Amanda Freitas Valentim

Análise espectrográfica da voz: efeito do treinamento visual na confiabilidade da avaliação

OBJETIVO: Verificar se o treinamento visual melhora a concordância inter e intra-avaliadores da interpretacao da analise acustica espectrografica. METODOS: Trata-se de um estudo experimental longitudinal que utilizou espectrogramas coletados em um banco de dados de consultorio particular, referentes a vozes de homens e mulheres analisadas pelo programa Gram 5.0 em escala de 60 dB, em display scroll, paleta BW, com analise de frequencias em escala linear, banda estreita, FFT 1024 e resolucao 5.4 Hz. Vinte sujeitos, estudantes de Fonoaudiologia, avaliaram 25 espectrogramas, sendo cinco destes repetidos para avaliar a concordância intra-sujeitos, antes e apos um treinamento de analise de espectrogramas. Os parâmetros analisados foram: forma do tracado espectrografico, grau de escurecimento dos harmonicos, estabilidade do tracado espectrografico, presenca de ruido, presenca de sub-harmonicos e definicao dos harmonicos. O treinamento teve a duracao total de quatro horas. Utilizou-se a estatistica Kappa para avaliar a concordância intrassujeitos e o teste Qui-quadrado de ajuste para a concordância intersujeitos. RESULTADOS: Em relacao a concordância intra-sujeitos, os aspectos escurecimento do tracado, estabilidade do tracado, presenca de sub-harmonicos, e definicao de harmonicos obtiveram melhora desta e os demais aspectos mantiveram concordância quase perfeita depois do treinamento. Quanto a concordância intersujeitos, os aspectos de estabilidade do tracado e presenca de sub-harmonicos obtiveram melhora, e o aspecto presenca de ruido obteve piora apos o treinamento. CONCLUSAO: O treinamento visual melhorou a confiabilidade inter e intra-avaliadores na interpretacao de espectrogramas.

Adesão a orientações fonoaudiológicas após a alta do tratamento vocal em docentes: estudo prospectivo

PURPOSE: to investigate the adherence to voice therapy guidelines of teachers in municipal schools that were treated at the Voice Clinic of Hospital das Clinicas, Federal University of Minas Gerais, and that were discharged from voice therapy. METHOD: 39 patients treated at the Voice Clinic of Hospital das Clinicas, Federal University of Minas Gerais were interviewed by phone from August 2007 to December 2008. The interviews aimed to analyze the adherence to the guidelines after voice therapy discharge. RESULTS: this study outcome indicates that 34 patients (87.1%) report following the guidelines, four (10.2%) do it partially and one (2.5%) referred not following the guidelines. CONCLUSION: the majority of teachers adhere to the guidelines after voice therapy discharge. The outcome suggests that the voice therapy helps to maintain the standard of voice and a healthy vocal behavior.

Protrusive tongue strength in people with severely weak tongues

Abstract The purpose of the study was to quantify tongue protrusion force and compare its characteristics between participants with severely weak tongues and those with normal lingual strength. The sample consisted of 11 participants with severe lingual strength deficits and 11 age- and sex-matched participants with normal lingual strength. Tongue force was evaluated quantitatively using the Forling instrument, and the average force, maximum force, average force application rate, and area under the graphic curve were analysed. These parameters were compared between the groups. In the participants with severely weak tongues, the average and the maximum forces in N (Newton) were 2.03 ± 1.17 and 3.56 ± 1.77, respectively. The average force application rate in N/s (Newton per second) was 1.25 and the area under the graphic curve in Ns (Newton times second) was 18.6. The values of the participants with normal lingual strength were, respectively, 13.27 ± 6.15 N, 18.91 ± 7.95 N, 10.46 N/s, and 108.08 Ns. All parameters analysed differed significantly between the groups. The data collected could aid speech-language pathologists in diagnosing problems related to tongue force.

Evaluation of the force applied by the tongue and lip on the maxillary central incisor tooth

PURPOSE To describe the development and testing of a system that measures forces exerted by the tongue and upper lip on a tooth during rest and during swallowing. METHODS Twenty-eight subjects, aged 19-31 years (mean: 23.2 years) were submitted to measurement of forces exerted by the upper lip and tongue on the maxillary right central incisor tooth. Flexiforce resistive sensors were fixed on the labial and lingual surfaces of the tooth. They were connected to an amplifier circuit and a data acquisition board for processing and transmitting information to a computer. RESULTS At rest, the tongue force on the tooth was 0.00±0.00 N and the lip force on tooth was 0.02±0.02 N. The difference between them was significant. During swallowing, the values were 0.31±0.38 N and 0.15±0.14 N, for the tongue and lip, respectively. This difference was not significant. CONCLUSION At rest, the lip exerts a larger force than the tongue on the maxillary right central incisor tooth. During swallowing, there was no difference between lip and tongue force on the tooth.

Métodos quantitativos para avaliação da força de língua

ABSTRACT For several years, researchers have been looking for methods to quantify tongue force and a lot of devices were constructed for this purpose. The purpose of this study is to present a critical literature review about the devices to quantify tongue strength. Thirty devices were found. They were grouped into four different categories: mouthpiece containing sensors (n=9), sensors attached on teeth surface or on palatal plates (n=8), bulbs filled with some fluid and connected to a pressure sensor (n=7) and other technologies (n=8). These methods can, potentially, help speech-language pathologists in the orofacial myology evaluation, making the diagnosis of tongue force more reliable. Some of them present disadvantages such as not being sensitive enough to small changes in force, difficulties in positioning reproducibility and other specific points. The large variation in maximum and average strength/pressure values are related to the large diversity of the methods, which use different technologies.

Achados da avaliação multiprofissional de crianças respiradoras orais

PURPOSE: to describe orofacial myofunctional findings, as well as the main otolaryngological, allergological and orthodontic problems found in mouth breathing children. METHODS: 502 medical charts from the Mouth Breathing Outpatient Clinic from Hospital das Clinicas da Universidade Federal de Minas Gerais were analyzed. The subjects were aged between 2 and 12 years (median 6.0 years) and, about genders, 289 (57.6%) were male and 213 (42.4%) were female. The data collected was regarding general anamnesis, speech-language pathology evaluation, as well as the relevant parts of otolaryngological, allergological and orthodontic assessments. Data was submitted to statistical analysis. RESULTS: at anamnesis, significant prevalence of maintaining the mouth opened (98.0%), snoring (89.9%) and nocturnal drooling (68.6%) was observed. Allergologic evaluation showed positive skin test (59.0%) and rhinitis (57.8%) and otolaryngological assessment revealed hypertrophic adenoids (91.7%) and tonsils (72.6%) and changed nasal mucosa (60.3%). The findings on orthodontic evaluation were malocclusion (86.8%), convex facial profile (62.9%) and overbite (55.5%). Data from speech-language pathology assessment indicated inappropriate usual lips position (70.5%), facial changes in lips (65.4%) and tongue (64.4%) strength, high hard palate (57.1%), altered nasolabial angle (57.0%) and asymmetry (55.0%). CONCLUSION: alterations were found on the evaluations made by all professionals, confirming the huge impact of mouth breathing on quality of life of those children, and therefore the need for multidisciplinary treatment for these patients.

Relationship between perception of tongue position and measures of tongue force on the teeth

Purpose To verify whether there are differences of tongue force on the teeth at rest and during swallowing between individuals who report appropriate tongue position and those who report tongue thrust. Methods Tongue forces on the teeth were evaluated in 28 participants aged 19 to 31 years. To this end, a Flexiforce® resistive sensor was fixed to the palatal surface of the maxillary right central incisor (tooth 8) and was connected to an amplifier circuit, a data acquisition board, and a computer. Measurements were taken at rest and during saliva swallowing. Participants were asked about their habitual tongue position and where the apex of tongue touched when they swallowed. The Mann Whitney test was used for statistical analysis at 5% significance level. Results At habitual position, tongue force on the teeth was 0.00 N both for participants that reported tongue touch and for those who did not. At directed swallowing, tongue force was 0.34 N for the group of individuals whose tongues touch the teeth and 0.08 N for the group of individuals whose tongues do not touch the teeth. This difference was significant. Conclusion No significant difference was found between the tongue forces of participants of both groups at habitual position. However, participants with tongue thrust during directed swallowing presented greater force than those whose tongues do not touch the teeth during this task.

Fatores associados à pressão de língua em pacientes pós-acidente vascular cerebral

Introdução: A prática clínica fonoaudiológica no ambiente hospitalar mostra que existe alta prevalência de disfagia em pacientes pós-acidente vascular cerebral. Objetivo: Verificar se o tempo de ocorrência e o tipo do acidente vascular cerebral, o hemicorpo acometido por hemiplegia, a gravidade do deficit neurológico, a presença e o grau de disfagia interferem na pressão de língua de pacientes internados pós-acidente vascular cerebral. Métodos: Estudo realizado com 31 pacientes. Foi aplicado protocolo da avaliação da disfagia, prova de mobilidade lingual e mediu-se a pressão de língua com o Iowa Oral Performance Instrument (IOPI). Foram realizadas três medidas da pressão anterior e três da pressão posterior. Os dados foram analisados por meio de estatística apropriada, com nível de significância de 5%. Resultados: Apenas a presença de disfagia se mostrou associada estatisticamente à pressão de língua, sendo que os pacientes pós-acidente vascular cerebral disfágicos apresentaram pressão anterior e posterior média e máxima da língua menor que aqueles sem a presença de disfagia. O tempo de ocorrência do acidente vascular cerebral, o tipo e o hemicorpo acometido e a gravidade do deficit neurológico não apresentaram associação com a pressão lingual. Dentre os 15 participantes que apresentaram a dificuldade de deglutição, 14 (93,3%) foram classificados com disfagia leve e um (6,7%) com disfagia moderada. Conclusão: Verificou-se que a disfagia, ainda que de grau leve, foi o fator preponderante para diminuição da pressão de língua em pacientes que sofreram acidente vascular cerebral.

Development and Clinical Application of Instruments to Measure Orofacial Structures

The muscles which compose the orofacial system are characterized by their small sizes and the ability to generate highly precise and differentiated movements that includes a series of rapid shape changes. This is made possible due to the large amount of innervations and the complex organization of the muscle fibers. These muscles play an essential role in mastication, swallowing, speech, breathing and suction, functions that require fast and complex movements. They also contribute to the orientation of facial bone growth and maintenance of teeth position.

Instrumentation to Evaluate and Train Orofacial Structures

Muscular pressure is the guide for teeth positioning. When balance between tongue, lips and cheeks is broken, there are always consequences for the face bones and teeth. The evaluation of these orofacial structures is then an important and routinely made task in Speech-language Pathology clinical practice. However, this assessment is carried out in a subjective way, according to the experience of the professional, what makes the diagnosis and the follow up harder to be done. Due to the need for precise methods of assessing the strength of orofacial muscles, the Biomechanical Engineering Group from Universidade Federal de Minas Gerais, in an interdisciplinary project, developed some devices with the purposes to measure tongue and lips strength and to rehabilitate tongue strength. Those appliances are currently going through improvements and a device to measure cheek forces is been developed. The use of such devices in clinical practice and research will enable Speech-language Pathologists to make a more reliable orofacial myofunctional evaluation, also improve patients´ follow up observing quantitatively the strength gained.