Kelly Cristina Alves Silverio

Postura crânio-cervical em mulheres disfônicas

Purpose: To analyze the posture and the function of the craniocervical region in women with dysphonia. METHODS: Twenty eight women participated in the study (31.25±8.14 years), divided into two groups: experimental (N=16, patients with dyphonia) and control (N=12, clinically normal). The volunteers were submitted to evaluation of the Craniocervical Dysfunction Index (CDI) and photogrammetry, determining the anterior angle formed between the seventh cervical vertebra and the tragus, which corresponds to the head position in the sagittal plane. The analysis of the photos was carried out by three examiners, twice each, with an interval of one week between them. Data analysis used the Shapiro-Wilk test, followed by the Students t-test, (p<0,05). RESULTS: No difference was found between the mean values of the anterior angle of the control (50.92±5.18 degrees) and the experimental (49.63±5.46 degrees) groups in the photogrammetry (p=0.2565). The CDI showed that the experimental group had craniocervical dysfunction, which was mild in 37.5% of the cases, moderate, in 37.5%, and severe in 25%. In the control group, 100% of the volunteers had presented mild craniocervical dysfunction. CONCLUSION: There was no difference between the evaluated groups regarding head position. However, dysphonic women presented more severe craniocervical dysfunction than the group control.

Alterações musculares e esqueléticas cervicais em mulheres disfônicas

The vocal and neck are associated with the presence of tension and cervical muscle contraction. These disorders compromise the vocal tract and musculoskeletal cervical region and, thus, can cause muscle shortening, pain and fatigue in the neck and shoulder girdle. Objective: To evaluate and identify cervical abnormalities in women with vocal disorders, and neck pains comparing them to women without vocal complaints independent of the neck. Method: This prospective study of 32 subjects studied in the dysphonic group and 18 subjects in the control group, aged between 25 and 55 year old female. The subjects underwent assessments, ENT, orthopedic, physical therapy and voice recording. Results: At Rx cervical region more patients in the control group had this normal, however, with regard to the reduction of spaces interdiscal dysphonic patients prevailed. Furthermore, postural assessment, the kyphosis of the 1st thoracic vertebra occurred in 77.0% of non-dysphonic group (p = 0.0091), while cervical rotation was present in 83% of control (p = 0.0051). Conclusion:

Estimulação elétrica nervosa transcutânea em mulheres disfônicas

BACKGROUND: studies indicate correlation between dysphonia and muscle tension. AIM: to evaluate bilaterally the electrical activity of the suprahyoid muscles (SH), sternocleidomastoid (SCM), and trapezius (T), the presence of pain and the voice, after applying transcutaneous electrical nerve stimulation (TENS). METHOD: ten (10) women with nodules or bilateral mucus thickening, and phonation fissure. Volunteers were submitted to 10 TENS sessions (200µs and 10Hz) for 30 minutes. Pain was evaluated using an analogical visual scale; the voice was evaluated through laryngoscopy and through a perceptive-auditory and acoustic analysis; and the myoelectric signal was converted using the Root Media Square (RMS). Voice and EMG data gathering was performed during the production of the E/vowel and during spontaneous speech (SS). STATISTICAL ANALYSIS: Shapiro-Wilk Test followed by the Wilcoxon Test, or t Student, or Friedman Test (p < 0.05). RESULTS: It was observed that the TENS decreased the RMS readings, pre and pos treatment, for the Right T (RT) (2.80 ± 1.36 to 1.77 ± 0.93), the Left T (LT) (3.62 ± 2.10 to 2.10 ± 1.06), the Left SCM (LSCM) (2.64 ± 0.69 to 1.94 ± 0.95), and the SH (11.59 ± 7.72 to 7.82 ± 5.95) during the production of the E/vowel; and for the RT (3.56 ± 2.77 to 1.93 ± 1.13), the LT (4.68 ± 2.56 to 3.09 ± 2.31), the Right SCM (RSCM) (3.94 ± 2.04 to 2.51 ± 1.87), and the LSCM (3.54 ± 1.04 to 3.12 ± 3.00) during SS. A relieve in pain was also observed. Regarding the voice analysis, there was a decrease in level of laryngeal injuries; no difference was observed during the production of the E/vowel in the perceptive-auditory analysis; there was a decrease in the level of dysphonia and hoarseness during SS. CONCLUSION: TENS is effective in improving the clinical and functional signs of dysphonic women.

Muscleskeletal pain in dysphonic women

OBJECTIVE To investigate the location, frequency and intensity of muscle pain in dysphonic functional/organofunctional women in comparison to women with healthy voices. METHODS Sixty women, ranging in age from 18 to 45 years, divided into two groups: Dysphonic Group (DG) - 30 women with functional or organofunctional dysphonia; Non-Dysphonic Group (NDG) - 30 women without vocal complaints, and with adapted voices. All answered a protocol, marking the localization, frequency and intensity symptoms of pain on the temporal area, masseters, submandibular areas, larynx/pharynx, front and back of the neck, shoulders, upper back, lower back, elbows, fists/hands/fingers, hip/this, knees and ankles/feet. The volunteer should report the frequency in which pain was present in the last 12 months: no, rarely, frequently or always. The intensity of pain was measured by visual-analogue scales. The DG and NDG groups were compared using the Mann-Whitney test (p<0.05). RESULTS The women of the DG reported significantly greater frequency of submandibular area (p=0.008), laryngeal pain (p<0.001), front of the neck (p=0.015), back of the neck (p=0.001), shoulder pain (p=0.027), upper back (p=0.027) and also reported significant greater intensity of pain in the larynx/pharynx (p=0.022) and back of the neck (p=0.003). CONCLUSION The frequency and intensity of musculoskeletal pain was more frequent and more intense in dysphonic women than in women without vocal complaints, showing that pain may be related to functional and organofunctional dysphonia in women.

Efeito imediato de técnicas vocais em mulheres sem queixa vocal

OBJETIVO: verificar o efeito imediato das tecnicas vocais vibracao, som nasal e sobrearticulacao na voz e na laringe de mulheres sem queixas vocais. METODO: participaram da pesquisa 32 sujeitos do sexo feminino, com idades entre 20 e 45 anos, sem queixas vocais, com qualidade vocal avaliada entre normal e alteracao de grau leve Os sujeitos foram submetidos a analise perceptivo-auditiva pela escala visual analogica da vogal /e/ e fala espontânea, analise acustica e laringoestroboscopia antes e apos a realizacao das tecnicas. RESULTADOS: a analise perceptivo-auditiva revelou melhora significante dos parâmetros impressao global da voz, rouquidao e estabilidade na vogal /e/ e articulacao na fala espontânea. A analise acustica evidenciou melhora significante do jitter e shimmer. A laringoestroboscopia evidenciou significante melhora no fechamento glotico e melhora na movimentacao muco-ondulatoria das pregas vocais. CONCLUSAO: as tecnicas vocais estudadas sao capazes de proporcionar melhora imediata significante da qualidade vocal e da configuracao laringea.

Coralistas amadores: auto-imagem, dificuldades e sintomas na voz cantada

PURPOSE: to evaluate vocal self-perception, difficulties and presence of negative symptoms after singing of amateur choir singers of different vocal classifications, age and experience. METHOD: one hundred and twenty five singers answered a questionnaire containing identification data, information about self-perception of the singing voice, difficulties with singing and negative symptoms after singing. RESULTS: the comparison considering vocal classification evidenced greater difficulties with high notes for altos and basses, greater difficulty regarding the transition to high notes for basses and greater vocal fatigue for altos. Comparing the singers by age, both adults and young adults referred more breathiness than the elderly. The adults referred better vocal intensity than the young adults. The young adults referred better timbre than adults. Regarding the experience, the less experienced singers reported self-perception of hoarseness and presence of hoarseness after singing in greater number than the experienced singers. CONCLUSION: the difficulties with singing are connected to the vocal classification and do not depend on age or experience. Vocal symptoms are related to the vocal classification and to the experience with singing. Negative self-perception is also related the vocal classification and to the experience with singing, and positive self-perception was more reported by experienced singers.

Ocorrência de sinais e sintomas de disfunção temporomandibular em músicos

PURPOSE: To verify the prevalence of signs and symptoms of temporomandibular dysfunction in groups of professional musicians, interpreters of brass and string instruments. METHODS: Ninety two musicians, with ages varying from 18 to 58 years, participated on the study. Seventy musicians who played brass instruments (76.08%) and 22 musicians who played string instruments (23.91%) at the Symphonic Orchestra of Parana, the Military Police Band or the Army Band were interviewed. The interview included questions regarding identification, time of practice, and presence of signs, symptoms and habits related to temporomandibular dysfunction. The answers were compared using the difference of proportions test. RESULTS: Thirty nine musicians (42.3%) noticed teeth grinding and/or teeth pressing, 23 (25%) reported to feel pain at the temporomandibular joint, 39 (42%) reported to hear noises at the temporomandibular joint, 37 (40%) reported sensation of auricular plenitude, and 33 (35%) presented tinnitus. No significant difference was found between brass and string players regarding the presence of signs and symptoms of temporomandibular dysfunction. CONCLUSION: The sum of factors presented puts players of certain musical instruments as a group susceptible to present signs and symptoms of temporomandibular disorder, including auditory symptoms. Therefore, the practice of these instruments may be considered a trigger, as well as an aggravating or perpetuating factor of a previously existing problem.

Efeito imediato da terapia manual laríngea em indivíduos disfônicos

Purposes: To investigate the immediate effect of Laryngeal Manual Therapy (LMT) in musculoskeletal pain, in voice and sensations referred to individuals with behavioral dysphonia and individuals without it. Methods: 30 individuals ranging from 18 to 45 years old were selected and sorted into two groups: the dysphonic group (DG) - 15 individuals with functional or organofunctional dysphonia, and the control group (CG) - 15 individuals without vocal complaints and with non-impaired voices. The individuals answered a pain questionnaire and their voices were subsequently registered. The initial evaluation was repeated after the LMT. The LMT was applied for 20 minutes. After the LMT, the individuals were self-evaluated in terms of sensations in their voices, larynxes, articulations and respiration. Results: After the application of LMT, the DG reported significant improvement of pain in the following areas: temporal, larynx, posterior neck, wrists/hands/fingers, upper and lower back, hip/thigh, which did not occur in CG. The perceptual analysis of the vowel /a/ revealed no significant difference in any parameter in both groups after the LMT. The analysis of the speech showed that there was an increase of the roughness parameter after the application of LMT just in the DG. The DG individuals reported better sensations in the larynx and articulations after the submission to LMT, which did not occur in CG. Conclusion: this study clarified that TML immediately reduces the intensity of corporal pain in dysphonic individuals, which did not occur in individuals without any vocal impairments. Although the perceptual analysis reveals an increase of the roughness in the quality of the voice, positive sensation in the larynx and articulation were reported by dysphonic individuals after the application of TML.PURPOSES To investigate the immediate effect of Laryngeal Manual Therapy (LMT) in musculoskeletal pain, in voice and sensations referred to individuals with behavioral dysphonia and individuals without it. METHODS 30 individuals ranging from 18 to 45 years old were selected and sorted into two groups: the dysphonic group (DG) - 15 individuals with functional or organofunctional dysphonia, and the control group (CG) - 15 individuals without vocal complaints and with non-impaired voices. The individuals answered a pain questionnaire and their voices were subsequently registered. The initial evaluation was repeated after the LMT. The LMT was applied for 20 minutes. After the LMT, the individuals were self-evaluated in terms of sensations in their voices, larynxes, articulations and respiration. RESULTS After the application of LMT, the DG reported significant improvement of pain in the following areas: temporal, larynx, posterior neck, wrists/hands/fingers, upper and lower back, hip/thigh, which did not occur in CG. The perceptual analysis of the vowel /a/ revealed no significant difference in any parameter in both groups after the LMT. The analysis of the speech showed that there was an increase of the roughness parameter after the application of LMT just in the DG. The DG individuals reported better sensations in the larynx and articulations after the submission to LMT, which did not occur in CG. CONCLUSION this study clarified that TML immediately reduces the intensity of corporal pain in dysphonic individuals, which did not occur in individuals without any vocal impairments. Although the perceptual analysis reveals an increase of the roughness in the quality of the voice, positive sensation in the larynx and articulation were reported by dysphonic individuals after the application of TML.

Avaliação videofluoroscópica da mastigação e deglutição em indivíduos com disfunção temporomandibular (DTM)

UNLABELLED To study mastication and swallowing disorders in patients with temporomandibular disorders (TMD). OBJECTIVE To investigate mastication and swallowing disorders in patients with severe TMD referred to surgery. MATERIALS AND METHODS Clinical and experimental study involving ten individuals with TMD submitted to deglutition videofluoroscopy. These patients did not have posterior teeth, mastication pain and food replacement in favor of pasty consistence food. The assessment of the oral and pharyngeal phases approached the following aspects: side of onset and preferential side for chewing, premature escape, remains of food residues in the oral cavity or in the pharyngeal recesses, number of necessary swallowing efforts, laryngeal penetration and/or tracheal aspiration. RESULTS During mastication and the oral phase we observed tongue compensatory movements upon chewing (n = 7; 70%), premature escape (n = 4; 40%), food remains in the cavity after swallowing (n = 5; 50%) and an excessive number of deglutition efforts (n = 5; 50%). On the pharyngeal phase we observed food remains in the valleculae (n = 6; 60%), in the pyriform sinuses (n = 4; 40%); laryngeal penetration (n = 1; 10%) and tracheal aspiration (n = 4; 40%). CONCLUSION TMD patients may have alterations in their chewing and swallowing patterns, with laryngeal penetration and/or tracheal aspiration. The study indicates the need for a multidisciplinary assessment because of dysphagia in TMD patients.

Evaluation of Electrostimulation Effect in Women With Vocal Nodules

OBJECTIVE To evaluate the effect of transcutaneous electrical nerve stimulation (TENS) with and without tongue trills in women with vocal nodules. STUDY DESIGN Randomized, prospective, comparative intra-subject study. METHODS A total of 60 women aged 18-55 years were included. Visual-perceptual assessment of laryngeal configuration, auditory-perceptual assessment of voice quality, acoustic analyses, and self-assessment of phonation effort were assessed after TENS. Sixty participants participants were randomized into two experimental groups: (1) subjects receiving TENS (EG1), (2) subjects receiving TENS plus tongue trills (EG2). The control group was composed of 15 subjects of EG1 and 15 subjects of EG2. The TENS condition involved electrostimulation for 20 minutes. Audio and video perceptual assessments were performed by three speech therapists with expertise in voice; all were blinded to the experimental conditions. The acoustic parameters included were fundamental frequency, jitter, and shimmer during sustained phonation. Subjects also reported the degree of vocal effort before and after TENS. RESULTS TENS applied alone or combined with tongue trills aided in glottal closure and in improved comfort during phonation. When the TENS was administered with tongue trills, roughness of voice quality improved. CONCLUSION TENS applied alone or combined with tongue trills was associated with improved glottal closure and phonation comfort. TENS associated with tongue trills yielded improved voice quality.