Mara Keli Christmann

SÍNDROME DE TENSÃO MUSCULOESQUELÉTICA, MUSCULATURA LARÍNGEA EXTRÍNSECA E POSTURA CORPORAL: CONSIDERAÇÕES TEÓRICAS

The theme of this study is the musculoskeletal stress syndrome, extrinsic laryngeal muscles and body posture. The purpose is to describe, from the literature review, the characteristics of the extrinsic muscles of the larynx; posture; vocal implications of musculoskeletal stress syndrome; evaluation and physical therapy and voice therapy. We performed a literature review of the last 13 years which included articles aimed and/or body textwere in line with the objectives of this study. The research was conducted in the databases of Literatura Latino-Americana e do Caribe em Ciencias da Saude, Biblioteca Regional de Medicina, Public Medline, Medical Literature Analysis and Retrieval System on Line, Scientific Electronic Library Online and Google Schoolar. Were established important relationships within the physical therapy and voice therapy, among which stand out the relationships muscular, postural and functional synergy in the vocal apparatus. In physical therapy to reduce muscle tension, the literature indicates use of transcutaneous electrical stimulation, low level laser, laser acupuncture, cryotherapy, manual therapy and traction, massage, cervical manipulations and mobilizations, associated or not to exercise, stretching, isometric relaxation , assisted soft tissue mobilization, therapeutic exercises aimed at correcting balance and muscle, diaphragm and respiratory rehabilitation therapy craniocervical flexion. In speech therapy, studies found only through digital manipulation of the larynx and semi-ocluded vocal tract exercises.

Exercícios de trato vocal semiocluído: revisão de literatura

Este trabalho tem como tema os exercicios de trato vocal semiocluido (ETVSO) e procura sintetizar e organizar, por meio de revisao de literatura, informacoes sobre nocoes fisicas e de anatomofisiologia subjacentes aos ETVSO e seus diferentes tipos, com descricao, aplicabilidades clinicas, restricoes, tempo de realizacao, efeitos e eficacia. Os ETVSO sao realizados com alguma oclusao no trato vocal que modifica a impedância acustica e gera ressonância retroflexa, afastando as pregas vocais na vibracao, reduzindo os riscos de trauma e equilibrando as pressoes sub e supraglotica, com economia vocal; tipos: vibracao de labios e de lingua, sons fricativos, /b/ prolongado, humming, firmeza glotica, constricao labial e fonacao em tubos; sao utilizados em disturbios vocais, incluindo a hipernasalidade, no aquecimento e aperfeicoamento vocal; a fonacao com tubo imerso a 15cm em agua somente deve ser utilizada em disfonias hipocineticas; nao ha definicao cientifica quanto ao tempo de execucao; os efeitos positivos gerados sao a melhora da propriocepcao, dos aspectos vocais perceptivo-auditivos e acusticos e mudancas no trato vocal; os estudos realizados com ressonância magnetica e tomografia computadorizada verificaram modificacoes no trato vocal apos a tecnica de fonacao em tubos, tais como area central mais alargada, firme fechamento do esfincter velofaringeo, diminuicao da regiao do esfincter velofaringeo, epiglote em posicao vertical, lingua mais elevada posteriormente, expansao das areas transversais da orofaringe e da cavidade oral; nao foram encontrados estudos sobre eficacia dos ETVSO.

Tempo máximo de fonação de futuros profissonais da voz

Objetivo: verificar os tempos maximos de fonacao (TMF) de vogais e correlacionar os resultados das relacoes entre /e/ afono e sonoro (ė/e), s/z e TMF obtido/previsto (TMFO/TMFP), conforme o sexo, em futuros profissionais da voz adultos com voz normal. Metodo: selecao por meio de avaliacao vocal pela escala RASATI; coleta dos TMF /a, i, u, e, s, z/, do /e/ afono (/ė/) e da capacidade vital; calculo das relacoes s/z, ė/e e TMFO/TMFP de 50 mulheres (media 21,42 anos) e 12 homens (media 24,25 anos). Resultados: em ambos os sexos, os TMF estiveram significantemente dentro da normalidade ou com valores diminuidos, sugerindo equilibrio ou escape aereo a fonacao. Relacao s/z significantemente normal, relacao ė/e significantemente aumentada quando comparada aos resul tados diminuidos e, relacao TMFO/TMFP sem diferencas significantes. Resultados que apontaram equilibrio ou hipercontracao de pregas vocais a fonacao. Correlacao positiva significante apenas entre as relacoes ė/e e s/z mostrando que crescem proporcionalmente e que a relacao TMFO/TMFP nao se correlaciona com elas. Conclusao: os futuros profissionais da voz adultos e com voz normal estudados em sua maioria apresentaram os TMF de vogais dentro da normalidade ou diminuidos, a relacao s/z normal; a relacao ė/e com valores aumentados quando comparada ao grupo com valores diminuidos, sugerindo a presenca de incoordenacao pneumofonoarticulatoria. A correlacao positiva entre as relacoes ė/e e s/z sugere que ambas fornecem resultados compativeis entre si, nao ocorrendo o mesmo com a relacao TMFO/TMFP. DESCRITORES: Voz; Fonacao; Saude do Trabalhador; Avaliacao em Saude

Finger Kazoo: modificações vocais acústicas espectrográficas e autoavaliação vocal

Purpose: to correlate the spectrographic vocal modifications and self-evaluation after finger kazoo. Methods: visual spectrographic analysis of the vowel /a:/ of 46 adult women, without vocal complaints or laryngeal alterations and self-evaluation before (Moment 1 – M1), after finger kazoo (M2) and after five minutes of silence (M3). Kappa, Chi-square and Spearman tests. The parameter for improving the voice was the statistical significance of the results after the finger kazoo. Results: improvement of darkening tracing of the formant (F) and high frequencies, of tracing regularity and definition of the harmonics. Best voice self-reported as increasing of intensity of the tracing darkening of F3, improvement of tracing definition and number of harmonic and replacement of harmonics with noise in medium frequencies. Conclusions: after the finger kazoo , there was an increase of darkening, regularity and definition of the spectrographic tracing and best voice self-reported.

Fluxo aéreo adaptado e coeficientes fônicos de futuros profissionais da voz

Purpose to verify and correlate adapted air flow (AAF), simple phonic coefficient (SPC) and composed phonic coefficient (CPC) in young adult future voice professionals of both genders which have normal voice as well as verifying frequency of sexes. Methods 62 subjects between 18 and 35 years old (12 men, mean 24,25 years old and 50 women, mean 21,42 years old); vocal evaluation by means of the RASATI scale with Kappa reliability coefficient; collecting of the maximum phonation time (MPT) of /a,i,u,s,z/, counting of numbers, vital capacity and AAF; calculation of the SPC and CPC; Spearmann test for correlations between variables and binomial test for the proportions of normal, diminished and increased values. Results majority significantly feminine presented SPC and CPC normal, and FAA normal and incresead when compared to the diminished values. Majority significantly masculine presented SPC normal and increased, when compared to the diminished values; normal CPC and no statistically meaningful difference on AAF. There was moderate positive correlation between SPC and CPC for both genders. Conclusion majority significantly of the studied future voice professionals presented SPC and CPC normal with moderate positive correlation between these measurements. Majority significantly feminine obtained normal results AAF when compared increased values and AAF did not have correlation with SPC and CPC. Majority significantly of the group of future voice professionals was women.

Pressão sonora e tempo máximo de fonação após a técnica de finger kazoo

Purpose: to determine the modal sound pressure level (SPL) and maximum phonation time (MPT) /a/ adult woman without vocal complaints or laryngeals disorders, before, immediately after and five minutes after the execution of the technique of Finger kazoo (FK). Method: collection of the MPT /a/, measure of fundamental frequency (f0) and its standard deviation, and measuring the modal SPL, 32 woman between 18 and 40 years of age without vocal complaints or laryngeal disorder before (M1), after three sets of 15 repetitions of FK (M2), and five minutes after silence (M3). Spearman, Tukey and Friedman tests. Results: increase of modal NPS M2 (significance), and M3, increased of MPT /a/ in M2 and M3. Conclusion: in the studied group of adult woman without vocal complains or laryngeal disorders, there was a higher in the modal NPS immediately after three sets of 15 repetitions of the FK technique, showing that the technique can influence the sound pressure the loudness and vocal projection.

Uso do programa MDVP em diferentes contextos: revisão de literatura

Este estudo tem como objetivo descrever, a partir de revisao de literatura, a confiabilidade da analise acustica utilizando o Multi Dimensional Voice Program,comparacao de suas medidas com outros programas de analise acustica; caracterizacao de vozes de diferentes grupos; e sua utilizacao para verificar os efeitos e eficacia de diferentes procedimentos terapeuticos. Realizou-se levantamento bibliografico que priorizaram estudos dos ultimos cinco anos, incluindo-se artigos cujo objetivo estivesse de acordo com o interesse da presente revisao. A pesquisa foi realizada nos bancos de dados das bases Lilacs, BIREME, PubMed, MedLine, Scielo e Google Schoolar, por meio dos descritores acoustic, speech acoustics e voice. As medidas mais utilizadas sao frequencia fundamental, jitter, shimmer e proporcao harmonico-ruido. As medidas de tremor nao apresentam boa confiabilidade. As medidas mais consistentes que apresentam alta concordância com outros programas de analise acustica sao as relacionadas com a frequencia fundamental. Diversos estudos buscam caracterizar diferentes tipos de vozes tais como as de sujeitos sem alteracoes vocais de ambos os sexos, buscando estabelecer parâmetro de normalidade para diferentes grupos populacionais. Alem disso, alguns estudos caracterizam vozes com diferentes disturbios. A analise acustica e um recurso objetivo e necessario na avaliacao de pacientes com disturbio vocal e, principalmente, na comparacao de diversos tipos de tratamento.

Relações entre /s/ e /z/ e entre /e/ e /e/ não vozeado ou áfono

ABSTRACTPurpose : correlate the maximum phonation time (MPT) and the relations between the fricative /s/ and /z/ (s/z) and between the vowels /ė/ and /e/ (ė/e) of women without laryngeal disorders. Method : participants were 60 women with a mean of 21.56 years old. Were collected MPT/ė/, /e/, /s/ and /z/ and calculated the relations ė/e and s/z, with normal pattern for the relationship from 0.8 to 1.2; for MPT/s/ and MPT/z/, between 15.57 and 34.17s; for the MPT/ė/, between 16 to 18s; and for the MPT/e/, between 14.04 and 26.96s. Lilliefords, Spearman, Binomial and Mann-Whitney tests with a significance level of 5%. Results: positive correlation between MPT/s/ and MPT/ė/, MPT/z/ and MPT/e/, MPT/s/ and MPT/z/, and MPT/ė/ and MPT/e/. There was no correlation between the ratios s/z and ė/e, no differences between the relative ė/e, while the relation s/z was significantly normal. MPT/ė/ and MPT/e/ significantly reduced; MPT/s/ and MPT/z/ significantly normal. MPT/ė/ significantly lower than MPT/s/; MPT/e/ significantly lower than MPT/z/.

Laryngeal disorders, maximum phonation times and vital capacity in women with organofunctional dysphonia

PURPOSE: to determine and to correlate the maximum phonation times (MPT) of vowels, vital capacity (VC) and laryngeal disorders (LD) for women with benign organic lesions resulting from vocal misuse or abuse (BOL). METHOD: retrospective, transverse, exploratory, non-experimental, quantitative study, with measurement database of MPT [a, i, u], VC and LD of women with BOL, and Chi-Square statistic and exact tests of Fisher in order to investigate the differences between the variables and their relationships and a binomial test in order to check the significance of proportion or percentage of descriptive analysis, with p<0.05. RESULTS: the majority (22; 75.86%) showed MPT significantly reduced (p = 0.0053) and seven (24.14%) normal MPT. The normal VC was statistically significant (p = 0.0001) (26; 89.66%), but three women (10.34%) showed it to be reduced. There was significant dominance of vocal nodules (p = 0.0016) (22; 75.86%), followed by Reinkes edema (6, 20.69%) and vocal polyp (1; 3.45%). Among the 22 woman (75.86%) which showed reduced MPT, there was a predominance with normal VC (19; 86.36%), although no statistical significance (p = 0,558). All the individuals with normal MPT showed VC normal (7; 100%). The majority with BOL showed normal VC, although not statistically significant (p=0,199). There was a predominance of vocal nodules and reduced MPT (16; 72.73%), although not statistically significant (p=0.086). In the correlation of the three variables, most of the subjects presented vocal nodules associated with MPT reduced and normal VC (15; 68.18%), although not statistically significant. CONCLUSION: in women with BOL in this study, the reduced MPT, the normal VC and the presence of vocal nodules were significant and there was no relationship between the MPT, VC and LD.Purpose: to determine and to correlate the maximum phonation times (MPT) of vowels, vital capacity (VC) and laryngeal disorders (LD) for women with benign organic lesions resulting from vocal misuse or abuse (BOL). Method: retrospective, transverse, exploratory, non-experimental, quantitative study, with measurement database of MPT [a, i, u], VC and LD of women with BOL, and Chi-Square statistic and exact tests of Fisher in order to investigate the differences between the variables and their relationships and a binomial test in order to check the significance of proportion or percentage of descriptive analysis, with p<0.05. Results: the majority (22; 75.86%) showed MPT significantly reduced (p = 0.0053) and seven (24.14%) normal MPT. The normal VC was statistically significant (p = 0.0001) (26; 89.66%), but three women (10.34%) showed it to be reduced. There was significant dominance of vocal nodules (p = 0.0016) (22; 75.86%), followed by Reinke’s edema (6, 20.69%) and vocal polyp (1; 3.45%). Among the 22 woman (75.86%) which showed reduced MPT, there was a predominance with normal VC (19; 86.36%), although no statistical significance (p = 0,558). All the individuals with normal MPT showed VC normal (7; 100%). The majority with BOL showed normal VC, although not statistically significant (p=0,199). There was a predominance of vocal nodules and reduced MPT (16; 72.73%), although not statistically significant (p=0.086). In the correlation of the three variables, most of the subjects presented vocal nodules associated with MPT reduced and normal VC (15; 68.18%), although not statistically significant. Conclusion: in women with BOL in this study, the reduced MPT, the normal VC and the presence of vocal nodules were significant and there was no relationship between the MPT, VC and LD.

Síndrome de Goldenhar: uma abordagem fonoaudiológica

BACKGROUND: the purpose of this paper is to tell the case of a child with Goldenhar Syndrome in speech-language treatment at a clinical school. PROCEDURES: data were collected from the patients records, through signature of the Free and Clarified Consent Term and approval in the Ethics Committee of the institution, during approximately 11 months of treatment. This case relates a child with 5 years and 11 months old, male gender, with a birth malformation at the right ear and mandibular condyle, as well as spina bifida. For this description, the patient passed through evaluations of hearing, stomatognathic system, face anthropometric measures, articulation examination, phonological assessment and hearing discrimination, before and after intervention. RESULTS: we noted changes as for conductive hearing loss in a moderate degree at the right ear; modifications in the mobility of lips and tongue; alterations in deglutition, mastication and respiration; reduced face anthropometric measures, mainly at the mandibular ramus; as well as the articulatory (distortions) and the phonological disorders (devoicing). From these data, we set out a therapeutic planning, with positive results in the mentioned period, mainly as for the mastication function. CONCLUSION: the patient showed several speech-language alterations arising from the oculoauriculovertebral spectrum, that is being increased in the association with Mouth Breathing, the deleterious oral habits and the environmental factors of the patient. New studies with more details and higher number of subjects are important to corroborate such results.