Leandro de Araújo Pernambuco

Incomplete Swallowing and Retracted Tongue Maneuvers for Electromyographic Signal Normalization of the Extrinsic Muscles of the Larynx

PURPOSE To investigate which muscular maneuvers provide larger electric activity (EA) of the suprahyoid (SH) and infrahyoid (IH) muscles to be used as surface electromyography (SEMG) signal normalization reference. METHODS The electrical potentials of the SH and IH muscles of 12 subjects were evaluated using six muscular maneuvers, involving the position of the tongue and effort. It was selected as maximum voluntary sustained activity maneuver, the one having the minor coefficient of variation and the smallest value for each muscle group. The EA signal was converted using the root mean square in microvolts. It was considered then the maximum signal of each maneuver as the difference between the mean of three measures and the resting potential. RESULTS The maneuvers that provided higher mean potentials with minor coefficient of variation and smallest P value were incomplete swallowing (IS) with effort (mean potential equal to 56.73±8.68 with coefficient of variation of 15.30%) in SH group, and tongue retracted with mouth open (TROM, mean potential equal to 46.57±7.83 with coefficient of variation of 16.81%) in IH group. CONCLUSION The IS with effort and TROM maneuvers should be considered for signal normalization in these muscles, respectively, and may provide conditions for using the SEMG in voice clinic. SIGNIFICANCE The use of normalization standards in researches of SH and IH muscles in the voice area will allow comparisons among future works.

Estudo da mortalidade por câncer de laringe no estado de Pernambuco - 2000-2004

The larynx is considered a site of the greatest occurrence of head and neck neoplasias, and for cancer studies, mortality is one of the most reliable health indicators. AIM: to study the mortality by laryngeal cancer in Pernambuco during 2000-2004. STUDY FORMAT: contemporary cross-sectional cohort. MATERIALS AND METHODS: we considered all deaths by laryngeal cancer in residents of Pernambuco State between 2000 and 2004, taken from the States Mortality Information System (SIM/SUS). The data was analyzed through descriptive statistics, with the results expressed in tables, graphs and maps, using Excel version 2000 and the EpiInfo version 6.04b software. RESULTS: There was little variation in the mortality coefficient in the years considered for study. The Sertao Mesoregion had the highest number of deaths and Fernando de Noronha island had the highest mortality rate. The patient profile found was: men, between 60-69 years, brown color, married, with low literacy, who died in a hospital setting. CONCLUSION: we found mortality stability and heterogeneity among the cities. The mortality profile according to social variables corroborates data found in other Brazilian States, except for race/color.

Use of surface electromyography in phonation studies: an integrative review

Summary Introduction: Surface electromyography has been used to assess the extrinsic laryngeal muscles during chewing and swallowing, but there have been few studies assessing these muscles during phonation. Objective: To investigate the current state of knowledge regarding the use of surface electromyography for evaluation of the electrical activity of the extrinsic muscles of the larynx during phonation by means of an integrative review. Method: We searched for articles and other papers in the PubMed, Medline/Bireme, and Scielo databases that were published between 1980 and 2012, by using the following descriptors: surface electromyography and voice, surface electromyography and phonation, and surface electromyography and dysphonia. The articles were selectedon the basis ofinclusion and exclusion criteria. Data Synthesis: This was carried out with a cross critical matrix. We selected 27 papers,i.e., 24 articles and 3 theses. The studies differed methodologically with regards to sample size and investigation techniques, making it difficult to compare them, but showed differences in electrical activity between the studied groups (dysphonicsubjects, non-dysphonicsubjects, singers, and others). Conclusion: Electromyography has clinical applicability when technical precautions with respect to application and analysis are obeyed. However, it is necessary to adopt a universal system of assessment tasks and related measurement techniques to allow comparisons between studies.

Eletromiografia de superfície do músculo masseter durante a mastigação: uma revisão sistemática

The chewing, a complex action controlled by the central nervous system, is one of the most important functions of the Stomatognathic System. During this action, the electrical activity of the masticatory muscles may be quantified using a surface electromyography. In order to systematically review the literature, on the methods and foods used in EMGS masseter muscle during mastication, we carried out a search in the databases SciELO, Brazil, Lilacs and Medline / Pubmed, from September to October 2009. We included population-based studies and excluded review studies without clear methodological definition and studies with children, adolescents and elderly. About 657 articles were found at the intersection of the following descriptors and their corresponding in English: chewing and masseter and electromyography, which 12 of them selected. It was found that the methods involved in the execution of surface electromyography of the masseter muscle during mastication, vary according to each author, and there is no standard for a specific food in order to perform the examination.

Autoavaliação vocal e avaliação perceptivo-auditiva da voz em mulheres com doença tireoidiana

Purpose to compare the vocal self-assessment and auditory-perceptual assessment of voice in women with thyroid disease. Methods the study was performed in 40 female patients, mean age of 49,50±10,40 years, using a visual-analogue scale (EAV) to perform the vocal self-assessment of voice and auditory-perceptual analysis by speech and language pathologist. The patient considered the usual emission of voice in its self-assessment and for the vocal analysis by speech and language pathologist voice samples was recorded with the patient emission of 1 to 20 counting. Descriptive analysis considered mean, median and standard deviation. It was used the Wilcoxon and Mann-Whitney tests to compare means and the Spearman test to verify correlation between voice evaluations.The level of significance was 5%. Results 19 (47.5%) patients reported complaints of dysphonia. Means and standard deviations of the VAS patient and the VAS speech therapist were 32.58 ± 27.99 and 37.23 ± 15.92, respectively, with no statistically significant difference. Patients with vocal complaint had worse scores on self-assessment when compared with those who did not complain. There was no statistically significant difference between these groups in terms of perceptual assessment. There was no statistically significant correlation between the perception that the individual has over her voice and speech therapist assessment. Conclusion there was no difference between means of vocal self-assessment and auditory-perceptual assessment by the speech and language pathologist; vocal self-assessment was worse in patients with vocal complaints; there was no correlation between evaluations.

Electrical Activity of Extrinsic Laryngeal Muscles in Subjects With and Without Dysphonia

OBJECTIVE To compare dysphonic individuals to nondysphonic with regards to electrical activity of extrinsic laryngeal muscles related to perceptual and acoustic vocal parameters. HYPOTHESIS Dysphonic individuals have higher electrical activity in the supra and infrahyoid muscles than those nondysphonic. STUDY DESIGN Prospective, cross-sectional, case series study. METHODS Forty-one subjects, divided into two groups according to the presence of dysphonia, underwent evaluation of surface electromyography, auditory-perceptual, and acoustic evaluations of voice during the vocal rest and sustained emissions of the vowel /ε/ and count of 20 to 30 at usual and strong intensities. RESULTS The dysphonic group differed significantly from the nondysphonic by (1) lower electrical activity normalized by the maximum sustained voluntary activity evaluated in all tasks of phonation in the suprahyoid group; (2) lower recruitment of electrical activity in emissions of strong intensity compared with those of usual intensity in the suprahyoid muscles to emit the vowel /ε/ (13.66 ± 5.17 in dysphonic group and 35.20 ± 7.60 in the nondysphonic group, P = 0.029) and in the infrahyoid muscles in the count of 20 to 30 (14.90 ± 4.69 vs. 42.01 ± 6.15; P < 0.001) and to emit the vowel /ε/ (11.47 ± 6.52 vs. 22.66 ± 9.05, P < 0.001); (3) lower vocal intensity to produce the vowel /ε/ in usual and strong intensities and count in strong intensity. The electrical activities of the maximum sustained voluntary activity were reduced with increasing degree of dysphonia. CONCLUSIONS There was lower electrical activity of the extrinsic laryngeal muscles in dysphonic individuals compared with nondysphonic, and related to the degree of dysphonia.

Instrumentos de rastreio para disfagia orofaríngea no acidente vascular encefálico

Purpose: To identify the parameters present in the screening tools for oropharyngeal dysphagia in stroke published in the literature. Research strategy: For the selection of studies, the swallowing disorder descriptors stroke, screening, evaluation and dysphagia were used. MEDLINE, Embase, LILACS, SciELO and the Cochrane Library databases were consulted. Selection criteria: We selected articles in the English, Portuguese and Spanish languages published up to December 2014 whose methodological approach referred to screening tools for oropharyngeal dysphagia designed for adults with stroke. The parameters used in the various screening tools were grouped by equality and/or likeness. We performed a descriptive analysis and calculated the frequency of found parameters. Results: We found 688 articles and after consideration of the inclusion and exclusion criteria, 23 articles were effectively analyzed. Of the 20 tools found, 90% used some type of food offer orally in screening for dysphagia, mostly water. We found 19 different parameters not related to food offer and 12 parameters related to food offer. Conclusion: There is no consensus among the studies on the most sensitive and specific parameters to compose the screening method for oropharyngeal dysphagia in stroke.

Tradução e adaptação transcultural do Northwestern Dysphagia Patient Check Sheet para o português brasileiro

PURPOSE To present the translation and cross-cultural adaptation of the Brazilian version of the Northwestern Dysphagia Patient Check Sheet (NDPCS). METHODS The translation to Portuguese was performed by two Brazilian bilingual speech language pathologists, followed by a back translation conducted by a bilingual native speaker of the original language. Afterwards, the three versions were compared by a committee of three speech language pathologists. Initially, the final translated version of the NDPCS was applied with 35 volunteers aged between 62 and 92 years old (74.77±7.08), who had no dementia or complaints of swallowing disorder. After some adjustments, the instrument was applied with other 27 volunteers aged between 60 and 87 years old (76.56±7.07) with the same profile. RESULTS There was divergence in semantic equivalence in relation to one item, which was modified in the translated version. The tasks requested for observation during deglutition were adapted in relation to the solid food and the volumes used in pudding and liquid consistencies. The instrument maintained the same structure as the original version, with five categories and into 28 items, three brief variables, and four closures. CONCLUSION The equivalence between the original and the translated version of the NDPCS was preserved after its translation and adaptation to Brazilian Portuguese. The validation process of the psychometric properties of the instrument is in progress.

A eletromiografia de superfície nos periódicos nacionais em fonoaudiologia

THEME: surface electromyography in national journals in Speech, Language and Hearing Sciences. PURPOSE: to characterize the approach of surface electromyography in national journals in Speech, Language and Hearing Sciences. CONCLUSIONS: there are few studies about the surface electromyography in national journals in Speech, Language and Hearing Sciences, but most pertain to the Orofacial Motricity and Fluency areas. There seems to be a need to develop this subject and to diversify the topics referring to Speech-Language Pathology interest.

Características morfofuncionais do trânsito orofaríngeo na bulimia: revisão de literatura

BACKGROUND: deglutition and bulimia. PURPOSE: to submit and discuss the scientific research concerning oropharyngeal characteristics related to deglutition in patients with purging type bulimia nervosa. CONCLUSIONS: bulimia nervosa entails a series of changes in structures and functions that compose the oropharyngeal tract, such as dental erosion, hypersensitivity, weakness and fracture of the teeth, occlusion problems, caries, periodontal diseases, intraoral desensitization, hypogeusia, ulceration, granulomas, angular cheilitis, enlargement of the parotid glands, coughs and odynophagia. There is a prevalence in the scientific literature of reports about morphologic alterations on the detriment of the functional ones. Few reports discussed the relationship between bulimia and deglutition, superficially mentioning the possibilities for triggering oropharyngeal dysphagia.