Analysis of different performance times of the voiced trill technique in older women. / Análise dos tempos de execução da técnica de sons vibrantes em idosas.

PURPOSE: To analyze and compare the immediate vocal effects of the voiced trill technique in the assessment of acoustic and auditory-perceptual measures of older women with and without self-perceived vocal changes. METHODS: Clinical, quasi-experimental study in older women, aged 60 to 70 years (n=53). A questionnaire on vocal self-perception, voice, and laryngeal assessment was applied, before and after performing the voiced trill technique. Before and during intervals of the technique, sustained vowel samples were collected, totaling four samples. Older women were divided into two groups: one with self-perceived voice changes (n=25), and the other without self-perceived voice changes (n=28). Auditory-perceptual assessments and acoustic analysis were performed. Statistical tests were used to correlate the data: ANOVA Test for repeated measures, Friedman Test, Wilcoxon Test, and Pearson's Chi-Square Test. For all tests, the significance level was set at 5%. RESULTS: There was a predominance of moderate dysphonia in both groups, according to the auditory-perceptual judgment. There was no statistically significant difference between the groups in the assessment of the auditory-perceptual analysis regarding voice changes (improved, worsened, and unaltered voices) before and after the different technique performance times. Most older women improved their voice after 1 minute of performing the technique. CONCLUSION: Older women often have voice changes when considering the perceptual judgment of the voice. There was no scientific evidence as to the ideal time to obtain a better effect on older women's voices.

OBJETIVO: Analisar e comparar os efeitos vocais imediatos da técnica de sons vibrantes sonoros na avaliação de medidas acústicas e perceptivo-auditivas de idosas com e sem autopercepção de alteração vocal. MÉTODO: Estudo clínico quase experimental, envolvendo 53 idosas com idade entre 60 e 70 anos. Foi aplicado um questionário de autopercepção vocal, avaliação vocal e laríngea, antes e após a realização da técnica vocal com sons vibrantes sonoros. Antes e durante os intervalos da técnica, foram coletadas amostras de vogais sustentadas, totalizando quatro amostras. As mulheres idosas foram divididas em dois grupos: grupo com autopercepção de alteração vocal (n = 25) e grupo sem autopercepção de alteração vocal (n = 28). Foram realizadas avaliações perceptivo-auditivas e análise acústica. Os testes estatísticos foram utilizados para correlacionar os dados: Teste Anova para medidas repetidas, Teste de Friedman e Teste de Wilcoxon e Teste Qui-Quadrado de Pearson. Para todos os testes foi considerado nível de significância de 5%. RESULTADOS: Houve predomínio de disfonia moderada em ambos os grupos, de acordo com a julgamento perceptivo-auditivo. Não houve diferença estatisticamente significante entre os grupos na avaliação da análise perceptivo-auditiva quanto à melhora, piora e voz inalterada antes e após os diferentes tempos de execução da técnica. A maioria das idosas melhorou a voz após um minuto de execução da técnica. CONCLUSÃO: As idosas apresentam elevada presença de alteração vocal quando considerada o julgamento perceptivo-auditivo da voz. Não houve evidências científicas quanto ao momento ideal para se obter um melhor efeito na voz das idosas.

Elderly people with human T-cell leukemia virus type 1-associated myelopathy present an early impairment in cognitive skills.

BACKGROUND: Cerebral changes occur in individuals with human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy (HAM) and seem to predominate in subcortical areas. Little is known about the cognitive decline in the elderly living with HTLV-1. OBJECTIVE: To evaluate the cognitive aging of individuals infected with HTLV-1 aged ≥ 50 years. METHODS: This is a cross-sectional study of former blood donors infected with HTLV-1 who have been followed in the cohort of the Interdisciplinary Research Group on HTLV-1 since 1997. The groups of study consisted of 79 HTLV-1 infected individuals aged ≥ 50 years, with 41 of them presenting symptomatic HAM and 38 being asymptomatic carriers, and 59 seronegative individuals (controls) aged ≥ 60 years. All were submitted to the P300 electrophysiological test and neuropsychological tests. RESULTS: Individuals with HAM presented delayed P300 latency in relation to the other groups, and this latency delay increased progressively with aging. The performance of this group in the neuropsychological tests was also the worst. The HTLV-1- asymptomatic group performance was similar to that of the control group. CONCLUSIONS: Individuals with HAM presented cognitive decline that progressed with aging and, although HTLV-1-asymptomatic carriers appear to present cognitive aging similar to that of healthy elderly people, concern about a subclinical cognitive impairment is warranted in this population.

ANTECEDENTES: Alterações cerebrais ocorrem em indivíduos com mielopatia associada ao vírus da leucemia de células T humanas tipo 1 (HTLV-1) (HAM) e parecem predominar em áreas subcorticais. Pouco se sabe sobre o declínio cognitivo em idosos vivendo com HTLV-1. OBJETIVO: Avaliar o envelhecimento cognitivo de indivíduos infectados pelo HTLV-1 com idade ≥ 50 anos. MéTODOS: Trata-se de um estudo transversal com ex-doadores de sangue infectados pelo HTLV-1 acompanhados na coorte do Grupo Interdisciplinar de Pesquisa em HTLV-1 há 20 anos. Os grupos de estudo foram compostos por 79 indivíduos infectados pelo HTLV-1 com idade ≥ 50 anos, sendo que 41 apresentavam HAM e 38 eram portadores assintomáticos, e 59 indivíduos soronegativos (controles) com idade ≥ 60 anos. Todos foram submetidos ao teste eletrofisiológico P300 e testes neuropsicológicos. RESULTADOS: Indivíduos com HAM apresentaram atraso na latência do P300 em relação aos demais grupos, e esse atraso de latência aumentou progressivamente com o envelhecimento. O desempenho desse grupo nos testes neuropsicológicos também foi o pior. O desempenho do grupo HTLV-1- assintomático foi semelhante ao do grupo controle. CONCLUSãO: Indivíduos com HAM apresentaram declínio cognitivo que progrediu com o envelhecimento e, embora os portadores assintomáticos do HTLV-1 pareçam apresentar envelhecimento cognitivo semelhante ao dos idosos saudáveis, justifica-se a preocupação com um comprometimento cognitivo subclínico nessa população.

Elderly people with human T-cell leukemia virus type 1-associated myelopathy present an early impairment in cognitive skills / Idosos com mielopatia associada ao vírus da leucemia de células T humanas tipo 1apresentam comprometimento precoce em habilidades cognitivas

Abstract Background Cerebral changes occur in individuals with human T-cell leukemia virus type 1 (HTLV-1 )-associated myelopathy (HAM) and seem to predominate in subcortical areas. Little is known about the cognitive decline in the elderly living with HTLV-1. Objective To evaluate the cognitive aging of individuals infected with HTLV-1 aged ≥ 50 years. Methods This is a cross-sectional study of former blood donors infected with HTLV-1 who have been followed in the cohort of the Interdisciplinary Research Group on HTLV-1 since 1997. The groups of study consisted of 79 HTLV-1 infected individuals aged ≥ 50 years, with 41 of them presenting symptomatic HAM and 38 being asymptomatic carriers, and 59 seronegative individuals (controls) aged ≥ 60 years. All were submitted to the P300 electrophysiological test and neuropsychological tests. Results Individuals with HAM presented delayed P300 latency in relation to the other groups, and this latency delay increased progressively with aging. The performance of this group in the neuropsychological tests was also the worst. The HTLV-1- asymptomatic group performance was similar to that of the control group. Conclusions Individuals with HAM presented cognitive decline that progressed with aging and, although HTLV-1-asymptomatic carriers appear to present cognitive aging similar to that of healthy elderly people, concern about a subclinical cognitive impairment is warranted in this population.

Resumo Antecedentes Alterações cerebrais ocorrem em indivíduos com mielopatia associada ao vírus da leucemia de células T humanas tipo 1 (HTLV-1) (HAM) e parecem predominar em áreas subcorticais. Pouco se sabe sobre o declínio cognitivo em idosos vivendo com HTLV-1. Objetivo Avaliar o envelhecimento cognitivo de indivíduos infectados pelo HTLV-1 com idade ≥ 50 anos. Métodos Trata-se de um estudo transversal com ex-doadores de sangue infectados pelo HTLV-1 acompanhados na coorte do Grupo Interdisciplinar de Pesquisa em HTLV-1 há 20 anos. Os grupos de estudo foram compostos por 79 indivíduos infectados pelo HTLV-1 com idade ≥ 50 anos, sendo que 41 apresentavam HAM e 38 eram portadores assintomáticos, e 59 indivíduos soronegativos (controles) com idade ≥ 60 anos. Todos foram submetidos ao teste eletrofisiológico P300 e testes neuropsicológicos. Resultados Indivíduos com HAM apresentaram atraso na latência do P300 em relação aos demais grupos, e esse atraso de latência aumentou progressivamente com o envelhecimento. O desempenho desse grupo nos testes neuropsicológicos também foi o pior. O desempenho do grupo HTLV-1- assintomático foi semelhante ao do grupo controle. Conclusão Indivíduos com HAM apresentaram declínio cognitivo que progrediu com o envelhecimento e, embora os portadores assintomáticos do HTLV-1 pareçam apresentar envelhecimento cognitivo semelhante ao dos idosos saudáveis, justificase a preocupação com um comprometimento cognitivo subclínico nessa população.

Cepstral Measurements: A Comparison of Results Between Singing and Non-Singing Individuals.

OBJECTIVE: To analyze and compare cepstral measurements in singing and non-singing men and women to understand if vocal adaptations of singers reflect greater cepstral measurement results. METHOD: The study included 91 vocally healthy individuals, consisting of 60 erudite or popular singers (30 males, 30 females) and 31 non-singers (16 males, 15 females). The Cepstral Peak Prominence (CPP) and Cepstral Peak Prominence-Smoothed (CPPS) measures were carried out using the sustained /a/ vowel recorded with a unidirectional condenser microphone associated with a sound card on the computer. The Praat software (version 6.1.16) was used to extract the CPP and CPPS measurements. The intra and intergroup values obtained for each sex were compared using the t-test with a 5% significance level. RESULTS: There was a CPP (P = 0,000) and CPPS (P = 0,000 and P = 0,001) value difference between the sexes in both groups. Cepstral measurements showed no statistically significant difference between singing and non-singing participants (male: P = 0,778 and P = 0,622; female: P = 0,622 and P = 0,460). CONCLUSION: Men presented higher CPP and CPPS values than women, which may be related to the presence of the physiological posterior glottic cleft in women. The knowledge of the cepstral values of singers shows that singing specificities may not reflect in all vocal evaluations.

Nebulized Saline Solution: A Multidimensional Voice Analysis.

PURPOSE: To verify the effect of nebulization on the voice of dysphonic and non-dysphonic individuals on acoustic, perceptual-auditory, aerodynamic, electroglottographic, laryngeal parameters and on the self-perception of vocal discomfort. MATERIALS AND METHODS: All the research subjects were submitted to vocal evaluation, laryngeal and voice self-perception. Then, the participants remained in vocal rest for a period of 10 minutes and the analysis mentioned above were again performed. After this first stage, the participants were submitted to the nebulization for a period of 10 minutes and the all analysis above were again performed. Descriptive analysis of the variables was carried. In the comparison of the pre- and post-nebulization groups, the Paired T-Student Test was used for variables with non-dysphonic distribution and the Wilcoxon Test for variables with asymmetric distribution. When categorical variables were evaluated (perceptual-auditory evaluation and laryngeal assessment), the Pearson's Chi-square test was used. In all analysis, a significance level of 5% was considered. The intra-rater agreement in the auditory-perceptual and perceptual-visual assessment was assessed using the AC1 statistic, using the R program. For this purpose, 20% of the voice samples and laryngeal images were replicated blindly and interpreted by the evaluators at the time evaluations. RESULTS: The results of this research show that non-dysphonic individuals have more positive vocal and laryngeal effects after nebulization than dysphonic ones. It is also observed that the EGG measurement was the most sensitive to the effect of nebulization, with an increase in the Closed quotient (CQ) in all groups evaluated. Regarding acoustic measurements, it is noted that the effect of nebulization in men is more evident than in women. After nebulization, there was an increase in fundamental frequency in the group of non-dysphonic women and dysphonic and non-dysphonic men. A decrease in the amplitude perturbation quotient values is observed in all groups, besides a reduction in the pitch perturbation quotient values after nebulization in non-dysphonic men groups. There was improves aerodynamic efficiency in groups of dysphonic and non-dysphonic men and in the self-perception of vocal discomfort in all groups studied after the hydration procedure. The results of this study demonstrate a significant improvement in the mucosal wave after nebulization in the groups of women and men who are not dysphonic. CONCLUSION: The nebulization procedure with saline solution improves acoustic measurements, the electroglottographic closed quotient and vocal self-perception of dysphonic and non-dysphonic women and men. Nebulization increases the mucosal wave of the vocal folds in non-dysphonic women and men and improves the aerodynamic efficiency of men.

Análise dos tempos de execução da técnica de sons vibrantes em idosas / Analysis of different performance times of the voiced trill technique in older women

RESUMO Objetivo Analisar e comparar os efeitos vocais imediatos da técnica de sons vibrantes sonoros na avaliação de medidas acústicas e perceptivo-auditivas de idosas com e sem autopercepção de alteração vocal. Método Estudo clínico quase experimental, envolvendo 53 idosas com idade entre 60 e 70 anos. Foi aplicado um questionário de autopercepção vocal, avaliação vocal e laríngea, antes e após a realização da técnica vocal com sons vibrantes sonoros. Antes e durante os intervalos da técnica, foram coletadas amostras de vogais sustentadas, totalizando quatro amostras. As mulheres idosas foram divididas em dois grupos: grupo com autopercepção de alteração vocal (n = 25) e grupo sem autopercepção de alteração vocal (n = 28). Foram realizadas avaliações perceptivo-auditivas e análise acústica. Os testes estatísticos foram utilizados para correlacionar os dados: Teste Anova para medidas repetidas, Teste de Friedman e Teste de Wilcoxon e Teste Qui-Quadrado de Pearson. Para todos os testes foi considerado nível de significância de 5%. Resultados Houve predomínio de disfonia moderada em ambos os grupos, de acordo com a julgamento perceptivo-auditivo. Não houve diferença estatisticamente significante entre os grupos na avaliação da análise perceptivo-auditiva quanto à melhora, piora e voz inalterada antes e após os diferentes tempos de execução da técnica. A maioria das idosas melhorou a voz após um minuto de execução da técnica. Conclusão As idosas apresentam elevada presença de alteração vocal quando considerada o julgamento perceptivo-auditivo da voz. Não houve evidências científicas quanto ao momento ideal para se obter um melhor efeito na voz das idosas.

ABSTRACT Purpose To analyze and compare the immediate vocal effects of the voiced trill technique in the assessment of acoustic and auditory-perceptual measures of older women with and without self-perceived vocal changes. Methods Clinical, quasi-experimental study in older women, aged 60 to 70 years (n=53). A questionnaire on vocal self-perception, voice, and laryngeal assessment was applied, before and after performing the voiced trill technique. Before and during intervals of the technique, sustained vowel samples were collected, totaling four samples. Older women were divided into two groups: one with self-perceived voice changes (n=25), and the other without self-perceived voice changes (n=28). Auditory-perceptual assessments and acoustic analysis were performed. Statistical tests were used to correlate the data: ANOVA Test for repeated measures, Friedman Test, Wilcoxon Test, and Pearson's Chi-Square Test. For all tests, the significance level was set at 5%. Results There was a predominance of moderate dysphonia in both groups, according to the auditory-perceptual judgment. There was no statistically significant difference between the groups in the assessment of the auditory-perceptual analysis regarding voice changes (improved, worsened, and unaltered voices) before and after the different technique performance times. Most older women improved their voice after 1 minute of performing the technique. Conclusion Older women often have voice changes when considering the perceptual judgment of the voice. There was no scientific evidence as to the ideal time to obtain a better effect on older women's voices.

Galvanic vestibular stimulation to improve postural instability, voluntary attention, and quality of life in Parkinson's disease patients / Estimulação vestibular galvânica na melhora da atenção voluntária e da qualidade de vida em pacientes com doença de Parkinson e desequilíbrio corporal

ABSTRACT Galvanic vestibular stimulation (GVS) influences body balance and has proved to be useful to improve patients' mood, quality of life, and cognitive skills. This study aimed to present three cases of patients with Parkinson's disease and postural instability who had been submitted to GVS to improve their balance, by assessing the impact of this intervention on their cognition, mood, and quality of life. Patients were assessed before and after GVS sessions concerning P300 latency and scores on the 15-item Geriatric Depression Scale (GDS-15) and the 39-item quality-of-life Parkinson's Disease Questionnaire (PDQ-39). The three patients' P300 latency improved, possibly indicating improved attention. Their PDQ-39 score also improved, possibly indicating a positive impact on their quality of life. Their GDS-15 score did not change before and after the intervention. None of the patients had any intervention side effects. This three-case experimental pilot study has shown that GVS is a safe method, possibly useful to improve attention and, therefore, the quality of life of patients presented with Parkinson's disease.

RESUMO A Estimulação Vestibular Galvânica (EVG) atua no equilíbrio corporal e tem se mostrado útil na melhora do humor, da qualidade de vida e de habilidades cognitivas. O objetivo deste estudo foi apresentar três casos de pacientes com doença de Parkinson e instabilidade postural que foram submetidos à EVG para melhorar o equilíbrio e avaliar o impacto dessa intervenção na cognição, no humor e na qualidade de vida. Os pacientes foram avaliados antes e após as sessões de EVG quanto a latência do potencial evocado P300, pontuação na escala de depressão geriátrica de 15 itens (EDG-15) e pelo questionário de qualidade de vida na doença de Parkinson de 39 itens (PDQ-39). Os três pacientes apresentaram melhora na latência do P300, indicando possível melhora na atenção. Apresentaram melhora na pontuação do PDQ-39, indicando possível impacto positivo na qualidade de vida. A pontuação na EDG-15 não modificou antes e após a intervenção. Nenhum paciente apresentou efeitos colaterais decorrentes da intervenção. Com base neste estudo piloto experimental de três casos, a EVG mostrou-se um método seguro e possivelmente útil para melhorar a atenção e, consequentemente, a qualidade de vida de pacientes com doença de Parkinson.

Galvanic vestibular stimulation and its applications: a systematic review,

Abstract Objective: Galvanic vestibular stimulation has been evaluated in the context of vestibular rehabilitation. The objective was to identify evidence in the scientific literature about the clinical applications of galvanic vestibular stimulation. Methods: In this systematic review, the articles describing the applications of galvanic vestibular stimulation were extracted from PubMed, Web of Science, MEDLINE, Scopus, LILACS and SciELO databases. The survey was limited to articles published in English, Portuguese and Spanish. All the articles about the clinical applications of galvanic vestibular stimulation were compiled. Repeated articles in the databases, literature review articles, case reports, letters and editorials were excluded. The descriptors included: galvanic vestibular stimulation, postural balance, central nervous system diseases, vestibular diseases, spinal cord diseases and cognition. Results: The search strategy resulted in the initial selection of 994 articles; the reading of titles and abstracts was accomplished in 470 articles and the complete reading in 23 articles. Clinical applications of galvanic vestibular stimulation included Ménière's disease, vestibular neuritis, bilateral vestibular disorders, vestibular schwannoma, Parkinson's disease, ischemic central lesions, motor myelopathies, anxiety disorders, cognition and memory. Conclusion: Galvanic vestibular stimulation has been considered a potentially useful strategy for balance rehabilitation, since it has the effect of stimulating the central connections related to the postural balance, favoring new neuronal synapses that allow the partial or total recovery of postural imbalance.

Galvanic vestibular stimulation and its applications: a systematic review.

OBJECTIVE: Galvanic vestibular stimulation has been evaluated in the context of vestibular rehabilitation. The objective was to identify evidence in the scientific literature about the clinical applications of galvanic vestibular stimulation. METHODS: In this systematic review, the articles describing the applications of galvanic vestibular stimulation were extracted from PubMed, Web of Science, MEDLINE, Scopus, LILACS and SciELO databases. The survey was limited to articles published in English, Portuguese and Spanish. All the articles about the clinical applications of galvanic vestibular stimulation were compiled. Repeated articles in the databases, literature review articles, case reports, letters and editorials were excluded. The descriptors included: galvanic vestibular stimulation, postural balance, central nervous system diseases, vestibular diseases, spinal cord diseases and cognition. RESULTS: The search strategy resulted in the initial selection of 994 articles; the reading of titles and abstracts was accomplished in 470 articles and the complete reading in 23 articles. Clinical applications of galvanic vestibular stimulation included Ménière's disease, vestibular neuritis, bilateral vestibular disorders, vestibular schwannoma, Parkinson's disease, ischemic central lesions, motor myelopathies, anxiety disorders, cognition and memory. CONCLUSION: Galvanic vestibular stimulation has been considered a potentially useful strategy for balance rehabilitation, since it has the effect of stimulating the central connections related to the postural balance, favoring new neuronal synapses that allow the partial or total recovery of postural imbalance.