Ana Cristina Côrtes Gama

Análise acústica da voz de mulheres idosas

PURPOSE: to analyze acoustic measures in elderly womens voices. METHODS: ninth six elderly women, with ages between 60 and 103-year old, were recruited and separated in tree groups according to their ages. RESULTS: the values of fundamental frequency were 193. 81 Hz (Group 1), 195.71 (Group 2) and 187.60 Hz (Group 3). The Maximum phonatory extension were 42.10 semitones (Group 1); 37.29 semitones (Group 2) and 38.75 semitones (Group 3). The values of the minimum frequency and maximum frequency were respectively 103.62 Hz and 1099.1 Hz (Group 1); 102.28 Hz and 918.10 Hz (Group 2) and 88.73 Hz and 876.8 Hz (Group 3). The maximum phonation time of the vowel /a/ were 8.54 seconds (Group 1), 7.97 seconds (Group 2) and 7.52 seconds (Group 3). For the vowel /i/ the values were 8.82 seconds (Group 1), 8.44 seconds (Group 2) and 8.05 seconds (Group 3). For the vowel /u/ were 9.22 seconds (Group 1), 8.09 seconds (Group 2) and 7.95 seconds (Group 3). CONCLUSION: elderly women showed lower values of fundamental frequency and maximum phonation time. Maximum phonatory extension measure was similar to those found in young adults. All studied measures showed a decreasing trend with advancing age.

Correlação entre dados perceptivo-auditivos e qualidade de vida em voz de idosas

BACKGROUND: vocal quality and voice-related quality of life in elderly women AIM: to assess the vocal quality and voice-related quality of life in elderly women, as well as verify if the presence of dysphonia has an influence on the life quality of these women. METHODS: one hundred and three elderly women, with ages ranging from 60 to 103 years, were recruited. The V-RQOL was answered by the participants and their voices were registered and analyzed perceptually by five experienced speech pathologists, using the GRBASI scale. After the intra-rater reliability analysis, three speech pathologists were selected with whom a single GRBASI scale was built for each of the participants voice. Later, this single assessment was compared to the physical, socio-emotional and total V-RQOL scores. RESULTS: most of the elderly women presented V-RQOL total scores between 70 and 100. They also presented a mild to moderate vocal disorder in the overall scores related to dysphonia, roughness, breathiness and instability in the GRBASI scale and did not present scores related to asthenia or strain. The G, R, B and I parameters of the GRBASI scale were statistically correlated to the physical and total V-RQOL scores. CONCLUSIONS: although most of the elderly women presented some level of dysphonia, the vocal disorders did not have an influence on their life quality. However, the physical and total V-RQOL scores were correlated to dysphonia severity, indicating that the more sever the dysphonia, the lower the voice-related quality of life.

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.

Análise visual de parâmetros espectrográficos pré e pós-fonoterapia para disfonias

OBJETIVO: Avaliar os efeitos da fonoterapia nos disturbios da voz por meio de diferentes parâmetros acusticos pre e pos-fonoterapia. METODOS: Trata-se de estudo experimental retrospectivo no qual se analisou as gravacoes de vozes de 67 individuos submetidos a reabilitacao vocal. Os espectrogramas pre e pos-terapia fonoaudiologica foram julgados por quatro fonoaudiologas. Os parâmetros para analise foram: forma do tracado, grau de escurecimento dos harmonicos, estabilidade do tracado dos harmonicos, presenca de ruido, presenca de harmonicos e de sub-harmonicos. Os dados obtidos foram submetidos a analise estatistica, em que tambem se buscou observar a eventual diferenca de padroes entre generos e diagnosticos. RESULTADOS: Nao houve diferenca estatisticamente significante entre a forma do tracado espectrografico nas condicoes pre e pos-fonoterapia, porem a maioria dos pacientes (58%) obteve melhora. O grau de escurecimento manteve-se estavel nas condicoes pre e pos-fonoterapia (p=0,000). Houve significativa melhora espectrografica, apos a fonoterapia, para os parâmetros de estabilidade do tracado (p=0,006), presenca de ruido (p=0,007), harmonicos (p=0,000) e sub-harmonicos (p=0,001). Nao houve relacao entre o genero do paciente e o grau de melhora espectrografica. Em relacao ao diagnostico, apenas o parâmetro forma do tracado apresentou diferencas significativas. CONCLUSAO: Apesar de nao terem sido encontradas mudancas significativas em todos os parâmetros avaliados, a espectrografia acustica demonstrou ser um instrumento eficaz para avaliar a evolucao da voz do paciente no processo terapeutico, sendo complementar a avaliacao perceptivo-auditiva e fazendo parte de um protocolo multidimensional.

Occupational and individual risk factors for dysphonia in teachers

BACKGROUND In recent decades several groups of researchers have been interested in describing and understanding vocal morbidity in teachers in order to explain the large number of teachers diagnosed with dysphonia and account for the absenteeism attributed to vocal disability. AIMS To determine the proportion of teachers who reported a diagnosis of dysphonia and measure associations between individual and contextual factors and the event of interest. METHODS Teachers were recruited from the city of Belo Horizonte and invited to complete a web-based institutional intranet questionnaire. RESULTS In total, 649 teachers responded; 32% (CI 28.5-35.5) reported that they had received a physician diagnosis of dysphonia. This prevalence was significantly higher among female teachers (prevalence ratio (PR) 2.33; CI 1.41-3.85), and groups who reported limited technical resources and equipment (PR 1.56; CI 1.14-2.15), a diagnosis of gastritis (PR 1.59; CI 1.28-1.98), not being summoned for an annual physician examination (PR 0.47; CI 0.32-0.68), or absenteeism (PR 1.39; CI 1.06-1.81). CONCLUSIONS The high prevalence of dysphonia in teachers was not associated with any individual variables, except for sex and comorbidity (diagnosis of gastritis). Limited technical resources and equipment were associated with dysphonia and suggests policy change is important in preventing dysphonia.

Oral language comprehension assessment among elderly: a population based study in Brazil.

BACKGROUND Determinants of oral language comprehension, a complex skill, are not clearly established, but may include age, schooling, health condition, depression and quality of life. OBJECTIVE To assess oral comprehension skill among Brazilian elderly and identify factors explaining elderly variability in the Token test performance. METHODS A population-based random sample of 373 elderly (> or = 60 years) in Belo Horizonte, 2007, answered standardized questionnaire including socio-demographic and health-related questions and performed the Token Test short version (SVTT), Snellen Test, Mini Mental State Examination, General Health Questionnaire, and Health Survey Short Form (SF12). RESULTS Token Test scores ranged from 8 to 35 points; 50% of participants scored < or = 24 points with no sex variation. Age, schooling, literacy, cognitive status, hypertension, self-rated conversational understanding and SF12 mental component explained 62% of SVTT variability. CONCLUSIONS Language comprehension disorder was quite common and test performance was highly influenced by education and cognitive status. Association between test performance and self-rated conversational comprehension indicated that elderly were aware of their difficulty.

Escala URICA-VOZ para identificação de estágios de adesão ao tratamento de voz

OBJETIVOS: Adaptar a escala URICA a avaliacao dos estagios de mudanca para a adesao de pacientes em tratamentos de voz; e verificar a relacao destes com a idade do paciente, o tipo de disfonia, a escolaridade, a profissao e o numero de sessoes de fonoterapia. METODOS: Estudo transversal, com amostra de conveniencia, composta por 66 pacientes com disfonia, sendo 58 mulheres e oito homens, com idade entre 18 e 65 anos, atendidos em dois ambulatorios de instituicoes de ensino de Fonoaudiologia. Como instrumento exploratorio, procedeu-se a adaptacao brasileira da escala URICA para a area de voz, tendo como base situacoes especificas relacionadas ao comportamento vocal, denominada URICA-VOZ. O instrumento foi aplicado individualmente e as variaveis foram relacionadas. RESULTADOS: A maioria dos pacientes, 38 (57,6%), concentrou-se no estagio de contemplacao, 20 (30,3%) no de pre-contemplacao e apenas oito (12,1%) no de acao, ideal para a terapia fonoaudiologica. Nao houve associacao entre os estagios de adesao com as variaveis idade, tipo de disfonia, escolaridade e numero de sessoes de fonoterapia. A variavel profissao apresentou associacao com o estagio de acao URICA-VOZ. CONCLUSAO: O uso da escala URICA-VOZ revelou que a maioria dos pacientes com disfonia em tratamento ainda se encontra no estagio de contemplacao, o que pode restringir os resultados da terapia. Nao houve relacao entre as demais variaveis estudadas e os estagios de adesao do protocolo URICA-VOZ.

Validação do Questionário de Performance Vocal no Brasil

PURPOSE: To validate the Vocal Performance Questionnaire into Brazilian Portuguese. METHODS: The guidelines of the Scientific Advisory Committee of the Medical Outcomes Trust - SAC were followed. Initially, aspects of conceptual model and measurement, reliability, validity, sensitivity, interpretability, and demand of management and response were analyzed. The questionnaire was translated and back translated by two speech-language pathologists fluent in English. The versions were compared and the Portuguese version of the questionnaire, denominated Questionario de Performance Vocal - QPV, was generated. The QPV was administered to 325 people, 160 with vocal complaints and 165 ones without vocal complaints, with similar distribution of gender and age. The scores of both groups were calculated and compared, and the questionnaire was administered again to 39 dysphonic participants, to determine its reliability and test-retest reproducibility. A 95% confidence interval was adopted. RESULTS: All 12 questions were maintained, and the questionnaire presented reliable psychometric measures of validity, reliability and reproducibility, and sensitivity. CONCLUSION: The Brazilian version of the VPQ, the Questionario de Performance Vocal - QPV, is a reliable and valid protocol, sensitive to changes, easy to use and calculate the results, and may be an important instrument to compose the speech-language pathology assessment of dysphonic patients.

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.

Avaliação acústica e perceptivo-auditiva da voz nos momentos pré e pós-operatório da cirurgia de implante de pré-fáscia do músculo temporal

PURPOSE: to analyze the impact of pre-fascia temporal muscle implantation in vocal fold for sulcus vocalis, using perceptual ratings, acoustical analysis and spectrograms analysis. METHODS: it is a retrospective study. We reviewed the records of the nine patients who underwent pre-fascia temporal muscle implantation for sulcus vocalis. Perceptual voice ratings [Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS)], acoustical analysis and spectrogram analysis were analyzed. Perceptual voice ratings was carried out by three speech-language pathologists and spectrograms analysis by three speech language pathology students after three hours of training. RESULTS: perceptual ratings (GRBAS): Statistically significant improvement was found just in parameter B (Breathiness) t>1.734. Analysis acoustical: The fundamental frequency decreased and the maximum phonation time increased after surgery. Spectrogram analysis: Harmonic form and periodicity remained without improvement after treatment. The noise of spectrogram decreased and harmonic definition increased after treatment. CONCLUSION: the patients who underwent pre-fascia temporal muscle implantation for sulcus vocalis showed improvement in perceptual rating of Breathiness (B), fundamental frequency, maximum phonation time and spectrograms analysis (noise decreased and harmonic definition increased).