Marcia Simões-Zenari

Fatores associados ao bruxismo em crianças de 4 a 6 anos

TEMA: o bruxismo tem trazido prejuizos para a qualidade de vida das pessoas. Suas implicacoes para a motricidade orofacial e fala em criancas ainda nao estao bem estabelecidas. OBJETIVO: investigar a ocorrencia do bruxismo e fatores associados relativos aos habitos orais, motricidade orofacial e funcoes de mastigacao, respiracao e degluticao em criancas de 4 a 6 anos. METODO: participaram 141 criancas da referida faixa etaria que frequentam tres centros de educacao infantil paulistas. Os pais preencheram protocolo de investigacao sobre bruxismo e as criancas passaram por avaliacao da motricidade orofacial. O grupo pesquisa foi composto pelas criancas cujos pais indicaram qualquer frequencia de ranger ou apertamento de dentes, durante o sono ou nao. Para analise estatistica utilizou-se Analise de Variância, Teste de Igualdade de Duas Proporcoes e calculo da Odds Ratio, nivel de significância de 5%. RESULTADOS: observou-se elevada ocorrencia de bruxismo entre as criancas (55,3%). Foram fatores associados a esta ocorrencia: sialorreia durante o sono, uso de chupeta, habito de morder labios e roer unhas, tonus de bochechas e tipo de mordida alterados, alem da participacao da musculatura perioral durante degluticao de liquidos. Houve alta ocorrencia de criancas dos dois grupos com queixa de dor de cabeca frequente (76%) e que dormem menos do que o recomendado para a idade (35%). CONCLUSAO: os achados comprovaram relacao entre bruxismo, habitos orais e aspectos alterados da motricidade orofacial das criancas da faixa etaria estudada reforcando a necessidade de acoes fonoaudiologicas junto as instituicoes e familias.

Impacto de treinamento auditivo na avaliação perceptivo-auditiva da voz realizada por estudantes de Fonoaudiologia

OBJETIVO: Analisar o impacto de treino auditivo na avaliacao perceptivo-auditiva da voz realizada por estudantes de Fonoaudiologia. METODOS: Durante dois semestres, 17 estudantes que cursavam disciplinas teoricas de fonacao (Fonacao/Disturbios da Fonacao) analisaram amostras de vozes alteradas e nao alteradas (selecionadas para este estudo), por meio da escala GRBAS. Todos receberam treinamento auditivo durante um total de nove encontros semanais, com cerca de 15 minutos de duracao cada. Em cada encontro foi apresentado um parâmetro, por meio de vozes diferentes da amostra avaliada, com predominância no aspecto treinado. A avaliacao das amostras por meio da escala foi realizada pre e pos o treinamento e em outros quatro momentos ao longo dos encontros. As avaliacoes dos alunos foram comparadas com uma avaliacao de juizas, realizada previamente por tres fonoaudiologos, especialistas em voz. Para verificar a efetividade do treinamento foi usado o teste de Friedman e Indice de Concordância Kappa. RESULTADOS: O indice de acertos dos alunos no momento pre-treinamento foi considerado entre regular e bom. Observou-se manutencao do numero de acertos ao longo das avaliacoes realizadas, para a maioria dos parâmetros da escala. No momento pos-treinamento observou-se melhora na analise da astenia, parâmetro enfatizado a partir das dificuldades apresentadas pelos alunos. Houve diminuicao dos acertos no parâmetro rugosidade apos este ter sido trabalhado de maneira segmentada em rouquidao e aspereza, e associado a diferentes diagnosticos e parâmetros acusticos. CONCLUSAO: O treino auditivo potencializa as habilidades iniciais dos alunos, refinando-as para realizacao da avaliacao, alem de nortear ajustes em dinâmicas das disciplinas.

Mudanças em comportamentos relacionados com o uso da voz após intervenção fonoaudiológica junto a educadoras de creche

BACKGROUND preventive programs have been used with teachers with the purpose of lowering the number of risk factors for voice disorders. However, few studies have focused on the effectiveness of these programs. AIM to assess changes in behaviors that are considered, according to the specific literature, as having a negative impact on the voice, during a speech therapy intervention program offered to educators. METHOD an experimental study where a theoretical-practical program involving the professional use of voice was developed with 26 educators from two day care centers of São Paulo. This program involved five monthly meetings, working up to a total of twelve hours. During the program, topics concerning negative behaviors that affect the voice were discussed. On four of the meetings the educators filled in a protocol, making it possible to analyze the frequency on which they presented those specific behaviors. Later on, scores were given to the answers on the protocol in order to compare the findings during the program. For this comparison the statistical test of Wilcoxon and the linear tendency chi-square test were used. RESULTS the gradual decrease in the use of voice out of work was observed, as well as in speaking with a very low or high pitch voice and in eating excessively before sleeping. There was an increase in the occurrence of coughing in the third application of the protocol. As for the overall monthly averages, statistically significant differences were not found when comparing the four applications of the protocol. The overall average score was of 11.75, which was considered moderately abusive. CONCLUSION the changes that were observed during the program were interesting, but very restrict which makes one wonder about the real effects of this kind of practice and how much broader changes rely on small individual changes. Actions that involve information about vocal well-being exclusively should be revised.

Efeito do ruído na voz de educadoras de instituições de educação infantil

OBJETIVO: Evaluar la asociacion entre niveles de ruido presentes en centros de educacion infantil y alteraciones vocales en educadoras. METODOS: Estudio transversal con 28 educadoras de tres instituciones de educacion infantil de Sao Paulo, Sureste de Brasil, en 2009. Los niveles de presion sonora se cuantificaron segun Asociacion Brasilena de Normas Tecnicas, con uso de medidor de nivel de presion sonora. Los promedios se clasificaron segun los niveles de conforto, incomodidad y dano auditivo propuestos por la Organizacion Panamericana de Salud. A las educadoras se les evaluo la voz: auto-evaluacion con escala analogica visual, evaluacion perceptivo-auditiva con escala GRBAS y analisis acustico con el programa Praat. Para analisis de asociacion entre ruido y evaluacion vocal, se utilizo estadistica descriptiva y prueba de chi-cuadrado, con 10% de significancia debido al tamano de la muestra. RESULTADOS: Las educadoras presentaban edades entre 21 y 56 anos. El promedio de ruido fue 72,7dB, considerado dano 2. La auto-evaluacion vocal de las profesionales presento promedio de 5,1 en la escala, considerada alteracion moderada. En la evaluacion perceptivo-auditiva, 74% presentaron alteracion vocal, principalmente ronquera; de estas, 52% fueron consideradas alteraciones leves. La mayor parte presento frecuencia fundamental por debajo de lo esperado en la evaluacion acustica. Promedios de jitter, shimmer y proporcion armonico-ruido estaban alterados. Presencia de ruido entre los armonicos se asocio a alteracion vocal. CONCLUSIONES: Hubo asociacion entre presencia de ruido entre armonicos y alteracion vocal, con elevados niveles de ruido. A pesar de que la mayoria de las educadoras presentaron voz alterada en grado reducido, la auto-evaluacion mostro alteracion moderada, probablemente por la dificultad de proyeccion.

Correlation of the Dysphonia Severity Index (DSI), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and Gender in Brazilians With and Without Voice Disorders

OBJECTIVES This study aims to analyze the Dysphonia Severity Index (DSI) in Brazilians with or without voice disorders and investigate DSIs correlation with gender and auditory-perceptual evaluation data obtained via the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol. STUDY DESIGN A total of 66 Brazilian adults from both genders participated in the study, including 24 patients with dysphonia confirmed on laryngeal examination (dysphonic group [DG]) and 42 volunteers without voice or hearing complaints and without auditory-perceptual voice disorders (nondysphonic group [NDG]). METHODS The vocal tasks included in CAPE-V and DSI were performed and recorded. Data were analyzed by means of the independent t test, the Mann-Whitney U test, and Pearson correlation at the 5% significance level. RESULTS Differences were found in the mean DSI values between the DG and the NDG. Differences were also found in all DSI items between the groups, except for the highest frequency parameter. In the DG, a moderate negative correlation was detected between overall dysphonia severity (CAPE-V) and DSI value, and between breathiness and DSI value, and a weak negative correlation was detected between DSI value and roughness. In the NDG, the maximum phonation time was higher among males. In both groups, the highest frequency parameter was higher among females. CONCLUSIONS The DSI discriminated among Brazilians with or without voice disorders. A correlation was found between some aspects of the DSI and the CAPE-V but not between DSI and gender.

The effect of noise on the voice of preschool institution educators

OBJETIVO: Evaluar la asociacion entre niveles de ruido presentes en centros de educacion infantil y alteraciones vocales en educadoras. METODOS: Estudio transversal con 28 educadoras de tres instituciones de educacion infantil de Sao Paulo, Sureste de Brasil, en 2009. Los niveles de presion sonora se cuantificaron segun Asociacion Brasilena de Normas Tecnicas, con uso de medidor de nivel de presion sonora. Los promedios se clasificaron segun los niveles de conforto, incomodidad y dano auditivo propuestos por la Organizacion Panamericana de Salud. A las educadoras se les evaluo la voz: auto-evaluacion con escala analogica visual, evaluacion perceptivo-auditiva con escala GRBAS y analisis acustico con el programa Praat. Para analisis de asociacion entre ruido y evaluacion vocal, se utilizo estadistica descriptiva y prueba de chi-cuadrado, con 10% de significancia debido al tamano de la muestra. RESULTADOS: Las educadoras presentaban edades entre 21 y 56 anos. El promedio de ruido fue 72,7dB, considerado dano 2. La auto-evaluacion vocal de las profesionales presento promedio de 5,1 en la escala, considerada alteracion moderada. En la evaluacion perceptivo-auditiva, 74% presentaron alteracion vocal, principalmente ronquera; de estas, 52% fueron consideradas alteraciones leves. La mayor parte presento frecuencia fundamental por debajo de lo esperado en la evaluacion acustica. Promedios de jitter, shimmer y proporcion armonico-ruido estaban alterados. Presencia de ruido entre los armonicos se asocio a alteracion vocal. CONCLUSIONES: Hubo asociacion entre presencia de ruido entre armonicos y alteracion vocal, con elevados niveles de ruido. A pesar de que la mayoria de las educadoras presentaron voz alterada en grado reducido, la auto-evaluacion mostro alteracion moderada, probablemente por la dificultad de proyeccion.

Disfonia psicogênica associada a outras doenças: desafio para o tratamento fonoaudiológico

BACKGROUND success and difficulties in the treatment of psychogenic dysphonia. AIM to discuss the limitations of speech therapy for psychogenic dysphonia associated with other diseases. METHOD evaluation protocols and therapy registrations were used for discussion of the case. RESULTS the patient arrived with a significant voice change and after evaluation psychogenic dysphonia was diagnosed. The treatment involved vocal activation and modification of the fixed adjustment. Positive changes were observed such as stability in vocal patterns and reduction of hoarseness, roughness, breathiness and throat discomfort and in the quality of life related to voice, but these changes were not sustained since other existing health problems aggravated. CONCLUSION speech therapy may be limited, although challenging, when psychogenic dysphonia occurs concomitantly to other diseases.

Dysphonia risk screening protocol

OBJECTIVE: To propose and test the applicability of a dysphonia risk screening protocol with score calculation in individuals with and without dysphonia. METHOD: This descriptive cross-sectional study included 365 individuals (41 children, 142 adult women, 91 adult men and 91 seniors) divided into a dysphonic group and a non-dysphonic group. The protocol consisted of 18 questions and a score was calculated using a 10-cm visual analog scale. The measured value on the visual analog scale was added to the overall score, along with other partial scores. Speech samples allowed for analysis/assessment of the overall degree of vocal deviation and initial definition of the respective groups and after six months, the separation of the groups was confirmed using an acoustic analysis. RESULTS: The mean total scores were different between the groups in all samples. Values ranged between 37.0 and 57.85 in the dysphonic group and between 12.95 and 19.28 in the non-dysphonic group, with overall means of 46.09 and 15.55, respectively. High sensitivity and specificity were demonstrated when discriminating between the groups with the following cut-off points: 22.50 (children), 29.25 (adult women), 22.75 (adult men), and 27.10 (seniors). CONCLUSION: The protocol demonstrated high sensitivity and specificity in differentiating groups of individuals with and without dysphonia in different sample groups and is thus an effective instrument for use in voice clinics.

Análise vocal acústica: efeito do treinamento auditivo-visual para graduandos de Fonoaudiologia

Purpose: To verify the effectiveness of a training for acoustic voice assessment with undergraduate students of Speech-Language Pathology. Methods: Study conducted with 14 undergraduate students of Speech-Language Pathology who participated in six theoretical/practical weekly encounters, whose total duration was four hours and a half. Basic concepts of acoustic voice assessment was performed; we used spectrographic analysis to each parameter, visually and auditory. In order to verify the proposal’s effectiveness, the undergraduate students assessed before and after de training, the measures of automatic extraction of the evaluation measures and also aspects of narrowband spectrograph of 15 voices, normal and disordered in varying degrees. We considered the performance of students, before and after the training comparing their mistakes and correct scores to a previous analysis performed by a specialist with Kappa index >0.70. To compare the results obtained by the undergraduate students in the two instances McNemar test was performed. Results: For all parameters analyzed the average of correct scores was higher after the training, as well as the overall average (24.2% before and 93.0% after). Conclusion: The developed training was effective for the learning of undergraduate students, and may be included into subjects which involve concepts of voice assessment and also might be transformed into teaching material available to other groups.

Cognitive Vocal Program applied to individuals with signals presbylarynx: preliminary results

PURPOSE To propose and verify the feasibility of a vocal program intervention in patients with presbylarynx signs with or without vocal complaints. METHOD Among 20 elder participants of the current research, 3 female patients with median age of 67 years were chosen for the pilot study. Laryngological examination, vocal recording with CAPE-V (Consensus Auditory-Perceptual Evaluation of Voice) protocol, and Screening Protocol of Risk of Dysphonia (SPRD) were conducted before and after the program intervention. They joined the Cognitive Vocal Program for presbyphonia based on the genetic epistemology by Jean Piaget associated with vocal techniques based on scientific literature. This program is structured with six sessions and each one of them is focused in different aspects of vocal production. RESULTS After the program intervention, some aspects such as loudness, coordination between breathing and speaking, accuracy in articulatory movements, jitter, and harmonics-to-noise ratio improved with parameters within the expected range for the age group. Three female participants were observed for better vocal quality, higher fundamental frequency, and better maximum phonation time. In two cases, tension related to loudness elevation and better scores on SPRD was observed. Using by high-speed laryngeal image, we also observed reduction of presbylarynx signs, and remarkable improvement in glottis closure competence and mucosal wave movement of the patients with and without vocal complaints. CONCLUSION The preliminary results suggest encouraging prospects for the proposal with improvement in the aspects analyzed. This program was well designed and did not require any further adjustments.