As seqüelas envolvidas nos acidentes vasculares encefálicos podem comprometer o funcionamento de diversos mecanismos, inclusive os responsáveis pela fala e voz. Desse modo, torna-se importante compreender a interface entre as manifestações vocais e o controle motor laríngeo em indivíduos idosos acometidos por acidente vascular encefálico (AVE). O objetivo deste estudo é correlacionar os resultados da diadococinesia laríngea com os aspectos perceptivo-auditivos das vozes idosos pós-acidente vascular encefálico. Participaram do estudo 29 idosos (15 homens e 14 mulheres) acometidos por AVE. Foi realizada a análise da Diadococinesia (DDC) laríngea, utilizando o programa Motor Speech Profile Advanced, da KayPentax. Também foi realizada a análise perceptivo-auditiva da voz, com base no Protocolo CAPE-V. Os resultados da DDC laríngea foram correlacionados com os resultados da análise perceptivo-auditiva da voz por meio dos Testes de Correlação de Pearson e de Spearman (p<0,05). Os resultados demonstraram haver correlação entre DDC laríngea e análise perceptivo-auditiva da voz quanto aos parâmetros de velocidade, instabilidade da duração da DDC, bem como instabilidade de intensidade. Desse modo, houve correlações entre: Grau Geral e velocidade da DDC (mP e mT) no grupo total e no grupo feminino; instabilidade da duração da DDC (dpP, cvP e jitP) no grupo total e feminino e instabilidade de intensidade (cvI) no grupo masculino. A rugosidade se correlacionou com: a velocidade (mP/a/) no grupo feminino; instabilidade do período da DDC no grupo total e feminino (dpP, cvP e jitP do /i/), bem como masculino (cvP do /i/); instabilidade de intensidade no grupo masculino (cvI /i/). A soprosidade se correlacionou com a velocidade da DDC no grupo total (mT /a/) e masculino (mP e mT /a/). Houve correlação entre tensão e: velocidade da DDC no grupo feminino (mP/a/) e masculino (mP/i/), instabilidade do período da DDC no grupo total (dpP e cvP do /a/) e instabilidade da intensidade da DDC para os homens (cvI /i/), sendo que no grupo total quanto maior a tensão, menos instável a DDC do /a/. A instabilidade do Cape-V da vogal /a/ se correlacionou com a instabilidade de duração do período (cvP/a/) para os homens e instabilidade da intensidade (cvI /a/) da DDC no grupo total e feminino. A pastosidade foi correlacionada com: velocidade da DDC (mP e mTdo /i/), instabilidade da duração (dpP e jitP do /i/) e instabilidade da intensidade da DDC (cvI /a/), no grupo total e masculino. Os resultados indicam que, quanto maior o grau de desvio vocal, mais lenta e/ou instável é a DDC para 96% das correlações significativas encontradas. Os resultados demonstraram haver correlação entre qualidade vocal e diadococinesia laríngea em homens e mulheres idosas pós Acidente Vascular Encefálico, sendo que o padrão de instabilidade da DDC demonstrou ser distinto de acordo com cada gênero. / The implications involved in stroke may compromise the function of several mechanisms, including those responsible for speech and voice. Thus, it is important to understand the interface between the vocal and laryngeal motor control in elderly subjects affected by stroke (CVA). This study aimed at correlating the vocal fold diadochokinesiss results with perceptual evaluation of elderly post stroke voices. The study included 29 elderly (15 men and 14 women) affected by stroke. The vocal fold diadochokinesis (DDK), was performed using the Motor Speech Profile Advanced software (KayPentax). Perceptual voice analysis was performed based on the CAPE-V protocol. The results of vocal fold DDK were correlated with those of perceptual voice analysis through Pearson´s and Spearman´s correlation tests (p <0.05). The results showed correlations between vocal fold DDK and the perceptual voice analysis in terms of speed, duration and intensity instability parameters of DDK. Thus, there were correlations between dysphonia degree and speed of the DDK (mP and mT) in the total group and female group, duration instability of DDK (dpP, jitP and cvP) in the total and female group, and intensity instability (cvI) in the male group. The hoarseness was correlated with: the speed (mP /a/) in the female group; instability of DDK period in the total and female group (dpP, cvP, jitP /i/) and male group (cvP/i/); intensity instability in the male group (cvI/i/). The breathiness was correlated with the speed of DDK in the total (mT /a/) and male group (mP and mT /a/). There was a correlation between strain and the speed of DDK in the female (mP /a/) and male group (mP /i/), instability of DDK period in the total group (dpP, cvP /a/) and intensity instability of DDK for men (cvI /i/); thus, in the total group, the higher the strain, the lower the instability of DDK /a/. The instability of vowel / a / in Cape-V was correlated with duration instability (cvP / a /) for men and intensity instability (cvI / in total and female group. The articulation and resonance was correlated with the speed of DDK (mP, mT /i/), duration instability (jitP, dpP /i/) and intensity instability (cvI / a /), in the total and male group. The results indicate that the higher the degree of dysphonia, the slower and/or unstable the DDK for 96% of the significant correlations found. The results showed a correlation between voice quality andvocal fold diadochokinesis in older men and women, following stroke, being the DDK instability pattern distinct, according to gender.

Orientador: Antonio Carlos Pereira / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-21T07:01:50Z (GMT). No. of bitstreams: 1 Pizolato_RaquelAparecida_D.pdf: 1388447 bytes, checksum: 0ab7ff35a8bf99f1d2fd93597dcb3000 (MD5) Previous issue date: 2012 / Resumo: Profissionais da voz, especificamente os professores, têm alto risco de desenvolver distúrbios da voz. Programas educativos de saúde vocal podem auxiliar o professor a cuidar melhor da voz e consequentemente na prevenção contra as disfonias. O objetivo deste trabalho foi desenvolver um programa educativo, que inclui treinamento de exercícios vocais e higiene vocal, e analisar os efeitos do treinamento dos exercícios e prática de hábitos vocais de forma transversal e longitudinalmente. Participaram do estudo 102 professores de 11 escolas da rede pública de ensino do município de Piracicaba, SP, selecionadas aleatoriamente. A amostra foi dividida em grupo controle (52 mulheres e 14 homens) e grupo experimental (29 mulheres e 7 homens) com média de idade 42,55±7,84 anos. O programa oferecido ao grupo controle baseou-se em 2 palestras educativas sobre hábitos de higiene vocal e mecanismo da produção da voz. Para o grupo experimental foi proferida uma palestra sobre hábitos de higiene vocal e mecanismo de produção da voz e 4 sessões de treinamento de exercícios específicos para a voz. Estes exercícios abordaram: postura e relaxamento cervical; respiração; fonação, intensidade e freqüência; ressonância e articulação. Os sujeitos de ambos os grupos responderam 2 questionários: um sobre queixas vocais, hábitos bons e ruins para a voz e organização do trabalho e outro referente a qualidade de vida e voz (QVV). Uma da coleta da emissão da vogal [i] em tom habitual da fala foi realizada no início do programa e após 3 meses de finalização deste. A cada sessão de exercícios no grupo experimental foi realizado a coleta da vogal [i] em situação pré e pós treino. Após 3 meses da finalização do programa educativo, 73 sujeitos de ambos os grupos participaram da reavaliação da qualidade da voz e 70 responderam o questionário qualidade de vida vocal. O teste t de Student (pareado) foi utilizado para comparar medidas repetidas dentro do mesmo grupo e para comparar o efeito de interação do tratamento com o tempo, intra e inter-grupos, foi aplicado o teste Proc Mixed (medidas repetidas), utilizando-se o nível de significância (p<0,05). Os testes Qui-quadrado e exato de Fisher foram utilizados para testar a associação das variáveis independentes do questionário geral com as dependentes "Frequência Fundamental" e "Intensidade Média Vocal". Os resultados mostraram que os exercícios de postura e relaxamento cervical proporcionaram diminuição da média da freqüência fundamental masculina e os exercícios de fonação, intensidade e freqüência proporcionaram aumento da média da freqüência fundamental feminina, após o treino. Não houve diferença estatisticamente significativa para as variáveis da análise acústica da voz, quando comparadas as avaliações inicial e final após 3 meses do programa educativo, entre os grupos. Nas avaliações iniciais e finais dos escores (físico, psicoemocional e total) do QVV houve diferenças estatisticamente significantes para todos os escores, para o grupo controle e experimental, e não houve diferença da análise intergrupos. Pode-se concluir que o programa educativo teve efeitos benéficos para os professores, refletindo na melhora da qualidade de vida e voz / Abstract: Professional voice users, specifically teachers, are at high risk for developing voice disorders. Therefore, educational programs for vocal health may help teachers take better care of their voice and consequently, to prevent dysphonia. The aim of this study was to develop an educational program with vocal training exercises and vocal hygiene, analyze the pre- and post-training effects of exercises and the effectiveness of the program after 3 months. One-hundred-and-two teachers from 11 public schools, randomly selected in the municipality of Piracicaba, State of São Paulo-Brazil, participated of this study. The sample was divided into a control group (52 women and 14 men) and experimental group (29 women and 7 men), mean age 42.55±7.84 years. The program offered to the control group was based on 2 educational lectures on vocal hygiene habits and the mechanism of voice production. For the experimental group, a lecture was presented on vocal hygiene habits and the mechanism of voice production, and 4 meetings about specific training exercises for the voice. This exercises comprised: Cervical posture and relaxation; respiration; phonation, intensity and frequency; resonance and articulation. The subjects of both groups answered two questionnaires: one about signs and symptoms of vocal problems, habits that are good and bad for the voice and organization of work, , and another about the Voice-Related Quality of Life (V-RQOL). A collection of vowel [i] emission in habitual tone of speech was made at the beginning of the program and after 3 months of completion. In each exercise session in the experimental group, vowel [i] emission was collected in the pre- and post-training situation. Three months after conclusion of the educational program, 73 subjects of both groups participated in re-evaluation of voice quality and 70 responded the questionnaire (V-RQOL). The paired Student's test was used to compare the repeated measures within the same group and Proc Mixed (repeated measures) were used to compare the effect of the interaction of treatment in the groups over time. For the analyses the level of significance (p<0.05) was considered. The Chi-square and Exact Fisher test were used to test the association of independent variables of the general questionnaire, considering the dependent variables Fundamental Frequency and Mean Vocal Intensity. The results showed that the cervical posture and relaxation exercises provided a mean reduction in fundamental frequency in men, and the phonation, intensity and frequency provided an increase in the mean value of fundamental frequency in women after training. There was no statistically significant difference between the groups for the variables acoustic analysis of the voice, when the initial and final evaluation after 3 months of the educational program were compared. In the initial and final evaluations of the scores (physical, psycho-emotional and total) of the V-RQOL there were statistically significant differences in all the scores, for both the control and experimental groups, and there was no difference in the inter-group analysis. It could be concluded that the educational program had beneficial effects for the teachers, reflected in improved quality of life / Doutorado / Saude Coletiva / Doutora em Odontologia

Disfonia é a principal sequela cirúrgica do paciente submetido à laringectomia parcial vertical (LPV) com presença de ruído glótico intenso o que dificulta a análise acústica convencional. Por esse motivo a análise não linear (ANL), teoria dinâmica de sistemas não lineares aplicada a séries temporais não lineares, tem sido recentemente adotada como uma nova abordagem para avaliação acústica vocal. Objetivo: aplicar a ANL por meio da escala L-IE na análise acústica da voz de pacientes submetidos à LPV. Método: foram analisadas 31 vozes de pacientes submetidos à LPV, denominado de grupo de pacientes (GP) e 31 vozes de indivíduos sem alteração vocal ou laríngea, denominado grupo controle (GC). Os gráficos bidimensionais gerados a partir dos sinais de voz foram avaliados com base na técnica dos padrões visuais da dinâmica vocal (PVDV), por meio da escala de classificação L-IE para os três parâmetros: número de laços (L), irregularidade (I) e espaçamento (E). Para a correlação dos dados da ANL com a avaliação perceptivo-auditiva da voz, as vozes do GP foram avaliadas por meio da escala GRBAS. Resultados: houve correlação significativa (p<0,05) entre os três parâmetros da escala L-IE para a análise total da amostra GP e GC. Os resultados da escala L-IE para a maioria do pacientes do GP se caracterizaram por: número de laços zero; irregularidade e espaçamento dos traçados, ambos com grau 6. O GP teve a maioria de suas vozes avaliadas com grau 3 de disfonia na escala GRBAS. Houve correlação estatisticamente significante (p<0,05) entre a escala L-IE e a GRBAS nos seguintes parâmetros: o \"L\" com o grau global da disfonia (G) e com soprosidade (B) e o \"I\" com a soprosidade (B). Conclusão: o método da ANL por meio da escala L-IE, se mostrou eficiente na avaliação das vozes de pacientes submetidos a LPV. / Dysphonia is the main surgical sequel in patients who underwent vertical partial laryngectomy (VPL) with the presence of intense glottal noise which makes more difficult conventional acoustic analysis. Therefore the nonlinear analysis, dynamic theory of nonlinear systems applied to nonlinear time series, has recently been adopted as a new approach to acoustic analysis of voice. Objective: apply to ANL by L- IS scale on acoustic voice analysis of patients underwent VPL. Method: 31 voices of patients underwent VPL called patient group (PG) and 31 voices of individuals without vocal or laryngeal disorder were analyzed called control group (CG). Two-dimensional graphs generated from the voice signals the both groups were evaluated based on the technique of VDVP through the rating scale L-IS for the three parameters: number of loops (L), irregularity (I) and spacing (S). For the correlation of data from nonlinear analysis with the perceptual evaluation, the voices of the PG were evaluated by GRBAS scale. Results: significant correlation (p <0.05) between the three parameters of the L-IS scale for the total sample analysis PG and CG. The results of the L-IS scale for the majority of PG patients were characterized by: zero for number of loops; 6 degree for both irregularity and spacing of the traces. The PG had most of their voices evaluated with 3 degree of dysphonia in GRBAS. There was a statistically significant correlation (p<0.05) between L-IS and GRBAS parameters: \"L\" with the overall grade of dysphonia (G) and breathiness (B) and \"I\" with breathiness (B). Conclusion: the method of ANL by L-IS scale, is efficient for evaluating the voices of patients underwent VPL.

The main purpose of this study was to consider the effects of amplification and vocal function exercises on the perceived vocal health of elementary music educators (N = 37) from Oklahoma (n = 11) and Texas (n = 26). Participants were assigned to the use of the ChatterVoxTM amplifier or vocal function exercises based on pretest scores on the Voice Handicap Index with Music Teacher Voice Questionnaire (VHI/MVQ). Following the 4-week study period, participants completed the posttest VHI/MVQ. The results of a one-way ANCOVA that used treatment group as the independent variable, the summed posttest scores as the dependent variable, and the summed pretest scores as the covariate or control variable indicated that there was a statistically significant difference between the adjusted means for the posttest scores, favoring the exercises group. The overall group and both treatment groups reported frequent loud voice use in work settings and in public places. The overall group and the amplification group reported hoarseness after prolonged talking. The exercises group did not report as great a problem with hoarseness after prolonged talking. Secondary purposes addressed demographic variables. Women perceived greater overall vocal difficulties than men; men frequently reported specific vocal complaints that were not commonly indicated by women. The vocal problems of women may have been associated with loud voice use. The following common vocal complaints of men may have been related to the use of falsetto while teaching: need for vocal rest, worse voices in the evening, dry throats, loss of voice, obvious pitch breaks in their singing voices, pain after singing for an extended time, and limited use of their high range. VHI/MVQ scores indicated that the study participants with 21 to 39 years of teaching experience had more vocal difficulties than other participants and indicated limited use of the low range of their speaking voices, inconsistency in the sound of their voices, dry throats, throat pain after singing for a prolonged time, difficulty singing softly, and the need for vocal rest. Participants with 6 or more years of experience experienced hoarseness after speaking for an extended time.

No description available.

The purpose of the present study is to test the feasibility of implementing a video-game based intervention protocol as a means to improve therapy compliance in school age children with hyperfunctional voice disorders. Three levels of modification were made to an existing entertainment software program in order to implement the therapeutic protocol and test compatibility. The third level of modification included a two-phase quasi-experimental single subject design with a school age participant receiving the video game therapy protocol and traditional therapy for equal time. The independent variables for this study included the mode of voice therapy delivery (traditional vs. video game). The dependent variables included therapy compliance, perceptual evaluations and acoustic measures. This study found that a purely entertainment video game can be implemented as a therapeutic protocol for a school age child diagnosed with a vocal pathology. Results illustrated no change in compliance with non-traditional therapy versus traditional therapy. However, perceptual measures improved post treatment for breathiness, strain and overall severity, as well as significant differences for mean amplitude. Discussion will focus on implications of employing video game based therapy and design of future studies.

PURPOSE: Vocal hyperfunction (VH) is considered a functional voice disorder, resulting in voice complaints of hoarseness and fatigue; however, recent work suggests that voice changes in VH may result from impairments in the neural control of voice (specifically, how voice perception is integrated into voice production). This study sought to clarify whether impaired auditory acuity of vocal pitch and the temporal production of voice, two known impairments in speakers with VH, were correlated. METHOD: The current study included 29 adults with VH. Vocal auditory perception was assessed via acuity to self-produced vocal pitch (quantified using an adaptive two-forced-choice paradigm). To investigate temporal acoustic measures of voice production, voice onset time (VOT) variability of voiced and voiceless stop consonants in a carrier phrase were separately assessed using a coefficient of variation (CoV). Two Pearson product-moment correlations were completed to assess the relationship between these measures of vocal perception and vocal production of either voiced or voiceless VOTs. RESULTS: No statistically significant correlations were observed between auditory acuity and CoV of VOT for neither voiced nor voiceless stop consonants. CONCLUSION: The current findings suggest that impairments in vocal pitch acuity and VOT production in VH are not governed by the same underlying mechanism. Further investigation is recommended to determine the etiology driving these vocal perception- and production-based impairments observed in prior work.

Good vocal health is a vital concern for those people who use the voice in a professional capacity, such as teachers, singers, actors, clergymen, and lawyers. Research in the area of vocal health reveals the need to determine if specific exercises are beneficial to the voice and if exercises used to train the singing voice might be beneficial to alleviate pathological and/or dysfunctional voice disorders. The purpose of this study was to describe the response of a variety of pathological voices to a selected set of singing exercises. Subjects were selected from the private practice of cooperating physicians who felt that the vocal instruction and exercise program might be helpful to the teachers, students, professional "pop" singers, and housewife-singers who were diagnosed to have muscle tension dysphonia, nodules, recurrent laryngeal nerve paralysis, or iatrogenic dysphonia. Instrumentation for assessing conditions before, during, and after exercise included a brief case history, subject interviews, attending physicians' medical charts, flexible fiberoptic video nasolaryngoscopy, video cassette recorder and video tape segments, three physician/observers, and a specific diagnostic procedure which provided a method of assessing organic, functional, and perceptual variables. For the exercise program the researcher chose seven vocalises from the routine designed by Allan R. Lindquest, whose techniques combined those of the Italian school with those of Swedish studios which produced such singers as Flagstad and Bjoerling. The seven vocalises included a warm up "massage" and exercises for separation and blending of the registers, vowel clarity and modification, tone focus, vocal attack, and flexibility. Since all the subjects showed improvement after exercise in the vocal conditions observed in this study, these vocalises and technique may be helpful to alleviate pathological conditions and/or dysfunctional behavior in other subjects. The researcher further suggests that the voice profession investigate the efficiency of other techniques, exercises, and musical vocalises which might bring about positive changes in vocal conditions and behavior.

Subglottic stenosis (SGS) is an abnormal narrowing of the airway at the level of the cricoid cartilage, above the first tracheal ring and immediately beneath the vocal folds. Individuals with SGS experience a reduction in their ability to breathe as well as adverse effects on voice function. SGS can result from a variety of causes with the type of treatment depending on stenosis severity. Surgical techniques such as laryngotracheal and cricotracheal reconstruction are beneficial for airway maintenance; however, these procedures have resulted in negative effects on voice production. On the other hand, there are patients with SGS who do not require surgery and still experience voice problems. The purpose of this study was to quantify the effects of SGS on vocal fold vibration using an excised larynx benchtop mechanical model. Using a within-subjects repeated measures design, nine porcine larynges underwent experimental conditions including 0% (i.e., normal airway), 50% and 75% stenosed. The primary outcome measure was phonation threshold flow (PTF), which is the rate of flow observed at the onset of phonation. For all larynges, the normal and stenosed conditions were sampled three times each and averaged. Analysis of the results revealed no statistically significant differences in PTF; however, descriptive data showed decreases in PTF and increased variability in PTF values as percent stenosis increased. These findings lay important groundwork for future research in SGS, specifically those that employ ex vivo methodologies. PTF has emerged as a promising means of quantifying voice function in addition to the traditional onset pressure measures. Future studies should examine a broader range of stenosis conditions with a larger sample size to promote generalization to clinical populations including individuals with SGS.

Subglottic stenosis (SGS) is a narrowing of the airway below the vocal folds and above the trachea. This narrowing may be idiopathic or caused by scarring in the airway due to prolonged endotracheal intubation, radiation therapy, trauma, or gastroesophageal reflux disease. People who present with SGS often experience respiratory difficulty both at rest and during exertion. Breathing difficulty increases with stenosis severity. SGS is also associated with voice problems. Research has identified relationships among stenosis severity, voice function and certain types of surgical management; however, many aspects of these relationships are not fully understood due to the complexities of studying human phonation in this population. The purpose of the present study was to examine the effects of SGS on aerodynamic features of voice function using an excised larynx benchtop mechanical model. Specifically, this research involved the comparison of excised porcine vocal fold vibration at baseline and under experimental conditions of 50% and 75% stenosed. The dependent variable was phonation threshold pressure (PTP), the minimum pressure needed to initiate and maintain vocal fold vibration. PTP was analyzed for nine excised porcine larynges, sampled three times each, at baseline and the two stenosis conditions. The results of this study revealed no differences in PTP based on within-subjects comparisons. Because airflow changes with airway narrowing, this finding might indicate that other factors are responsible for the voice problems associated with SGS that were not accounted for in the current mechanical model. Vocal fold tone is not easily simulated in a benchtop setup and might be an important consideration for future studies. The quantification and manipulation of vocal fold adduction, as well as the study of high-speed imaging, could be useful in future work involving excised larynx mechanical models for the study of SGS. The results from this pilot work represent an important step toward optimizing the experimental setup for studying aerodynamic features of SGS.