Uso do método de Pontos para a Reestruturação de Objetivos Fonéticos e Oro-Musculares (PROMPT) no Transtorno do Espectro Autista: um estudo de caso / Use of the Prompts for Reestructuring Oral Muscular Phonetic Targets (PROMPT) in Autism Spectrum Disorder: a case study

RESUMO O Transtorno do Espectro Autista (TEA) é classificado pelo Manual de Diagnóstico e Estatístico de Transtornos Mentais (DSM-5) como um Transtorno do Neurodesenvolvimento, sendo caracterizado, principalmente, por alterações na comunicação social e pela presença de um repertório restrito de atividades e interesses. Na literatura, há muitos estudos sobre autismo, fala e linguagem, mas poucos correlacionando fala e autismo. Este estudo teve como finalidade realizar um estudo de caso que abordou autismo, fala e PROMPT (Pontos para a Reestruturação de Objetivos Fonéticos e Oro-Musculares) e mensurou a melhora da fala no participante com autismo, utilizando o método. Foram definidas palavras-alvo para toda a intervenção, conforme o Sistema de Observação e Análise (SOA) e Hierarquia Motora de Fala (HMF), que fazem parte da avaliação de PROMPT. Após a avaliação, o participante foi atendido por 16 sessões, uma vez semanalmente. Após análise dos dados, observou-se melhora em todos os aspectos que foram delineados de acordo com a avaliação no pré-tratamento, como controle fonatório, controle mandibular, controle lábio-facial e controle lingual, como também no movimento sequenciado, apesar deste não ser o objetivo traçado na avaliação. Também foi possível mensurar melhora no número de vocábulos adequados, número de fonemas adequados, porcentagens de consoantes corretas - revisado (PCC-R) e inteligibilidade.

ABSTRACT Autism Spectrum Disorder (ASD) is classified by Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a neurodevelopmental disorder, whose characteristics are mainly deficits in social communication and a restricted range of interests. There are several studies about autism, speech, and language in the literature, but few correlate speech and autism. This study aims to carry out a case study that will address autism, speech, and PROMPT (Restructuring Oral Muscular Phonetic Targets) and also to describe the speech improvement in the participant with autism using the method. The target words were defined for the entire intervention according to the System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH), which are parts of the PROMPT evaluation. After the evaluation, the participant was attended for 16 sessions, once weekly, with the objective of improving their speech. After analyzing the data, it was possible to observe improvement in all aspects outlined according to the pre-treatment evaluation of the method such as phonatory control, mandibular control, lip-facial control and lingual control as well as in the sequenced movement although this was not the aim outlined in the evaluation. It was also possible to measure the improvement of an adequate number of words, an adequate number of phonemes, percentages of correct consonants - revised (PCC-R), and intelligibility.

Proposals to promote health and prevent voice disorders in occupational voice users: A scoping review / Propostas de promoção da saúde e prevenção de distúrbios vocais para profissionais da voz: revisão de escopo

ABSTRACT Purpose: to characterize the actions of vocal health promotion and/or prevention of vocal disorders applied to voice professionals. Methods: a scoping review following the PRISMA-ScR guidelines in SciELO and PubMed databases was conducted. Articles that had as participants voice professionals without concomitant vocal treatment, that described proposals for health promotion or vocal disorders prevention, published between 2010 and 2023, were included. They were grouped into categories and data were presented descriptively. Literature Review: eighteen articles with artistic and non-artistic voice professionals, mostly teachers, were included. Most of the studies focused on healthy voices, aiming at primary prevention. Many articles presented guidance on vocal hygiene and health and used resources such as vocal enhancement, voice workshop, voice amplifiers and apps. All the articles positively mentioned their results, especially with regard to self-perception in relation to voice, vocal quality and quality of life, awareness of positive and harmful practices to the voice. Conclusion: the proposals contemplated different levels of prevention, but most focused on primary prevention, including vocally healthy participants; all articles indicated positive results in voice self-perception, voice quality and quality of life, and awareness of positive and harmful voice practices.

RESUMO Objetivo: caracterizar as ações de promoção de saúde vocal e/ou prevenção de distúrbios vocais aplicadas em profissionais da voz. Métodos: foi conduzida uma revisão de escopo seguindo as diretrizes do PRISMA-ScR nas bases de dados SciELO e PubMed. Foram incluídos artigos que tivessem como participantes profissionais da voz sem tratamento vocal concomitante, que descrevessem propostas de promoção da saúde ou prevenção de distúrbios vocais, publicados entre 2010 e 2023. Os artigos foram agrupados em categorias e os dados apresentados de forma descritiva. Revisão da Literatura: foram incluídos 18 artigos com profissionais da voz artística e não-artística, em sua maioria professores. A maior parte dos estudos tinha como foco vozes saudáveis, visando a prevenção primária. Muitos artigos apresentaram orientações sobre higiene e saúde vocal e utilizaram recursos como aprimoramento vocal, oficina de voz, amplificadores de voz e aplicativos. Todos os artigos mencionam resultados benéficos, principalmente no que se refere à autopercepção em relação a voz, qualidade vocal e de vida, conscientização de práticas positivas e prejudiciais à voz. Conclusão: as propostas contemplaram diferentes níveis de prevenção, mas a maioria tinha como foco a prevenção primária, incluindo participantes vocalmente saudáveis; todos os artigos indicaram resultados favoráveis na autopercepção em relação à voz, qualidade vocal e de vida e conscientização de práticas benéficas e prejudiciais à voz.

Risk of Dysphonia in Legal Professionals: Proposal for a Screening Protocol

Introduction: Due to the communicative requirements inherent to the profession, the legal professional benefits from speech therapy monitoring for the proper use of the voice and to avoid the occurrence of vocal disorders. The development of specific instruments will contribute with more relevant data to guide this monitoring. Objective: To verify the applicability of the General Dysphonia Risk Screening Protocol (DRSP-G) and the Specific Dysphonia Risk Screening Protocol for Legal Professionals (DRSP-LP) and to correlate the average scores of both with vocal deviation, sex, age, professional performance time, vocal signs and symptoms, and vocal self-assessment. Methods: Fifty legal professionals participated. All participants completed the DRSP-G and DRSP-LP and recorded their voices for detection of the presence of altered vocal quality. Results: Most participants presented a high risk of dysphonia, which was higher in men. Altered vocal quality was observed in 34% of the participants. The items with the highest scores in the DRSP-G were talking a lot (76%), excessive daily coffee intake (70%), contact with smokers (60%), and insufficient hydration and sleep (48%); in the DRSP-LP, alcohol consumption (68%) and exposure to air conditioning (64%). There was no correlation between risk scores and the degree of dysphonia, or with age or length of professional experience. The DRSP-G score correlated with vocal signs and symptoms and vocal self-perception. Conclusions: The joint application of the DRSP-G and the DRSP-LP enabled a quantitative and qualitative analysis of risk factors for dysphonia in legal professionals.

Introducción: Debido a las exigencias comunicativas inherentes a la profesión, el profesional del derecho se beneficia del seguimiento logopédico para el correcto uso de la voz y para evitar la aparición de trastornos vocales. El desarrollo de instrumentos específicos contribuirá con datos más relevantes para guiar este seguimiento. Objetivo: Verificar la aplicabilidad del Protocolo General de Detección de Riesgo de Disfonía (DRSP-G) y el Protocolo de Detección de Riesgo Específico para Profesionales del Derecho (DRSP-LP) y correlacionar las puntuaciones de ambos con varias variables de interés. Metodología: Participaron 50 profesionales del derecho. Todos completaron el DRSP-G y DRSP-LP y grabaron sus voces para detectar la presencia de alteraciones en la calidad de la voz. Resultados: La mayoría presentó un alto riesgo de disfonía, que fue mayor en los hombres. Se observó alteración en la calidad de la voz en el 34% de los participantes. Los ítems con puntajes más altos en el DRSP-G fueron hablar mucho (76%), ingesta diaria excesiva de café (70%), contacto con fumadores (60%) e hidratación y sueño insuficientes (48%); y en el DRSP-LP, consumo de alcohol (68%) y exposición al aire acondicionado (64%). No hubo correlación entre las puntuaciones de riesgo y el grado de disfonía, ni con la edad o la antigüedad profesional. La puntuación DRSP-G se correlacionó con los signos y síntomas vocales y la autopercepción vocal. Conclusiones: La aplicación conjunta del DRSP-G y el DRSP-LP permitió un análisis cuantitativo y cualitativo de los factores de riesgo de disfonía en profesionales del derecho.

Acoustic Measurements of Speech and Voice in Men with Angle Class II, Division 1, Malocclusion

Abstract Introduction The acoustic analysis of speech (measurements of the fundamental frequency and formant frequencies) of different vowels produced by speakers with the Angle class II, division 1, malocclusion can provide information about the relationship between articulatory and phonatory mechanisms in this type of maxillomandibular disproportion. Objectives To investigate acoustic measurements related to the fundamental frequency (F0) and formant frequencies (F1 and F2) of the oral vowels of Brazilian Portuguese (BP) produced by male speakers with Angle class II, division 1, malocclusion (study group) and compare with men with Angle class I malocclusion (control group). Methods In total, 60 men (20 with class II, 40 with class I) aged between 18 and 40 years were included in the study. Measurements of F0, F1 and F2 of the seven oral vowels of BP were estimated from the audio samples containing repetitions of carrier sentences. The statistical analysis was performed using the Student t-test and the effect size was calculated. Results Significant differences (p-values) were detected for F0 values in five vowels ([e], [i], [o], [o] and [u]), and for F1 in vowels [a] and [ɔ], with high levels for class II, division 1. Conclusion Statistical differences were found in the F0 measurements with higher values in five of the seven vowels analysed in subjects with Angle class II, division 1. The formant frequencies showed differences only in F1 in two vowels with higher values in the study group. The data suggest that data on voice and speech production must be included in the protocol's assessment of patients with malocclusion.

The public health system and the place of autism / O sistema de saúde pública e o lugar do autismo

ABSTRACT Purpose: to characterize the population with autism spectrum disorder and the Psychosocial Care Network. Methods: a study conducted with patients presented with autism spectrum disorder up to 18 years old treated at the health network in Taboão da Serra, Brazil. Participants' data were collected from medical records of the Psychosocial Care Network for Children of that city, authorized by the Municipal Department of Health, and quantitatively analyzed. Results: altogether, there were 237 patients with autism spectrum disorder in the said health network by April 2019. Of these, 188 were treated at the Psychosocial Care Network for Children, 110 of them with weekly therapy. There was a predominance of males (73.63%), age range from 3 to 10 years, with a higher percentage of 5-year old (17.27%) patients, and a mean treatment time of 32 months. The youngest age was 2 years old. Half the sample (50%) had weekly therapy and received homeopathic medication; 24 users (21.81%) were referred by speech-language-hearing therapists and 19 (17.27%), by the school they attended. Final Considerations: although the Psychosocial Care Network for Children is the reference in the region, it is known that this facility alone cannot meet all needs of individuals with autism spectrum disorder. A service network coordinated according to patient's individual needs and the region's reality would ensure their expected rights, decrease public spending, and enable these users to occupy not only one but many places in society.

RESUMO Objetivo: caracterizar a população com Transtorno do Espectro Autista e a Rede de Atenção Psicossocial de Taboão da Serra-SP. Métodos: estudo realizado com usuários da rede de saúde de Taboão da Serra com Transtorno do Espectro Autista com até 18 anos. Os dados dos participantes foram coletados dos prontuários do Centro de Atenção Psicossocial Infantil de Taboão da Serra com autorização da Secretaria Municipal de Saúde e as informações coletadas foram analisadas por vertente quantitativa. Resultados: o total de usuários com Transtorno do Espectro Autista na referida rede de saúde em abril de 2019 foi de 237. Destes, 188 realizavam atendimento no Centro de Atenção Psicossocial infantil, 110 em atendimento semanal. Verificou-se predominância do sexo masculino (73,63%), faixa etária de 3 a 10 anos com maior porcentagem em 5 anos (17,27%), e tempo médio de atendimento de 32 meses. a menor idade encontrada foi 2 anos de idade. Metade da amostra (50%) concentra-se em atendimento semanal e abordagem medicamentosa da homeopatia. Foram encaminhados 24 usuários (21,81%) pelo fonoaudiólogo e 19 (17,27%) pela escola. Considerações Finais: apesar da referência do território ser o Centro de Atenção Psicossocial infantil sabe-se que este equipamento por si só não atende a todas as necessidades dos indivíduos com Transtorno do Espectro Autista. Utilizar uma rede de serviços articulada segundo a demanda individual do paciente e a realidade do território garantiria os direitos almejados, diminuição de gastos públicos e permitiria a ocupação destes usuários não mais em um único lugar, mas sim "lugares".

Risco de disfonia e qualidade vocal em estudantes de artes cênicas / Risk of dysphonia and voice quality in performing arts students

RESUMO Objetivo Analisar a relação entre o risco de disfonia e a qualidade vocal em estudantes de graduação em Artes Cênicas. Método Estudo transversal observacional com 38 estudantes de graduação em Artes Cênicas. Foram aplicados protocolos de rastreio de risco de disfonia geral e específico para atores, e realizadas gravações da emissão sustentada da vogal /a/, fala espontânea e leitura de texto, usadas para análise perceptivo-auditiva, efetuada por três avaliadores, com o uso da escala GRBASI. Após testes de confiabilidade intra e interavaliadores chegou-se à classificação final do grau geral do desvio vocal para cada participante. Foram feitas comparações entre grupos que tinham ou não outra profissão/atividade com o uso da voz e os grupos formados a partir do grau geral. Resultados A maioria dos estudantes apresentou alto risco para disfonia. Todos apresentaram alteração vocal, com predominância de grau leve. Os estudantes que tinham outra profissão/atividade com uso da voz obtiveram maior pontuação no protocolo específico para atores, bem como na soma desse protocolo com o de rastreio geral. Não houve relação entre o grau de alteração vocal e o risco de disfonia. Os estudantes que ainda não atuavam profissionalmente apresentaram mais alterações vocais de grau moderado ou severo, e os que atuavam profissionalmente apresentaram com maior frequência alteração vocal de grau leve. Conclusão A maior parte dos estudantes apresentou alto risco para disfonia. Todos apresentaram alteração vocal, com predomínio de grau leve. Não houve relação entre o risco de disfonia e o grau de alteração vocal.

ABSTRACT Purpose To analyse the relationship between the risk of dysphonia and vocal quality in undergraduate performing arts students. Methods Observational cross-sectional study with 38 undergraduate students in Performing Arts. We applied screening protocols for general and specific risk of dysphonia for actors and made recordings of sustained emission of the vowel /a/, spontaneous speech and reading a text, used for perceptual analysis performed by three evaluators using the GRBASI scale. After intra and inter-rater reliability tests it was obtained final classification of the general degree of vocal deviation parameter for each participant. Comparisons were made considering groups that had or did not have other profession/activity with the use of voice, and the groups were formed from the general grade. Results Most students were at high risk for dysphonia. All had vocal alteration, with a predominance of mild degree. Students who had another profession/activity with voice use scored higher in the specific protocol for actors, and in the sum of this protocol with the general screening protocol. There was no relationship between the degree of vocal alteration and the risk of dysphonia. Students who did not yet work professionally had more moderate or severe vocal alterations, and those who did work professionally had a higher frequency of mild vocal alterations. Conclusion Most students were at high risk for dysphonia. All had vocal alteration, with a predominance of mild alteration. There was no relationship between the risk of dysphonia and the degree of vocal alteration.

Voz do idoso: o avanço da idade gera diferentes impactos? / Aged voice: does advancing age generate different impacts?

RESUMO Objetivo Verificar se existem diferenças em aspectos vocais entre idosos com presbifonia, divididos em três faixas etárias. Método Participaram 60 idosos de ambos os sexos com idades entre 60 e 90 anos (média=72,3), com diagnóstico de presbifonia estabelecido em avaliação otorrinolaringológica. A partir da gravação das vozes foi realizada análise perceptivo-auditiva e acústica e os dados foram comparados por meio dos testes estatísticos com os participantes divididos nos grupos etários 60-70 anos, 71-80 anos e 81-90 anos. Resultados Ainda que os idosos dos três grupos tenham apresentado alterações em aspectos vocais variados, como instabilidade e ruído em frequências graves, aqueles com mais de 80 anos apresentaram maior grau de disfonia, rugosidade, soprosidade e pitch. Também foram observados neste grupo maiores desvios em jitter, shimmer e irregularidade e a medida GNE no limite da normalidade. Todas as diferenças foram estatisticamente significativas. A maioria dos idosos dessa faixa etária apresentou ainda alteração no diagrama de desvio fonatório e quebra de frequência. Conclusão Diversos aspectos perceptivo-auditivos e acústicos se apresentaram mais desviados nos idosos mais velhos, o que reforça a necessidade de serem consideradas essas especificidades tanto na avaliação dos efeitos do envelhecimento na voz quanto no desenvolvimento de ações para minimizar o declínio vocal.

ABSTRACT Purpose To verify if there are differences in the vocal aspects of older people from three different age groups with presbyphonia diagnosis. Methods Sixty older adults joined this study. They were both female and male, with an age range from 60 to 90 years old (average: 72.3) and with presbyphonia diagnosis established after otolaryngology evaluation. From their voice recordings, it was possible to make the acoustic and auditory-perceptual analysis. The data collected was compared through statistical tests considering the division of the participants into the following groups: 60-70 years old, 71-80 years old, and 81-90 years old. Results Even though the older people from all of the three groups have presented deviation in multiple vocal aspects such as instability and vocal noise in low frequencies, those with more than 80 years old have presented a higher deviation of the general grade of dysphonia, roughness, breathiness, and pitch. In this group, it was also observed higher deviations in jitter, shimmer, vocal breaks, and the GNE measure on the edge of normality. All the differences were statistically significant. The majority of the older participants from that group presented even a deviation in the phonatory deviation diagram and frequency break. Conclusion Various acoustic and auditory-perceptual aspects had a higher deviation in the older adults over 80 years old, which reinforces the need to consider those specificities in the evaluation of the vocal aging impacts and also in the development of actions to minimize vocal declination.

Protocolo de Rastreio do Risco de Disfonia para Atores de Teatro Musical: resultados preliminares / Dysphonia Risk Screening Protocol for Musical Theatre Actors: a preliminary study

RESUMO Objetivo Propor o Protocolo de Rastreio do Risco de Disfonia para Atores do Teatro Musical (PRRD-TM), verificar sua aplicabilidade em associação ao Protocolo de Rastreio do Risco de Disfonia Geral (PRRD-G), correlacionar escores finais de ambos, e desses com o escore total, e comparar o risco de disfonia entre atores com e sem queixa vocal. Método Estudo transversal observacional com 34 atores de teatro musical adultos, ambos os sexos, com e sem queixa vocal, profissionais ou estudantes. Os questionários foram aplicados individualmente. A análise estatística possibilitou verificar a correlação entre os escores de risco de disfonia e para comparação entre os grupos com e sem queixa vocal. Resultados A maioria dos participantes era do gênero masculino, jovens adultos, atores profissionais e sem queixa vocal. Observou-se elevado risco de disfonia, evidenciado pela aplicação do PRRD-G, com escores médios compatíveis com valores encontrados em indivíduos com disfonia, e reforçado pelos índices encontrados com aplicação do PRRD-TM. Observou-se correlação moderada e diretamente proporcional entre os escores dos dois questionários e desses com o escore total. Escores mais elevados do PRRD-G foram encontrados no grupo que apresentou queixa vocal. Conclusão O PRRD-TM mostrou-se viável e de fácil aplicabilidade e apresentou correlação positiva com o escore do PRRD-G e com o escore total. Elevado risco de disfonia foi evidenciado em indivíduos com queixa vocal. Apesar do escore específico do PRRD-TM não diferenciar atores de teatro musical com e sem queixa vocal, tanto o escore do PRRD-G quanto o escore total realizaram tal diferenciação.

ABSTRACT Purpose To propose the Dysphonia Risk Screening Protocol for Musical Theatre Actors (DRSP-MTA), to verify its applicability in association with the General Dysphonia Risk Screening Protocol (G-DRSP), to correlate the final scores of both, and these with the total risk score, and to compare the risk of dysphonia measured in musical theater actors with and without vocal complaint. Methods An observational cross-sectional study with 34 musical theater actors, adults, of both genders, with and without vocal complaints and regardless of whether they are professionals or students. The questionnaires were applied individually. Statistical analysis made it possible to verify the correlation between the dysphonia risk scores and to compare the groups with and without vocal complaint. Results Most of the participants were male, young adults, professional actors and without vocal complaint. There was a high risk of dysphonia, evidenced by the application of G-DRSP, with means scores compatible with values found in individuals with dysphonia, and reinforced by the indices found with DRSP-MTA application. There was a moderate and directly proportional correlation between the two questionnaire scores; and a correlation of both with the total risk score. Higher G-DRSP scores were observed in the vocal complaint group. Conclusion DRSP-MTA was feasible and easy to apply and was positively correlated with the total score and G-DRSP score. A high risk of dysphonia was evidenced in individuals with vocal complaints. Although the specific DRSP-MTA score did not differentiate musical theatre actors with and without vocal complaints, the G-DRSP score and the total risk score performed such differentiation.

COVID-19 and the teacher's voice: self-perception and contributions of speech therapy to voice and communication during the pandemic

OBJECTIVES: We aimed to analyze the vocal self-perception of Brazilian teachers and their communication needs, vocal signs and symptoms, and voice-related lifestyles during the coronavirus disease (COVID-19) pandemic and, based on this information, to develop guidance materials intended for dissemination to these teachers and the general community. METHODS: An online questionnaire designed for this survey was distributed via the researchers' networks and was available for completion by any teacher, except those who were not working at the time. There were 1,253 teachers from all over Brazil, of both sexes, covering a wide age range, working at different levels of education, and most with more than ten years of experience. Descriptive and inferential analyses of the data were performed. RESULTS: On comparing the prepandemic period with the current one, participants indicated voice improvements. In contrast, they presented symptoms such as dry throat, effort in addressing remote classes, hoarseness after classes, and difficulties with the use of headphones, among others. They further indicated stress, general fatigue, impact of the pandemic on mental health, and the overlapping of many home tasks with professional tasks. Some smoked, and others hydrated insufficiently. CONCLUSION: Although teachers generally noticed voice improvements during the pandemic, a proportion of them perceived worsening of voices. Many indicated several factors in which speech-language pathologists could guide them with the aim of improving performance and comfort during remote and hybrid classes, an initiative that will positively impact not only their voice and communication but also their quality of life.

Cut-off point for high dysphonia risk in children based on the Child Dysphonia Risk Screening Protocol: preliminary findings

OBJECTIVES: The objective of the study was to establish a cut-off point for high dysphonia risk in children using the Child Dysphonia Risk Screening Protocol (DRSP-C). METHODS: Through a preliminary study, voice recordings of 59 children (4-12 years of age) were collected during an auditory-perceptual analysis using the Consensus Auditory-Perceptual Evaluation of Voice protocol. Thirty of the patients had voice disorders (patient group), and 29 did not (control group). A risk score for dysphonia was then calculated, and data were compared between groups. The relationship between overall degrees of deviation and questionnaire scores was analysed. The questionnaire's validity was verified from the area under the Receiver Operating Characteristic (ROC) curve, and cut-off points were obtained based on diagnostic criteria for screening procedures. RESULTS: The DRSP-C score was found to be higher for the patient group, as was the partial score for vocal behaviour. No correlation was found between overall degrees of dysphonia and questionnaire scores. The area under the ROC curve was measured as 0.678, denoting limited diagnostic capacity. The cut-off point was set at 16.50. Thus, above this value, dysphonia risk is higher. CONCLUSION: A cut-off point for high dysphonia risk was calculated. The DRSP-C proved to be a promising tool for children's clinical vocal and health promotion and should be used in conjunction with General Dysphonia Risk Screening.

Quality of life among total laryngectomized patients undergoing speech rehabilitation: correlation between several instruments

OBJECTIVE: The aim of this study was to correlate several instruments currently used for the assessment of the quality of life of patients who underwent total laryngectomy and speech rehabilitation. METHODS: A cross-sectional, observational study was conducted with 38 patients after total laryngectomy and speech therapy aiming to develop oesophageal speech. The patients were divided into the following two groups (19 participants each): speakers and non-speakers. The quality of life instruments used were as follows: visual analogue scale (VAS); Voice Handicap Index (VHI); Voice-Related Quality of Life (V-RQOL); Functional Assessment of Cancer Therapy - Head & Neck (FACT-H&N); European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck (EORTC QLQ-H&N35); and University of Washington Quality of Life (UW-QOL). RESULTS: The V-RQOL global health domain exhibited a strong correlation with the VHI. The EORTC QLQ-C30 exhibited a moderate to strong correlation with the EORTC QLQ-H&N35 functional domain in both groups. The EORTC QLQ-C30 functional domain exhibited a strong to moderate correlation with all other instruments in both groups. The UW-QOL exhibited a moderate to strong correlation with the VHI and EORTC QLQ-C30 in both groups. CONCLUSION: The EORTC QLQ-C30, EORTC QLQ-H&N35 and UW-QOL were the instruments that most correlated with the remaining instruments, indicating that any of the three can be used to assess the quality of life of the target population regardless of oesophageal voice development.

Ações para a melhoria do conforto acústico em instituições de educação infantil / Noise in early childhood education institutions

Resumo Elevados níveis de pressão sonora têm sido observados em escolas e, por sua interferência na saúde das crianças e professores, teve-se por objetivo analisar esses níveis em centros de educação infantil que atendem crianças com idades entre zero e seis anos, investigar a percepção dos funcionários quanto à exposição ao ruído e identificar a audição desses trabalhadores. O estudo foi realizado em dez instituições que empregam 320 trabalhadores. Os níveis de pressão sonora foram medidos segundo as normas técnicas, os funcionários preencheram questionário sobre a percepção do ruído e passaram por avaliação auditiva. Observou-se elevado nível de pressão sonora e diferenças entre as instituições, situações e locais. A maioria dos funcionários se considerou exposta ao ruído com dificuldades de atenção e concentração, ansiedade e dor de cabeça. Cerca de 30% dos funcionários apresentaram perda auditiva neurossensorial bilateral em frequências específicas. Os níveis de pressão sonora encontrados podem comprometer a aprendizagem das crianças e a saúde de todos. Os funcionários percebem o ruído e indicam prejuízos em sua rotina de trabalho. Ações para melhorar o conforto acústico nessas instituições foram discutidas e estão sendo implementadas.

Abstract High sound pressure levels have been observed in schools, and its interference in the health of children and teachers it was taken to analyze these levels in childhood education centers serving children aged zero to six years, investigate the staff's perceptions concerning noise exposure and identify the auditory conditions of these workers and the occurrence of diseases. The study was conducted in ten institutions employing 320 workers. Sound pressure levels were measured according to the technical norms; employees completed a questionnaire on the perception of noise and underwent auditory evaluation. There was high sound pressure level and differences between institutions, situations and places. Most employees are considered exposed to noise with attention and concentration difficulties, anxiety and headache. About 30% of employees had bilateral sensorineural hearing loss in specific frequency. The sound pressure levels found can affect children's learning and the health of all. The employees also perceived elevated levels of noise and indicated some possible negative aspects in their work routine. Actions to improve the acoustic comfort in these institutions will be discussed with the management teams.

Voice deviation, dysphonia risk screening and quality of life in individuals with various laryngeal diagnoses

OBJECTIVES: To characterize the voice quality of individuals with dysphonia and to investigate possible correlations between the degree of voice deviation (D) and scores on the Dysphonia Risk Screening Protocol-General (DRSP), the Voice-Related Quality of Life (V-RQOL) measure and the Voice Handicap Index, short version (VHI-10). METHODS: The sample included 200 individuals with dysphonia. Following laryngoscopy, the participants completed the DRSP, the V-RQOL measure, and the VHI-10; subsequently, voice samples were recorded for auditory-perceptual and acoustic analyses. The correlation between the score for each questionnaire and the overall degree of vocal deviation was analyzed, as was the correlation among the scores for the three questionnaires. RESULTS: Most of the participants (62%) were female, and the mean age of the sample was 49 years. The most common laryngeal diagnosis was organic dysphonia (79.5%). The mean D was 59.54, and the predominance of roughness had a mean of 54.74. All the participants exhibited at least one abnormal acoustic aspect. The mean questionnaire scores were DRSP, 44.7; V-RQOL, 57.1; and VHI-10, 16. An inverse correlation was found between the V-RQOL score and D; however, a positive correlation was found between both the VHI-10 and DRSP scores and D. CONCLUSION: A predominance of adult women, organic dysphonia, moderate voice deviation, high dysphonia risk, and low to moderate quality of life impact characterized our sample. There were correlations between the scores of each of the three questionnaires and the degree of voice deviation. It should be noted that the DRSP monitored the degree of dysphonia severity, which reinforces its applicability for patients with different laryngeal diagnoses.

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 / Acoustic voice analysis: effect of an audio-visual training for speech therapy undergraduates

Objetivo Verificar a efetividade de treino para avaliação acústica da voz com graduandos de Fonoaudiologia. Métodos Estudo realizado com 14 estudantes de curso de graduação em Fonoaudiologia, que participaram de seis encontros semanais teóricos e práticos, com duração total de quatro horas e meia. Foram abordados os conceitos básicos para avaliação vocal acústica perceptivo-auditiva e foi praticada a análise espectrográfica de cada parâmetro, visualmente e auditivamente. Para verificar a efetividade da proposta, os graduandos realizaram, antes e ao final do treino, a avaliação das medidas de extração automáticas e de aspectos da espectrografia de banda estreita de uma amostra de 15 vozes, normais e alteradas em variados graus. O desempenho dos alunos foi considerado nos dois momentos, comparando-se os erros e acertos em relação à análise prévia realizada por especialista, com índice Kappa >0,70. Para comparação entre os resultados obtidos pelos graduandos, nos dois momentos, utilizou-se o teste de McNemar. Resultados Para todos os parâmetros analisados, as médias de acerto foram maiores no momento pós-treino, com maioria dos índices acima de 90%; o mesmo observou-se em relação à média geral (24,2% no momento pré-treino e 93,0% no momento pós-treino). Conclusão O treino mostrou-se efetivo para a aprendizagem dos graduandos, podendo ser incorporado às disciplinas que envolvem os conceitos de avaliação da voz e transformado em material didático disponível para outros grupos .

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. .

Impacto da videoendoscopia da deglutição na fonoterapia após tratamento de tumor de cabeça e pescoço / Impact of swallowing videoendoscopy in Speech therapy after treatment of head and neck tumor

Objetivo: Investigar mudanças na conduta terapêutica fonoaudiológica após resultados da vídeoendoscopia da deglutição (VED) de pacientes após cirurgia de tumor de cabeça e pescoço ou após tratamento exclusivo ou coadjuvante com radioterapia e quimioterapia. Métodos: Estudo retrospectivo, com coleta de dados de prontuário e análise de exame funcional. A amostra constou de 20 pacientes com disfagia moderada ou grave (11 homens e nove mulheres), com média de idade de 58 anos. Do total, 17 pacientes realizaram tratamento cirúrgico e três apenas radioquimioterapia. A VED foi realizada após o mínimo de três sessões de terapia fonoaudiológica para disfagia. Para análise do pós exame foi considerado igualmente o mínimo de três sessões de fonoterapia. Os dados coletados foram relacionados à classificação de deglutição no período terapêutico baseado na Functional Communication Measures - Swallowing (ASHA-NOMs) (FCM), estratégias terapêuticas utilizadas quanto à consistência e manobras de deglutição, necessidade de outro exame funcional e encaminhamento médico. Os dados foram comparados nos momentos pré e pós VED. Resultados: Houve 25% de mudança na conduta fonoaudiológica pós VED; 50% de mudança na classificação FCM, dos quais 30% para maior grau; 70% de influência da VED nas estratégias terapêuticas - modificação em 30% quanto às consistências seguras; 30% no uso de manobras posturais, 25% em manobras de limpeza e 40% em manobras de proteção. Houve 25% de necessidade de outro exame funcional, sendo a videofluoroscopia o exame indicado; 10% foram encaminhados ao médico. Conclusão: Há impacto da VED na conduta fonoaudiológica, especialmente em relação às estratégias terapêuticas com predomínio de mudanças de consistência e manobras seguras.

Purpose: Investigate changes in speech therapy after Fiberoptic Endoscopy Evaluation of Swallowing (FEES) in patients after head and neck oncological treatment. Methods: retrospective study, based in collection and analysis of speech therapy and functional examination. The sample consisted of 20 patients (11 males and nine females), mean age 58 years. Of the total, 17 patients underwent surgical treatment and three only radiochemotherapy. The VED was performed after a minimum of three sessions of speech therapy for dysphagia. For analyzing the post test was also considered at least three speech therapy sessions. The data collected were related to the classification of swallowing during treatment based on the Functional Communication Measures - Swallowing (ASHA-NOMs) (FCM), therapeutic strategies related to consistency, swallowing maneuvers, functional test and physician evaluation. Data were compared for the pre and post FEES. Results: There was change 25% in speech behavior after FEES, 50% in the classification FCM, of which 30% to greater scale, 70% in therapeutic strategies - 30% in regard to safe consistencies, 30% the use of postural maneuvers, in 25% cleaning maneuvers and 40% protection maneuvers. There was 25% of the necessity of a functional examination, with the fluoroscopy examination indicated, 10% were referred to a doctor. Conclusion: There was impact of FEES on the speech therapy purpose, especially in relation to therapeutic strategies with predominant changes for consistency and safely operated.

Disfonia como principal queixa num quadro de miastenia grave: diagnóstico e fonoterapia / Dysphonia as the primary complaint in a case of myasthenia gravis: diagnosis and speech therapy

Miastenia grave é uma doença autoimune que se manifesta por fraqueza e fadiga muscular progressivas. São frequentes os sintomas oculares e bulbares, dentre eles, a disfonia. Este artigo relata um caso de disfonia, cuja avaliação fonoaudiológica contribuiu com o diagnóstico de miastenia grave e seu tratamento. A paciente em questão procurou o atendimento fonoaudiológico com diagnóstico otorrinolaringológico de presbifonia. A avaliação perceptivo-auditiva e acústica da voz identificou alterações em respiração, fonte glótica e filtro/ressonância. Como alguns dados obtidos com a anamnese e observados nas provas vocais não se relacionavam diretamente com a presença de presbifonia, houve a necessidade de discussão do caso com o médico, quando ambos concluíram a necessidade de encaminhar a paciente para avaliação neurológica. O neurologista consultado levantou a hipótese diagnóstica de miastenia grave e solicitou exames. A paciente seguiu em acompanhamento fonoaudiológico e medicamentoso. Na reavaliação vocal, ocorrida cerca de dois meses após o início do tratamento, foi constatada melhora na qualidade vocal, com grande impacto na qualidade de vida. Este trabalho evidencia a importância da avaliação fonoaudiológica detalhada e da participação do fonoaudiólogo na equipe interdisciplinar.

Myasthenia gravis is an autoimmune disease, manifested by progressive muscular weakness and fatigue. There are frequent ocular and bulbar symptoms, among them, dysphonia. This article reports a case of dysphonia that contributed to the diagnosis of myasthenia gravis through a speech evaluation. The patient sought speech therapy with the ENT diagnosis of presbyphonia. The perceptual voice assessment and acoustic analysis pointed out respiration, glottal voice source and resonance affections. Considering that some of the data obtained from anamnesis and vocal assessments were not directly related to presbyphonia, the speech therapist discussed the case with the physician and they both concluded it was necessary to refer the patient to a neurological evaluation. The neurologist then raised the diagnostic hypotheses of myasthenia gravis and requested further examinations. The patient underwent speech therapy and drug treatment. A vocal reassessment, which occurred two months after the initial treatment, showed improvement in voice quality, with great impact on quality of life. This article shows the importance of detailed clinical speech evaluation and participation of a speech therapist in an interdisciplinary team.

Efeito do ruído na voz de educadoras de instituições de educação infantil / The effect of noise on the voice of preschool institution educators

OBJETIVO: Avaliar a associação entre níveis de ruído presentes em centros de educação infantil e alterações vocais em educadoras. MÉTODOS: Estudo transversal com 28 educadoras de três instituições de educação infantil de São Paulo, SP, em 2009. Os níveis de pressão sonora foram mensurados segundo a Associação Brasileira de Normas Técnicas, com uso de medidor de nível de pressão sonora. As médias foram classificadas de acordo com os níveis de conforto, desconforto e dano auditivo propostos pela Organização Panamericana de Saúde. As educadoras tiveram a voz avaliada com: autoavaliação com escala analógica visual, avaliação perceptivo-auditiva com escala GRBAS e análise acústica com o programa Praat. Estatística descritiva e teste do qui-quadrado, com 10% de significância devido ao tamanho da amostra, foram usados para análise da associação entre ruído e avaliação vocal. RESULTADOS: As educadoras possuíam idades entre 21 e 56 anos. A média de ruído foi 72,7 dB, considerado dano 2. A autoavaliação vocal das profissionais apresentou média de 5,1 na escala, considerada alteração moderada. Na avaliação perceptivo-auditiva, 74% apresentaram alteração vocal, principalmente rouquidão; destas, 52% foram consideradas alterações leves. A maior parte apresentou frequência fundamental abaixo do esperado na avaliação acústica. Médias de jitter, shimmer e proporção harmônico-ruído estavam alteradas. Presença de ruído entre os harmônicos associou-se a alteração vocal. CONCLUSÕES: Há associação entre presença de ruído entre harmônicos e alteração vocal, com elevados níveis de ruído. Apesar de a maioria das educadoras ter apresentado voz alterada em grau leve, a autoavaliação mostrou alteração moderada, provavelmente pela dificuldade de projeção.

OBJECTIVE: To analyze the association between noise levels present in preschool institutions and vocal disorders among educators. METHODS: Cross-sectional study conducted in 2009 with 28 teachers from three preschool institutions located in the city of São Paulo (Southeastern Brazil). Sound pressure levels were measured according to Brazilian Technical Standards Association, with the use of a sound level meter. The averages were classified according to the levels of comfort, discomfort, and auditory damage proposed by the Pan American Health Organization. The educators underwent voice evaluation: self-assessment with visual analogue scale, auditory perceptual evaluation using the GRBAS scale, and acoustic analysis utilizing the Praat program. To analyze the association between noise and voice evaluation, descriptive statistics and the chi-square test were employed, with significance of 10% due to sample size. RESULTS: The teachers' age ranged between 21 and 56 years. The noise average was 72.7 dB, considered as damage 2. The professionals' vocal self-assessment ranked an average of 5.1 on the scale, being considered as moderate alteration. In the auditory-perceptual assessment, 74% presented vocal alteration, especially hoarseness; of these, 52% were considered mild alterations. In the acoustic assessment the majority presented fundamental frequency below the expected level. Averages for jitter, shimmer and harmonic-noise ratio showed alterations. An association between the presence of noise between the harmonics and vocal disorders was observed. CONCLUSIONS: There is an association between presence of noise between the harmonics and vocal alteration, with high noise levels. Although most teachers presented mild voice alteration, the self-evaluation showed moderate alteration, probably due to the difficulty in projection.

Impacto de treinamento auditivo na avaliação perceptivo-auditiva da voz realizada por estudantes de Fonoaudiologia / Impact of auditory training for perceptual assessment of voice executed by undergraduate students in Speech-Language Pathology

OBJETIVO: Analisar o impacto de treino auditivo na avaliação perceptivo-auditiva da voz realizada por estudantes de Fonoaudiologia. MÉTODOS: Durante dois semestres, 17 estudantes que cursavam disciplinas teóricas de fonação (Fonação/Distúrbios da Fonação) analisaram amostras de vozes alteradas e não 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 duração cada. Em cada encontro foi apresentado um parâmetro, por meio de vozes diferentes da amostra avaliada, com predominância no aspecto treinado. A avaliação das amostras por meio da escala foi realizada pré e pós o treinamento e em outros quatro momentos ao longo dos encontros. As avaliações dos alunos foram comparadas com uma avaliação de juízas, realizada previamente por três fonoaudiólogos, especialistas em voz. Para verificar a efetividade do treinamento foi usado o teste de Friedman e Índice de Concordância Kappa. RESULTADOS: O índice de acertos dos alunos no momento pré-treinamento foi considerado entre regular e bom. Observou-se manutenção do número de acertos ao longo das avaliações realizadas, para a maioria dos parâmetros da escala. No momento pós-treinamento observou-se melhora na análise da astenia, parâmetro enfatizado a partir das dificuldades apresentadas pelos alunos. Houve diminuição dos acertos no parâmetro rugosidade após este ter sido trabalhado de maneira segmentada em rouquidão e aspereza, e associado a diferentes diagnósticos e parâmetros acústicos. CONCLUSÃO: O treino auditivo potencializa as habilidades iniciais dos alunos, refinando-as para realização da avaliação, além de nortear ajustes em dinâmicas das disciplinas.

PURPOSE: To analyze the impact of auditory training for auditory-perceptual assessment carried out by Speech-Language Pathology undergraduate students. METHODS: During two semesters, 17 undergraduate students enrolled in theoretical subjects regarding phonation (Phonation/Phonation Disorders) analyzed samples of altered and unaltered voices (selected for this purpose), using the GRBAS scale. All subjects received auditory training during nine 15-minute meetings. In each meeting, a different parameter was presented using the different voices sample, with predominance of the trained aspect in each session. Sample assessment using the scale was carried out before and after training, and in other four opportunities throughout the meetings. Students' assessments were compared to an assessment carried out by three voice-experts speech-language pathologists who were the judges. To verify training effectiveness, the Friedman's test and the Kappa index were used. RESULTS: The rate of correct answers in the pre-training was considered between regular and good. It was observed maintenance of the number of correct answers throughout assessments, for most of the scale parameters. In the post-training moment, the students showed improvements in the analysis of asthenia, a parameter that was emphasized during training after the students reported difficulties analyzing it. There was a decrease in the number of correct answers for the roughness parameter after it was approached segmented into hoarseness and harshness, and observed in association with different diagnoses and acoustic parameters. CONCLUSION: Auditory training enhances students' initial abilities to perform the evaluation, aside from guiding adjustments in the dynamics of the university subject.

Fatores associados ao bruxismo em crianças de 4 a 6 anos / Factors associated to bruxism in children from 4 - 6 years

TEMA: o bruxismo tem trazido prejuízos para a qualidade de vida das pessoas. Suas implicações para a motricidade orofacial e fala em crianças ainda não estão bem estabelecidas. OBJETIVO: investigar a ocorrência do bruxismo e fatores associados relativos aos hábitos orais, motricidade orofacial e funções de mastigação, respiração e deglutição em crianças de 4 a 6 anos. MÉTODO: participaram 141 crianças da referida faixa etária que frequentam três centros de educação infantil paulistas. Os pais preencheram protocolo de investigação sobre bruxismo e as crianças passaram por avaliação da motricidade orofacial. O grupo pesquisa foi composto pelas crianças cujos pais indicaram qualquer frequência de ranger ou apertamento de dentes, durante o sono ou não. Para análise estatística utilizou-se Análise de Variância, Teste de Igualdade de Duas Proporções e cálculo da Odds Ratio, nível de significância de 5 por cento. RESULTADOS: observou-se elevada ocorrência de bruxismo entre as crianças (55,3 por cento). Foram fatores associados a esta ocorrência: sialorreia durante o sono, uso de chupeta, hábito de morder lábios e roer unhas, tônus de bochechas e tipo de mordida alterados, além da participação da musculatura perioral durante deglutição de líquidos. Houve alta ocorrência de crianças dos dois grupos com queixa de dor de cabeça frequente (76 por cento) e que dormem menos do que o recomendado para a idade (35 por cento). CONCLUSÃO: os achados comprovaram relação entre bruxismo, hábitos orais e aspectos alterados da motricidade orofacial das crianças da faixa etária estudada reforçando a necessidade de ações fonoaudiológicas junto às instituições e famílias.

BACKGROUND: bruxism has brought losses for the life quality of people. Its implications in the orofacial motricity and speech of children are still not well known. AIM: to investigate bruxism occurrence and associated factors concerning oral habits, orofacial motricity and functions of chewing, breathing and swallowing in children from 4 to 6 years. METHOD: 141 children from the referred age group who attend three education centers in São Paulo took part in the study. Parents filled in an investigation protocol on bruxism and the children were submitted to an orofacial motricity assessment. The research group was composed by children whose parents indicated habits of teeth clenching or grinding, during sleep or not. For the statistical analysis the Analysis of Variance, the Two-Proportion Equality Test and the Odds Ratio calculation were used, with a significance level of 5 percent. RESULTS: a high occurrence of bruxism among the children (55.3 percent) was observed. The identified associated factors were: sialorrhea during sleep, pacifier use, habit of lip and fingernails biting, altered cheek tonus and bite, besides the participation of the perioral muscles during liquid swallowing. There was a high occurrence of children from both groups complaining about frequent headaches (76 percent) and who slept less hours than what is recommended for their age (35 percent). CONCLUSION: the findings corroborated the relationship among bruxism, oral habits and altered aspects of orofacial motricity in children from the studied age group, reinforcing the necessity of speech therapy actions next to the institutions and families.