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Moura GC, Antonetti AEDS, Dos Santos AP, Vitor JDS, Brasolotto AG, Siqueira LTD, Silverio KCA. The influence of the low-frequency transcutaneous electrical nerve stimulation application moment in vocal quality of dysphonic women. LOGOP PHONIATR VOCO 2024; 49:96-103. [PMID: 36367198 DOI: 10.1080/14015439.2022.2143557] [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: 12/16/2021] [Revised: 10/24/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Abstract
Objective: to compare the immediate effects of low-frequency TENS employment on vocal quality in women with behavioral dysphonia before and after vocal exercises. Methodology: 30 women (mean = 31.3 years old), diagnosed with behavioral dysphonia received low-frequency TENS before (TENS + VE Group) and after vocal exercises (VE + TENS Group) with a 1-week washout. They had their sustained vowel/a/and running speech recorded before and after each procedure for auditory-perceptual analysis and acoustic measures. The low-frequency TENS parameters applied were symmetrical biphasic quadratic pulse, 200 µs phase, 10 Hz frequency, intensity on the motor threshold, and the electrodes were positioned on the submandibular and superior fibers of the trapezius muscle region. The vocal exercises: tongue trill, humming, finger kazoo, and water resistance therapy were performed totalizing 20 min. Results: intragroup analysis of sustained vowel/a/showed reduction in both groups of strain parameter and increased the breathiness; only VE + TENS Group increased the instability parameter, decreased fundamental frequency, and increased in SPI values; the running speech analysis showed an increase in the overall degree, roughness, and breathiness parameters. However, in VE + TENS Group, there was a statistically significant decrease in the intensity of the strain and an increase in breathiness. The acoustic measures showed that VE + TENS Group had a higher variation than TENS + VE Group regarding NHR. Conclusion: vocal exercises followed by low-frequency TENS have more immediate positive effects on voice quality than the low-frequency TENS followed by vocal exercises. This is a preliminary immediate effects study, and these effects could be verified through long-term assessments.
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Affiliation(s)
- Gabriela Campos Moura
- Speech-Language and Hearing Disorders Department, Bauru School of Dentristy, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Ana Paula Dos Santos
- Speech-Language and Hearing Disorders Department, Bauru School of Dentristy, University of Sao Paulo, Sao Paulo, Brazil
| | - Jhonatan da Silva Vitor
- Speech-Language and Hearing Disorders Department, Bauru School of Dentristy, University of Sao Paulo, Sao Paulo, Brazil
| | - Alcione Ghedini Brasolotto
- Speech-Language and Hearing Disorders Department, Bauru School of Dentristy, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Kelly Cristina Alves Silverio
- Speech-Language and Hearing Disorders Department, Bauru School of Dentristy, University of Sao Paulo, Sao Paulo, Brazil
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Plotas P, Papadopoulos A, Tsiamaki E, Apostolou MD, Chaniotaki MA, Ganiatsou E, Goutzeri EM, Kalogeraki T, Karra E, Malliou M, Marinitsi D, Papoutsaki C, Vagianou IS, Trimmis N. Effects of Transcutaneous Electrical Nervous Stimulation (TENS) on Dysphonic Patients: A Systematic Review Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1737. [PMID: 37893455 PMCID: PMC10608172 DOI: 10.3390/medicina59101737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Transcutaneous electrical nerve stimulation (TENS), a pain-alleviating and muscle-relaxing treatment used in physio-therapeutic clinical practice, has recently appeared to be just as effective in dysphonia. This review aimed at clarifying whether TENS can be an effective practice in dysphonia therapy and/or management on its own or combined with other types of interventions and, hence, whether its practice can be a useful, more widespread establishment to speech and language therapy intervention methods. Materials and Methods: A search was conducted on the PubMed database using specific terms based on the PICO search strategy. Eventually, four randomized controlled studies and four clinical trials were included. The methodological quality of the included studies was evaluated using the physiotherapy evidence-based database (PEDro) assessment tool, and this indicated high-quality research with an average score of 8.43. Results: The studies utilized various TENS devices, predominantly the Dualpex 961 device (frequency of 10 Hz, phase of 200 ms). The assessment methods varied, including auditory perception, vocal therapy, electrostimulation, audio and video perceptual assessments, and laryngeal evaluations. The clinical outcomes of TENS showed a reduction in musculoskeletal pain in various areas, while the acoustic analysis results were significant in only one study. TENS was compared to manual laryngeal therapy (LMT), placebo TENS, and vocal therapy in different studies with mixed results. Conclusions: This review supports the idea that a multidimensional approach, incorporating various therapeutic modalities (TENS, LMT, speech therapy, and vocal training) can yield positive outcomes for patients with voice disorders. Further research is needed to explore the specific mechanisms of action and optimal treatment protocols for TENS in voice therapy.
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Affiliation(s)
- Panagiotis Plotas
- Laboratory of Primary Health Care, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (M.-D.A.); (M.-A.C.); (E.G.); (E.-M.G.); (T.K.); (E.K.); (M.M.); (D.M.); (C.P.); (I.-S.V.); (N.T.)
| | - Angelos Papadopoulos
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (M.-D.A.); (M.-A.C.); (E.G.); (E.-M.G.); (T.K.); (E.K.); (M.M.); (D.M.); (C.P.); (I.-S.V.); (N.T.)
- General Children’s Hospital of Patras “Karamandaneio”, 26331 Patras, Greece
| | - Eirini Tsiamaki
- Department of Neurology, School of Medicine, University of Patras, 26504 Patras, Greece;
| | - Maria-Dimitra Apostolou
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (M.-D.A.); (M.-A.C.); (E.G.); (E.-M.G.); (T.K.); (E.K.); (M.M.); (D.M.); (C.P.); (I.-S.V.); (N.T.)
| | - Maria-Antonia Chaniotaki
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (M.-D.A.); (M.-A.C.); (E.G.); (E.-M.G.); (T.K.); (E.K.); (M.M.); (D.M.); (C.P.); (I.-S.V.); (N.T.)
| | - Efthimia Ganiatsou
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (M.-D.A.); (M.-A.C.); (E.G.); (E.-M.G.); (T.K.); (E.K.); (M.M.); (D.M.); (C.P.); (I.-S.V.); (N.T.)
| | - Eleni-Marianthi Goutzeri
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (M.-D.A.); (M.-A.C.); (E.G.); (E.-M.G.); (T.K.); (E.K.); (M.M.); (D.M.); (C.P.); (I.-S.V.); (N.T.)
| | - Thalia Kalogeraki
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (M.-D.A.); (M.-A.C.); (E.G.); (E.-M.G.); (T.K.); (E.K.); (M.M.); (D.M.); (C.P.); (I.-S.V.); (N.T.)
| | - Elpida Karra
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (M.-D.A.); (M.-A.C.); (E.G.); (E.-M.G.); (T.K.); (E.K.); (M.M.); (D.M.); (C.P.); (I.-S.V.); (N.T.)
| | - Maria Malliou
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (M.-D.A.); (M.-A.C.); (E.G.); (E.-M.G.); (T.K.); (E.K.); (M.M.); (D.M.); (C.P.); (I.-S.V.); (N.T.)
| | - Dimitra Marinitsi
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (M.-D.A.); (M.-A.C.); (E.G.); (E.-M.G.); (T.K.); (E.K.); (M.M.); (D.M.); (C.P.); (I.-S.V.); (N.T.)
| | - Chariklia Papoutsaki
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (M.-D.A.); (M.-A.C.); (E.G.); (E.-M.G.); (T.K.); (E.K.); (M.M.); (D.M.); (C.P.); (I.-S.V.); (N.T.)
| | - Ilianna-Stamatia Vagianou
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (M.-D.A.); (M.-A.C.); (E.G.); (E.-M.G.); (T.K.); (E.K.); (M.M.); (D.M.); (C.P.); (I.-S.V.); (N.T.)
| | - Nikolaos Trimmis
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (M.-D.A.); (M.-A.C.); (E.G.); (E.-M.G.); (T.K.); (E.K.); (M.M.); (D.M.); (C.P.); (I.-S.V.); (N.T.)
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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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Almeida ANSD, Cunha DAD, Ferreira SLDS, Guimarães BTDL, Balata PMM, Silva HJD. Effect of Electrical Stimulation on the Treatment of Dysphonia: A Systematic Review. J Voice 2022; 36:650-660. [PMID: 32868145 DOI: 10.1016/j.jvoice.2020.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to review systematically the literature and to investigate the effects of electrical stimulation in treating dysphonia. STUDY DESIGN This is a systematic review. METHODS The publications indexed on the MEDLINE, LILACS, PubMed, Web of Science, and SciELO databases were searched. Original articles with experimental, clinical trial and randomized studies involving a control group and approaching dysphonia treatment with electrical stimulation in humans, regardless of age, gender, or race were included. Those excluded were theses, editorials, comments and opinions, reflexive articles, case studies, experimental studies with animals, models, projects, reports and technical reports, and review articles, as well as articles approaching other alterations, not related to dysphonia. RESULTS Eleven articles were found and it evaluated the effects of neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation on dysphonia caused by vocal fold paralysis, spasmodic dysphonia, behavioral dysphonia, and in patients with vocal fold nodules. The methodological analysis of the articles through the PEDro scale resulted in a mean score of 5.18; the studies were classified as either high quality (N = 3) or fair quality (N = 8). The results indicated that electrical stimulation had a therapeutic effect on various aspects of dysphonia. However, due to the high risk of bias and the heterogeneity of the studies, it is not possible to state the effectiveness of electrical stimulation in treating dysphonia. CONCLUSION Using electrical stimulation as an evidence-based conventional rehabilitation therapy in the treatment of dysphonia cannot yet be done.
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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] [MESH Headings] [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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Almeida ANSD, Cunha DAD, Duarte BF, Guimarães BTDL, Lucena JA, Pernambuco LDA, Paes MCNDM, Cunha MDD, Balata PMM, Silva HJD. Effect of Vocal Therapy Associated With TENS in Women With Behavioral Dysphonia. J Voice 2022; 36:585.e27-585.e37. [PMID: 32863100 DOI: 10.1016/j.jvoice.2020.07.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to investigate the effect of transcutaneous electrical nerve stimulation (TENS) associated with vocal therapy in women with behavioral dysphonia. METHOD Seventeen women with behavioral dysphonia were divided into an experimental group (n = 8) and a placebo group (n = 9). All were submitted to six sessions of vocal therapy, according to the Comprehensive Voice Rehabilitation Program. In the experimental group, therapy was associated with TENS (30 minutes) and in the placebo group, the electrodes were placed and the equipment remained off. The vocal handicap, the voice through the acoustic and auditory perception evaluation, the electrical activity, and the superficial temperature of the suprahyoid and infrahyoid muscles were evaluated. Pre and post data were compared by parametric and nonparametric tests. RESULTS There was a decreased in vocal handicap of the placebo group (P = 0.002) and a decreased in the percentage of electrical activity of the right (P = 0.036) and left (P = 0.017) infrahyoid muscles of the experimental group in vowel emission and sequential speech (P = 0.036). There was an increase in temperature in the right infrahyoid region in vowel emission (P = 0.027) and the temperature difference decreased quantitatively between the supra and infrahyoid regions in the experimental group. CONCLUSION TENS associated with vocal therapy reduced the electrical activity of the infrahyoid muscles and balance the temperature between the supra- and infrahyoid regions in women with behavioral dysphonia.
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Transcranial magnetic stimulation versus transcutaneous neuromuscular electrical stimulation in post stroke dysphagia: A clinical randomized controlled trial. J Stroke Cerebrovasc Dis 2022; 31:106554. [PMID: 35691184 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106554] [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: 01/06/2022] [Revised: 05/01/2022] [Accepted: 05/08/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To evaluate the efficacy of high-frequency repeated transcranial magnetic stimulation (rTMS) applied contralesionally versus transcutaneous neuromuscular electrical stimulation (TNES) in acute post-stroke dysphagic patients. MATERIALS AND METHODS A randomized, parallel, comparative, controlled trial was conducted on patients with acute ischemic stroke who were admitted to our department. Fifteen patients received rTMS, 15 patients received TNES, and 15 patients were recruited as a control group. Between the second and tenth days after a stroke, patients were enrolled. The study and follow-up periods were completed by all patients. RESULTS Among the screened patients, 45 (31.47%) right-handed patients were diagnosed with post-stroke dysphagia with a mean age of 60.53 ± 8.23 years. Immediately after intervention both rTMS and TNES groups significantly improve the swallowing disturbance questionnaire (SDQ) and penetration aspiration scale (PAS), compared to the control (p < 0.001 and p = 0.027), respectively. rTMS was more effective than TNES in reducing SDQ and PAS (p < 0.05). rTMS and TNES improved the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) significantly (p = 0.002); however, their efficacy was comparable (p > 0.05). A significant (p < 0.001) strong negative correlation was observed between the grade of weakness and all scores. CONCLUSION Our findings showed that high-frequency rTMS and TNES effectively improved the clinical condition of acute post-stroke dysphagic patients in terms of swallowing disturbance assessed by SDQ, pharyngeal residue assessed by YPRSRS, and the severity of penetration and aspiration events evaluated by PAS, compared to the controls. The outcomes of high-frequency rTMS were more favorable than those of TNES in terms of SDQ and PAS.
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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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da Silva MA, Mangilli LD. Transcutaneous electrical nerve stimulation in speech therapy rehabilitation of voice and swallowing function in adults-a systematic review. Clin Exp Dent Res 2021; 7:1131-1143. [PMID: 34587375 PMCID: PMC8638275 DOI: 10.1002/cre2.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/15/2021] [Accepted: 06/25/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION In recent years, a number of clinical trials have been published comparing transcutaneous electrical nerve stimulation (TENS) and traditional speech therapy treatment of voice and swallowing functions, but results have been conflicting. OBJECTIVE Assess the methodological quality of studies and determine whether TENS is an efficient therapeutic strategy for speech therapy treatment of healthy adults or those with dysphonia and/or dysphagia. METHODS The databases used were Medical Literature Analysis and Retrieval System Online (MedLine), Biblioteca Virtual em Saúde (BVS), Cochrane Library and Web of Science (ISI Web of Knowledge). The study was conducted between May 2018 and January 2019, in line with Cochrane Handbook guidelines, and included studies on the use of TENS in healthy adults or those with compromised voice and/or swallowing function. RESULTS After the search and extraction of studies, the following were identified: TENS + VOICE: 7 articles; TENS + SWALLOWING: 5 articles. The studies exhibited medium quality and are heterogeneous, making it difficult to determine their effectiveness and the parameters to be used in future research. There were no statistically significant differences between the use of TENS alone or associated with another therapeutic technique for voice. For swallowing function, one study proved better results in cases of associated techniques - TENS + traditional therapy. DISCUSSION Speech therapy should increase the number of studies published and improve their methodological quality, reassessing methodological criteria. Current clinical practice is not grounded in evidence-based science. CLINICAL MESSAGE: the studies analyzed exhibited medium methodological quality; there are variations in the time, number and periodicity of the therapeutic sessions for TENS; there were no statistically significant differences between the use of TENS alone or associated with another therapeutic technique in voice; there were statistically significant differences between the use of TENS associated with traditional therapeutic in swallowing function.
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Affiliation(s)
- Milena Assis da Silva
- Rehabilitation Sciences Program, Faculdade de Ceilândia, University of Brasília, Brasília, Brazil
| | - Laura Davison Mangilli
- Rehabilitation Sciences Program, Faculdade de Ceilândia, University of Brasília, Brasília, Brazil
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Andrade PA, Frič M, Otčenášek Z. Assessment of Changes in Laryngeal Configuration and Voice Parameters Among Different Frequencies of Neuromuscular Electrical Stimulation (NMES) and Cumulative Effects of NMES in a Normophonic Subject: A Pilot Study. J Voice 2021:S0892-1997(21)00114-4. [PMID: 34045154 DOI: 10.1016/j.jvoice.2021.03.018] [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: 01/30/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Neuromuscular electrical stimulation (NMES) is a complementary resource to voice therapy that can be used for the treatment of hypofunctional voice disorders. Although positive clinical studies have been reported, neutral and even potentially harmful effects of NMES are also described in the literature. Furthermore, in the studies examined by the authors, the use of different methods of NMES have been identified, which further contributes to the inconsistent results found among studies. Moreover, limited rationale is provided for the chosen NMES parameters such as electrode placement, frequency of NMES and length of treatment. The aims of this pilot study were to investigate the a) impact of different frequencies of NMES on glottal configuration and vocal fold vibration patterns and b) changes in laryngeal configuration and vocal output across 12 minutes of NMES. METHOD Three experiments were carried out looking at changes in laryngeal configuration and voice output using different imaging techniques (fibreoptic nasolaryngoscopy and high-speed video), acoustical analysis (F0, formant analysis, SPL, CPPS and LHSR values), electroglottography (EGG) and Relative Fundamental Frequency (RFF) analyses. Glottal parameters and acoustical measures were recorded before, during, and after stimulation. Data was collected at rest and during phonation. RESULTS Overall the results showed global changes in laryngeal configuration from normal to hyperfunctional (ie, increased RFF, SPL, CQ, and stiffness). Changes were more pronounced for lower frequencies of NMES and were significant within less than three minutes of application. CONCLUSION NMES is an effective resource for the activation of intrinsic laryngeal muscles producing significant levels of adduction within few minutes of application. Lower NMES frequencies produced greater muscle activation when compared to higher frequencies.
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Affiliation(s)
- Pedro Amarante Andrade
- Music and Dance Faculty, Academy of Performing Arts in Prague, Musical Acoustics Research Centre, Prague, Czechia.
| | - Marek Frič
- Music and Dance Faculty, Academy of Performing Arts in Prague, Musical Acoustics Research Centre, Prague, Czechia.
| | - Zdeněk Otčenášek
- Music and Dance Faculty, Academy of Performing Arts in Prague, Musical Acoustics Research Centre, Prague, Czechia.
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Romansina D, Simões-Zenari M, Nemr K. Functional electrostimulation associated with phonation in women without vocal disorders. Codas 2021; 33:e20190190. [PMID: 33909842 DOI: 10.1590/2317-1782/20202019190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 03/25/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To verify the immediate effect of the Excitomotor Electrical Current, called Functional Electrical Stimulation (FES), on vocal quality, Maximum Phonation Time (MPT) and possible discomfort, in women without vocal alteration, with application at Maximum Supported Intensity (MSI) and associated with phonation. METHODS Experimental study with 20 normophonic adult women. They emitted the sustained vowel / a / and then it was applied to FES during emission of the same vowel. There were five series with three minutes of emission each, interspersed with passive rest. The electrical stimulus was at the MSI by the participant, adjusted by series. Before and after the emissions the voices were recorded and the MPT and the intensity of the stimuli were collected. The vocal quality was rated by judges. Statistical analysis made it possible to compare pre and post emission / electrostimulation data in each phase. Qualitative analysis was performed based on self-reported symptoms. RESULTS There was no difference in vocal quality and MPT between pre and post moments in both phases. The difference between MSI and stimulus perception intensity was greater in series 1 than in series 2. There was an increase in MSI in series 5 compared to series 1. No significant negative symptoms or within 48h after procedures were reported. CONCLUSION The FES at MSI, associated with phonation, did not generate an immediate change in vocal quality, in the MPT or self-reported discomforts by women without vocal alteration, even with a gradual increase in the stimulus, series by series.
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Affiliation(s)
- Dinete Romansina
- Curso de Fonoaudiologia, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Marcia Simões-Zenari
- Curso de Fonoaudiologia, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Kátia Nemr
- Curso de Fonoaudiologia, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
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Fuentes Aracena C. Rol de los agentes físicos en la rehabilitación vocal: una revisión de la literatura. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2020. [DOI: 10.5209/rlog.65341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Los agentes físicos son elementos naturales o artificiales que se aplican para el tratamiento de determinados síntomas o patologías. En la rehabilitación vocal su estudio es un área emergente, donde las revisiones sistemáticas y los meta-análisis son escasos. Esto, muchas veces, dificulta la toma de decisiones y la correcta elección por parte del clínico. El objetivo de este trabajo fue analizar el rol de los agentes físicos en la rehabilitación vocal. Se realizó una revisión de la literatura a través de la búsqueda de artículos en las bases de datos PubMed, EBSCOHost y Scielo. Se establecieron criterios de elegibilidad según tipo, año y características de los estudios. Se evaluaron 603 artículos, de los cuales, luego del análisis de su título, abstract y del cumplimiento de los criterios de elegibilidad, se seleccionaron 16. Se entregan resultados en base a la cantidad de participantes, nivel de evidencia, tipo y configuración del agente físico, procedimientos e instrumentos de evaluación y beneficios obtenidos. Los agentes físicos de mayor utilización en la clínica vocal son la electroterapia (TENS y NMES) y la laserterapia. En general, estos actúan como coadyuvantes en la terapia vocal. La TENS reduce el dolor, la tensión laríngea y la percepción de voz apretada durante la fonación. La NMES beneficia la activación neuromuscular de las cuerdas vocales y el uso de láser permite la recuperación de los tejidos laríngeos posterior a tareas de sobrecarga.
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Alegria R, Vaz Freitas S, Manso MC. Effectiveness of voice therapy in patients with vocal fold nodules: a systematic search and narrative review. Eur Arch Otorhinolaryngol 2020; 277:2951-2966. [PMID: 32444967 DOI: 10.1007/s00405-020-06059-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND/OBJECTIVE An adult with vocal fold nodules can suffer from hoarseness, breathiness and vocal fatigue, which, in turn, significantly affects their vocal participation as well as activities. A well-designed voice therapy program improves the quality of life and vocal functionality. This is a narrative review with a systematic search of the current literature about the effectiveness of voice therapy interventions in adults with vocal fold nodules. METHODS Several key terms were used for the database electronic search of articles. Strict inclusion criteria were used and a broad evaluation of the studies was performed. This included the level of evidence based on the National Health and Medical Research Council levels of evidence, assessment, and critical appraisal. RESULTS Nine out of 30 reviewed articles met the criteria of inclusion and reported positive effects of voice therapy intervention on adult patients with vocal fold nodules. The vast majority of the reviewed studies reported multidimensional voice measures outcome data, most of them containing visual-perceptual, auditory-perceptual, acoustic and self-assessment results. Regardless of receiving direct or indirect or a combination of both voice therapy contents, nearly all voice quality parameters were found to improve after treatment. Short-term treatment (< 3 weeks) may be as beneficial as longer traditional voice therapy programs, and using telepractice voice therapy may be an achievable and practical way of delivering treatment and enhance adherence to therapy. The study design and the evidence levels of the included studies were low (≤ III-2) and the risk of bias of the comparative studies was moderate. CONCLUSION This narrative review cannot conclude the general effectiveness of voice therapy programs. Further research and understanding of what specific parameters (exercise and techniques) of a therapy's content will improve voice outcome measures. More studies are required to investigate whether or not voice therapy benefits are sustainable 6 months after ending the therapy. However, improved evidence is required to suggest that short period treatments are as beneficial as traditional therapy programs. Telepractice voice therapy may be an achievable and practical way of delivering treatment and enhance adherence to therapy.
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Affiliation(s)
- Rita Alegria
- Fernando Pessoa College of Health, Speech Therapy Department, University Fernando Pessoa, Porto, Portugal.
| | - Susana Vaz Freitas
- Faculty of Health Sciences, Speech Therapy Department, University Fernando Pessoa, Porto, Portugal.,Speech Pathology Unit of Otoryngology Service, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,LIAAD - INESC TEC, Porto, Portugal
| | - Maria Conceição Manso
- Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal.,Fernando Pessoa Energy, Environment and Health Research Unit (FP-ENAS), University Fernando Pessoa, Porto, Portugal.,LAQV, REQUIMTE, University of Porto, Porto, Portugal
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Stangherlin DAC, Lemos IDO, Bello JZ, Cassol M. Transcutaneous Electrical Nerve Stimulation in Dysphonic Patients: A Systematic Review. J Voice 2020; 35:876-885. [PMID: 32273210 DOI: 10.1016/j.jvoice.2020.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This paper aims to systematically review the application methods and clinical outcomes of transcutaneous electrical nerve stimulation (TENS) in the rehabilitation of dysphonic patients. METHODS The study consists of a systematic review performed in the Medline (via PubMed), Cochrane Library, Scopus and Lilacs databases, using a search strategy related to the research theme. Inclusion criteria involve experimental studies that investigated the effects of TENS on dysphonic patients, published in the last 15 years in Portuguese, English or Spanish. The Physiotherapy Evidence-Based Database was used to evaluate the methodological quality of the articles. RESULTS In the first search, 100 publications were found, 57 of which were duplicated and 23 did not address TENS as an intervention. According to the exclusion criteria of the remaining 20 studies, eight were selected for this review. The studies showed a pattern regarding the application of TENS. Of the studies analyzed, 87.5% had effective results after the intervention. Regarding pain, studies have found a reduction of this symptom in the neck, shoulders, back, masseter, and larynx. In the perceptual analysis, an improvement was verified in the parameters of tension, breathiness, roughness, instability, and asthenia. In addition, different types of vocal symptoms such as pain, burning, lump in the throat and effort to speak were reduced after TENS. CONCLUSION Although the studies included in this review indicate that there were changes related to the reduction of vocal symptoms, reduction of pain and improvement of vocal quality after the application of TENS in dysphonic patients, studies with a higher level of evidence and rigorous assessments of methodological quality are necessary so that findings are more robust and replicable in clinical practice.
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Affiliation(s)
| | - Isadora de Oliveira Lemos
- Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; and the Federal University of Health Sciences of Porto Alegre
| | - Jade Zaccarias Bello
- Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; and the Federal University of Health Sciences of Porto Alegre
| | - Mauriceia Cassol
- Rehabilitation Sciences Program and Speech-Language Pathology Department, Porto Alegre, Rio Grande do Sul, Brazil
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Walton C, Carding P, Conway E, Flanagan K, Blackshaw H. Voice Outcome Measures for Adult Patients With Unilateral Vocal Fold Paralysis: A Systematic Review. Laryngoscope 2018; 129:187-197. [DOI: 10.1002/lary.27434] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/14/2018] [Accepted: 06/18/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Chloe Walton
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University (ACU); Brisbane Australia
| | - Paul Carding
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University (ACU); Brisbane Australia
| | - Erin Conway
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University (ACU); Brisbane Australia
| | - Kieran Flanagan
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University (ACU); Brisbane Australia
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Mansuri B, Tohidast SA, Soltaninejad N, Kamali M, Ghelichi L, Azimi H. Nonmedical Treatments of Vocal Fold Nodules: A Systematic Review. J Voice 2018; 32:609-620. [DOI: 10.1016/j.jvoice.2017.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 07/11/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
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Conde MDCM, Siqueira LTD, Vendramini JE, Brasolotto AG, Guirro RRDJ, Silverio KCA. Transcutaneous Electrical Nerve Stimulation (TENS) and Laryngeal Manual Therapy (LMT): Immediate Effects in Women With Dysphonia. J Voice 2018; 32:385.e17-385.e25. [DOI: 10.1016/j.jvoice.2017.04.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 11/26/2022]
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Benign vocal fold lesions: update on nomenclature, cause, diagnosis, and treatment. Curr Opin Otolaryngol Head Neck Surg 2017; 25:453-458. [DOI: 10.1097/moo.0000000000000408] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Fabron EMG, Petrini AS, Cardoso VDM, Batista JCT, Motonaga SM, Marino VCDC. Efeitos imediatos da técnica de vibração sonorizada de língua associada à estimulação nervosa elétrica transcutânea (TENS). Codas 2017; 29:e20150311. [DOI: 10.1590/2317-1782/20172015311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 11/21/2016] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo Verificar variação da qualidade vocal após realização da técnica de vibração sonorizada de língua associada à estimulação nervosa elétrica transcutânea (TVSL+TENS) sobre a laringe em mulheres com função laríngea normal. Verificar, ainda, a influência do tempo de realização desta técnica na voz. Método Participaram 40 mulheres (média 23,4 anos) sem queixas ou alterações vocais. Foi realizada TVSL associada ou não à TENS por 3 minutos, descanso e realização da técnica por mais 2 minutos (total 5 min). Foram feitas gravações das vozes antes (Pré), após três minutos (Pós 3 min) e após dois minutos adicionais de técnica (Pós 5 min). Utilizou-se a corrente TENS, com dois eletrodos sobre a cartilagem tireóidea. Realizou-se autoavaliação, avaliação acústica e perceptivoauditiva. Resultados Ao comparar TVSL isolada e TVSL+TENS observou-se que a combinação das técnicas resultou em sensação de maior estabilidade na emissão vocal (autoavaliação) e melhor ganho na qualidade vocal (avaliação perceptivoauditiva). Não houve diferença estatística nos achados acústicos entre TVSL e TVSL+TENS. Ao considerar a TVSL+TENS e comparar seu tempo de realização, observou-se, na autoavaliação, sensação de menor tensão muscular (3 min) e maior conforto da emissão (5 min); na análise acústica, elevação de F0 (3 e 5 min) e intensidade (5 min), em relação ao momento Pré; e na avaliação perceptivoauditiva, melhor qualidade vocal (3 min). Conclusão Comparando TVSL isolada e TVSL+TENS, houve mudanças na sensação de conforto e tensão muscular e também, na qualidade vocal. Por outro lado, a TVSL+TENS realizada em 3 ou 5 mintuos resultou em efeitos benéficos na voz, identificados nas avaliações realizadas.
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