Effect of Resonance Tube Technique on Oropharyngeal Geometry and Voice in Individuals with Parkinson's Disease

Volitional and Non-volitional Devices Used in Voice Therapy and Training: A Scoping Review-Part A

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.

Eficacia de los ejercicios de tracto vocal semiocluído en el Temblor Esencial

El temblor esencial (TE) es una enfermedad neurológica que se manifiesta con trastornos del movimiento, experimentando la persona que lo sufre temblores que no puede controlar. Además de producirse temblores en manos, también manifiestan temblores en las mandíbulas y laringe, quedando principalmente la voz de estos pacientes afectada.  Por otro lado, se ha demostrado que los ejercicios de tracto vocal semiocluído (ETVSO) provocan cambios beneficiosos en el patrón vibratorio de los pliegues vocal. Es por ello que se presenta el caso clínico de una mujer de 61 años diagnosticada de TE con la finalidad de comprobar la efectividad de los  ETVSO en pacientes con dicha enfermedad. Los resultados post intervención logopédica mostraron un descenso en los Hz de los formantes de la voz, una mejora de fonación continua y mejora de la prosodia. Por lo que se concluye que el uso de los ETVSO podría ser beneficioso en pacientes con temblor esencial.

Oropharyngeal geometry and acoustic parameters of voice in healthy and Parkinson's disease subjects

PURPOSE

to verify whether there are differences in acoustic measures and oropharyngeal geometry between healthy individuals and people with Parkinson's disease, according to age and sex, and to investigate whether there are correlations between oropharyngeal geometry measures in this population.

METHODS

40 individuals participated, 20 with a diagnosis of Parkinson's disease and 20 healthy individuals, matched by age, sex, and body mass index. Acoustic variables included fundamental frequency, jitter, shimmer, glottal-to-noise excitation ratio, noise, and mean intensity. Oropharyngeal geometry variables were measured with acoustic pharyngometry.

RESULTS

geometry variables were smaller in the group with Parkinson's disease, and older adults with Parkinson's disease had a smaller oropharyngeal junction area than healthy older adults. Regarding acoustic parameters of voice, fundamental frequency values were lower in males with Parkinson's disease, and jitter values ​​were higher in the non-elderly subjects with Parkinson's disease. There was a moderate positive correlation between oral cavity length and volume, pharyngeal cavity length and vocal tract length, and pharyngeal cavity volume and vocal tract volume.

CONCLUSION

individuals with Parkinson's disease had smaller glottal areas and oropharyngeal junction areas than healthy individuals. When distributed into sex and age groups, the fundamental frequency was lower in males with Parkinson's disease. There was a moderate positive correlation between oropharyngeal length and volume measures in the study sample.

Relationship Between Oropharyngeal Geometry and Acoustic Parameters in Singers: A Preliminary Study

OBJECTIVE

To verify possible correlations between formant and cepstral parameters and oropharyngeal geometry in singers, stratified by sex.

METHOD

Voice records and oropharyngeal measures of 31 singers - 13 females and 18 males, mean age of 28 (±5.0) years - were retrieved from a database and analyzed. The oropharyngeal geometry measures were collected with acoustic pharyngometry, and the voice records consisted of sustained vowel /Ԑ/ phonation, which were exported to Praat software and edited to obtain the formant and cepstral parameters, stratified by sex. The Pearson linear correlation test was applied to relate voice parameters to oropharyngeal geometry, at the 5% significance level; the linear regression test was used to justify the variable related to the second formant.

RESULTS

Differences between the sexes were identified only in the oral cavity length (greater in males) and pharyngeal cavity length (greater in females). There was a linear correlation between the third formant and the cepstrum in the female group. In the male group, there was a linear correlation between the cepstrum and the third and fourth formants. A positive linear correlation with up to 95% confidence was also identified between the pharyngeal cavity volume and the second formant in the female group, making it possible to estimate a regression model for the second formant (R2 = 0.70).

CONCLUSION

There are correlations between the oropharyngeal geometry and formant and cepstral parameters in relation to sex. The pharyngeal cavity volume showed the greatest correlation between females and the second formant.

Relationship Between Oropharyngeal Geometry and Vocal Parameters in Subjects With Parkinson's Disease

OBJECTIVE

To verify whether the dimensions of different segments of the oropharyngeal cavity have different proportions between Parkinson's disease patients and vocally healthy subjects and investigate whether the measurements of these subjects' oropharyngeal geometry associate with their acoustic measurements of voice.

METHOD

Quantitative, descriptive, cross-sectional, and retrospective study with secondary data, approved by the Human Research Ethics Committee under no. 4.325.029. We used vocal samples and data from the oropharyngeal geometry of 40 subjects - 20 with Parkinson's disease stages I to III and 20 who formed the control group, matched for sex and age. Each group had 10 males and 10 females, mean age of 61 years (±6.0). Formant (F1, F2, and F3) and cepstral measures of the sustained vowel /ε/ were extracted and arranged in the database to determine their values using Praat software. The data were descriptively analyzed, with statistics generated with R software. The proportion of oropharyngeal geometry measurements was arranged by mean values and coefficients of variation. Pearson's linear correlation test was applied to relate voice parameters to oropharyngeal geometry, considering P < 0.05, and linear regression test, to justify F2.

RESULTS

The Parkinson's disease group showed a linear relationship between oral cavity length and F1 in males (P = 0.04) and between glottal area and F2 in females (P = 0.00); linear relationships were established according to age in both groups, and a regression model for F2 was estimated (R2 = 0.61). There was no difference between pathological and healthy voices; there was a difference in the proportional relationship of oropharyngeal geometry between the groups.

CONCLUSION

The proportional relationship of oropharyngeal geometry differs between the Parkinson's disease group and the control group, as well as the relationship between oropharyngeal geometry and formant and cepstral values of voice according to the subjects' sex and age.

Immediate Effect of the Finger-Kazoo Technique Associated with Glissandos in the Voice of Individuals with Parkinson's Disease

OBJECTIVE

To verify the immediate effect of the Finger Kazoo technique associated with glissandos in the voice of individuals with Parkinson's disease.

METHOD

Thirty subjects with Parkinson's Disease comprised of 15 men and 15 women with a mean age of 63.8 years (± 6.88) and mean time of diagnosis of 97.33 (± 63.53) months, all with preserved cognition. The subjects' voice range profile (VRP), speech range profile (SRP), and the maximum phonation time were assessed, before and after applying the Finger Kazoo technique associated with ascending and descending glissando. After the technique, a vocal satisfaction questionnaire was completed.

RESULTS

After the applied technique there was an increase in the minimum and maximum fundamental frequency recorded respectively in the SRP and in the VRP; there was an increase in the vocal range (measured in Hertz and semitones) of the women, recorded in the VRP; in the male population, there was an increase in maximum phonation time. A higher percentage of positive references to vocal improvement was observed after the exercise.

CONCLUSION

In patients with Parkinson's Disease, the Finger Kazoo with glissando technique promoted an increase in the minimum fundamental frequency of the SRP and in the vocal extensions of women, as well as increasing the maximum phonatory time of men. In addition, patients reported satisfaction with the use of the technique and its results.

The physical significance of acoustic parameters and its clinical significance of dysarthria in Parkinson's disease

Dysarthria is universal in Parkinson’s disease (PD) during disease progression; however, the quality of vocalization changes is often ignored. Furthermore, the role of changes in the acoustic parameters of phonation in PD patients remains unclear. We recruited 35 PD patients and 26 healthy controls to perform single, double, and multiple syllable tests. A logistic regression was performed to differentiate between protective and risk factors among the acoustic parameters. The results indicated that the mean f0, max f0, min f0, jitter, duration of speech and median intensity of speaking for the PD patients were significantly different from those of the healthy controls. These results reveal some promising indicators of dysarthric symptoms consisting of acoustic parameters, and they strengthen our understanding about the significance of changes in phonation by PD patients, which may accelerate the discovery of novel PD biomarkers.