Singing Voice Therapy Revisited / Revisión de la terapia de voz cantada

Introduction. Singing is a type of sportive activity and, like sports medicine, profes-sional voice medicine is interested in the habilitation and rehabilitation of the vocal performer. The vocal needs of the professional vocal performer may not be similar to other professional or non-professional voice users. Like a professional athlete, a vocal performer's ability to perform for many decades at a high level will be enhanced by basing artistic and lifestyle decisions on a scientifically sound foundation. Objective. The aim of this study is to present a multidimensional introduction to the methods of SVT, incorporating the principles of sport and exercise medicine, and physical therapy and rehabilitation.Reflection. Singing voice therapy needs to provide answers to "what", "why", "how", and "when" questions. SVT must first correctly identify the problem, leading to the "how to do" solutions for a wide variety of cases, followed by a schedule of prescribed activities including answers to the "why" question (which exercise relates to which muscle). The periodization and motor learning principles provide a temporal answer to the "when" question when developing habilitation and/or rehabilitative protocols.Conclusion. Singing is not only an artistic expression, but also a sportive performance. The clinical approach to professional voice is a multidimensional and multilayered team effort. All practices are structured by blending scientific and ped-agogical knowledge

Introducción. El canto es una forma de actividad deportiva y, al igual que la medicina deportiva, la medicina vocal profesional se interesa por la habilitación y rehabilitación del intérprete vocal. Las necesidades vocales del intérprete vocal profesional pueden no ser similares a las de otros usuarios de voz profesionales o no profesionales. Al igual que un atleta profesional, la capacidad de un intérprete vocal para desempeñarse durante muchas décadas a un alto nivel se mejorará al basar las decisiones artísticas y de estilo de vida en un fundamento científicamente sólido. Objetivo. El objetivo de este estudio es presentar una introducción multidimensional a los métodos de TSV, incorporando los principios de la medicina del deporte y el ejercicio, y la fisioterapia y rehabilitación. Reflexión. La terapia de la voz cantada debe proporcionar respuestas a preguntas de "qué", "por qué", "cómo" y "cuándo". SVT primero debe identificar correctamente el problema, lo que lleva a las soluciones de "cómo hacer" para una amplia variedad de casos, seguido de un programa de actividades prescritas que incluyen respuestas a la pregunta "por qué" (qué ejercicio se relaciona con qué músculo). Los principios de periodización y aprendizaje motor proporcionan una respuesta temporal a la pregunta de "cuándo", al desarrollar protocolos de habilitación y/o rehabilitación. Conclusión. Cantar no es solo una expresión artística, sino también una actuación deportiva. El enfoque clínico de la voz profesional es un esfuerzo de equipo multidimensional y de múltiples capas. Todas las prácticas están estructuradas, al combinar conocimientos científicos y pedagógicos.

Atuação fonoaudiológica na doença de Machado-Joseph: relato de caso / Effect of speech-language therapy in Machado-Joseph disease: case report

RESUMO A doença de Machado-Joseph é a forma de ataxia espinocerebelar de maior prevalência no Brasil e tem como alguns dos principais sinais clínicos a disfagia e a disartria. Este relato de caso objetivou verificar os efeitos da intervenção intensiva fonoaudiológica em um paciente com a doença de Machado-Joseph. A coleta de dados foi realizada a partir de protocolos de avaliação de fala e deglutição e protocolos de autoavaliação de qualidade de vida, em relação à deglutição e comunicação. Também foram realizadas avaliações quantitativas de parâmetros acústicos. A intervenção foi administrada por meio do método Lee Silverman, programa intensivo que visa ao aumento da intensidade vocal. A partir das avaliações clínicas e instrumentais, os resultados demonstraram melhora em todas as bases motoras de fala, respiratória, fonatória, ressonantal, articulatória e a prosódia, além da diminuição dos sinais disfágicos. Na qualidade vocal, houve diminuição de rouquidão e instabilidade, regularização de jitter e shimmer, aumento da intensidade vocal, melhora na coordenação de palavras e frases por expiração e, ainda, melhora discreta da diadococinesia. Após intervenção, a autoavaliação de qualidade de vida relacionada à deglutição apresentou valores iguais ou maiores nos domínios diretamente ligados à alimentação, porém, os domínios emocionais diminuíram. O paciente relatou satisfação em todos os domínios da qualidade de vida em voz e foram obtidos valores maiores em todos os domínios. Concluiu-se que a intervenção intensiva beneficiou o participante e impactou positivamente sua qualidade de vida.

ABSTRACT Machado-Joseph disease is the most prevalent form of spinocerebellar ataxia in Brazil, and has dysphagia and dysarthria among its main clinical signs. This case report aims to ascertain the effects of intensive speech-language intervention in a patient with Machado-Joseph disease. Data collection was performed based on speech and swallowing assessment protocols and self-assessment protocols specific to swallowing-related and communication-related quality of life. Quantitative assessments of acoustic parameters were also performed. The intervention was administered through the Lee Silverman method, which is an intensive program aimed at increasing vocal intensity. The results of clinical and instrumental evaluations showed improvement in all motor parameters of speech (respiration, phonation, resonance, articulation, and prosody), besides a reduction in dysphagic signs. Regarding vocal quality, there was a decrease in hoarseness and instability, regularization of jitter and shimmer, increased vocal intensity, and improved coordination of words and phrases by expiration, as well as slight improvement of diadochokinesis. After intervention, self-assessment of swallowing-related quality of life was unchanged or improved in the domains directly related to food, but reduced in emotional domains. The patient reported satisfaction in all domains of voice-related quality of life, and scores were increased in all domains. We conclude that intensive intervention was beneficial for the participant and positively impacted their quality of life.

Lee Silverman voice treatment can improve the speech and the life quality of patients with Parkinson'sdisease / 中华物理医学与康复杂志

Objective To explore the effect of Lee Silverman voice treatment on the speech and life quality of Parkinson's disease patients.Methods A total of 98 patients with Parkinson's disease anddifferent degrees of speech disorder (Hoehn-Yahr clinical stages 1 to 3) were randomly divided into an intervention group and a control group,each of 49,according to a random number table.The control group was given routine speech therapy covering tongue and lip movement,rhythm,sound,volume,speed and respiratory control.The intervention group was provided with 12 weeks of Lee Silverman voice treatment aimed at abnormal voice and emphasizing pronunciation,4 times a week and 1 hour each time.During the treatment,all patients were required to practice once at home on treatment days and twice on days without treatment.The voice handicap index (VHI),the western aphasia battery (WAB),the speech function portion of UPDRS-Ⅲ and the speech articulation assesstnent were used to evaluate the 2 groups before and after the 12 weeks ofintervention.Results Beforethe intervention there was no significant differencebetween the two groups in any of the measurements.After the interventionsignificant improvement was ohserved in all of these indicesin bothgroups.After treatment the average total VHI score of the intervention group (60.39±9.84) had improved significantly more than that of the control group,as did the WAB score for spontaneous speech (14.64±1.98),listening comprehension (112.67± 19.43),repeating (65.31±7.98),Name (39.89±9.84) and the average AQ scores (69.19±10.78) and UPDRS-scores [(1.39±0.61)] [of the intervention group than the control group [(71.03±11.01),(13.67±1.06),(111.53±29.61),(63.75±7.41),(37.89± 9.29),(62.14±10.21) and (1.82±0.82)].After the intervention,the average speech articulation scores of the intervention and control group were (77.61± 11.72) and (59.67± 10.04),significantly higher than those before the intervention [(54.36±10.71) and (53.98±9.92)],with the improveinent of the intervention group significantly higher than the control group.Conclusion Lee Silverman voice treatment can effectively improve the speech and life quality of patients with Parkinson's disease.

Telerehabilitation in Parkinson's disease: Influence of cognitive status / Telerehabilitação na doença de Parkinson: influência do estado cognitivo

ABSTRACT Background: The need for efficacy in voice rehabilitation in patients with Parkinson's disease is well established. Given difficulties traveling from home to treatment centers, the use of telerehabilitation may represent an invaluable tool for many patients. Objective: To analyze the influence of cognitive performance on acceptance of telerehabilitation. Methods: Fifty patients at stages 2-4 on the Hoehn-Yahr scale, aged 45-87 years old, with cognitive scores of19-30 on the Mini-Mental State Examination, and 4-17 years of education were enrolled. All patients were submitted to evaluation of voice intensity pre and post in-person treatment with the Lee Silverman Voice Treatment (LSVT) and were asked to fill out a questionnaire regarding their preferences between two options of treatment and evaluating basic technological competence. Results: Comparisons between pre and post-treatment values showed a mean increase of 14dBSPL in vocal intensity. When asked about potential acceptance to participate in future telerehabilitation, 38 subjects agreed to take part and 12 did not. For these two groups, 26% and 17% self-reported technological competence, respectively. Agreement to engage in remote therapy was positively associated with years of education and cognitive status. Conclusion: Responses to the questionnaire submitted after completion of traditional in-person LSVT showed that the majority of patients (76%) were willing to participate in future telerehabilitation. Age, gender, disease stage and self-reported basic technological skills appeared to have no influence on the decision, whereas other factors such as cognitive status and higher school education were positively associated with acceptance of the new therapy approach.

RESUMO Embasamento: A eficácia na reabilitação da voz em pacientes com doença de Parkinson está bem estabelecida. Tendo em vista as dificuldades de lidar com a locomoção de casa para centros de tratamento, o uso da telerreabilitação pode representar uma ferramenta inestimável para muitos pacientes. Objetivo: Analisar a influência do desempenho cognitivo na aceitação da telerreabilitação. Métodos: Participaram cinquenta pacientes em estágios 2-4 de acordo com a escala de Hoehn-Yahr, com idade entre 45 e 87 anos, escores cognitivos de 19 a 30 no Mini-Exame do Estado Mental e escolaridade entre 4-17 anos. Todos foram submetidos à avaliação da intensidade da voz antes e depois do tratamento pelo Lee Silverman Voice Treatment (LSVT) e foram convidados a responder um questionário sobre suas preferências entre duas opções de tratamento. Resultados: O tratamento resultou em aumento médio de 14dBNPS. Quando questionados sobre a possibilidade de aceitação para participar de um futuro programa de telerreabilitação, 38 indivíduos concordaram e 12 não. Em relação a estes dois grupos, a competência tecnológica foi referida em 26% e 17%, respectivamente. A aceitação à telerreabilitação foi positivamente relacionada com anos de estudo e estado cognitivo. Conclusão: As respostas ao Questionário após a conclusão do LSVT tradicional mostraram que a maioria dos pacientes (76%) concordaria em participar de uma futura telerreabilitação. Idade, sexo, estágio da doença ou competência tecnológica não pareceu influenciar na adesão à telerreabilitação enquanto que outros fatores, como estado cognitivo e anos de escolaridade foram positivamente relacionados com a aceitação da nova forma de terapia.

Efeitos do som basal em fendas glóticas / Effects of vocal fry incomplete glottal closure

TEMA: som basal em fendas glóticas. PROCEDIMENTOS: participaram desta pesquisa dois sujeitos do sexo feminino, com idades entre 20 e 40 anos e diagnóstico otorrinolaringológico de fenda em ampulheta. Houve gravação da emissão sustentada da vogal /a/ e exame videolaringoestroboscópico, imediatamente a seguir, os sujeitos realizaram o som basal em três séries de 15 repetições, e foram submetidos a novo exame laríngeo e gravação da vogal. Os dados pré e pós-realização do som basal foram submetidos às analises acústica, perceptivo-auditiva e videolaringoestroboscópica, realizadas por juízes (três fonoaudiólogas e três otorrinolaringologistas, respectivamente). RESULTADOS: em ambos os sujeitos, houve melhora no fechamento glótico e amplitude de vibração da mucosa das pregas vocais; piora no tipo de voz; aumento das medidas de ruído e de Jitter. CONCLUSÃO: o som basal promoveu redução das fendas glóticas e aumento da amplitude de vibração da mucosa das pregas vocais; piora do tipo de voz, que ficou mais ruidoso; aumento das medidas de ruído e de Jitter, sugerindo irregularidade vibratória, provavelmente devido ao efeito do ajuste do som basal ao mobilizar intensamente a mucosa.

BACKGROUND: vocal fry in incomplete glottal closure. PROCEDURE: two individuals aged between 20 and 40 years old presenting an otolaryngological diagnosis of ampoule chink were part of the study. A recording of the sustained emission of /a/ vowel took place, as well as a videostroboscopic examination. Right after, the individuals completed the vocal fry in three series of 15 repetitions, being submitted to a new laryngeal examination and to the vowel's recording. Both pre-vocal and post vocal fry data were assessed through acoustic, perceptive-auditive and videostroboscopic analysis, carried out by judges (three speech and language pathologists and three otolaryngologists, respectively). RESULTS: for both individuals, there was an improvement in the glottal coaptation and in the amplitude of the vocal folds mucosa vibration; worsen in the voice type; enlargement of noise and Jitter measurements. CONCLUSION: the vocal fry promoted glottal closure reduction and enlargement in the amplitude of the vocal folds mucosa vibration; worsen in the voice type, which became noisier; enlargement of noise and Jitter measurements, suggesting vibratory irregularities, probably due to the basal fry motor adjustments effects when strongly mobilizing the mucosa.