Mauriceia Cassol

Measurement of Voice Quality, Anxiety and Depression Symptoms After Speech Therapy

OBJECTIVEnTo verify changes in vocal behavior of dysphonia patients and components of anxiety and depression symptoms before and after voice therapy.nnnSTUDY DESIGNnIt is an uncontrolled clinical trial on individuals with dysphonia who attended voice therapy at the outpatient clinic of a hospital in southern Brazil.nnnMETHODSnStatistical analysis was carried out using descriptive statistics, Mann-Whitney and Wilcoxon tests, assuming maximum significance level of 5% (Pxa0≤xa00.05), SPSS 16.0. All patients underwent otorhinolaryngologic assessment for laryngeal disorder diagnosis. Perceptual-auditory voice assessment (GRBAS scale) and the Hospital Anxiety and Depression Scale were applied before and after voice therapy.nnnRESULTSnSixty-eight patients, 23 of whom were men (33.82%), mean age of 49xa0years (standard deviationxa0±xa019.14). The number of voice therapy sessions varied according to each case, with a mean of 10.31 (standard deviationxa0±xa05.32). The comparisons between psychological or psychiatric referral and participants age revealed statistical significance, suggesting that younger people were referred to the specialties because they were suspected potential clinical cases. Comparisons between voice parameters, anxiety and depression scores before and after voice therapy showed statistically significant findings.nnnCONCLUSIONSnThis study identified the presence of emotional symptoms in dysphonia patients and indicated that voice therapy is effective to improve voice quality and to early detect and help reduce anxiety and depression symptoms. It also highlights the influence of psychological and psychiatric referral on emotional symptoms. The need for controlled trials and the importance of interdisciplinary interventions in this area for the complete care of individuals with dysphonia is pointed out.

Effects of Voice Therapy on Muscle Tension Dysphonia: A Systematic Literature Review

The present study aimed to carry out a systematic review of the effects of voice therapy on individuals diagnosed with muscle tension dysphonia (MTD) or hyperfunctional dysphonia. This is a systematic literature review on the databases Medline (via PubMed), Cochrane Library, Scopus, and Lilacs using a search strategy related to the theme of the study. The selection included clinical trials that assessed the effects of speech therapy intervention on patients diagnosed with MTD or hyperfunctional dysphonia published over the last 10 years in Portuguese, English, or Spanish. The Physiotherapy Evidence-Based Database (PEDro) Scale was used to assess the methodology of the studies. Of the 634 publications, 12 studies were included in this review, of which three were excluded due to a low score on the PEDro Scale, resulting in a final number of nine publications. Regarding the techniques approached, semioccluded vocal tract exercises (22.22%), nasal sound and frequency modulation (22.22%), maximum phonation time (MPT) technique and vocal hygiene (11.11%), vocal function exercises (11.11%), respiratory exercises along with phonoarticulatory sounds (11.11%), manual laryngeal therapy (11.11%), and manual laryngeal therapy associated with respiratory exercises (11.11%) were identified. These techniques promoted the following effects: improvement in intraoral and subglottal pressure, positive alterations in the glottal contact quotient, significant changes in fundamental frequency measures, increased MPT, and reduced voice roughness. Methodology was identified to be a shortcoming in the studies. The clinical trials reviewed showed positive results in using the therapeutic techniques selected in the speech therapy approach.

Effects of Repetitive Transcranial Magnetic Stimulation in the Rehabilitation of Communication and Deglutition Disorders: Systematic Review of Randomized Controlled Trials

Objective: To systematically review randomized controlled trials that evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on rehabilitation aspects related to communication and swallowing functions. Methods: A search was conducted on PubMed, Clinical Trials, Cochrane Library, and ASHA electronic databases. Studies were judged according to the eligibility criteria and analyzed by 2 independent and blinded researchers. Results: We analyzed 9 studies: 4 about aphasia, 3 about dysphagia, 1 about dysarthria in Parkinsons disease and 1 about linguistic deficits in Alzheimers disease. All aphasia studies used low-frequency rTMS to stimulate Brocas homologous area. High-frequency rTMS was applied over the pharyngoesophageal cortex from the left and/or right hemisphere in the dysphagia studies and over the left dorsolateral prefrontal cortex in the Parkinsons and Alzheimers studies. Two aphasia and all dysphagia studies showed a significant improvement of the disorder, compared to the sham group. The other 2 studies related to aphasia found a benefit restricted to subgroups with a severe case or injury on the anterior portion of the language cortical area, respectively, whereas the Alzheimers study demonstrated positive effects specific to auditory comprehension. There were no changes for vocal function in the Parkinsons study. Conclusion: The benefits of the technique and its applicability in neurogenic disorders related to communication and deglutition are still uncertain. Therefore, other randomized controlled trials are needed to clarify the optimal stimulation protocol for each disorder studied and its real effects.

Factors Associated With Attrition in Randomized Controlled Trials of Vocal Rehabilitation: Systematic Review and Meta-Analysis

OBJECTIVES/HYPOTHESISnThis study aimed to determine the dropout rates and the reasons for dropout in randomized clinical trials of vocal rehabilitation.nnnSTUDY DESIGNnThis study used systematic review and meta-analysis (CRD42013003807).nnnMETHODSnWe included randomized controlled trials for voice disorders. In June 2015, we searched the following databases: MEDLINE, EMBASE, Cochrane, Clinical Trials, and AJSLP. The titles and abstracts or full texts of articles were independently analyzed by two reviewers. Study quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) scale. Our initial research base included more than 8491 articles.nnnRESULTSnA total of 51 articles were obtained using our eligibility criteria. The low-quality studies evaluated had higher dropout rates (odds ratio: 3.3, 95% confidence interval: 1.04-12.9). Studies with healthy patients (45%) or vocal training versus no training (25%) also had higher dropout rates. Methodological issues seemed to have a greater influence on the dropout rates of the studies included in the co-occurrence matrix.nnnCONCLUSIONSnDropout rates of approximately 15% occur in randomized clinical trials of speech therapy when assessed by the Grading of Recommendations Assessment, Development and Evaluation. Studies with lower methodological quality had higher patient loss rates. Methodological and clinical reasons accounted for the highest dropout rates in the studies included in this meta-analysis.

Effects of a Voice Therapy Program for Patients with Muscle Tension Dysphonia

Objective: This study aimed to verify the effects of a voice therapy program focusing on patients with muscle tension dysphonia (MTD). Patients and Methods: The sample comprised 30 participants diagnosed with MTD, 8 men and 22 women, none of whom was a voice professional. The assessments and reassessments employed the perceptual-auditory protocol GRBASI, measures of maximum phonation times, s/z ratio, and acoustic voice analysis. The voice therapy program included indirect and direct therapy approaches. Results: All parameters assessed using the GRBASI protocol improved following treatment, particularly in regard to lowering voice strain, which is important when treating MTD. The average overall maximum phonation times increased from 8.15 to 10.8 s, while the average s/z ratio did not significantly change. Among the various acoustic parameters, a positive difference was observed for vocal jitter and shimmer. Conclusions: The therapeutic approach adopted in this study proved effective in the treatment of primary and secondary MTD. Speech therapy favored lower phonation effort, lowered vocal strain, and adequacy of adjustment of laryngeal muscles.

Factors Involved in Vocal Fatigue: A Pilot Study.

Objective: The purpose of this retrospective study was to determine the vocal characteristics of a treatment-seeking population with the primary complaint of vocal fatigue (VF). Methods: Forty-three men (mean age 42 years, range 19-69) and 145 women (mean age 34 years, range 18-68) were included. None of the subjects had received voice therapy or previous laryngeal surgery. A questionnaire, laryngeal and perceptual evaluations, aerodynamic and acoustic parameters, and the Dysphonia Severity Index (DSI) were used to determine vocal characteristics. Results: In 74% of the subjects, flexible laryngeal videostroboscopic evaluation revealed a vocal pathology, with vocal nodules and muscle tension dysphonia as the most frequently diagnosed pathologies. Vocal abuse/misuse was present in 65% of the subjects. A median DSI value of -0.4 and -0.8 was found in female and male patients, respectively. Aerodynamic and acoustic parameters and DSI scores were significantly different from normative data. Conclusion: VF is a vocal sign with a significant need for medical consultation, especially in future professional voice users. Understanding the occurrence and the influencing variables of VF may help to close the gap between early stages of a vocal problem and the starting point of a well-established disorder.

The Effectiveness of the EASE Scale in the Development of a Vocal Warm-up Program for an Amateur Choir

OBJECTIVESnThis study aims to assess the effectiveness of the EASE-BR (Evaluation of the Ability to Sing Easily for Brazil) protocol in the development of a vocal warm-up program for members of an amateur choir.nnnSTUDY DESIGNnThis is a prospective cross-sectional study measuring pre- and postintervention results at two moments.nnnMETHODSnForty-four subjects filled out a questionnaire to characterize the sample and underwent two major applications of the EASE-BR scale-the first to determine the groups vocal requirements and the second to assess the performance after the application of a customized vocal warm-up routine.nnnRESULTSnOverall reduction of the scores in the postintervention moment has been determined. The score of 16 of the questions (72.7%) showed a statistically relevant reduction after the intervention.nnnCONCLUSIONSnThe EASE-BR scale proved a valuable assessment tool and its use may help develop customized vocal warm-up programs for different types of singers.

Vocal and depressive benefits of choral singing

Difficulties on verbal communication are associated to loss of self-confidence and decrease in social participation.1 Thus, quality of life in older adults may be affected by the quality of their voice. Presbyphonia is the scientific term used to describe age related changes in voice (dysphonia). The etiology of Presbyphonia is multifactorial as it is not only related to the molecular effects of normal aging on the laryngeal tissues, but also different morbidities may affect phonation.1 However, changes observed in the voice of the older adults are not age specific since they are similar to those observed in some diseases and also in voice disused status. As phonatory functions can be rehabilitated after vocal diseases and long periods of disuse, and if the changes observed are similar to the senescence, we should invest in the rehabilitation of oral communication of the elderly.2 Thus, the authors present in this paper the background on the association between voice and depressive symptoms and their experience in a successful intervention using choral singing participation of a group of older adults. : http://dx.doi.org/10.15448/2357-9641.2014.2.22035