6 months later. Tolerance cost and noise cost were positively correlated with decreases in error during early practice and late practice, respectively. After extended practice, temporal variability was modulated to align with the task's solution manifold. Conclusions These case studies illustrated, in a healthy control and a patient with nonphonotraumatic vocal hyperfunction, that the virtual floating ball task produces quantitative measures characterizing the learning process. Future work will further investigate the task's potential to enhance clinical assessment and treatments involving voice control. Supplemental Material https://doi.org/10.23641/asha.13322891.
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Affiliation(s)
- Jarrad H. Van Stan
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | | | | | | | - Robert E. Hillman
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
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16
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Gomes NR, Teixeira LC, de Medeiros AM. Vocal Symptoms in University Professors: Their Association With Vocal Resources and With Work Environment. J Voice 2020; 34:352-357. [DOI: 10.1016/j.jvoice.2018.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 11/29/2022]
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17
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Cardoso R, Meneses RF, Lumini-Oliveira J, Pestana P. Associations Between Teachers' Autonomic Dysfunction and Voice Complaints. J Voice 2020; 35:843-851. [PMID: 32345502 DOI: 10.1016/j.jvoice.2020.03.013] [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: 12/29/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This investigation aimed to verify if there were any differences in autonomic nervous system function and voice parameters of teachers with and without voice complaints. STUDY DESIGN Cross-sectional study. METHODS The Questionnaire of Autonomic Dysfunction was answered by 24 teachers, 6 males, and 18 females, whose heart rate variability was also assessed. Aerodynamic assessment of voice, acoustic and auditory-perceptual analysis of voice were done. Participants were divided into two groups: without voice complaints (WVCG; n = 11) and with voice complaints (VCG; n = 13) based on the completion of the Sociodemographic and Clinical Questionnaire. RESULTS For auditory-perceptual analysis, VCG showed significantly higher values on GRBASH subscales Grade (P < 0.001) and Roughness (P = 0.011). Regarding the heart rate variability, it was found that in the VCG, the square root of the mean squared difference of successive RR intervals (RMSSD) and the percentage of adjacent NN intervals differing by more than 50 milliseconds (pNN50) were significantly lower than in the WVCG (P = 0.023 and P = 0.032, respectively). The VCG presented a higher occurrence of neurovegetative symptoms directly related to voice, namely in fluctuating nose obstruction (P = 0.011), neck pain (while or after speaking) (P = 0.017) and in fatigability when speaking (P = 0.004). Concerning the aerodynamic assessment of voice, acoustic analysis of voice and neurovegetative symptoms not directly related to voice, no statistically significant differences between groups were found. CONCLUSIONS Findings indicated significantly lower values in RMSSD and pNN50 of teachers VCG when compared with teachers WVCG and that the teachers VCG presented a higher occurrence of neurovegetative symptoms directly related to voice than the ones WVCG.
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Affiliation(s)
- Ricardo Cardoso
- Fernando Pessoa University, Porto, Portugal; Transdisciplinary Center of Consciousness Studies of Fernando Pessoa University, Porto, Portugal; FP-B2S - Behaviour and Social Sciences Research Center of Fernando Pessoa University, Porto, Portugal.
| | - Rute F Meneses
- Fernando Pessoa University, Porto, Portugal; Transdisciplinary Center of Consciousness Studies of Fernando Pessoa University, Porto, Portugal; FP-B2S - Behaviour and Social Sciences Research Center of Fernando Pessoa University, Porto, Portugal; Longevity and Development Observatory of Fernando Pessoa University, Porto, Portugal
| | - José Lumini-Oliveira
- Fernando Pessoa University, Porto, Portugal; CIAFEL - Research Centre in Physical Activity, Health and Leisure, Porto University, Porto, Portugal; LABIOMEP - Porto Biomechanics Laboratory, Porto University, Porto, Portugal
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18
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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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19
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The Influence of Auditory Feedback and Vocal Rehabilitation on Prelingual Hearing-Impaired Individuals Post Cochlear Implant. J Voice 2019; 33:947.e1-947.e9. [DOI: 10.1016/j.jvoice.2018.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/30/2018] [Accepted: 07/02/2018] [Indexed: 11/18/2022]
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20
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Aghadoost S, Jalaie S, Khatoonabadi AR, Dabirmoghaddam P, Khoddami SM. A Study of Vocal Facilitating Techniques Compared to Manual Circumlaryngeal Therapy in Teachers With Muscle Tension Dysphonia. J Voice 2019; 34:963.e11-963.e21. [PMID: 31353126 DOI: 10.1016/j.jvoice.2019.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/01/2019] [Accepted: 06/05/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There are several voice therapy techniques been suggested in patients with muscle tension dysphonia (MTD), however a few studies are compared between them. The purpose of present study was to compare the effect of vocal facilitating techniques (VFTs) and manual circumlaryngeal therapy (MCT) in teachers with MTD. STUDY DESIGN This is a randomized clinical trial study. METHODS Sixteen teachers with MTD (female; mean age: 38.6 ± 4.6 years) participated in this study. The participants allocated to two treatment groups: the first group received VFTs (n: 8) and MCT was presented to the second one (n: 8). In each group, the voice therapy techniques were given for 10 individual sessions twice a week. The effect of both techniques was assessed using voice handicap index (VHI) and dysphonia severity index (DSI). RESULTS Within group comparison, the VHI, DSI, and theirs components showed significantly better results after both treatment groups (P ≤ 0.05). Although, effect size was strong for all target features (η2 > 0.36); the greatest magnitude was obtained on the physical subscale of VHI following MCT and for the DSI after VFTs (η2 = 0.92 and 0.90, respectively). Moreover, the interactive effect of time and treatment groups indicated that there was significant main effect on the physical and functional subscales of VHI (P = 0.00 and 0.02, respectively) as well as I-low and DSI (P = 0.01 and 0.02, respectively). CONCLUSION VFTs and MCT are two effective techniques in voice therapy of teachers with MTD. However, the greatest improvement obtained on the DSI following VFTs and for the physical aspect of VHI after MCT demonstrated voice therapist can use appropriate technique based on the voice complaints and results of voice assessments in MTD.
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Affiliation(s)
- Samira Aghadoost
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Jalaie
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Khatoonabadi
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Seyyedeh Maryam Khoddami
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
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21
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Angadi V, Dressler E, Kudrimoti M, Valentino J, Aouad R, Gal T, Stemple J. Efficacy of Voice Therapy in Improving Vocal Function in Adults Irradiated for Laryngeal Cancers: A Pilot Study. J Voice 2019; 34:962.e9-962.e18. [PMID: 31235195 DOI: 10.1016/j.jvoice.2019.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Radiation therapy (XRT) for laryngeal cancers causes acute and chronic vocal dysfunction. Although these deleterious effects of XRT are well-established, there is a dearth of research with respect to effective voice rehabilitation following XRT for laryngeal cancers. OBJECTIVE To obtain preliminary data on the efficacy of voice rehabilitation, using vocal function exercises (VFEs) in improving vocal function in adults irradiated for laryngeal cancer. The comparison treatment group (VH) received vocal hygiene counseling. STUDY DESIGN Randomized clinical trial. METHODS Participants were randomized to the VFE + VH or VH group. Both interventions lasted 6 weeks. The primary outcome measure was improvement in VHI scores. Secondary outcome measures included auditory-perceptual assessments, acoustic and aerodynamic measures, and laryngeal imaging. RESULTS Ten participants were recruited for the study. The VFE + VH (n = 6) group demonstrated a statistically significant improvement in the primary outcome measure (P = 0.03), as well as select parameters of all secondary outcome measures. The VH (n = 4) group did not demonstrate a statistically significant improvement in primary or secondary outcome measures. CONCLUSIONS This study offers preliminary data for the utility of VFEs in the irradiated laryngeal cancer population. However, findings in the VFE + VH group lack generalizability, secondary to sample heterogeneity, and limited sample size.
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Affiliation(s)
- Vrushali Angadi
- Division of Communication Sciences and Disorders, University of Kentucky, Lexington, Kentucky.
| | - Emily Dressler
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mahesh Kudrimoti
- Department of Radiation Medicine, University of Kentucky, Chandler Medical Center, Lexington, Kentucky
| | - Joseph Valentino
- Department of Otolaryngology-Head and Neck surgery, University of Kentucky, Lexington, Kentucky
| | - Rony Aouad
- Department of Otolaryngology-Head and Neck surgery, University of Kentucky, Lexington, Kentucky
| | - Thomas Gal
- Department of Otolaryngology-Head and Neck surgery, University of Kentucky, Lexington, Kentucky
| | - Joseph Stemple
- Division of Communication Sciences and Disorders, University of Kentucky, Lexington, Kentucky
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22
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Araújo TMD, Pinho PDS, Masson MLV. Teachers' work and health in Brazil: thoughts on the history of research, strides, and challenges. CAD SAUDE PUBLICA 2019; 35Suppl 1:e00087318. [PMID: 31166380 DOI: 10.1590/0102-311x00087318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 03/26/2019] [Indexed: 11/22/2022] Open
Abstract
This Essay discusses the theme of teachers' work and health in Brazil. The objectives are to describe the initial history of research on teachers' health, discuss elements leading to a consensus on the characterization of the group's work and principal health problems, and systematize the main strides and challenges. The Essay draws on more than two decades of research and practice in this field. Based on this experience, the authors identify the movements, the accumulated evidence, and prospects for future development. The elements brought to the discussion point to substantial growth in the field: the number of studies, the diversity and scope of topics, the groups of men and women teachers studied, and the experiences with application of the knowledge (programs and interventions). Despite these strides, the studies and practices still emphasize the individual and the disease, with little or no attention to work factors (work process and management) in the health/disease process. Issues pertaining to gender differences (in work and in health status) also remain invisible. There is little linkage between researchers and teachers' movements (a relevant characteristic of the first initiatives in the field). There are no public policies to regulate the workplace and work management. The contributions to the discussion provide insight for thought to assist the identification of critical nodes and analytical scenarios with the potential for progress in this field of research and intervention.
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Bane M, Brown M, Angadi V, Croake DJ, Andreatta RD, Stemple JC. Vocal function exercises for normal voice: With and without semi-occlusion. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:175-181. [PMID: 29614887 PMCID: PMC6207476 DOI: 10.1080/17549507.2017.1416176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE This study examined the effect of varying degrees of vocal tract (VT) occlusion used during Vocal Function Exercises (VFEs) on attainment of maximum phonation time (MPT) goals in normal voice. Greater VT occlusion was expected to result in increased MPT. The overarching goal was to determine whether the semi-occluded vocal tract (SOVT) posture used during VFEs could be modified while preserving efficacy. METHOD Twenty-six females ages 18-30 participated in this pre-post longitudinal group study. Participants were randomly assigned to three experimental groups and completed a six-week VFE protocol. The first group performed exercises using the prescribed SOVT posture; the second group used the vowel /o/; group three used the vowel /a/. The primary outcome measure was MPT as performed on the exercise tasks using the assigned vocal tract posture. RESULT MPT significantly improved in the prescribed SOVT group, but did not significantly improve in the modified /o/ and /a/ groups. CONCLUSION The SOVT posture used during VFEs is modifiable to a small extent without significantly undermining efficacy. Changes in MPT are less robust with reduced VT occlusion. Research in a clinical population is warranted.
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Affiliation(s)
- Maria Bane
- a Department of Rehabilitation Sciences, University of Kentucky , Lexington , KY , USA
| | - Megan Brown
- a Department of Rehabilitation Sciences, University of Kentucky , Lexington , KY , USA
| | - Vrushali Angadi
- a Department of Rehabilitation Sciences, University of Kentucky , Lexington , KY , USA
| | - Daniel J Croake
- a Department of Rehabilitation Sciences, University of Kentucky , Lexington , KY , USA
| | - Richard D Andreatta
- a Department of Rehabilitation Sciences, University of Kentucky , Lexington , KY , USA
| | - Joseph C Stemple
- a Department of Rehabilitation Sciences, University of Kentucky , Lexington , KY , USA
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Ribeiro VV, de Oliveira AG, da Silva Vitor J, Siqueira LTD, Moreira PAM, Brasolotto AG, Silverio KCA. The Effect of a Voice Therapy Program Based on the Taxonomy of Vocal Therapy in Women with Behavioral Dysphonia. J Voice 2019; 33:256.e1-256.e16. [DOI: 10.1016/j.jvoice.2017.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 11/24/2022]
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Bane M, Angadi V, Dressler E, Andreatta R, Stemple J. Vocal function exercises for normal voice: The effects of varying dosage. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:37-45. [PMID: 28925286 PMCID: PMC6207485 DOI: 10.1080/17549507.2017.1373858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE This study examined the effect of varying dosage of vocal function exercise (VFE) home practice on attainment of pre-established maximum phonation time (MPT) goals in individuals with normal voice. High dosage VFE practice was expected to result in greatest MPT. The overarching goal of this study was to contribute to a VFE dosage-response curve, potentially including a point of observable toxicity. METHOD Twenty-eight females ages 18-25 with normal voice participated in this pre-post longitudinal group study. Participants were randomly assigned to one of three experimental groups and completed a six-week VFE protocol with practice twice daily. The low dosage group performed each exercise once, the traditional group twice, and the high dosage group four times. The primary outcome measure was MPT as performed on the fourth VFE using the prescribed semi-occluded vocal tract posture. RESULT No toxic effects were observed. MPT increased for all participants, with significant improvement for traditional and high dosage groups. CONCLUSION High dosage VFEs may yield more rapid improvement in MPT, however benefits must be weighed against the risk of increased attrition. Low dosage VFEs insufficiently improved MPT. Further research on dosage is warranted, and should include individuals with disordered voice.
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Affiliation(s)
- Maria Bane
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
| | - Vrushali Angadi
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
| | - Emily Dressler
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
| | - Richard Andreatta
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
| | - Joseph Stemple
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
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Effects of Vocal Function Exercises: A Systematic Review. J Voice 2019; 33:124.e13-124.e34. [DOI: 10.1016/j.jvoice.2017.08.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/08/2017] [Accepted: 08/31/2017] [Indexed: 11/23/2022]
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Barsties V Latoszek B. Preliminary study of Novafon local vibration voice therapy for dysphonia treatment. LOGOP PHONIATR VOCO 2018; 45:1-9. [PMID: 29583016 DOI: 10.1080/14015439.2018.1453541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: The objective of this study was to explore the effectiveness of a five-week Novafon local vibration voice therapy (NLVVT) program for dysphonia treatment.Methods: Eleven dysphonic subjects participated in this specific program.Results: Treatment effects were assessed during (i.e. weekly) and after NLVVT. Large and significant treatment effects were revealed in acoustics (i.e. spectrography), and multiparametric indices (i.e. Acoustic Voice Quality Index (AVQI), and Dysphonia Severity Index (DSI)) during and after NLVVT (all p values < .01). Additionally, self-evaluation (i.e. Voice Handicap Index (VHI)) showed a significant improvement after NLVVT (p < .01). Gender independent voice range profile parameters (i.e. acoustics) only showed significant effects after treatment (p ≤ .01), but not during the treatment. Finally, aerodynamic measurement (i.e. phonation quotient) showed low treatment effects after NLVVT, which were not significant (p > .05).Conclusions: The preliminary results showed that NLVVT might be successful in voice treatment. Large treatment effects might be expected in AVQI, DSI, spectrography and VHI after using NLVVT. Other voice characteristics showed smaller treatment effects (i.e. voice range profile parameters) or no meaningful treatment effects (i.e. phonation quotient).
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Affiliation(s)
- Ben Barsties V Latoszek
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
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28
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Behlau M. The 2016 G. Paul Moore Lecture: Lessons in Voice Rehabilitation: Journal of Voice and Clinical Practice. J Voice 2018; 33:669-681. [PMID: 29567050 DOI: 10.1016/j.jvoice.2018.02.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 02/22/2018] [Indexed: 12/19/2022]
Abstract
This Paul Moore Lecture honors the contributions made by authors to the Journal of Voice during a period of 30 years, from 1987. Fifty articles were selected and included under the following five topics: (1) normalcy of the larynx and voice; (2) the clinical speech-language pathologist's evaluation; (3) the patient's perspective; (4) the core of vocal rehabilitation; and (5) behavioral versus organic dysphonias. The analysis reflects a vivid landscape of the specific area and significant advances in knowledge. It also shows the valuable interdependence between science and clinical practice. The topics highlight the following information: (1) The physical appearance of a healthy larynx varies across individuals with normal voices. (2) The voice is not a binary descriptor (normal versus abnormal) but a variable measure, with many cultural influences on the perceptual auditory analysis of a voice. (3) The clinical speech-language pathologist assessment is multidimensional and multiparametric, with both subjective and objective analyses. The patients' opinion about the impact of a voice problem on his or her quality of life is significant when proposing a treatment. Therefore, it is also included in the initial assessment. (4) Vocal rehabilitation is a nonlinear process that combines direct and indirect approaches. Evidence of the positive effect of voice therapy is now well established. (5) Behavioral dysphonias may be linked to self-regulation of the use of voice and this needs to be taken into consideration. Although organic dysphonias are not necessarily the result of harmful vocal behaviors, they too can benefit from vocal rehabilitation.
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Affiliation(s)
- Mara Behlau
- "Centro de Estudos da Voz" - CEV, São Paulo, Brazil; "Universidade Federal de São Paulo-UNIFESP", São Paulo, Brazil.
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Masson MLV, de Araújo TM. Protective Strategies Against Dysphonia in Teachers: Preliminary Results Comparing Voice Amplification and 0.9% NaCl Nebulization. J Voice 2018; 32:257.e1-257.e10. [DOI: 10.1016/j.jvoice.2017.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/01/2022]
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Assad JP, Gama ACC, Santos JN, de Castro Magalhães M. The Effects of Amplification on Vocal Dose in Teachers with Dysphonia. J Voice 2017; 33:73-79. [PMID: 29122417 DOI: 10.1016/j.jvoice.2017.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/29/2017] [Accepted: 09/14/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to determine if voice amplification influenced vocal dose in female teachers with dysphonia. MATERIAL AND METHODS This was an experimental study with comparative intrasubjects in which 15 individuals were compared in two different moments: condition 1 (C1) without voice amplification and condition 2 (C2) with voice amplification. All of them were female, kindergarten and elementary school teachers who presented organic or functional dysphonia. The search was carried out at the school where the teachers work. The professional voice use was considered the teachers' activity for a continuous period of two classes (average recording time of 96 minutes, with no difference in time between C1 and C2). To measure the dose we used the vocal dosimeter composed of a microphone, an accelerometer fixed to the neck, and a portable unit that stores the vocal data. The phonation data (intensity, fundamental frequency, phonation percentage, cycle dose, and distance dose) were analyzed by the equipment software (VoxLog). RESULTS The use of vocal amplification in teachers promotes a reduction of the fundamental frequency (295.6-267.7 Hz), the voice intensity (96.2-93.3 dB sound pressure level), the cycle doses (489.4-345.2 thousand cycles per second), and distance doses (3,800-2,300 m). CONCLUSION The vocal amplification allows the teacher to maintain the same phonation time (phonation percentage) but decreases the number of vocal fold oscillations (cycle dose) and the total distance traveled by the vocal fold tissue during phonation (distance dose), reducing the exposure of the vocal folds to voice trauma.
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Affiliation(s)
- Joana Perpetuo Assad
- Department of Speech-Language Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Cristina Côrtes Gama
- Department of Speech-Language Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Juliana Nunes Santos
- Department of Speech-Language Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Physical Therapy, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Minas Gerais, Brazil
| | - Max de Castro Magalhães
- Department of Structural Engineering, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Assad JP, Magalhães MDC, Santos JN, Gama ACC. Dose Vocal: uma revisão integrativa da literatura. REVISTA CEFAC 2017. [DOI: 10.1590/1982-021620171932617] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo da pesquisa foi realizar uma revisão da literatura referente aos tipos de dose vocal e aos resultados destas medidas em diferentes situações comunicativas. Houve levantamento da literatura nacional e internacional, publicada nos idiomas Inglês, Espanhol ou Português, utilizando-se as bases de dados MEDLINE, LILACS, IBECS e ISI (Web of Science), dos últimos 21 anos, cujos artigos estavam disponíveis na íntegra. Quinze estudos contemplaram os critérios propostos. A maioria dos artigos estudou professores, visto que são mais vulneráveis para a ocorrência de disfonia. Os tipos de dose encontrados foram porcentagem de fonação, dose temporal, dose cíclica, dose de distância, dose de energia radiada e dose de energia dissipada. O aumento da dose vocal está associado ao uso excessivo e prolongado da voz na atividade docente, principalmente entre os professores da educação infantil e os de canto. As altas doses vocais correlacionam-se também à presença de disfonia, ao maior nível de ruído ambiental, à grande variação prosódica na fala e à autopercepção de fadiga vocal. Pacientes com disfonia comportamental (nódulos e pólipos) apresentam maiores doses vocais que pacientes com outros quadros disfônicos. Fatores como repouso de voz e uso do amplificador vocal indicam a diminuição da dose da voz.
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Desjardins M, Halstead L, Cooke M, Bonilha HS. A Systematic Review of Voice Therapy: What “Effectiveness” Really Implies. J Voice 2017; 31:392.e13-392.e32. [DOI: 10.1016/j.jvoice.2016.10.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/29/2016] [Accepted: 10/04/2016] [Indexed: 12/31/2022]
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Jafari N, Salehi A, Izadi F, Talebian Moghadam S, Ebadi A, Dabirmoghadam P, Faham M, Shahbazi M. Vocal Function Exercises for Muscle Tension Dysphonia: Auditory-Perceptual Evaluation and Self-Assessment Rating. J Voice 2016; 31:506.e25-506.e31. [PMID: 27993500 DOI: 10.1016/j.jvoice.2016.10.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/12/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Muscle tension dysphonia (MTD) is a functional dysphonia, which appears with an excessive tension in the intrinsic and extrinsic laryngeal musculatures. MTD can affect voice quality and quality of life. The purpose of the present study was to assess the effectiveness of vocal function exercises (VFEs) on perceptual and self-assessment ratings in a group of 15 subjects with MTD. METHODS The study comprised 15 subjects with MTD (8 men and 7 women, mean age 39.8 years, standard deviation 10.6, age range 24-62 years). All participants were native Persian speakers who underwent a 6-week course of VFEs. The Voice Handicap Index (VHI) (the self-assessment scale) and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale (perceptual rating of voice quality) were used to compare pre- and post-VFEs. RESULTS GRBAS data of patients before and after VFEs were compared using Wilcoxon signed-rank test, and VHI data of patients pre- and post-VFEs were compared using Student paired t test. These perceptual parameters showed a statistically significant improvement in subjects with MTD after voice therapy (significant at P < 0.05 (*) and P < 0.004 (**)). Also results indicated statistically noticeable reduction in the mean VHI scores across subjects with MTD (significant at P < 0.05 (*) and P < 0.004 (**)). CONCLUSIONS Significant improvement after therapy for participants has been observed by the aid of auditory-perceptual ratings of voice quality (with the GRBAS scale) and the patient's self-assessment ratings measurements (with the VHI). As a result, the data provide evidence regarding the efficacy of VFEs in the treatment of patients with MTD.
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Affiliation(s)
- Narges Jafari
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Abolfazl Salehi
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Farzad Izadi
- Department of Ear, Nose, Throat, Head and Neck Research Center, Hazrat-e-Rasoul Hospital, Tehran, Iran
| | - Saeed Talebian Moghadam
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Department of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Payman Dabirmoghadam
- Otolaryngology Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Maryam Faham
- Department of Speech and Language Pathology, School of Rehabilitation Science, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Shahbazi
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Croake DJ, Andreatta RD, Stemple JC. Immediate Effects of the Vocal Function Exercises Semi-Occluded Mouth Posture on Glottal Airflow Parameters: A Preliminary Study. J Voice 2016; 31:245.e9-245.e14. [PMID: 27595526 DOI: 10.1016/j.jvoice.2016.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 08/05/2016] [Accepted: 08/09/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The study aimed to quantify immediate alterations in the airflow glottogram between the Vocal Function Exercises semi-occluded mouth posture (/ol/ with lip buzz) and the sustained vowel /o/ in individuals with normal voices, and to determine if noted changes were in agreement with established semi-occluded vocal tract aerodynamic theory. Based on semi-occluded vocal tract aerodynamic theory, we hypothesized the following immediate changes in the flow glottogram during the /ol-buzz/ condition: a greater open quotient, a greater skewing quotient, a greater maximum flow declination rate, increased average airflow, decreased peak airflow, and increased minimum airflow. METHODS A cohort of eight men with normal voices produced the sustained vowel /o/ and the Vocal Function Exercises semi-occluded mouth posture (/ol-buzz/). Flow glottograms for both conditions were obtained from the inverse-filtered oral airflow signal via a circumferentially vented pneumotachograph mask. RESULTS Data revealed that open quotient and minimum airflow rates increased significantly between conditions. All other measures trended in the directions predicted by aerodynamic theory, but were not statistically significant. CONCLUSIONS The Vocal Function Exercises semi-occluded mouth posture appeared to provide an effective vocal tract semi-occlusion that immediately altered the flow glottogram in accordance with predictions made by computer-modeled aerodynamic theory.
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Affiliation(s)
- Daniel J Croake
- College of Health Sciences, University of Kentucky, Lexington, Kentucky.
| | | | - Joseph C Stemple
- College of Health Sciences, University of Kentucky, Lexington, Kentucky
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