Lucia Figueiredo Mourão

Effect of voice rehabilitation on oral communication of Parkinson's disease patients

Voice and speech disorders are common in Parkinsons disease patients and may lead to social isolation. We employed routine clinical voice therapy measures to evaluate the effect of voice rehabilitation. Twenty patients with a stable drug regimen participated in this study. The patients were assessed before and after a program of voice rehabilitation consisting of 13 group therapy sessions during 1 month, with emphasis on the increase in laryngeal sphincteric activity. Voice rehabilitation produced an increase in maximal phonation times, decrease in the values of s/z ratio and air flow, increase in vocal intensity, decrease in the complaints of weak and strained‐strangled voice and monotonous and unintelligible speech and elimination of complaints of swallowing alterations. These data indicate a greater glottic efficiency after voice rehabilitation reflecting a more functional oral communication.

Acoustic voice assessment in Parkinson's disease patients submitted to posteroventral pallidotomy

UNLABELLED Long-term complications in levodopa treated Parkinsons disease (PD) patients caused a resurgence of interest in pallidotomy as an option of treatment. However, postoperative complications such as speech disorders can occur. PURPOSE The aim of this study is to evaluate the acoustic voice in PD patients, before and after posteroventral pallidotomy. METHOD Twelve patients with PD were submitted to neurological and voice assessments during the off and on phases, in the pre-operative, 1st and 3rd post-operative months. The patients were evaluated with the UPDRS and the vocal acoustic parameters -- f0, NHR, jitter, PPQ, Shimmer, APQ (using the software MultiSpeech-Kay Elemetrics-3700). RESULTS The off phase UPDRS scores revealed a tendency to improvement at the 1st month and the off phase worsened. The shimmer and APQ improved. CONCLUSION This study shows that pallidotomy has little improvement on functional use of communication of PD patients.

Amyotrophic lateral sclerosis: combined nutritional, respiratory and functional assessment

OBJECTIVE To establish correlations between nutritional, functional and respiratory indices of patients with amyotrophic lateral sclerosis (ALS). METHOD Twenty patients (13 appendicular-GA and 7 bulbar-GB) were included in the multidisciplinary study at the Neurological Clinic Ambulatory of the University of Campinas Hospital. RESULTS Among the GA type significant correlation was observed between maximal inspiratory (MIP) and expiratory (MEP) pressure (r=-0.76), MEP and pulse oxymetry (r=0.58), MIP and percent weight loss (%WL; r=0.59), and between MIP, total and subscale respiratory scores (ALSFRS-R) with %WL. With regard to the GB, correlation was found between MEP and body mass index (BMI) (r=0.97). In both GA and GB correlations were noticed between the BMI and the variables mass (kg), fat (%), arm and wrist circumference (cm), and tricipital, subscapular and supra-iliac skinfolds (mm), as well as the arm muscle circumference (cm) and fatty arm muscular area (mm2). CONCLUSION It is suggested that the application of simple anthropometric measurements could be useful in routine monitoring of patients with ALS.

Importância da interdisciplinaridade na avaliação das disfagias: avaliação clínica e videofluoroscópica da deglutição

Opaciente disfagico apresenta prejuizos em diversos aspectos, sendo a atuacao interdisciplinar fundamental para definicao do diagnostico e da conduta. A atuacao em conjunto na avaliacao clinica e videoendoscopica e de extrema importância. OBJETIVO: Estudar a correlacao entre a avaliacao clinica (ACD) e videoendoscopica da degluticao (VED) por meio da classificacao do grau de severidade e a analise qualitativo/descritiva dos procedimentos. FORMA DE ESTUDO: Estudo transversal, descritivo, comparativo. MATERIAL E METODO: Realizado no marco a dezembro de 2006 no ambulatorio de Otorrinolaringologia/Disfagia de um hospital do interior de Sao Paulo. Foram avaliados pela ACD e VED 30 pacientes disfagicos com diferentes doencas. Os dados foram classificados por meio de escalas de severidade e analise qualitativa/descritiva. RESULTADOS: A correlacao entre as escalas de severidade de ACD e VED apontou concordância baixa (KAPA = 0,4) de modo estatisticamente significante (p=0,006). A correlacao entre a analise qualitativa/descritiva apontou concordância excelente (KAPA=0.962) estatisticamente significante (p<0.001) para a amostra total. CONCLUSAO: A concordância baixa entre as escalas de severidade aponta a necessidade da realizacao de ambos os procedimentos, reforcando a VED como procedimento factivel. A analise qualitativa descritiva apontou concordância excelente, dado que reforca a necessidade da compreensao da degluticao como um processo.

Ações de promoção e prevenção à saúde vocal de professores: uma questão de saúde coletiva

PURPOSE: to examine possible actions for preventing and promoting vocal health of teachers through the understanding of interactions among vocal, occupational and preventive aspects. METHODS: we developed a qualitative and quantitative study at a public school in the state of Sao Paulo, Brazil, with 26 teachers. This study developed a program to improve voice, which counted on a laryngological examination, a questionnaire application and a preventive intervention-therapy group. To quantify the degree of association between the vocal, occupational and preventive aspects, we used the Chi-square test. RESULTS: it was observed that most teachers (except two) reported some type of complaint related to the use of voice in the profession. Alterations were observed in three of the ten teachers who underwent laryngological examination. Twenty subjects reported some type of stress, and from these, 10 reported vocal stress. Thirteen teachers took part in the intervention group, however, only five completed it. There was a statistically significant association between the quantity of vocal symptoms and participation in the preventive-therapeutic intervention group, showing that teachers with more than three vocal symptoms took part in the group. There was also a trend for association between lack of time and reference to vocal stress. CONCLUSION: we believe that vocal health of teachers is largely related to occupational aspects, even if we did not find statistically significant associations in all investigated. The preventive actions are to capitalize on the importance of multi-or interdisciplinary performances, on the works to raise awareness of the importance of voice in the education process, on the identification and mitigation of risk factors, on vocal enhancement programs and on voice integration among all actors involved with the school.

Dysphagia progression and swallowing management in Parkinson's disease: an observational study

INTRODUCTION Dysphagia is relatively common in individuals with neurological disorders. OBJECTIVE To describe the swallowing management and investigate associated factors with swallowing in a case series of patients with Parkinsons disease. METHODS It is a long-term study with 24 patients. The patients were observed in a five-year period (2006-2011). They underwent Fiberoptic Endoscopic Evaluation of Swallowing, Functional Oral Intake Scale and therapeutic intervention every three months. In the therapeutic intervention they received orientation about exercises to improve swallowing. The Chi-square, Kruskal-Wallis and Fishers tests were used. The period of time for improvement or worsening of swallowing was described by Kaplan-Meier analysis. RESULTS During the follow-up, ten patients improved, five stayed the same and nine worsened their swallowing functionality. The median time for improvement was ten months. Prior to the worsening there was a median time of 33 months of follow-up. There was no associated factor with improvement or worsening of swallowing. The maneuvers frequently indicated in therapeutic intervention were: chin-tuck, bolus consistency, bolus effect, strengthening-tongue, multiple swallows and vocal exercises. CONCLUSION The swallowing management was characterized by swallowing assessment every three months with indication of compensatory and rehabilitation maneuvers, aiming to maintain the oral feeding without risks. There was no associated factor with swallowing functionality in this case series.

Influence of smoking isolated and associated to multifactorial aspects in vocal acoustic parameters.

INTRODUCTION Smoking affect voice quality in a long period of time, but other factors may compromise it, such as professional using of voice, habits, alcohol dependence and GERD. The aim was associate the influence of these factors on vocal parameters. STUDY DESIGN Contemporary cohort study with cross-sectional. MATERIALS AND METHODS Eighty adults of 35 to 60 years old had participated in this study, they had been divided into two groups, smokers (GF) and control (GC). There was application of questionnaire and voices were recorded. Praat software has been used for voice assessment and Man-Whitney, chi-square and logistic regression has been used for statistical analysis. RESULTS The GF had a higher incidence of alcohol dependence, coughing, throat clearing and professional voice using. Respecting to the acoustic parameters: noise-to-harmonic ratio (NHR), jitter and shimmer, the GF presented higher values. Relating these data to the questionnaire, its noticed that female gender have influence over all acoustic parameters, GERD have influence over jitter and smoking can affect fundamental frequency, jitter, shimmer and NHR. CONCLUSION Smoking interferes in acoustics parameters isolated and associated with alcohol dependence, GERD, cough, throat clearing, gender and professional using of voice.Introduction: Smoking affect voice quality in a long period of time, but other factors may compromise it, such as professional using of voice, habits, alcohol dependence and GERD. The aim was associate the influence of these factors on vocal parameters. Study design: Contemporary cohort study with cross-sectional. Materials and methods: Eighty adults of 35 to 60 years old had participated in this study, they had been divided into two groups, smokers (GF) and control (GC). There was application of questionnaire and voices were recorded. Praat software has been used for voice assessment and Man-Whitney, chi-square and logistic regression has been used for statistical analysis. Results: The GF had a higher incidence of alcohol dependence, coughing, throat clearing and professional voice using. Respecting to the acoustic parameters: noise-to-harmonic ratio (NHR), jitter and shimmer, the GF presented higher values. Relating these data to the questionnaire, its noticed that female gender have influence over all acoustic parameters, GERD have influence over jitter and smoking can affect fundamental frequency, jitter, shimmer and NHR. Conclusion: Smoking interferes in acoustics parameters isolated and associated with alcohol dependence, GERD, cough, throat clearing, gender and professional using of voice.

Comportamento reológico e nomenclatura dos alimentos utilizados por fonoaudiólogos de serviços de disfagia

OBJETIVO: estudar o comportamento reologico e a forma de classificacao e nomeacao das diferentes preparacoes utilizadas nas intervencoes com pacientes disfagicos, realizada por fonoaudiologos do estado de Sao Paulo, tendo como referencia a proposta australiana de padronizacao da nomenclatura. METODO: estudo quantitativo descritivo e qualitativo. Os dados foram coletados por meio da aplicacao de questionarios semi-estruturados com fonoaudiologos de servicos de disfagia no estado de Sao Paulo. Os fonoaudiologos relataram os alimentos utilizados em sua pratica por meio de exemplos de preparacoes bem como exemplos comerciais. Os profissionais classificaram os alimentos em diferentes niveis e relataram a nomenclatura utilizada para cada nivel. A viscosidade das preparacoes foi medida em viscosimetro e agrupadas de acordo com os valores obtidos. Em seguida foram classificados de acordo a proposta australiana de unificacao da nomenclatura. RESULTADOS: foram analisados 18 questionarios. Os profissionais utilizaram alimentos de comportamento reologico proximo em sua pratica. Os fonoaudiologos apresentaram, em sua maioria, 06 formas de agrupamento dos alimentos baseados em suas caracteristicas reologicas, principalmente a viscosidade. Foram apontados 33 termos para nomear 07 classes de alimentos segundo a proposta australiana. Os principais termos foram: liquido, pastoso e solido, seguidos de graduacoes e especificacoes. CONCLUSAO: fonoaudiologos de diferentes servicos de atencao em disfagia utilizam diferentes terminologias para designar a mesma preparacao no estado de Sao Paulo. Sao necessarios maiores estudos para que se possa estabelecer uma nomenclatura unificada no Brasil.

Influência do tabagismo isolado e associado a aspectos multifatoriais nos parâmetros acústicos vocais

INTRODUCTION Smoking affect voice quality in a long period of time, but other factors may compromise it, such as professional using of voice, habits, alcohol dependence and GERD. The aim was associate the influence of these factors on vocal parameters. STUDY DESIGN Contemporary cohort study with cross-sectional. MATERIALS AND METHODS Eighty adults of 35 to 60 years old had participated in this study, they had been divided into two groups, smokers (GF) and control (GC). There was application of questionnaire and voices were recorded. Praat software has been used for voice assessment and Man-Whitney, chi-square and logistic regression has been used for statistical analysis. RESULTS The GF had a higher incidence of alcohol dependence, coughing, throat clearing and professional voice using. Respecting to the acoustic parameters: noise-to-harmonic ratio (NHR), jitter and shimmer, the GF presented higher values. Relating these data to the questionnaire, its noticed that female gender have influence over all acoustic parameters, GERD have influence over jitter and smoking can affect fundamental frequency, jitter, shimmer and NHR. CONCLUSION Smoking interferes in acoustics parameters isolated and associated with alcohol dependence, GERD, cough, throat clearing, gender and professional using of voice.Introduction: Smoking affect voice quality in a long period of time, but other factors may compromise it, such as professional using of voice, habits, alcohol dependence and GERD. The aim was associate the influence of these factors on vocal parameters. Study design: Contemporary cohort study with cross-sectional. Materials and methods: Eighty adults of 35 to 60 years old had participated in this study, they had been divided into two groups, smokers (GF) and control (GC). There was application of questionnaire and voices were recorded. Praat software has been used for voice assessment and Man-Whitney, chi-square and logistic regression has been used for statistical analysis. Results: The GF had a higher incidence of alcohol dependence, coughing, throat clearing and professional voice using. Respecting to the acoustic parameters: noise-to-harmonic ratio (NHR), jitter and shimmer, the GF presented higher values. Relating these data to the questionnaire, its noticed that female gender have influence over all acoustic parameters, GERD have influence over jitter and smoking can affect fundamental frequency, jitter, shimmer and NHR. Conclusion: Smoking interferes in acoustics parameters isolated and associated with alcohol dependence, GERD, cough, throat clearing, gender and professional using of voice.

Dysarthria as a predictor of dysphagia following stroke.

BACKGROUND Stroke is the leading cause of mortality and disability worldwide. Important sequels are frequent, including dysphagia and communication disorders. OBJECTIVE to determine the prevalence of dysphagia and communication disorders following stroke, and to identify if communication disorders can predict dysphagia. METHODS Thirty-one prospective and consecutive patients were admitted to the Otolaryngology-Dysphagia Outpatient Clinic with diagnosis of ischemic or hemorrhagic stroke. Stroke was confirmed by computed tomography or magnetic resonance imaging, and medical evaluation. All patients had a swallowing and communication evaluation. We compared patients with and without dysphagia, and established the co-occurrence among dysphagia and communication disorders. RESULTS Twenty-five patients presented dysphagia. Aphasia occurred in 32.3% of the patients; dysarthria in 45.2%. Dysphagia and aphasia co-occurred in 29% of the population; dysphagia and dysarthria in 45.2%; the three conditions co-occurred in 22.6%. Dysarthria was a predictor of dysphagia, and it was associated with the presence of oral stage problems. CONCLUSIONS A comprehensive evaluation of dysphagia, aphasia, and dysarthria are important to improve clinical outcome following stroke. The identification of dysarthria as a predictor of dysphagia can help identify risk for dysphagia in stroke and assist in the therapeutic process of swallowing problems.