Evaluation of Psychometric Properties of Voice Activity and Participation Profile (VAPP): A Spanish Version.

OBJECTIVES: This study aimed to analyze the psychometric properties of the Spanish version of the Voice Activity and Participation Profile (SVAPP) questionnaire. STUDY DESIGN: A randomized, cross-sectional sampling strategy with controls was used. METHODS: Two samples with a total of 169 participants were analyzed, specifically 61 men (mean age 37.02) and 108 women (mean age 37.78). Of these participants, 112 were patients and 57 were controls. The instrument was submitted to reliability (internal consistency and corrected item-total correlations) and reproducibility analyses. Validation assessment was based on the construct validity, convergent validity, discriminant validity, and concurrent validity. RESULTS: The global internal consistency was excellent (Cronbach's α = 0.976), corrected item-total correlations were satisfactory and ranged 0.63-0.89, and factor loadings were above 0.50. The different subscales showed good internal consistency (alpha coefficients ranged 0.830-0.956) and test-retest values were consistently associated. The exploratory factor analysis evidenced a strongly defined five factors internal structure, with factors loadings ranging 0.51-0.86. Convergent validity demonstrated that all subscales and scores were very strongly correlated (Pearson r above 0.735) and significantly associated. The discriminant validity analysis showed that SVAPP had good specificity to distinguish dysphonic from healthy voice subjects. Concurrent validity with Voice Handicap Index Spanish version (SVHI) showed very strong correlations between total scores, and between SVHI total score and SVAPP Daily and Social Communication subscales; correlations between both tests subscales were strong; only between SVAPP Work and SVHI Physical sections correlations were moderate. CONCLUSIONS: The findings of the present study demonstrated evidence for the SVAPP questionnaire reliability and validity, and provided insightful implications of voice disorders on Spanish patients' quality of life. However, further investigations are required.

Estrategias para potenciar el aprendizaje motor en el tratamiento vocal de las enfermedades neurodegenerativas / Strategies to stimulate motor learning during vocal therapy in neurodegenerative diseases

Los déficits del sistema sensoriomotor tienen un efecto dramático sobre la calidad de vida de las personas con enfermedades neurodegenerativas, especialmente la afectación de los nervios craneales responsables de la deglución, de la fonoarticulación, de la expresión facial y de la voz. Actualmente existe evidencia científica de que al entrenar sistemáticamente los grupos musculares encargados de los movimientos fonorrespiratorios, puede mejorarse o lentificarse el avance de la enfermedad y sus efectos sobre el deterioro sensoriomotor. Sin embargo, aún no se ha avanzado lo suficiente en el diseño de estrategias específicas para propiciar la generalización de los resultados terapéuticos, esto es, para favorecer la transferencia de las mejorías desde la clínica a la vida cotidiana del enfermo neurodegenerativo. En este estudio se exponen los principios básicos del aprendizaje motor, sus fases y pautas de administración, centrándose en la aplicación de estos aspectos al tratamiento de personas con problemas de voz de origen neurodegenerativo. En una segunda parte se hace una revisión de la literatura sobre los factores que potencian la efectividad del método LSVT®. Se analiza cómo dicho modelo terapéutico aplica las teorías del aprendizaje motor al tratamiento de los problemas fonatorios de las personas que padecen Parkinson, proporcionando una generalización de las mejorías motoras y una repercusión de dichos beneficios a nivel de la lesión neurológica, la función vocal, la inteligibilidad del habla y la deglución, con resultados terapéuticos que han demostrado mantenerse a corto, medio y largo plazo por encima del nivel previo al tratamiento (AU)

Sensorimotor deficits have a devastating effect on the quality of life of people with neurodegenerative diseases, especially disruptions of craniofacial nerves. These disorders affect voice, speech, facial expression and deglutition. Scientific evidence indicates that targeted training of laryngeal and respiratory muscle groups may reverse or slow disease progression as well as its cranial sensorimotor deficits. However there is still a lack of specifically designed strategies to achieve motor learning and to enhance the generalization of therapeutic results; e.g. there is a need for specific treatment protocols that improve the transfer of motor abilities from the clinical setting to the patient's actual environment. The purpose of this study is primarily aimed at reviewing the principles, phases and forms of motor learning and the application of motor learning requisites to the treatment of vocal problems in neurodegenerative diseases. In the second part of the article we analyze how the Lee Silverman Voice Treatment (LSVT®) method applies theories of motor learning to the treatment of voice problems in persons with Parkinson's disease. This method has been shown to improve the neurological lesion, vocal function, speech intelligibility and deglutition, with most of its effects being maintained in the short, medium and long term (AU)

Revisión del concepto de eficacia en el tratamiento vocal de las enfermedades neurodegenerativas / Revising the concept of efficacy in the vocal therapy of neurodegenerative diseases

El tratamiento de los trastornos de la voz en las enfermedades neurodegenerativas es un tema muy controvertido, ya que no es posible esperar ni que la función se recupere totalmente, ni que las mejorías derivadas del tratamiento se mantengan a largo plazo. Es por ello que programar el tratamiento de la voz en estos trastornos implica replantearse el concepto de eficacia, ya que en estas personas no es posible conseguir logros permanentes. Sin embargo, actualmente existen estudios que demuestran resultados funcionales que permiten mantener por más tiempo una mejor calidad de vida. En este trabajo se ha revisado el estado actual de la literatura sobre el concepto de eficacia en el tratamiento de los problemas vocales de las enfermedades neurodegenerativas, analizando una serie de factores que favorecen esta eficacia y propician una mayor y más permanente disminución de la limitación funcional. Entre los factores propuestos cabe señalar la precocidad en la intervención, la jerarquización sistemática de objetivos terapéuticos y la diversificación de recursos. Asimismo se han seleccionado los protocolos de intervención para paliar los 3 tipos de déficits fonorrespiratorios más comunes en este tipo de enfermedades, esto es: la insuficiencia fonorrespiratoria, la incoordinación fonorrespiratoria y las disfunciones laríngeas. La eficacia de las tareas propuestas ha sido avalada en la literatura, bien por la medicina basada en la evidencia, bien por la opinión de expertos (AU)

Treating voice problems in neurodegenerative diseases is a controversial topic due to the lack of expectations of achieving complete functional recovery or long-lasting improvement. Therefore, when planning voice therapy in these disorders, the concept of efficacy needs to be redefined, since permanent improvements cannot be achieved in these patients. However, studies have been published that show more permanent functional benefits and improvements in quality of life of these persons. The present study was designed to review the state of the art on the vocal therapy of neurodegenerative diseases and to analyze the factors that enhance treatment efficacy and favor greater and longer-lasting reduction of functional limitations. Among the proposed factors to increase treatment efficacy are starting the intervention in the initial phases of the disorder, systematically planning the hierarchy of therapeutic targets, and implementing a multidimensional approach to different types of treatment resources. Additionally, a series of therapeutic protocols were selected to address the three main phonation deficits in neurodegenerative diseases, i.e. respiratory insufficiency, phonation incoordination and laryngeal dysfunction. All of the therapeutic strategies proposed in this study have been documented as being target efficient by either scientific evidence or expert opinion (AU)

School teachers' vocal use, risk factors, and voice disorder prevalence: guidelines to detect teachers with current voice problems.

UNLABELLED: Teachers' voice problems are widely recognized as a consequence of their work. The measurement of vocal demands and risk factors is essential for adjusting occupational safety and health services to this population's needs. OBJECTIVES: To correlate vocal behavior and symptomatology with risk factors and voice disorders, and to further analyze gender influence on these variables. SUBJECTS AND METHODS: 282 kindergarten and elementary education teachers were surveyed in a cross-sectional study using a self-administered questionnaire. For the purpose of this study, voice disorder prevalence was estimated based on the presence of a vocal effort plus 2 frequent symptoms. RESULTS: 81.5% of teachers reported some degree of vocal effort; more than 60% of subjects evidenced frequent throat paresthesias or vocal fatigue at the end of a working day, and about 55% reported hoarseness. Voice disorder prevalence was 59%. Multivariate logistic regression analysis revealed that female gender, time required to alleviate vocal symptoms, perceived general state of health, prolonged use of the voice, and pupils' indiscipline significantly increased the odds of having vocal problems. CONCLUSIONS: Voice disorders affected most teachers and had a multifactorial nature. Vocal health care is particularly necessary for those subjects reporting vocal effort and more than 2 frequent symptoms.