Luciana Lemos de Azevedo

Queixas vocais e grau de disfonia em professoras do ensino fundamental

PURPOSE: The aim of this study was to survey vocal complaints and degree of dysphonia among teachers from a public elementary school at Betim, MG (Brazil). METHODS: Thirteen elementary school teachers with ages between 20 and 50 years (mean of 36 years old), who taught at least 20 hours a week, participated in the study. Data were obtained using a questionnaire and voice recording, analyzed on the GRAM 5.7 acoustic analysis program. After acoustic analysis, the voices were perceptually analyzed and classified by three speech therapists with at least five years of clinical experience in the area. RESULTS: From the selected teachers, 30.77% showed normal voice quality, while 23.08% were considered to have mild dysphonia and 46.15% moderate dysphonia. None of the subjects showed severe dysphonia. Confidence intervals of 95% provided estimations of a minimum of 6.6% of teachers with discrete dysphonia and 22.39% with moderate dysphonia in the population of reference. Regardless of the type of vocal complaint, the total number of complaints among teachers with moderate dysphonia was significantly higher than among teachers with normal voice quality. Nevertheless, there were no differences between groups in the distribution of specific complaints, when these were individually analyzed. CONCLUSION: The majority of the teachers in this study had altered vocal quality, mostly being classified with moderated degree dysphonia. Specific vocal complaints appear to be equally distributed among teachers with normal voice and with dysphonia. Results point out the importance of vocal health projects directed to this population.

Avaliação da performance vocal antes e após a vibração sonorizada de língua

ABSTRACT Purpose: To verify the ideal period of time to perform the voiced tongue vibration technique in order to interfere in the measures of short-term disturbance (of the vibration of the vocal folds), fundamental frequency (F 0 ) and vocal intensity. Methods: Forty three female volunteers with ages varying from 18 to 31 years (average of 21,2) were analyzed. They underwent a screening performed by a speech-language pathologist and an otorhinolaryngologist, in order to eliminate possible laryngeal pathologies and/or voice disor-ders. The recording of a long [a] was carried out before the use of the voiced tongue vibration technique, and after the first, third and fifth minutes of its completion. Acoustic analysis of the data was carried out using the software Vox Metria® 1.1, which analyzed the average F 0 and its variability, average intensity, and measures of short-term disturbance. Results: The F 0 increased after three minutes of execution of the technique, and intensity increased after one minute. On the contrary, noise decreased after three minutes using the technique. The parameters F

Ação da levodopa e sua influência na voz e na fala de indivíduos com doença de Parkinson: [revisão]

Parkinsons disease (PD), a progressive degenerative disease characterized by death of neurons of pars compacta of substantia nigra and other pigmented nucleii of the brainstem, is associated with dopamine depletion. Clinically, it is characterized primarily by motor deficits which may interfere with communication. Levodopa, which is converted into dopamine, is the most effective drug for the treatment of PD. A myriad of studies show that levodopa improves several vocal paremeters, resulting in increase of fundamental frequency, melodic variation, vocal intensity, speed of the speech, maximum speech time and values of respiratory pressure. Moreover, it improves speech intelligibility and type of voice, as well as reduces or even suppresses vocal tremor. However, more recent data have shown that the effect of this drug on prosodic aspects of parkinsonian speech is quite modest, since few prosodic variables are modified after its use. It has been observed that levodopa improves the duration parameters of speech, whereas speech therapy, alone and combined with the use of levodopa, results in improvements on all prosodic parameters: frequency, duration and intensity. This highlights the importance of the association of these treatments for better communication and global motor benefits.

Expressão da atitude através da prosódia em indivíduos com doença de Parkinson idiopática

Pacientes com doenca de Parkinson (DP) apresentam incidencia significativa de alteracoes de voz e fala. O presente estudo teve como objetivo verificar os parâmetros prosodicos empregados na expressao das atitudes em individuos com DP idiopatica (DPI), alem de estudar a interferencia da levodopa e do metodo Lee Silverman de Tratamento Vocal® adaptado, e comparar com o padrao normalmente empregado por informantes que nao apresentavam a referida doenca. Para tanto, foram selecionados 10 informantes idosos com DPI e 10 informantes idosos sem alteracoes neurologicas. Todos os informantes foram submetidos a gravacao do corpus em ambiente acusticamente tratado, onde eram solicitados a emitir tres enunciados inseridos em um contexto, sendo que tais enunciados foram produzidos em quatro momentos: expressando a atitude de certeza (AC), expressando a atitude de duvida (AD), expressando a modalidade declarativa (MD) e expressando a modalidade interrogativa (MI). A partir da analise critica dos dados, pudemos observar que, na comparacao entre a MD e a AC e entre a MI e a AD, apenas o grupo controle (GC) apresentou um diferencial na expressao da AC, que foi o aumento da amplitude de variacao melodica da atona pretonica. Ao realizarmos uma analise mais detalhada, levando em consideracao cada um dos 10 informantes do GC, pudemos verificar que todos eles apresentaram de uma a tres variaveis que diferenciavam tanto a MD da AC quanto a MI da AD, o que evidencia que a manipulacao dos parâmetros prosodicos para expressar as atitudes e uma caracteristica individual. Ja para os informantes com DP nao foi observado nenhum comportamento prosodico que caracterizasse a expressao das atitudes (ao compararmos a MD com a AC e a MI com a AD). No entanto, quando comparamos todas as atitudes (certeza e duvida) com todas as modalidades (declarativa e interrogativa), observamos que a duracao do enunciado foi uma variavel de peso na expressao das atitudes, apresentando-se aumentada para a expressao delas, o que nao aconteceu apenas para informantes parkinsonianos sem nenhum tipo de tratamento. Ao estudar o emprego dos parâmetros prosodicos por parte destes informantes sem levar em consideracao as atitudes, observamos que a DP prejudica a producao eficiente dos parâmetros prosodicos. Apos a administracao da levodopa, observamos uma melhora significativa nos parâmetros de duracao, mas mesmo assim os parkinsonianos nao chegam a ter um desempenho tao satisfatorio quanto o do GC. O tratamento medicamentoso promoveu melhora nos parâmetros de duracao e o tratamento fonoaudiologico proporcionou mais beneficios para a variavel frequencia fundamental, ao passo que a associacao dos tratamentos (fonoaudiologico e medicamentoso) promoveu melhora de todos os parâmetros prosodicos: frequencia fundamental, duracao e intensidade. Foi possivel observar um padrao melodico semelhante na emissao dos enunciados, sendo que, para todos os grupos de comparacao, foi verificado que enunciados de MD e AC apresentaram pico de frequencia fundamental na atona pretonica (exceto para a expressao da AC para informantes do sexo feminino do GC, cujo pico foi na tonica nuclear), enquanto enunciados de MI e AD apresentaram o pico de frequencia fundamental na tonica nuclear.

Effect of speech therapy and pharmacological treatment in prosody of parkinsonians

OBJECTIVE Parkinsonian patients usually present speech impairment. The aim of this study was to verify the influence of levodopa and of the adapted Lee Silverman Vocal Treatment® method on prosodic parameters employed by parkinsonian patients. METHOD Ten patients with idiopathic Parkinsons disease using levodopa underwent recording of utterances produced in four stages: expressing attitudes of certainty and doubt and declarative and interrogative modalities. The sentences were recorded under the effect of levodopa (on), without the effect of levodopa (off); before and after speech therapy during the on and off periods. RESULTS The speech therapy and its association with drug treatment promoted the improvement of prosodic parameters: increase of fundamental frequency measures, reduction of measures of duration and greater intensity. CONCLUSION The association of speech therapy to medication treatment is of great value in improving the communication of parkinsonian patients.

Análise de parâmetros perceptivo-auditivos e acústicos em indivíduos gagos

PURPOSE: To analyze auditory-perceptual and acoustic parameters of the voices of adult stutterers. METHODS: Fifteen male stutterers in the age range from 21 to 41 years (mean 26.6 years), attended at the institutions Speech-Language Pathology Clinical Center in the period from February 2005 to July 2007, were analyzed. The auditory-perceptual parameters analyzed were vocal quality, type of voice, resonance, vocal tension, speech rate, pneumo-phonic coordination, vocal attack and pitch range; the acoustic parameters analyzed were fundamental frequency and its variability during spontaneous speech. RESULTS: The auditory-perceptual analysis showed that the most frequent characteristics among the subjects were normal vocal quality (60%), altered resonance (66%), vocal tension (86%), altered vocal attack (73%), normal speech rate (54%), altered pitch range (80%) and altered pneumo-phonic coordination (100%). However, only the presence of vocal tension and the altered pneumo-phonic coordination and pitch range were statistically significant in the stutterers studied. In the acoustic analysis, fundamental frequency varied from 125,54 to 149,59 Hz, and the variability of the fundamental frequency ranged from 16 to 21 halftones, or from 112,50 to 172,40 Hz. CONCLUSION: The auditory-perceptual parameters that were significantly frequent among stutterers were: presence of vocal tension, altered pneumo-phonic coordination, and altered pitch range. Therefore, it is important to evaluate the vocal aspects of these patients, for the fluency disorders might undermine some vocals parameters, causing dysphonia.