Patricia Maria Mendes Balata

Incomplete Swallowing and Retracted Tongue Maneuvers for Electromyographic Signal Normalization of the Extrinsic Muscles of the Larynx

PURPOSE To investigate which muscular maneuvers provide larger electric activity (EA) of the suprahyoid (SH) and infrahyoid (IH) muscles to be used as surface electromyography (SEMG) signal normalization reference. METHODS The electrical potentials of the SH and IH muscles of 12 subjects were evaluated using six muscular maneuvers, involving the position of the tongue and effort. It was selected as maximum voluntary sustained activity maneuver, the one having the minor coefficient of variation and the smallest value for each muscle group. The EA signal was converted using the root mean square in microvolts. It was considered then the maximum signal of each maneuver as the difference between the mean of three measures and the resting potential. RESULTS The maneuvers that provided higher mean potentials with minor coefficient of variation and smallest P value were incomplete swallowing (IS) with effort (mean potential equal to 56.73±8.68 with coefficient of variation of 15.30%) in SH group, and tongue retracted with mouth open (TROM, mean potential equal to 46.57±7.83 with coefficient of variation of 16.81%) in IH group. CONCLUSION The IS with effort and TROM maneuvers should be considered for signal normalization in these muscles, respectively, and may provide conditions for using the SEMG in voice clinic. SIGNIFICANCE The use of normalization standards in researches of SH and IH muscles in the voice area will allow comparisons among future works.

Use of surface electromyography in phonation studies: an integrative review

Summary Introduction: Surface electromyography has been used to assess the extrinsic laryngeal muscles during chewing and swallowing, but there have been few studies assessing these muscles during phonation. Objective: To investigate the current state of knowledge regarding the use of surface electromyography for evaluation of the electrical activity of the extrinsic muscles of the larynx during phonation by means of an integrative review. Method: We searched for articles and other papers in the PubMed, Medline/Bireme, and Scielo databases that were published between 1980 and 2012, by using the following descriptors: surface electromyography and voice, surface electromyography and phonation, and surface electromyography and dysphonia. The articles were selectedon the basis ofinclusion and exclusion criteria. Data Synthesis: This was carried out with a cross critical matrix. We selected 27 papers,i.e., 24 articles and 3 theses. The studies differed methodologically with regards to sample size and investigation techniques, making it difficult to compare them, but showed differences in electrical activity between the studied groups (dysphonicsubjects, non-dysphonicsubjects, singers, and others). Conclusion: Electromyography has clinical applicability when technical precautions with respect to application and analysis are obeyed. However, it is necessary to adopt a universal system of assessment tasks and related measurement techniques to allow comparisons between studies.

Gustatory and olfactory dysfunction in laryngectomized patients

UNLABELLED After total laryngectomy surgery, nasal airflow is moved permanently to the tracheostomy opening, compromising the contact of odorant molecules with the nasal cavity, which may reflect changes in the olfactory and gustatory perception in these individuals. OBJECTIVE To evaluate the functions of smell and taste in total laryngectomized patients. STUDY DESIGN a study of series. METHOD The sample included a group of 25 patients submitted to total laryngectomy and another group of 25 patients who did not underwent the procedure. The taste function was evaluated by gustatory strips of filter paper. To assess the olfactory function we employed the Brief Smell Identification Test. RESULTS Among the laryngectomized patients there was more hypogeusia (80%, p < 0.05), as well as hyposmia (88%, p < 0.001), alone and concomitant (72%, p < 0.001). Concerning flavor discrimination, the bitter taste did not differ between the groups - which was different from the other flavors. In the olfactory aspect, laryngectomized patients performed worse in detecting warning and food-related odors. We found that a history of smoking and alcohol consumption were significantly more frequent among laryngectomized patients. CONCLUSION We found a decrease of gustatory and olfactory functions in total laryngectomized patients in this study.

Electrical Activity of Extrinsic Laryngeal Muscles in Subjects With and Without Dysphonia

OBJECTIVE To compare dysphonic individuals to nondysphonic with regards to electrical activity of extrinsic laryngeal muscles related to perceptual and acoustic vocal parameters. HYPOTHESIS Dysphonic individuals have higher electrical activity in the supra and infrahyoid muscles than those nondysphonic. STUDY DESIGN Prospective, cross-sectional, case series study. METHODS Forty-one subjects, divided into two groups according to the presence of dysphonia, underwent evaluation of surface electromyography, auditory-perceptual, and acoustic evaluations of voice during the vocal rest and sustained emissions of the vowel /ε/ and count of 20 to 30 at usual and strong intensities. RESULTS The dysphonic group differed significantly from the nondysphonic by (1) lower electrical activity normalized by the maximum sustained voluntary activity evaluated in all tasks of phonation in the suprahyoid group; (2) lower recruitment of electrical activity in emissions of strong intensity compared with those of usual intensity in the suprahyoid muscles to emit the vowel /ε/ (13.66 ± 5.17 in dysphonic group and 35.20 ± 7.60 in the nondysphonic group, P = 0.029) and in the infrahyoid muscles in the count of 20 to 30 (14.90 ± 4.69 vs. 42.01 ± 6.15; P < 0.001) and to emit the vowel /ε/ (11.47 ± 6.52 vs. 22.66 ± 9.05, P < 0.001); (3) lower vocal intensity to produce the vowel /ε/ in usual and strong intensities and count in strong intensity. The electrical activities of the maximum sustained voluntary activity were reduced with increasing degree of dysphonia. CONCLUSIONS There was lower electrical activity of the extrinsic laryngeal muscles in dysphonic individuals compared with nondysphonic, and related to the degree of dysphonia.

Quality of life and deglutition after total laryngectomy

Summary Introduction: Total laryngectomy creates deglutition disorders and causes a decrease in quality of life Aim: To describe the impact of swallowing and quality of life of patients after total laryngectomy. Method: A case series study. Patients completed a Swallowing and Quality of Life questionnaire composed of 44 questions assessing 11 domains related to quality of life (burden, eating duration, eating desire, frequency of symptoms, food selection, communication, fear, mental health, social functioning, sleep, and fatigue). The analysis was performed using descriptive statistics, including measures of central tendency and variability. Results: The sample comprised 15 patients who underwent total laryngectomy and adjuvant radiotherapy. Of these, 66.7% classified their health as good and 73% reported no restrictions on food consistency. The domains “communication” and “fear” represented severe impact and “eating duration” represented moderate impact on quality of life. The items with lower scores were: longer time to eat than others (domain “eating duration”), cough and cough to remove the liquid or food of the mouth when they are stopped (domain “symptom frequency”), difficulties in understanding (domain “communication”) and fear of choking and having pneumonia (domain “fear”). Conclusion: After total laryngectomy, patients report that swallowing issues have moderate to severe impact in “communication,” “fear,” and “eating duration” domains.

Limits on quality of life in communication after total laryngectomy

Summary Introduction: Among people affected by cancer, the impairment of quality of life of people affected by cancer can cause have devastating effects. The self-image of patients after post-laryngectomyzed patients may be find themselves compromised, affecting the quality of life in this population. Objective: To characterize quality of life in related to communication in people who have undergone went total laryngectomy surgery. Methods: This is an observational study, with a cross-sectional and descriptive series. Design of series study. The sample were comprised 15 patients interviewed the period from January to February of 2011. We used the Quality Protocol for Life Communication in Post-laryngectomy adapted from Bertocello (2004); which this questionnaire contains 55 questions. The protocol was organized from the nature of using responses classified as positive and negative aspects, proposals in with respect to five 5 communication domains: family relationships, social relationships, personal analysis; morphofunctional aspect, and use of writing. To promote and guarantee the autonomy of the respondents, was examiners made use of used assistive technology with the Visual Response Scale. Results: The responses that total laryngectomy compromises the quality of life in communication amounted to 463 occurrences (65.7%), and that who responses suggesting good quality of life were represented with amounted to 242 occurrences (34.3%), from a total of 705 occurrencesresponses. From Among the five 5 Communication domains, four 4 had percentages of above 63% for occurrences of negative content for impact on communication. Appearance Morphofunctional appearance gave the had the highest percentage of negative content, amounting to 77.3% of cases. Conclusions: The results showed important limitations of a personal and social nature due to poor communication with their peers. Thus, there is a need for multidisciplinary interventions that aim to minimize the entrapment of negative impact on these people communication among these patients.

Electrical activity of the masseter during swallowing after total laryngectomy

UNLABELLED Total laryngectomy is a surgical procedure that can change swallowing biomechanics, including muscle activity of the masseter; this muscle stabilizes the mandible. AIM To characterize the electrical activity of the masseter muscle during swallowing after total laryngectomy. Series study. MATERIAL AND METHODS An electromyographic evaluation of swallowing was carried out; three different volumes of water (14.5 ml, 20 ml and 100 ml) were swallowed, and there was a rest condition. The electromyographic signal was normalized by Maximum Resisted Voluntary Activity - considered as 100% of electrical activity of muscles. All other values were calculated as a percentage of this parameter. RESULTS There is moderate electrical activity of the masseter during swallowing with higher averages on the left. There was no difference between swallowing 14.5 ml or 20 ml. Natural swallowing of 100ml had the lowest average. Electromyographic signals were recorded at rest on both sides, indicating the existence of electric activity in this situation. CONCLUSION Patients submitted to total laryngectomy present electrical activity of the masseter muscles during swallowing and at rest. This activity is influenced by the volume of swallowed liquid, and showed significant differences among the tasks. Clinical Trials: NCT01095289.

Preferência de lado mastigatório e simetria facial em laringectomizados totais: estudo clínico e eletromiográfico

PURPOSE: to observe whether a relationship exists between the preference of chewing side, facial anthropometry and electrical activity of masseter muscle in total laryngectomy. METHODS: data collection, performed in the Speech Therapy Cancer Hospital of Pernambuco (HCP), with the participation of fifteen volunteers laryngectomized males and mean age of 64 years. We performed measurement of distances between points and anthropometric facial ex ch in hemifaces of volunteers and later executed EMG of the masseter muscles, bilaterally, in his habitual intercuspal (MHI), unilateral right and left chewing and during mastication. Filming took place during mastication to identify the side of the preference side. RESULTS: individuals whose right side is the masticatory predominance showed of the left side of the face to a greater extent (72.37 mm), while those whose prevalence of side left masticatory had higher estensao the side right (68.85 mm). In unilateral chewing right the electrical activity of the right masseter had an average 123.57% , while the left masseter showed an average 84.85% of the activity in relation to MHI (p = 0.016). CONCLUSION: in laryngectomized anthropometric facial measurements correlate with the preference side chewing and the values of the masseter EMG during mastication.

Biofeedback in dysphonia - progress and challenges.

INTRODUCTION There is evidence that all the complex machinery involved in speech acts along with the auditory system, and their adjustments can be altered. OBJECTIVE To present the evidence of biofeedback application for treatment of vocal disorders, emphasizing the muscle tension dysphonia. METHODS A systematic review was conducted in Scielo, Lilacs, PubMed and Web of Sciences databases, using the combination of descriptors, and admitting as inclusion criteria: articles published in journals with editorial committee, reporting cases or experimental or quasi-experimental research on the use of biofeedback in real time as additional source of treatment monitoring of muscle tension dysphonia or for vocal training. RESULTS Thirty-three articles were identified in databases, and seven were included in the qualitative synthesis. The beginning of electromyographic biofeedback studies applied to speech therapy were promising and pointed to a new method that enabled good results in muscle tension dysphonia. Nonetheless, the discussion of the results lacked physiological evidence that could serve as their basis. The search for such explanations has become a challenge for speech therapists, and determined two research lines: one dedicated to the improvement of the electromyographic biofeedback methodology for voice disorders, to reduce confounding variables, and the other dedicated to the research of neural processes involved in changing the muscle engram of normal and dysphonic patients. CONCLUSION There is evidence that the electromyographic biofeedback promotes changes in the neural networks responsible for speech, and can change behavior for vocal emissions with quality.

Assessment of electrical activity in the supra and infra hyoid muscle in individuals with type 2 diabetes mellitus

Materials and methods Sample was composed of thirty female adults, aged between 40 and 60 years, distributed in Diabetes group and Control group and they were submitted to a electromyography exam with electromyography MIOTEC (Rio Grande do Sul, Brazil) connected to a notebook SAMSUMG brand provided the Miotool 200 software, using windowing 32 and gain equal to 2000 for each channel. An electrode reference and three channels connected to active sensors with connection SDS500 by claws were used. The signal analysis was performed with the Miograph 2.0 software. For normalization of the supra-hyoid group (HS) swallowing incomplete maneuver and the infra-hyoid (IH), the tongue retracted technique was used. Then, it was performed the catchment of the muscular electrical activity through the rest moment following by the evaluation during vowel/e/ vocalization and the usual speech. It had been used the t test to calculate the differences between the averages of electrical activity of the groups evaluated.