Função fonatória em pacientes com doença de Parkinson: uso de instrumento de sopro

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.

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

OBJECTIVE

To verify the immediate effect of the flexible resonance tube vocal technique on the oropharyngeal geometry and vocal acoustic parameters of individuals with Parkinson's disease (PD) and to study the correlation between oropharyngeal geometry and the intensity and fundamental frequency (f0) parameters of the voice.

METHODS

Forty individuals participated-20 with PD and 20 healthy individuals, with a mean age of 60.95 (± 5.69) years. There were 10 men and 10 women in each group. All underwent pharyngometric analysis of the vocal tract and voice acoustics parameters before and after use of the vocal technique with a flexible resonance tube.

RESULTS

After the technique, there was a reduction in pharyngeal cavity volume only in females in the healthy group, a reduction in shimmer values in females in both groups and males in PD group and an improvement in noise parameters in females in the PD group. There was a negative correlation between vocal tract volume and intensity, between f0 and vocal tract volume, between f0 and oropharyngeal junction area, between f0 and oral cavity volume as well as a positive correlation between oral cavity length and f0.

CONCLUSION

The vocal technique with the flexible resonance tube applied to individuals with PD improved the subjects' voice quality in the perceptual and acoustic voice parameters. Regarding the oropharyngeal geometry, it was possible to observe its correlation with the parameters of vocal intensity and frequency in the studied population.

The Effectiveness of Singing or Playing a Wind Instrument in Improving Respiratory Function in Patients with Long-Term Neurological Conditions: A Systematic Review

BACKGROUND

Many long-term neurological conditions adversely affect respiratory function. Singing and playing wind instruments are relatively inexpensive interventions with potential for improving respiratory function; however, synthesis of current evidence is needed to inform research and clinical use of music in respiratory care.

OBJECTIVE

To critically appraise, analyze, and synthesize published evidence on the effectiveness of singing or playing a wind instrument to improve respiratory function in people with long-term neurological conditions.

DESIGN

Systematic review of published randomized controlled trials and observational studies examining singing or playing wind instruments to improve respiratory function in individuals with long-term neurological conditions.

METHODS

Articles meeting specified inclusion criteria were identified through a search of the Medline, Embase, PsycINFO, Cochrane Library, CINAHL, Web of Science, CAIRSS for Music, WHO International Clinical Trials Registry Platform Search Portal, and AMED databases as early as 1806 through March 2015. Information on study design, clinical populations, interventions, and outcome measures was extracted and summarized using an electronic standardized coding form. Methodological quality was assessed and summarized across studies descriptively.

RESULTS

From screening 584 references, 68 full texts were reviewed and five studies included. These concerned 109 participants. The studies were deemed of low quality, due to evidence of bias, in part due to intervention complexity. No adverse effects were reported. Overall, there was a trend toward improved respiratory function, but only one study on Parkinson's disease had significant between-group differences.

CONCLUSIONS

The positive trend in respiratory function in people with long-term neurological conditions following singing or wind instrument therapy is of interest, and warrants further investigation.

Eficácia e limitação da terapia vocal na doença de Parkinson: revisão de literatura

RESUMO: O objetivo desta revisão de literatura foi verificar as evidências científicas e restrições dos diferentes tipos de tratamentos para voz na Doença de Parkinson. O levantamento dos artigos foi realizado nas bases de dados PubMed/MEDLINE, SciELO e Lilacs. Utilizou-se como estratégia de busca as combinações com os seguintes descritores: "Parkinson disease and vocal therapy"; "Parkinson disease and speech acoustic"; "Parkinson disease and voice". Os critérios de inclusão foram: idioma em português ou inglês; artigos dos anos 2003-2013; e estudos de intervenção. Adotou-se como critérios de exclusão: os repetidos nas bases de dados; pesquisas com animais. Durante a busca foram localizados 351 artigos, dos quais apenas 18 deles preenchiam os critérios de inclusão adotados no estudo. Os resultados foram apresentados considerando os diferentes tipos de tratamento para a voz na Doença de Parkinson, de acordo com a técnica de intervenção: medicamentoso, cirúrgico e reabilitação, identificando os autores e ano de publicação, características da amostra, o tipo de tratamento, o método utilizado e a conclusão do estudo. Nesta pesquisa observou-se reduzida produção científica no tratamento da voz na doença de Parkinson. A maioria dos artigos abordou as técnicas de tratamento para a voz de alto custo, ou que necessitam de habilitação/certificação no método para a realização da terapia de voz.

Respiratory Muscle Strength, Sound Pressure Level, and Vocal Acoustic Parameters and Waist Circumference of Children With Different Nutritional Status

OBJECTIVE

Relate respiratory muscle strength (RMS), sound pressure (SP) level, and vocal acoustic parameters to the abdominal circumference (AC) and nutritional status of children.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Eighty-two school children aged between 8 and 10 years, grouped by nutritional states (eutrophic, overweight, or obese) and AC percentile (≤25, 25-75, and ≥75), were included in the study. Evaluations of maximal inspiratory pressure (IPmax) and maximal expiratory pressure (EPmax) were conducted using the manometer and SP and acoustic parameters through the Multi-Dimensional Voice Program Advanced (KayPENTAX, Montvale, New Jersey).

RESULTS

There were significant differences (P < 0.05) in the EPmax of children with AC between the 25th and 75th percentiles (72.4) and those less than or equal to the 25th percentile (61.9) and in the SP of those greater than or equal to the 75th percentile (73.4) and less than or equal to the 25th percentile (66.6). The IPmax, EPmax, SP levels, and acoustic variables were not different in relation to the nutritional states of the children. There was a strong and positive correlation between the coefficient of amplitude perturbations (shimmer), the harmonics-to-noise ratio and the variation of the fundamental frequency, respectively, 0.79 and 0.71.

CONCLUSIONS

RMS and acoustic voice characteristics in children do not appear to be influenced by nutritional states, and respiratory pressure does not interfere with acoustic voice characteristics. However, localized fat, represented by the AC, alters the EPmax and the SP, each of which increases as the AC increases.

Uso do programa MDVP em diferentes contextos: revisão de literatura

Resumo:Este estudo tem como objetivo descrever, a partir de revisão de literatura, a confiabilidade da análise acústica utilizando o Multi Dimensional Voice Program,comparação de suas medidas com outros programas de análise acústica; caracterização de vozes de diferentes grupos; e sua utilização para verificar os efeitos e eficácia de diferentes procedimentos terapêuticos. Realizou-se levantamento bibliográfico que priorizaram estudos dos últimos cinco anos, incluindo-se artigos cujo objetivo estivesse de acordo com o interesse da presente revisão. A pesquisa foi realizada nos bancos de dados das bases Lilacs, BIREME, PubMed, MedLine, Scielo e Google Schoolar, por meio dos descritores acoustic, speech acoustics e voice. As medidas mais utilizadas são frequência fundamental, jitter, shimmer e proporção harmônico-ruído. As medidas de tremor não apresentam boa confiabilidade. As medidas mais consistentes que apresentam alta concordância com outros programas de análise acústica são as relacionadas com a frequência fundamental. Diversos estudos buscam caracterizar diferentes tipos de vozes tais como as de sujeitos sem alterações vocais de ambos os sexos, buscando estabelecer parâmetro de normalidade para diferentes grupos populacionais. Além disso, alguns estudos caracterizam vozes com diferentes distúrbios. A análise acústica é um recurso objetivo e necessário na avaliação de pacientes com distúrbio vocal e, principalmente, na comparação de diversos tipos de tratamento.

Characteristics of voice and personality of patients with vocal fold immobility

Purpose: To examine the voice and personality characteristics of patients diagnosed with organic dysphonia secondary to vocal fold immobility. Methods: The study comprised patients of both genders, attending the Clinic School of Speech Therapy of the Federal University of Paraíba, with otorhinolaryngological diagnosis of vocal fold immobility and speech therapy diagnosis of dysphonia. The self-assessment of voice was measured through a Vocal Screening Protocol and Voice Symptoms Scale (VoiSS), the voice was collected for auditory-perceptive evaluation, and the Factorial Personality Battery (FPB) was used. Descriptive statistical analysis was performed to determine the frequency, mean, and standard deviation of the studied variables. Results: Eight patients participated in the study, of both genders, with average age of 40.4±16.9 years. The more frequent risk factors were the personal ones (4.7±2.1). In the VoiSS, the patients presented a higher average in the limitation score (34.1±15.7). From the auditory-perceptive evaluation, moderate intensity of vocal deviation was obtained, with predominant vocal roughness (57.7±25.2). In the FPB, the patients had an average higher than the cutoff scores in neuroticism (3.8±1.4) and accomplishment (5.2±1.0). Conclusion: The predominant vocal parameter was roughness. The patients referred to a few risk factors that compromise the vocal behavior and presented the neuroticism and realization factors as a highlight in their personality. Thus, individuals with vocal fold immobility show personality characteristics that may be a reflection of their voice disorder, not a factor that determines their dysphonia.

Effect of speech therapy and pharmacological treatment in prosody of parkinsonians

OBJECTIVE

Parkinsonian patients usually present speech impairment. The aim of this study was to verify the influence of levodopa and of the adapted Lee Silverman Vocal Treatment® method on prosodic parameters employed by parkinsonian patients.

METHOD

Ten patients with idiopathic Parkinson's disease using levodopa underwent recording of utterances produced in four stages: expressing attitudes of certainty and doubt and declarative and interrogative modalities. The sentences were recorded under the effect of levodopa (on), without the effect of levodopa (off); before and after speech therapy during the on and off periods.

RESULTS

The speech therapy and its association with drug treatment promoted the improvement of prosodic parameters: increase of fundamental frequency measures, reduction of measures of duration and greater intensity.

CONCLUSION

The association of speech therapy to medication treatment is of great value in improving the communication of parkinsonian patients.

Vocal acoustic and auditory-perceptual measures, vocal complaints and professional characteristics of teachers from the city of Santa Maria (Rio Grande do Sul), Brazil

Purpose Describe and correlate acoustic and auditory-perceptual vocal measures, vocal complaints and professional characteristics of a group of teachers. Methods Ninety-nine female primary school teachers, aged 20 to 66 years, underwent auditory-perceptual (CAPE-V) and acoustic (Multi-Dimensional Voice Program Advanced) vocal assessments, and answered a questionnaire with questions about personal identification, overall health, occupational activities and vocal complaints. The ANOVA and Pearson’s correlation statistical tests have been applied. Results The teachers worked 6.98 hours a day, on average, and had been working as teachers for 12.91 years, approximately. Most of them reported vocal complaints and were employed in private schools. Auditory perceptual parameters were normal. All measures of jitter, shimmer, voiceless or unvoiced and subharmonic segments were above the normal range, as well as the standard deviation for fundamental frequency and soft phonation index. Perturbation frequency and age, roughness, breathiness and overall degree of voice were positively correlated with age and length of professional practice. There was also a negative correlation between amplitude perturbation and daily use of voice. Conclusion The teachers’ voices were considered as normal by the auditory-perceptual assessment, but noise and instability were detected in the acoustic analysis; there were, particularly, vocal complaints, and alteration of vocal acoustic and auditory-perceptual measures with increasing age and length of professional practice.

Pressão sonora e tempo máximo de fonação após a técnica de finger kazoo

OBJETIVO: verificar o nível de pressão sonora (NPS) modal e o tempo máximo de fonação (TMF) de /a/ de mulheres adultas, sem queixas vocais ou afecções laríngeas, antes, imediatamente após e cinco minutos após a execução da técnica de finger kazoo (FK). MÉTODO: coleta do TMF/a/, medida da frequência fundamental (f0) e seu desvio-padrão e do NPS modal, de 32 mulheres entre 18 e 40 anos de idade sem queixas vocais ou afecções laríngeas antes (M1), imediatamente após três séries de 15 repetições do FK (M2), e cinco minutos após silêncio (M3). Testes Spearman, Tukey e Friedman. RESULTADOS: aumento do NPS modal em M2 (com significância) e em M3; aumento de TMF/a/ em M2 e M3. CONCLUSÃO: no grupo pesquisado de mulheres adultas sem queixas vocais ou afecções laríngeas, houve aumento do NPS modal imediatamente após três séries de 15 repetições da técnica de FK, mostrando que a técnica pode influenciar a pressão sonora, a loudness e a projeção vocal.

Idiopathic Parkinson's disease: vocal and quality of life analysis

OBJECTIVE: To compare voice and life quality of male patients with idiopathic Parkinson's disease, with individuals without disease (Control Group). METHODS: A cross-sectional study that evaluated the voice of individuals with Parkinson's disease, the group was composed of 27 subjects, aged from 39 to 79 years-old (average 59.96). The Control Group was matched on sex and age. Participants underwent voice recording. Perceptual evaluation was made using GRBASI scale, which considers G as the overall degree of dysphonia, R as roughness, B as breathiness, A as asthenia, S as strain and I as instability. The acoustic parameters analyzed were: fundamental frequency, jitter, shimmer, and harmonic to noise ratio (NHR). For vocal self-perception analysis, we used the Voice Related Quality of Life protocol. RESULTS: Fundamental frequency and jitter presented higher values in the Parkinson's group. NHR values were higher in the Control Group. Perceptual analysis showed a deviation ranging. The vocal disorder self-perception demonstrated a worse impact on quality of life. CONCLUSIONS: Individuals with Parkinson's disease have an altered voice quality and a negative impact on quality of life.

Capacidade vital e tempos máximos de fonação de /e/ áfono e de /s/ em mulheres adultas

OBJETIVO: verificar a capacidade vital (CV) e os valores de tempo máximo de fonação (TMF) do /e/ áfono (representado por /ė/) e do /s/ de mulheres adultas, estabelecendo o perfil da amostra e comparando-o com o padrão de normalidade proposto. MÉTODO: coleta do maior valor de três medidas de CV, de TMF/ė/ e de TMF/s/; e da estatura auto-referida de 48 mulheres entre 18 e 44 anos de idade, normais de acordo com avaliações otorrinolaringológica, miofuncional, vocal, respiratória e auditiva. Aplicou-se análise estatística descritiva, teste de normalidade de Shapiro-Wilk, e cálculo do coeficiente de variação; adotou-se o nível de significância de 5%. RESULTADOS: valores médios de CV de 3.206ml, de TMF/s/ de 17,49s e de estatura de 1,65m, com distribuição normal; TMF/ė/ sem distribuição normal e média de 10,43s significantemente menor do que os valores da literatura (P<0.001). No entanto, o TMF/ė/ apresentou valores de média e mediana bastante próximos (10,43s e 10,25s) e coeficiente de variação muito similar ao TMF/s/. CONCLUSÃO: para o grupo de analisado, encontraram-se valores médios de CV e de TMF/s/ compatíveis com os referidos pela literatura. Os valores médios de TMF/ė/ se apresentaram abaixo do proposto pela única referência teórica existente, evidenciando a necessidade de mais pesquisas como esta - que investiguem em campo a medida de TMF/ė/ - a fim de estabelecer a faixa normalidade conforme o sexo e obter mais dados científicos sobre o que parece ser a medida mais indicada para a avaliação isolada do controle respiratório durante a emissão.

Aspectos respiratorios, posturais e vocais da Doença de Parkinson: considerações teóricas

TEMA: manifestações respiratórias, posturais e vocais, associadas aos estágios da Doença de Parkinson (DP) e suas possíveis inter-relações. OBJETIVO: revisar a literatura, a fim de descrever as características respiratórias, posturais e vocais associadas aos estágios na DP e suas possíveis inter-relações. CONCLUSÃO: Na DP, a etiologia das manifestações respiratórias é multifatorial, sendo obstrutivas; restritivas; relacionadas à bradicinesia, à rigidez e às alterações posturais; fraqueza da musculatura; anormalidades na musculatura laríngea; interferência da medicação antiparkisoniana. A postura em flexão altera a dinâmica corporal, interferindo nas funções estomatognáticas e na relação tóraco-abdominal. As alterações vocais podem estar presentes desde os estágios iniciais com diminuição dos tempos máximos de fonação e da intensidade vocal; adução glótica incompleta; fendas glóticas; tremor e instabilidade fonatória; perturbações de frequência e de intensidade; e qualidade vocal alterada. Os déficits na força muscular respiratória se refletem no menor suporte respiratório à emissão vocal e, por consequência, na diminuição da intensidade vocal e dos tempos máximos de fonação. Do mesmo modo, a postura em flexão gera desvantagem biomecânica à atividade respiratória, com menor expansão e redução dos volumes pulmonares, e déficit na excursão diafragmática. Os distúrbios respiratórios, posturais e/ou vocais, à medida que a DP evolui, de acordo com os seus estágios, tendem ao maior comprometimento, apresentando efeitos na comunicação verbal e não-verbal.

Medidas vocais acústicas na doença de Parkinson: estudo de casos

TEMA: características vocais acústicas de indivíduos com Doença de Parkinson (DP). PROCEDIMENTOS: estudo de casos, estatística descritiva; cinco pares de parkinsonianos e controle, três masculinos e dois femininos, entre 36 e 63 anos. Avaliação otorrinolaringológica, fonoaudiológica, voz analisada pelo Multi-Dimensional Voice Program Advanced Model 5105 da Kay Pentax®. RESULTADOS: a f0 das mulheres adultas de meia-idade com DP ficou na faixa masculina e a f0 dos controles no limite inferior da faixa feminina. Nos demais sujeitos, que eram homens de diferentes idades, a f0 foi normal; houve aumento de todas as medidas acústicas principalmente nos sujeitos com DP de todas as faixas etárias estudadas. CONCLUSÃO: o processo de envelhecimento e suas consequências parecem atuar como fator interferente nas modificações acústicas da voz, mas, aparentemente, a DP e a idade precoce de seu aparecimento podem acentuar tais alterações, repercutindo de forma negativa na fonação.