Angélique Remacle

Vocal Impact of a Prolonged Reading Task at Two Intensity Levels: Objective Measurements and Subjective Self-Ratings

OBJECTIVES The objectives of this study are to evaluate the impact on voice of both duration and intensity level of 2 hours of continuous oral reading. Voice modifications accompanying changes in intensity level during prolonged reading tasks are analyzed. METHODS Fifty normophonic women undergo two sessions of voice loading in which the required intensity level of voice varied between 60-65 dB(A) for the first session and 70-75 dB(A) for the second session. The effects of loading on objective data (average fundamental frequency [F0], jitter%, shimmer%, noise-to-harmonic ratio, maximum phonation time, lowest frequency [F-Low], highest frequency [F-High], frequency range [Range], lowest intensity [I-Low] level, and highest intensity level) and self-ratings (voice quality, phonation effort, vocal fatigue, and laryngeal discomfort) are assessed every 30 minutes during the loading tasks. RESULTS Results indicate that average F0, F-Low, I-Low, maximum phonation time, feeling of phonation effort, vocal fatigue, and laryngeal discomfort increase during prolonged reading, whereas shimmer% and self-rating of voice quality decrease. Average F0, F-High, and Range are the only parameters influenced by the required intensity of vocal load; they are significantly higher in the 70- to 75-dB session compared with the 60- to 65-dB session. Concerning the subjective self-ratings, similar results for the four ratings used suggest that only one would suffice in future studies. CONCLUSIONS These results confirm the importance of both duration and intensity level as loading factors, even if intensity level affects fewer variables than duration.

Vocal Impact of a Prolonged Reading Task in Dysphonic Versus Normophonic Female Teachers

OBJECTIVES This study evaluates the effect of a 2-hour reading task between 70 and 75 dB(A) in 16 normophonic and 16 dysphonic female teachers with vocal nodules. METHODS Objective measurements (acoustic analysis, voice range measurements, and aerodynamic measurements) and subjective self-ratings were collected before and every 30 minutes during the reading to determine the voice evolution in both groups. RESULTS Fundamental frequency, lowest frequency, highest frequency (F-High), highest intensity, and intensity range increase through the reading, whereas shimmer decreases. Maximum phonation time decreases after 30 minutes. Estimated subglottal pressure (ESP) and sound pressure level increase during the first hour. Afterward, ESP decreases. Self-ratings worsen through time. When comparing the normophonic and the dysphonic teachers, self-ratings reveal more complaints in the dysphonic group. Few differences in objective measurements are found between both groups: normophonic teachers show lower ESP, higher F-High, and greater frequency range. CONCLUSIONS Frequency modifications from acoustic analysis and voice range measurements suggest an increased laryngeal tension during vocal load, while subjects perceive a worsening of voice. Aerodynamic parameters depict first a deterioration of voice efficiency and then an adaptation to the prolonged reading. The comparison between both groups shows a discrepancy between objective measurements and self-ratings, suggesting that both approaches are necessary to have a complete view of vocal load effects. Surprisingly, both groups behave similarly through vocal load, without more or quicker deterioration of voice in the dysphonic group.

Implantation of Esterified Hyaluronic Acid in Microdissected Reinke's Space After Vocal Fold Microsurgery: Short- and Long-Term Results

In this study are reported the laryngeal and vocal results obtained after a microflap excision of benign vocal fold (VF) lesions and immediate implantation of esterified hyaluronic acid (EHA) in the surgical wound. In a previous pilot study on 11 cases, we have shown an excellent tolerance of this bioimplant. The objectives are to confirm the innocuity of the technique, to demonstrate the laryngeal and vocal evolution at short and long term, and to evaluate the eventual positive impact of EHA implantation on the pliability of the superficial layer of the lamina propria (SLLP) and on voice. This is a prospective and comparative study on 83 patients suffering from various benign VF lesions. Thirty-three patients were implanted with EHA, whereas 50 patients did not undergo implantation at the end of the microsurgical procedure. All patients undergo rigid laryngoscopy and microflap excision procedure under general anesthesia. After freeing up of the Reinkes space and creation of a mucosal microflap, a few fibers of EHA are inserted in the surgical wound, before closure of the incision with fibrin glue. Serial laryngeal and vocal assessments are performed in all patients using videostroboscopy (Wolff and Xion), perceptual and objective voice evaluation (MDVP software, Kay Elemetrics), and phonatory function measurements (Aerophone II). Pre- and early postoperative means are compared by analysis of variance. Delayed and long-term evolution of laryngeal and vocal data are compared by means of nonparametric statistical methods. The longest follow-up in the implanted group is 4 years. Early postoperative results are similar in both groups: a significant improvement of a majority of laryngeal and vocal data is observed after microsurgery. In the long term, the two groups exhibit a different behavior: further improvement of voice, as an ongoing process, is only observed in the EHA implanted group, together with improvement of some videostroboscopic characteristics. The nonimplanted group remains stable, with no further improvement of the voice quality obtained after microsurgery. Excellent short- and long-term tolerance of EHA implantation is confirmed by this larger series. The use of EHA implant in microdissected SLLP is safe and leads to good laryngeal and vocal outcomes in the treated patients. More interestingly, treated cases exhibit a continuous improvement over a long period of time.

Proposition of a Classification of Adult Patients with Hemiparesis in Chronic Phase.

Background Patients who have developed hemiparesis as a result of a central nervous system lesion, often experience reduced walking capacity and worse gait quality. Although clinically, similar gait patterns have been observed, presently, no clinically driven classification has been validated to group these patients’ gait abnormalities at the level of the hip, knee and ankle joints. This study has thus intended to put forward a new gait classification for adult patients with hemiparesis in chronic phase, and to validate its discriminatory capacity. Methods and Findings Twenty-six patients with hemiparesis were included in this observational study. Following a clinical examination, a clinical gait analysis, complemented by a video analysis, was performed whereby participants were requested to walk spontaneously on a 10m walkway. A patient’s classification was established from clinical examination data and video analysis. This classification was made up of three groups, including two sub-groups, defined with key abnormalities observed whilst walking. Statistical analysis was achieved on the basis of 25 parameters resulting from the clinical gait analysis in order to assess the discriminatory characteristic of the classification as displayed by the walking speed and kinematic parameters. Results revealed that the parameters related to the discriminant criteria of the proposed classification were all significantly different between groups and subgroups. More generally, nearly two thirds of the 25 parameters showed significant differences (p<0.05) between the groups and sub-groups. However, prior to being fully validated, this classification must still be tested on a larger number of patients, and the repeatability of inter-operator measures must be assessed. Conclusions This classification enables patients to be grouped on the basis of key abnormalities observed whilst walking and has the advantage of being able to be used in clinical routines without necessitating complex apparatus. In the midterm, this classification may allow a decision-tree of therapies to be developed on the basis of the group in which the patient has been categorised.

Brain plasticity after implanted peroneal nerve electrical stimulation to improve gait in chronic stroke patients: Two case reports

BACKGROUND Recent studies have shown that stimulation of the peroneal nerve using an implantable 4-channel peroneal nerve stimulator could improve gait in stroke patients. OBJECTIVES To assess structural cortical and regional cerebral metabolism changes associated with an implanted peroneal nerve electrical stimulator to correct foot drop related to a central nervous system lesion. METHODS Two stroke patients presenting a foot drop related to a central nervous system lesion were implanted with an implanted peroneal nerve electrical stimulator. Both patients underwent clinical evaluations before implantation and one year after the activation of the stimulator. Structural magnetic resonance imaging (MRI) and [18F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) were acquired before and one year after the activation of the stimulator. RESULTS Foot drop was corrected for both patients after the implantation of the stimulator. After one year of treatment, patient 1 improved in three major clinical tests, while patient 2 only improved in one test. Prior to treatment, FDG-PET showed a significant hypometabolism in premotor, primary and supplementary motor areas in both patients as compared to controls, with patient 2 presenting more widespread hypometabolism. One year after the activation of the stimulator, both patients showed significantly less hypometabolism in the damaged motor cortex. No difference was observed on the structural MRI. CONCLUSION Clinical improvement of gait under peroneal nerve electrical stimulation in chronic stroke patients presenting foot drop was paralleled to metabolic changes in the damaged motor cortex.

Vocal Change Patterns During a Teaching Day: Inter- and Intra-Subject Variability

OBJECTIVES To describe the mean voice changes of 22 female teachers during a typical workday, examine the inter- and intra-subject variability, and establish a typology of different voice patterns during the workday. METHODS For each participant, fundamental frequency (F0), harmonics-to-noise ratio (HNR), jitter, and shimmer were measured on sustained vowels at the beginning and at the end of the workday, at three different times during the school year. RESULTS The group mean pattern showed significant increases in F0 and HNR during the workday and significant decreases in jitter and shimmer. However, considerable inter- and intra-subject variability was observed. Based on the variation in the acoustic parameters during the workday, three different voice patterns were identified. The first is characterized by a greater F0 increase during the day, interpreted as a common, appropriate adaptation to vocal load. The second is characterized by a greater increase in HNR during the day and greater decreases in jitter and shimmer, interpreted as hyperfunctional voice production. The third is characterized by greater decreases in F0 and HNR and greater increases in jitter and shimmer, suggesting acute inflammation or muscle fatigue following the workday. CONCLUSIONS The observed variety of vocal patterns during the workday emphasizes the need to study this phenomenon individually and target different types of behaviors to develop tailored prevention and treatment methods.

Influence of a rhythmic auditory stimulation on asymptomatic gait.

The direct effects of a rhythmic auditory stimulation (RAS) on the gait of asymptomatic subjects are not clear. Previous studies only showed modifications in the gastrocnemius activity, inconsistent effects on temporal parameters, and no modification of spatial parameters. Furthermore, the influence of RAS on kinematics and kinetics has only been reported in pathological gait. The objective of this study was to perform a full comparison of gait characteristics in asymptomatic subjects at preferred and reduced walking speed between without and with RAS conditions. Spatiotemporal parameters, kinematics, kinetics and EMG signals datasets were collected for each condition. RAS conditions were obtained by asking subjects to walk on metronomic beats. 17 asymptomatic subjects were included in the study (12M/5W, 37.4±15.7years, 74.0±14.8kg, 1.77±0.09m). Comparisons between without and with RAS conditions were then performed using the Statistical Parametric Mapping method. For all combined subjects, the effect of RAS was limited whatever the walking speed. Meanwhile, global effects were observed for kinematics, kinetics and EMG at both spontaneous and reduced walking speed, which can only be explained by covariances (i.e., no effect on individual time-series). The use of RAS to impose a specific cadence matching the desired walking speed (e.g., to collect normative data) appears thus possible, as none parameters were modified individually. However, RAS should be used with caution taking into account covariances (i.e., muscle synergy or joint coordination patterns). This study has to be extended to a larger number of subjects to confirm these observations.