Efeito da terapia vocal associada ao biofeedback eletromiográfico em mulheres com disfonia comportamental: ensaio clínico randomizado, controlado e cego / Effect of vocal therapy associated with electromyographic biofeedback in women with behavioral dysphonia: randomized controlled blinded clinical trial

Introdução: as disfonias podem acometer o nível respiratório, glótico e ressonantal/articulatório, limitar a eficiência da comunicação e gerar prejuízos na qualidade de vida. Quando a etiologia da disfonia está relacionada ao uso vocal incorreto, elas são classificadas como comportamentais. Apesar da literatura mostrar a efetividade de alguns métodos e programas de reabilitação vocal, poucos exploram a autopercepção corporal e a participação da musculatura corporal no quadro da disfonia. A fim de melhorar essas questões, a literatura propôs o biofeedback eletromiográfico. Estudos que analisaram esse método são antigos e apresentam heterogeneidade metodológica, o que dificulta sua reprodução. Dessa forma, é necessário analisar o efeito do método por meio de um ensaio clínico para se obter evidências científicas sobre a intervenção para respaldar a prática clínica baseada em evidências. Objetivo: analisar a efetividade e a duração dos efeitos da terapia vocal associada ao biofeedback eletromiográfico em mulheres com disfonia comportamental. Delineamento do estudo: ensaio clínico, randomizado, controlado e cego. Método: participaram do estudo 22 mulheres (idades entre 18 e 45 anos) com diagnóstico de disfonia comportamental, alocadas de forma randomizada em dois grupos: Grupo Experimental (GE) ­ 11 mulheres que realizaram terapia vocal associada a aplicação do biofeedback eletromiográfico nos músculos esternocleidomastoideo e supra-hioideos; Grupo Placebo (GP) ­ 11 mulheres que realizaram terapia vocal associada a aplicação do biofeedback eletromiográfico placebo. Ambos os grupos realizaram 8 sessões de terapia, duas vezes por semana, com duração de 30 minutos. A terapia vocal de ambos os grupos foi composta por exercícios de trato vocal semiocluído (vibração, humming e fricativo). As avaliações foram realizadas em três momentos: antes, imediatamente após, depois de um e três meses da intervenção fonoaudiológica, e constaram de: avaliação vocal (perceptivo-auditiva e acústica), avaliação eletromiográfica de superfície, autoavaliação vocal, de sintomas vocais e laríngeos, da dor musculoesquelética e da qualidade de vida em voz. Os dados foram analisados estatisticamente, comparando-se os grupos e os momentos de avaliação (p=0,05). Resultados: A terapia vocal proposta promoveu resultados positivos na qualidade vocal, nos sintomas vocais, na qualidade de vida relacionada à voz e na atividade elétrica muscular durante o repouso em mulheres com disfonia comportamental, com ênfase nos aspectos fonatórios e comportamento vocal em nível glótico. Já o biofeedback eletromiográfico promoveu resultados positivos na atividade elétrica muscular durante as tarefas fonatórias e na dor musculoesquelética em mulheres com disfonia comportamental, com base nos aspectos comportamentais e musculares da região extrínseca da laringe, cintura escapular e cervical. Conclusão: Conclui-se que a terapia vocal associada ao biofeedback eletromiográfico tem efetividade equivalente e efeitos que se mantém pelo mesmo tempo na laringe, na voz e na autopercepção de sintomas e da qualidade de vida em voz, e é mais efetiva e tem efeitos que se mantêm por mais tempo na atividade elétrica muscular e na autopercepção da dor musculoesquelética de mulheres com disfonia comportamental do que a terapia vocal realizada de forma tradicional.(AU)

Introduction: dysphonia can affect the respiratory, glottic and ressonantal/articulatory levels, this limits the efficiency of communication and can cause quality of life damages. When the etiology of dysphonia is related to incorrect vocal use, it is classified as behavioral. Although the literature shows the effectiveness of several methods and programs of vocal rehabilitation, few investigate the self-perception and the participation of the body musculature in the dysphonia. In order to improve these issues, the literature proposed the electromyographic biofeedback. The studies that analyzed this method are remote and have methodological heterogeneity which makes it difficult to reproduce. Thus, it is necessary to analyze the effect of the method through a clinical trial to obtain scientific evidence on the intervention to support evidence-based clinical practice. Purpose: to analyze the effectiveness and duration of the effects of vocal therapy associated with electromyographic biofeedback in women with behavioral dysphonia. Study design: randomized controlled blinded clinical trial. Methods: Twenty-two women (18 to 45 years) with a diagnosis of behavioral dysphonia were randomly divided into two groups: Experimental Group (EG) - 11 women participated in vocal therapy associated with the application of electromyographic biofeedback of the sternocleidomastoid and supra-hyoids muscles; Placebo Group (GP) - 11 women participated in vocal therapy associated with the application of placebo electromyographic biofeedback. Both groups performed eight therapy sessions, twice a week, lasting 30 minutes. The vocal therapy of both groups was composed of semioccluded vocal tract exercises (trill, humming and fricative sounds). The evaluations were performed at four time points: before, after, one and three months after the vocal therapy and will consist of the assessments: vocal (auditory-perceptual and acoustic evaluation), surface electromyographic, vocal self-assessment, vocal and laryngeal symptoms, musculoskeletal pain and quality of life in voice. The data were analyzed statistically comparing the groups and the time of evaluation (p0.05). Results: The proposed vocal therapy promoted positive results in vocal quality, laryngeal and vocal symptoms, voice-related quality of life and muscular electrical activity during rest in women with behavioral dysphonia for both groups. Electromyographic biofeedback promoted additional positive results in muscle electrical activity during phonatory tasks and musculoskeletal pain in women with behavioral dysphonia. These results are based on the behavioral and muscular aspects of the extrinsic region of the larynx, scapular and cervical muscles. Conclusion: in this study, the vocal therapy associated with electromyographic biofeedback had equivalent efficacy to traditional therapy in the larynx, voice and self-assessment of symptoms and quality of life. The biofeedback was more effective than traditional therapy on muscular electrical activity and self-perception of musculoskeletal pain and had effects that remained for a longer time in women with behavioral dysphonia.(AU)

Measurement of the excessive stimulus time after the sensory threshold level during electric pulp testing / 대한치과보존학회지

Use of electric pulp testing elicits painful response in vital teeth. In this study, we examined the excessive time from pain feeling to stimulation disconnection in clinical situation. D626D (Parkell Inc., USA.) scan type electric pulp tester was used in total of 23 young healthy individuals. Each of the right central incisors and first premolars were used as testing teeth. Stimulation disconnection was achieved by EMG in anterior belly of digastric muscle, finger span, and voice and the excessive stimulation time over the sensory threshold was recorded. As a result, we found that the short responses before the stimulation disconnection appeared following order; EMG, finger span, and voice. The EMG disconnection is suggested to be used to reduce the excessive stimulus time in electric pulp testing.

The Comparison of the TOF Ratios between Electromyograph and Accelerograph following Vecuronium Administration / 대한마취과학회지

The present study was firstly undertaken in an attempt to compare simultaneously EMG(electromyography) and two new ACC(accelerography) reponses in the both hand following vecuronium administration in 26 ASA 1 or 2 adult patients undergoing general anesthesia. In the three NMT monitors, stimulating electrodes are applied similarly over the ulnar nerve on the volar side of the wrist, but the evoked EMG(Relaxograph, Datex Co.) responses obtained from the hypothenar muscles, TOFGUARD(Biometer Co.) responses from adductor pollicis and ParaGraph(Utah Med. Prod. Co.) responses from both muscles of hypothenar and thenar muscle of the hand respectively. Following induction of anesthesia with thiopental sodium(5 mg/kg) and vecuronium(0.08 mg/kg) intravenously, endotracheal intubation was facilitated and anesthesia was maintained with a mixture of enflurane(1~2%) and N2O(50%) . After loss of consciousness, the assessment of the neuromuscular blockade was started. We compared simultaneously TR(train-of-four ratio) responses of EMG at the one hand, and two new ACC named TOF-GUARD and ParaGraph at the other hand respectively during evoked recovery from vecuronium induced neuromuscular blockade. The result was the greater depression of TR response in TOF-GUARD and the lesser depression of TR response in ParaGraph than those in EMG. But test for parallelism did not show a statistically significant difference between the slope of these regression lines. Conclusively, the regression line for TR seems to be tend to give an impression that two new ACC named TOF-GUARD and ParaGraph would be suitable in the assessment of neuromuscular blockade in clinical anesthesia.