Vocal Tract Discomfort Scale-Brazil (VTDS-BR): Validation Based on Internal Consistency, Reliability, and Accuracy.

OBJECTIVE: To validate the Vocal Tract Discomfort Scale for the Brazilian Portuguese (VTDS-BR), based on internal consistency, reliability, and accuracy. METHODS: The participants were 431 adults of both sexes, divided in two groups: dysphonia (DG) and vocally healthy (VHG). We built a digital database with personal, professional information and the item-by-item VTDS-BR responses of the participants. We applied Cronbach's alpha, exploratory factor analysis; confirmatory factor analysis; Item Response Theory (IRT) using the Samejima model; and ROC (Receiver Operating Characteristic) curve analysis to obtain the VTDS-BR cut-off point. RESULTS: The VTDS-BR has an eight-item structure and two factors: vocal hyperfunction without phonotraumatic injury and with phonotraumatic injury. Each item is evaluated based on two facets related to frequency and intensity, with a Likert scale response key. There are four possible answers: never, sometimes, often, and always for frequency and none, mild, moderate, and intense for intensity. We applied an IRT model, which allowed the identification of which items are more related to dysphonia, based on higher values in the parameters discrimination (a) and difficulty (b), which contributed to the calculation of each participant's aptitude for the development of voice problems, by means of a score. The cut-off value was determined using the ROC curve, in which values greater than - 1.432 indicate a higher probability of voice alterations. CONCLUSION: VTDS-BR went through the stages of validation of internal consistency, reliability, and accuracy. It presents an 8-item, two-factor, and two-facet structure to assess frequency and intensity of vocal tract discomfort symptoms. VTDS-BR is suitable for clinical use or in screening activities, as it is quick to apply and its interpretation is indicative of people with and without phonotraumatic injury.

Evidências de validade de critério concorrente e preditiva do Instrumento de Rastreio da Comunicação de Crianças de 0 a 36 meses (IRC-36) / Evidence of concurrent and predictive criterion validity of the Child Communication Screening Instrument from 0 to 36 months (IRC-36)

RESUMO Objetivo Determinar evidências de validade de critério concorrente e preditiva do Instrumento de Rastreio da Comunicação de crianças de 0 a 36 meses (IRC-36). Método Participaram da pesquisa 78 pais/responsáveis de crianças que frequentam o serviço de puericultura das Unidades de Saúde da Família, além de 33 crianças com idades entre 0 e 36 meses, convidadas para segunda etapa do estudo. Na primeira etapa do estudo, 13 profissionais de saúde foram treinados para realizar a aplicação do IRC-36 nos pais/responsáveis das crianças. No segundo momento, os pais responderam a uma nova aplicação do IRC-36 e as crianças foram avaliadas com o Denver II. Resultados O IRC-36 apresentou correlação com o Denver II em mais da metade dos casos, confirmando a validade de critério concorrente do instrumento. Os resultados do IRC-36 da primeira etapa quando correlacionados com o Denver II, não apresentaram valores significativos. O valor de ponto de corte do instrumento foi 12, sendo este o valor de referência entre crianças em risco e sem risco para alteração da comunicação. O instrumento apresentou valor de acurácia dentro dos níveis preconizados e alta sensibilidade. A ocorrência de risco para alteração da comunicação apresentou-se maior na segunda aplicação do IRC-36. Conclusão O estudo apresentou evidências de validade de critério concorrente, indicando que o instrumento possui evidências de medidas de acurácia e de validade para o rastreio da comunicação de crianças de 0 a 36 meses sendo capaz de identificar risco para as alterações da comunicação.

ABSTRACT Purpose To determine evidence of concurrent and predictive criterion validity of the Communication Screening Instrument for children aged 0 to 36 months (IRC-36). Methods 78 parents/guardians of children who attend the childcare service of the Family Health Centers participated in the research, in addition to 33 children aged between 0 and 36 months, invited to the second stage of the study. In its first stage, 13 health professionals were trained to apply the IRC-36 to the children's parents/guardians. In the second moment, the parents responded to a new IRC-36 application, and the children were evaluated with Denver II. Results IRC-36 correlated with Denver II in more than half of the cases, confirming the instrument's concurrent criterion validity. IRC-36 results in the first stage did not significantly correlate with Denver II. The instrument's cutoff value was 12, which is the reference value between children at risk and not at risk of communication disorders. The instrument had high sensitivity and an accuracy value within the recommended levels. The occurrence of risk of communication changes was higher in the second IRC-36 application. Conclusion The study presented evidence of concurrent criterion validity, indicating that the instrument has evidence of accuracy and validity measures to screen communication in children aged 0 to 36 months, being able to identify the risk for communication disorders.

Characterization of linguistic development of children affected by congenital Zika virus syndrome as compared to typically developing peers / Caracterização do desenvolvimento infantil e linguístico de crianças acometidas da Síndrome Congênita do Zika Vírus comparadas com crianças de desenvolvimento típico

ABSTRACT Purpose: to describe the development, focusing on language, of children affected by congenital Zika syndrome and compare it with that of typically developing children. Methods: a quantitative, observational, cross-sectional, case-control study. Data from the group of children with congenital Zika virus syndrome (case) were matched for sex and age with data from the group of typically developing children without comorbidities (control). The research included 20 parents/guardians of the children in the case group and 20 parents/guardians of the children in the control group, using interview as an adapted instrument. The data underwent descriptive and inferential statistical analysis, through association tests and comparison of means, with the significance level set at 5%. Results: there was a statistical difference in motor, auditory, and language development between the groups, according to the parents' perception. Conclusion: Based on the caregivers' reports, most of the case group communicated non-verbally through babbling, shouting, and eye contact, whereas the minority communicated through dialogue, understood simple orders, and performed imitative behaviors, symbolic play, and shared attention. On the other hand, the control group communicated through complex sentences constructed into narratives.

RESUMO Objetivo: descrever o desenvolvimento infantil, com enfoque na linguagem, de crianças acometidas da síndrome congênita do Zika e compará-lo com o de crianças com desenvolvimento típico. Métodos: trata-se de um estudo observacional, transversal, do tipo caso-controle, e de natureza quantitativa. Os dados do grupo de crianças com Síndrome Congênita do Zika vírus (caso) foram pareados por sexo e idade com os dados do grupo de crianças sem comorbidades e desenvolvimento típico (controle). Participaram da pesquisa, 20 responsáveis pelas crianças do grupo caso e 20 pelas crianças do grupo controle e o instrumento utilizado foi uma entrevista adaptada. Os dados foram examinados por meio de uma análise estatística descritiva e inferencial por meio de testes de associação e de comparação de médias, com nível de significância de 5%. Resultados: foi observada diferença estatística entre os grupos estudados, referente ao desenvolvimento infantil, no âmbito motor, auditivo e de linguagem, com base na percepção dos pais. Conclusão: diante das informações dos cuidadores, a comunicação da maioria do grupo caso ocorre de forma não verbal por meio de gorjeios, gritos e contato visual; e a minoria comunica-se por diálogo, compreende ordens simples, realiza condutas imitativas, brincar simbólico e tem atenção compartilhada. Diferentemente, o grupo controle comunica-se por meio de frases complexas presentes em narrativas.

Evidence of concurrent and predictive criterion validity of the Child Communication Screening Instrument from 0 to 36 months (IRC-36). / Evidências de validade de critério concorrente e preditiva do Instrumento de Rastreio da Comunicação de Crianças de 0 a 36 meses (IRC-36).

PURPOSE: To determine evidence of concurrent and predictive criterion validity of the Communication Screening Instrument for children aged 0 to 36 months (IRC-36). METHODS: 78 parents/guardians of children who attend the childcare service of the Family Health Centers participated in the research, in addition to 33 children aged between 0 and 36 months, invited to the second stage of the study. In its first stage, 13 health professionals were trained to apply the IRC-36 to the children's parents/guardians. In the second moment, the parents responded to a new IRC-36 application, and the children were evaluated with Denver II. RESULTS: IRC-36 correlated with Denver II in more than half of the cases, confirming the instrument's concurrent criterion validity. IRC-36 results in the first stage did not significantly correlate with Denver II. The instrument's cutoff value was 12, which is the reference value between children at risk and not at risk of communication disorders. The instrument had high sensitivity and an accuracy value within the recommended levels. The occurrence of risk of communication changes was higher in the second IRC-36 application. CONCLUSION: The study presented evidence of concurrent criterion validity, indicating that the instrument has evidence of accuracy and validity measures to screen communication in children aged 0 to 36 months, being able to identify the risk for communication disorders.

OBJETIVO: Determinar evidências de validade de critério concorrente e preditiva do Instrumento de Rastreio da Comunicação de crianças de 0 a 36 meses (IRC-36). MÉTODO: Participaram da pesquisa 78 pais/responsáveis de crianças que frequentam o serviço de puericultura das Unidades de Saúde da Família, além de 33 crianças com idades entre 0 e 36 meses, convidadas para segunda etapa do estudo. Na primeira etapa do estudo, 13 profissionais de saúde foram treinados para realizar a aplicação do IRC-36 nos pais/responsáveis das crianças. No segundo momento, os pais responderam a uma nova aplicação do IRC-36 e as crianças foram avaliadas com o Denver II. RESULTADOS: O IRC-36 apresentou correlação com o Denver II em mais da metade dos casos, confirmando a validade de critério concorrente do instrumento. Os resultados do IRC-36 da primeira etapa quando correlacionados com o Denver II, não apresentaram valores significativos. O valor de ponto de corte do instrumento foi 12, sendo este o valor de referência entre crianças em risco e sem risco para alteração da comunicação. O instrumento apresentou valor de acurácia dentro dos níveis preconizados e alta sensibilidade. A ocorrência de risco para alteração da comunicação apresentou-se maior na segunda aplicação do IRC-36. CONCLUSÃO: O estudo apresentou evidências de validade de critério concorrente, indicando que o instrumento possui evidências de medidas de acurácia e de validade para o rastreio da comunicação de crianças de 0 a 36 meses sendo capaz de identificar risco para as alterações da comunicação.

Comparison of efficiency of different self-assessment instruments for screening dysphonia. / Comparação da eficiência de diferentes instrumentos de autoavaliação para o rastreio da disfonia.

PURPOSE: To compare the efficiency of different vocal self-assessment instruments for dysphonia screening. METHODS: 262 dysphonic and non-dysphonic individuals participated in the research. The mean age was 41.3 (±14.5) years. The diagnosis of dysphonia was based on the auditory-perceptual analysis of the sustained vowel "é" and on laryngological diagnosis. The responses of the instruments were collected: Voice-Related Quality of Life (V-RQOL), Voice Handicap Index (VHI), VHI-10, Voice Symptoms Scale (VoiSS), and the Brazilian Dysphonia Screening Tool, (Br-DST) called in Brazilian Portuguese Instrumento de Rastreio da Disfonia (IRDBR). To analyze assertiveness in relation to the presence of dysphonia, the cutoff points of each instrument and the decision rule recommended by the IRDBR were used. An exploratory analysis was performed to compare mean scores of instruments and verify associations between variables. RESULTS: The instruments evaluated were sensitive to capture the impact of dysphonia in a similar way regardless of professional voice use and type of dysphonia. There was a difference only in VoiSS scores for the variable gender, with a higher score for females. Regarding global assertiveness, the instruments showed high rates of success in classification, with emphasis on the VoiSS, which had the highest rate (86.3%), followed by the IRDBR (84.0%), VQL (80.9%), VHI (78.2%), and VHI-10 (75.2%). CONCLUSION: The VoiSS has the highest assertiveness index in the identification of dysphonia, followed by the IRDBR. The IRDBR is a short, simple, and easy-to-apply tool for screening procedures.

OBJETIVO: Comparar a eficiência de diferentes instrumentos de autoavaliação vocal para o rastreio da disfonia. MÉTODO: Participaram 262 indivíduos disfônicos e não disfônicos, com média de idade de 41,3 (±14,5) anos. O diagnóstico da disfonia foi dado a partir da análise perceptivo-auditiva da vogal sustentada "é" e do diagnóstico laringológico. Foram coletadas as respostas dos instrumentos: Questionário de Qualidade de Vida em Voz (QVV), Índice de Desvantagem Vocal (IDV), IDV-10, Escala de Sintomas Vocais (ESV) e do Br-DST (Brazilian Dysphonia Screening Tool), denominado no português brasileiro como Instrumento de Rastreio da Disfonia (IRDBR). Para análise da assertividade destes em relação à presença da disfonia, foram utilizados os pontos de corte de cada instrumento e a regra de decisão preconizada pelo IRDBR. Foi realizada uma análise exploratória para comparação das médias dos escores dos instrumentos e verificação de associações entre as variáveis. RESULTADOS: Os instrumentos avaliados foram sensíveis para captar o impacto da disfonia de forma semelhante independentemente do uso profissional da voz e tipo de disfonia. Foi observada diferença apenas nos escores da ESV para a variável sexo, com maior pontuação observada no sexo feminino. Em relação à assertividade global, os instrumentos apresentaram elevados índices de acerto na classificação, com destaque para a ESV que apresentou maior índice (86,3%), seguida do IRDBR (84,0%), QVV (80,9%), IDV (78,2%) e IDV-10 (75,2%). CONCLUSÃO: A ESV apresenta maior índice de assertividade na identificação da disfonia, seguida do IRDBR. O IRDBR é uma ferramenta curta, simples e de fácil aplicação para procedimentos de rastreio.

Validation of the Brazilian Scale of Perceived Control Over Voice in the Present using Item Response Theory.

OBJECTIVE: this study aims to verify the stages of evidence of validity of the voice-adapted present perceived control scale (V-APPCS) in its translated and cross-culturally adapted version for the Brazilian Portuguese "Voice-Adapted Present Perceived Control Scale" and to estimate the psychometric measurements of the properties of its items based on the item response theory (IRT). METHODS: the instrument underwent a process of translation and cross-cultural adaptation for the Brazilian Portuguese, the process was carried out by two qualified translators, native in the destination language, and fluent in the language and culture of origin. The first translated version of the protocol was forwarded to a back-translation, performed by a third bilingual Brazilian translator. The translations were analyzed and compared by a committee composed of five speech therapists who are specialists in voice and with proficiency in the English language. The empirical study used data from 168 individuals, 127 had voice problems and 41 vocally healthy ones. For the stages of validity evidence, the following analyses were performed: Cronbach's alpha, exploratory factor analysis, confirmatory factor analysis and IRT. RESULTS: The stages of translation and cross-cultural adaptation allowed linguistic adjustments to be made so that the items were understandable and suitable for use in Brazil. The adequacy, structure, and application of the items were confirmed through the application of the final version of the scale in twenty individuals in a real context. The instrument in its Brazilian version presented good internal consistency, with bifactorial structure the exploratory factor analysis, besides presenting satisfactory values in the adjustment indexes of the model, confirming the structure of the confirmatory factor Analysis. The IT was applied to evaluate the parameters discrimination (a) and difficulty (b) of the items of the instrument; item 5 "I have control over my day-to-day reactions to the voice problem." Presented itself as a more discriminative item and item 8 "My reaction to the voice problem is not under my control." As an item of greater difficulty. CONCLUSION: The V-APPCS, translated, cross-culturally adapted, and validated, is robust and adequate to represent the construct in the Brazilian versions.

Comparação da eficiência de diferentes instrumentos de autoavaliação para o rastreio da disfonia / Comparison of efficiency of different self-assessment instruments for screening dysphonia

RESUMO Objetivo Comparar a eficiência de diferentes instrumentos de autoavaliação vocal para o rastreio da disfonia. Método Participaram 262 indivíduos disfônicos e não disfônicos, com média de idade de 41,3 (±14,5) anos. O diagnóstico da disfonia foi dado a partir da análise perceptivo-auditiva da vogal sustentada "é" e do diagnóstico laringológico. Foram coletadas as respostas dos instrumentos: Questionário de Qualidade de Vida em Voz (QVV), Índice de Desvantagem Vocal (IDV), IDV-10, Escala de Sintomas Vocais (ESV) e do Br-DST (Brazilian Dysphonia Screening Tool), denominado no português brasileiro como Instrumento de Rastreio da Disfonia (IRDBR). Para análise da assertividade destes em relação à presença da disfonia, foram utilizados os pontos de corte de cada instrumento e a regra de decisão preconizada pelo IRDBR. Foi realizada uma análise exploratória para comparação das médias dos escores dos instrumentos e verificação de associações entre as variáveis. Resultados Os instrumentos avaliados foram sensíveis para captar o impacto da disfonia de forma semelhante independentemente do uso profissional da voz e tipo de disfonia. Foi observada diferença apenas nos escores da ESV para a variável sexo, com maior pontuação observada no sexo feminino. Em relação à assertividade global, os instrumentos apresentaram elevados índices de acerto na classificação, com destaque para a ESV que apresentou maior índice (86,3%), seguida do IRDBR (84,0%), QVV (80,9%), IDV (78,2%) e IDV-10 (75,2%). Conclusão A ESV apresenta maior índice de assertividade na identificação da disfonia, seguida do IRDBR. O IRDBR é uma ferramenta curta, simples e de fácil aplicação para procedimentos de rastreio.

ABSTRACT Purpose To compare the efficiency of different vocal self-assessment instruments for dysphonia screening. Methods 262 dysphonic and non-dysphonic individuals participated in the research. The mean age was 41.3 (±14.5) years. The diagnosis of dysphonia was based on the auditory-perceptual analysis of the sustained vowel "é" and on laryngological diagnosis. The responses of the instruments were collected: Voice-Related Quality of Life (V-RQOL), Voice Handicap Index (VHI), VHI-10, Voice Symptoms Scale (VoiSS), and the Brazilian Dysphonia Screening Tool, (Br-DST) called in Brazilian Portuguese Instrumento de Rastreio da Disfonia (IRDBR). To analyze assertiveness in relation to the presence of dysphonia, the cutoff points of each instrument and the decision rule recommended by the IRDBR were used. An exploratory analysis was performed to compare mean scores of instruments and verify associations between variables. Results The instruments evaluated were sensitive to capture the impact of dysphonia in a similar way regardless of professional voice use and type of dysphonia. There was a difference only in VoiSS scores for the variable gender, with a higher score for females. Regarding global assertiveness, the instruments showed high rates of success in classification, with emphasis on the VoiSS, which had the highest rate (86.3%), followed by the IRDBR (84.0%), VQL (80.9%), VHI (78.2%), and VHI-10 (75.2%). Conclusion The VoiSS has the highest assertiveness index in the identification of dysphonia, followed by the IRDBR. The IRDBR is a short, simple, and easy-to-apply tool for screening procedures.

Forensic analysis of auditorily similar voices / Perícia em vozes auditivamente semelhantes

ABSTRACT Purpose: to verify contributions of acoustic spectrographic analysis in the forensic identification of speakers with auditorily similar voices, considering the distinctive behavior of acoustic parameters: formants of vowel "é", of connected speech, mean fundamental frequency in Hz, linear prediction curve of vowel "é" and linear prediction curve area; and to propose an objective method to use the analyzed parameters. Methods: a quantitative, qualitative and descriptive study, conducted in Pernambuco on 16 pairs of male siblings, aged 18-60 years. The subjects recorded videos from which the audios were extracted, numbered and sent to three examiners, in two groups: older brothers and younger brothers, for perceptual-auditory pairing. The correct pairings, indicated by at least two examiners, were submitted to acoustic analysis. The statistical tests included Wilcoxon, Kruskal-Wallis and Bonferroni, with p<0.05. Results: the results of analyses of formants and the mean fundamental frequency were not enough to distinguish similar voices. Unprecedentedly, in the measurements of areas generated by the linear prediction curve graphs, a distinctive statistical significance was observed. Conclusion: it was concluded that, among the parameters studied, the measurements of areas of the linear prediction curve objectively indicated effectiveness in distinguishing speakers with auditorily similar voices.

RESUMO Objetivo: verificar contribuições da análise espectrográfica acústica na identificação forense de falantes em vozes auditivamente semelhantes, considerando o comportamento distintivo dos parâmetros acústicos: formantes da vogal "é", da fala encadeada, média da frequência fundamental em Hz, curva de predição linear da vogal "é" e área da curva de predição linear; propor um método objetivo da utilização dos parâmetros analisados. Métodos: estudo quantitativo, qualitativo e descritivo, realizado em Pernambuco com 16 pares de irmãos do sexo masculino, entre 18-60 anos. Os sujeitos gravaram vídeos de onde extraíram-se os áudios que foram numerados e enviados a três avaliadores, em dois grupos: dos irmãos mais velhos e dos irmãos mais novos, para pareamento perceptivo-auditivo. Os pareamentos corretos, apontados por pelo menos dois avaliadores, foram submetidos à análise acústica. Os testes estatísticos foram Wilcoxon, Kruskal-Wallis, Bonferroni, com p<0,05. Resultados: os resultados das análises dos formantes e da média da frequência fundamental não foram suficientes para distinguir as vozes semelhantes. Ineditamente nas medidas das áreas geradas pelos gráficos da curva de predição linear, foi verificada significância estatística distintiva. Conclusão: concluiu-se que entre os parâmetros estudados, as medidas das áreas da curva de predição linear apontaram, objetivamente, eficácia na distinção de falantes com vozes auditivamente semelhantes.

Auditory Perception of Roughness and Breathiness by Dysphonic Women.

OBJECTIVE: To investigate the auditory perception of roughness and breathiness by dysphonic women. METHODS: Twenty-two dysphonic native Brazilian Portuguese women participated in this research. All participants underwent audiological evaluation and laryngeal examination to confirm the diagnosis. During the tests, they recorded the sustained vowel /Ɛ/. A speech-language pathologist performed the auditory-perceptual judgment of voice quality for these vocal samples, categorizing the general degree of vocal deviation (mild, moderate, and severe degree) and the predominant type of deviation (roughness or breathiness). Thirty-two (32) stimuli were selected from a voice database, including twenty-four (24) dysphonic voice samples and eight (8) voice samples from vocally healthy women. The authors conducted five perception experiments, being three categorization tasks (normal vs. deviated, breathy vs. nonbreathy, rough vs. nonrough) and two tasks for discriminating the degree of deviation (roughness degree and breathiness degree). RESULTS: The experiments showed a difference between the answers for presence/absence of deviation, presence/absence of breathiness, and presence/absence of roughness in the stimuli, and a difference in the proportion of similar answers of dysphonic women (P < 0.001) regarding the identification of the deviation. Participants classified a large part of the deviated (57.9%), breathy (63.13%), and rough (65.31%) voices as normal. The degree of vocal deviation (P = 0.008) and the degree of roughness in the stimuli correlated positively with the proportion of similar answers of the participants. As for the discrimination of breathiness degrees, less deviated (normal and mild) voices were less discriminated, and more deviated (moderate and severe) voices were better discriminated. Regarding the discrimination of roughness degrees, only the voices with severe deviations showed good discrimination. CONCLUSION: Dysphonic women had a high rate of not similar answers in the identification of normal and deviated voices. They identified more than half of the deviated voices as normal. Samples with more severe deviations were proportionally more identified as deviated by the participants. The greater the vocal deviation of the participants' voices, the smallest the number of similar answers. Participants had a high rate of not similar answers in the identification of normal and breathy voices. Dysphonic women show less ability to perceive mildly and moderately breathy voices in the breathy category. Participants had a high rate of similar answers in the identification of normal and rough voices. Dysphonic women show less ability to perceive mildly and moderately breathy voices in the breathy category. Participants show less ability to perceive only mildly roughness voices with similar responses. Dysphonic women could discriminate between voices with adjacent degrees of roughness but had a low percentage of similar answers for discrimination between voices with adjacent degrees of breathiness.

Factor Analysis of the Brazilian Version of the Voice-Related Quality of Life (V-RQOL) Questionnaire.

OBJECTIVE: To investigate the psychometric properties of the Voice-Related Quality of Life (V-RQOL) questionnaire in Brazilian Portuguese by assessing its reliability and conducting exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). METHODS: This research was carried out in two stages: (1) a document-based retrospective approach and (2) a field study step. The study included 566 dysphonic and vocally healthy individuals. For data collection, the Vocal Screening Protocol and the V-RQOL questionnaire were used, and these measures were later statistically analyzed through descriptive analysis, reliability tests, CFA, and EFA. Ethical issues were considered. RESULTS: A Cronbach's alpha coefficient of 0.916 was observed, indicating good internal consistency for the V-RQOL questionnaire. The item-total correlation coefficient indicated that the items had good correlation with each other and with the construct, with values higher than 0.30. EFA was performed based on the Kaiser-Meyer-Olkin index and Bartlett's test of sphericity, which indicated the adequacy of the tested sample. The items presented commonality of >0.30 and satisfactory factor loadings, resulting in a single factor. The unifactorial structure of the V-RQOL questionnaire was confirmed by CFA. CONCLUSION: EFA and CFA indicated that a single factor should be adopted to encompass all the items of the V-RQOL questionnaire.

Voice and Self-Regulation: Integrating Review of the Literature.

OBJECTIVE: To verify the relationship between self-regulation and voice behavior according to national and international literature. METHODS: A literature survey was performed using the PubMed, LILACS, and SciELO databases. The search terms used were the following: self-regulation, self-control, combined with voice, voice disorders, and dysphonia, in Portuguese, English, and Spanish. Articles that addressed self-regulation and voice behavior or voice disorders published in English, Spanish, or Portuguese were included, without restriction of date. The variables preselected for the data organization were authors, database, country, impact factor, journal, type of study, sample size, sample characteristics, methods for data collection, group comparison, objective, and outcome. RESULTS: A total of 10,176 articles were identified in the databases, of which 10 were selected based on title, read in full, and kept for data analysis. The studies were found predominantly in American journals and were published between 2013 and 2019. The United States published most articles, and the predominant methodological aspect was observational and cross-sectional. CONCLUSION: Despite the small number of articles, the studies analyzed can show self-regulation as an important factor in vocal behavior and call attention to its performance in voice disorders.

Factorial Analysis of the Brazilian Version of the Vocal Tract Discomfort Scale in patients with dysphonia.

OBJECTIVES: To investigate the psychometric properties of the Brazilian version of the Vocal Tract Discomfort Scale, known as Escala de Desconforto do Trato Vocal (EDTV), based on factor analysis, in patients with dysphonia. METHODS: This was a retrospective documentary and cross-sectional study. The study database contained sociodemographic variables, laryngeal diagnosis, auditory-perceptual evaluation and EDTV items. All of these variables were extracted from the medical records of 310 patients seen at the Integrated Laboratory of Voice Studies. A descriptive statistical analysis, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were performed. RESULTS: The sample consisted of patients of both sexes with a mean age of 39.36 (SD = 15.80) years; the majority were female and were nonvoice professionals. The EFA grouped the EDTV items into four factors according to the interitem correlations. The CFA grouped the EDTV items into three factors because the last two factors found in the EFA were correlated and constituted a single factor. Thus, the CFA revealed that the EDTV was organized as follows: Factor 1, "Hybrid," comprised the items corresponding to the frequency and severity of the symptoms of burning, sore, and irritated throat; Factor 2, "Inflammatory process/tissue lesion," comprised the items related to throat itching and throat sensitivity; and Factor 3, "Muscle discomfort," comprised the items related to symptoms of tightness, dryness, and the sensation of a lump in the throat. Item responses are dichotomous (High/Low), and the result is determined by the sum of the responses, in which high frequency/severity is assigned two points and reduced frequency/severity assigned one point. CONCLUSIONS: The CFA allows the proposal of an adjustment to the EDTV and suggests that the described changes be made to the instrument to make it a scale with three factors that behave differently but are related.

Effects of photobiomodulation associated with orofacial myofactional therapy on temporomandibular joint dysfunction. / Efeitos da fotobiomodulação associada à terapia miofuncional orofacial na disfunção temporomandibular muscular.

PURPOSE: To investigate the influence of photobiomodulation associated with orofacial myofunctional therapy (OMT) in patients with temporomandibular muscle disorders (TMD). METHODS: Randomized, blinded trial clinical study with a sample of eleven women with muscle TMD divided into two groups. The experimental group (EG) consisted of five women submitted to orofacial myofunctional therapy associated with photobiomodulation, and the control group (CG) consisted of six women submitted to orofacial myofunctional therapy associated with inactive photobiomodulation (placebo). The intervention was performed in the following twelve sessions: one evaluation, ten speech therapy sessions associated with photobiomodulation, and one reevaluation. For outcomes, investigation on pain perception using the visual analogue scale (VAS), investigation of palpation sensitivity with the research diagnostic criteria for temporomandibular disorders (RDC/TMD), and quality of life (QOL) verification through oral health impact profile - short form (OHIP-14) were considered. RESULTS: The EG increased measurements of mandibular movements of opening and protrusion and improved in the evaluation of QOL. CONCLUSION: Orofacial myofunctional therapy, when associated with photobiomodulation, contributed to increase the range of mandibular movements, with important improvements in the perception of quality of life and with significant improvement in the painful conditions of volunteers with TMD.

OBJETIVO: Investigar a influência da fotobiomodulação associada à terapia miofuncional orofacial (TMO) em pacientes com disfunção temporomandibular muscular (DTM). MÉTODO: Trata-se de uma pesquisa do tipo ensaio-clínico randomizado e cego, com uma amostra de 11 mulheres com DTM muscular, dividida em dois grupos. O Grupo Experimental (GE) composto por 05 voluntárias submetidas à TMO associada à fotobiomodulação, e o Grupo Controle Positivo (GC) composto por 06 mulheres submetidas à TMO associada à fotobimodulação inativa (placebo). A intervenção foi realizada em 12 sessões: uma avaliação, 10 sessões de fonoterapia associada à fotobiomodulação, e uma reavaliação. Para os desfechos foram consideradas a investigação da percepção de dor, com a Escala Visual Analógica (EVA), a investigação da sensibilidade à palpação com o protocolo Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), e a verificação da qualidade de vida (QV) por meio do protocolo Oral Health Impact Profle ­ short form (OHIP-14). RESULTADOS: o GE teve aumento nas medidas dos movimentos de abertura e de protrusão mandibular, e evidenciou melhora na avaliação da QV. CONCLUSÃO: A TMO quando associada à fotobiomodulação contribuiu no aumento da amplitude dos movimentos mandibulares e com ganhos importantes na percepção da qualidade de vida, e com melhora significativa nos quadros dolorosos das voluntárias com DTM.

Voice Symptoms, Perceived Voice Control, and Common Mental Disorders in Elementary School Teachers.

INTRODUCTION: Evaluating the relationship among teachers' voice symptoms, perceived voice control, and common mental disorders (CMDs) might contribute to the understanding of the relationship between vocal wear and the teacher well-being. The understanding of this relationship may also help in taking more informed clinical decisions in voice rehabilitation when considering possible perceived voice control difficulties and the need to develop voice self-control strategies. OBJECTIVE: The aim of this study was to determine the voice symptoms, perceived voice control, and CMDs in public elementary and secondary school teachers, and to analyze the relationships among these variables. METHODS: The study included 85 public elementary and secondary school teachers of both genders. Four instruments were used to measure the variables: an identification and characterization questionnaire, the Voice Symptom Scale, the Present Perceived Control of Voice scale, and the Self-Reporting Questionnaire. RESULTS: A significant correlation between voice symptoms and CMDs was found, along with correlations between the emotional domain of the Voice Symptom Scale and teachers' ages and years of teaching. A negative correlation between CMDs and voice self-control was also observed. CONCLUSIONS: Teachers with voice symptoms had more CMD symptoms, and as the number of mental disorder symptoms increased, voice self-control decreased.

Autoavaliação da memória de jovens universitários / Memory self-assessment of university students

RESUMO Objetivo analisar a autoavaliação da memória de jovens universitários. Métodos trata-se de um estudo observacional, transversal, de caráter analítico, com abordagem quantitativa. Participaram 519 estudantes, matriculados regularmente em instituições de ensino superior, com média de idade de 22,9 anos (±5,5), sendo 408 mulheres e 111 homens. Os instrumentos utilizados foram o Questionário de Memória Prospectiva e Retrospectiva - QMPR (Prospective and Retrospective Memory Questionnaire - PRMQ-10) e um questionário com informações sociodemográficas e com queixas de memória relacionadas às atividades acadêmicas. Os dados foram analisados quantitativamente, de forma descritiva e inferencial, com uso do teste Qui-quadrado, considerando o valor de p<5%. Resultados os jovens universitários relataram dificuldades frequentes de memória, em especial na prospectiva e de curto prazo. Foi visto que 46,6% dos participantes apresentaram queixas de memória e 62,8% referiram acreditar que a rotina na universidade pode provocar aumento nas falhas de memória. Na autoavaliação, verificou-se que 47,7% mencionaram dificuldades na memória prospectiva e de curto prazo e, em relação à rotina acadêmica dos universitários, 46,4% relataram dificuldades na memória retrospectiva. Conclusão há associação entre a presença de queixa e os dados da autoavaliação da memória.

ABSTRACT Purpose To investigate the memory self-assessment of university students. Methods Observational, cross-sectional, analytical study with a quantitative approach. A total of 519 students regularly enrolled in higher education institutions participated, with a mean age of 22.9 years (±5.5), being 408 women and 111 men. Data was collected through the Prospective and Retrospective Memory Questionnaire (PRMQ-10) and a questionnaire with sociodemographic information and memory complaints related to academic activities. Data were evaluated quantitatively, descriptively and inferentially, using the Chi-Squared Test with a p-value <5%. Results University students reported frequent memory difficulties, especially in the prospective and short term memory. It was found that 46.6% of the participants had memory complaints and 62.8% reported believing that routine at the university may lead to an increase in memory failure. In the self-assessment, 47.7% reported difficulties in prospective and short-term memory and, in relation to the academic routine of university students, 46.4% reported difficulties in retrospective memory. Conclusion There is an association between the presence of a memory complaint and the self-assessment of memory data.

Fotobiomodulação com laser de baixa potência na área de motricidade orofacial: uma análise comparativa a partir do conhecimento dos especialistas / Photobiomodulation with low-level laser therapy in the area of orofacial motricity: comparative analysis from the knowledge of specialists

RESUMO Objetivo comparar os conhecimentos e interesses dos fonoaudiólogos especialistas em motricidade orofacial quanto ao uso do laser de baixa potência antes e após a aprovação da Resolução nº 541 do Conselho Federal de Fonoaudiologia. Métodos trata-se de um estudo observacional, transversal e quantitativo, de caráter comparativo. Foi composto por dois momentos distintos: uma primeira coleta de dados, realizada em 2016, antes da aprovação da resolução e a segunda coleta, realizada em 2020, após a publicação das normativas. A primeira amostra foi constituída por 25 participantes e a segunda por 49, todos especialistas em motricidade orofacial. O instrumento de coleta consistiu em um formulário online elaborado no Google Forms, composto por questões do perfil do fonoaudiólogo, conhecimentos, interesses e aplicabilidades da fotobiomodulação com o laser de baixa potência. Os dados foram analisados utilizando estatística descritiva e inferencial. Resultados nos dois momentos, a expressiva maioria dos profissionais indicou saber o que é fotobiomodulação e concordou que o especialista em motricidade orofacial pode atuar com a técnica. Além disso, os profissionais apontaram a disfunção temporomandibular e a paralisia facial como principais casos para aplicações. Foram encontradas diferenças estatisticamente significativas entre os resultados obtidos antes e após a publicação da resolução, verificando-se aumento expressivo no acesso à bibliografia, capacitação, conhecimento das normas de biossegurança, acesso ao aparelho de laser e utilização na prática clínica. Conclusão constatou-se mudança no perfil profissional em relação ao uso da fotobiomodulação, com aumento dos conhecimentos, interesses e aplicabilidades pelos especialistas em motricidade orofacial, após a publicação da resolução normativa.

ABSTRACT Purpose To compare knowledge and interest of speech therapists specialized in Orofacial Motricity regarding the use of low-level laser before and after approval of resolution No. 541 by the Brazilian Federal Speech Language Pathology and Audiology Council (CFFa). Methods Cross-sectional observational and quantitative study of comparative character consisting of two distinct moments: first data collection performed in 2016, before approval of the resolution; and second, collection performed in 2020, after publication of the regulation. The first sample consisted of 25 participants and the second of 49, with the entire sample consisting of specialists in Orofacial Motricity. The collection instrument was an online Google Form consisting of questions on the profile of the speech therapist, knowledge, interests, and applicability of photobiomodulation with low-level laser. Data were analyzed using descriptive and inferential statistics. Results In both moments, the significant majority of professionals indicated knowing what is photobiomodulation, agreed that the Orofacial Motricity specialist can act with the technique and indicated temporomandibular dysfunction and facial paralysis as main applications. Statistically significant differences were found between the results obtained before and after the publication of the resolution, with a significant increase in access to bibliography, training, knowledge of biosafety standards, access to the low-level laser apparatus and use in clinical practice. Conclusion Change in the professional profile regarding the use of photobiomodulation was verified, with increased knowledge, interest, and applicability by Orofacial Motricity specialists after publication of the normative resolution.

Processo de validação de instrumentos de autoavaliação da voz no Brasil / Validation process of voice self-assessment instruments in Brazil

RESUMO Objetivo caracterizar e refletir sobre o processo de equivalência cultural e/ou validação de instrumentos de autoavaliação vocal traduzidos e adaptados para o português brasileiro, utilizados na prática clínica e em pesquisas científicas. Estratégia de pesquisa Buscas realizadas nas bases de dados: SciELO, LILACS, PubMed e The Cochrane Library. Critérios de seleção estudos selecionados quanto à presença dos descritores citados em seu título, resumo ou lista de descritores; artigos de validação de instrumento de autoavaliação em voz, ou com o objetivo de realizar equivalência cultural; direcionados à população brasileira; estudos originais com amostra de seres humanos, independentemente da idade do ciclo vital, tipo de disfonia ou sintomas vocais. Resultados nove artigos selecionados. Qualidade de vida em voz e desvantagem vocal foram os construtos mais abordados. A maioria das validações ocorreu na Região Sudeste do Brasil. A maior parte dos escores dos instrumentos foi calculada por somatório simples das respostas dos participantes nos itens; pontos de corte nem sempre foram apresentados. Os domínios dos instrumentos, bem como os itens que os compunham, foram mantidos conforme apresentado no instrumento em sua língua original. A estatística mais comum para análise dos instrumentos foi o coeficiente Alfa de Crombach. Conclusão os construtos mais abordados nos artigos selecionados foram qualidade de vida em voz e índice de desvantagem vocal. Os instrumentos foram considerados válidos e sensíveis para autoavaliação vocal, mesmo quando não consideradas as etapas propostas internacionalmente para validação de instrumentos em saúde.

ABSTRACT Objective to characterize and reflect on the process of cultural equivalence and/or validation of vocal self-assessment instruments translated and adapted to the Brazilian Portuguese, used in clinical practice and scientific research. Research strategy The search of articles was carried out in the following databases: SciELO, LILACS, PubMed and "The Cochrane Library". Selection criteria The studies were selected regarding the presence of the descriptors cited in their title, abstract or in the list of descriptors; validation articles of a self-assessment instrument in voice or with the objective of performing cultural equivalence; to be directed to the Brazilian population; original studies with a sample of human beings; regardless of the age of the life cycle, type of dysphonia or vocal symptoms. Results Nine articles were selected. Quality of life in voice and vocal handicap were the most addressed constructs. Most validations occurred in the Southeast region of Brazil. The scores of the instruments is calculated by a simple sum of the answers given by the participants in the items; cutoff points are not always presented. The domains of the instruments, as well as the items that compose them, were maintained as presented in the instrument in its original. The most common statistic for instrument analysis was Cronbach's Alpha coefficient. Conclusion The constructs most addressed in the selected articles were quality of life in voice and vocal handicap index. The instruments were considered valid and sensitive for vocal self-assessment, even not considering the international proposals for validation of health instruments.

Efeitos da fotobiomodulação associada à terapia miofuncional orofacial na disfunção temporomandibular muscular / Effects of photobiomodulation associated with orofacial myofactional therapy on temporomandibular joint dysfunction

RESUMO Objetivo Investigar a influência da fotobiomodulação associada à terapia miofuncional orofacial (TMO) em pacientes com disfunção temporomandibular muscular (DTM). Método Trata-se de uma pesquisa do tipo ensaio-clínico randomizado e cego, com uma amostra de 11 mulheres com DTM muscular, dividida em dois grupos. O Grupo Experimental (GE) composto por 05 voluntárias submetidas à TMO associada à fotobiomodulação, e o Grupo Controle Positivo (GC) composto por 06 mulheres submetidas à TMO associada à fotobimodulação inativa (placebo). A intervenção foi realizada em 12 sessões: uma avaliação, 10 sessões de fonoterapia associada à fotobiomodulação, e uma reavaliação. Para os desfechos foram consideradas a investigação da percepção de dor, com a Escala Visual Analógica (EVA), a investigação da sensibilidade à palpação com o protocolo Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), e a verificação da qualidade de vida (QV) por meio do protocolo Oral Health Impact Profle - short form (OHIP-14). Resultados o GE teve aumento nas medidas dos movimentos de abertura e de protrusão mandibular, e evidenciou melhora na avaliação da QV. Conclusão A TMO quando associada à fotobiomodulação contribuiu no aumento da amplitude dos movimentos mandibulares e com ganhos importantes na percepção da qualidade de vida, e com melhora significativa nos quadros dolorosos das voluntárias com DTM.

ABSTRACT Purpose To investigate the influence of photobiomodulation associated with orofacial myofunctional therapy (OMT) in patients with temporomandibular muscle disorders (TMD). Methods Randomized, blinded trial clinical study with a sample of eleven women with muscle TMD divided into two groups. The experimental group (EG) consisted of five women submitted to orofacial myofunctional therapy associated with photobiomodulation, and the control group (CG) consisted of six women submitted to orofacial myofunctional therapy associated with inactive photobiomodulation (placebo). The intervention was performed in the following twelve sessions: one evaluation, ten speech therapy sessions associated with photobiomodulation, and one reevaluation. For outcomes, investigation on pain perception using the visual analogue scale (VAS), investigation of palpation sensitivity with the research diagnostic criteria for temporomandibular disorders (RDC/TMD), and quality of life (QOL) verification through oral health impact profile - short form (OHIP-14) were considered. Results The EG increased measurements of mandibular movements of opening and protrusion and improved in the evaluation of QOL. Conclusion Orofacial myofunctional therapy, when associated with photobiomodulation, contributed to increase the range of mandibular movements, with important improvements in the perception of quality of life and with significant improvement in the painful conditions of volunteers with TMD.

Vocabulary performance of children up to 36 months of age with Down syndrome

ABSTRACT Purpose: this study aimed to analyze the vocabulary performance of children with Down syndrome, up to 36 months of age, in different semantic categories. Methods: eighteen children with Down syndrome, between 8 and 36 months of age. Section D of the MacArthur-Bates Communicative Development Inventory was applied with guardians: First Words and Gestures, in order to obtain expressive and receptive performance in 22 semantic categories. The data were analyzed in a descriptive and inferential manner, using the Kruskal-Wallis, Spearman's correlation and Tukey's range tests (p <0.05). Results: children had higher performance averages in understanding semantic categories than in understanding and expression. The "action words" were the most understood ones, while the "people" category was the most understood and expressed. The greater the chronological age, the greater the children's vocabulary. A statistical difference was found between the understanding of nouns and other categories, according to chronological age, with a greater performance after 24 months of age. Conclusion: children with Down syndrome, up to 36 months of age, perform better in understanding vocabulary in all semantic categories.

Orofacial myofunctional changes and electromyographic activity of the orbicularis oris muscle in trombonists / Alterações miofuncionais orofaciais e atividade eletromiográfica do músculo orbicular da boca em trombonistas

ABSTRACT Objective: to analyze whether trombonists present orofacial myofunctional changes and compare the electrical activity of the orbicularis oris muscle before and after playing their instrument. Methods: an observational, descriptive, and cross-sectional study. The sample consisted of 20 university trombonists. Data collection involved three steps: application of a questionnaire investigating some peculiarities of trombonists (Orofacial Myofunctional Evaluation with Expanded Scores - OMES-E), and electromyographic analysis of the orbicularis oris muscle before and after performing a piece with the trombone. The mean, standard deviation, frequency, and percentage were calculated, and the paired Student's t test was used to compare the means of the electromyographic records before and after playing the trombone, at a 5% significance. Results: seventy per cent of trombonists reported some symptom of orofacial myofunctional alteration, namely, muscle compensations, tension, and pain. The myofunctional evaluation showed a mild change in cheek volume (90%) and labial commissure asymmetry (60%). The electrical activity of the lower orbicularis oris muscle decreased significantly after the trombone practice (p = 0.04), while that of the superior orbicularis oris muscle remained unchanged. Conclusion:trombonists show clinical and self-reported oromyofunctional changes as well as decreased electrical activity of the lower orbicularis oris muscle, after playing the trombone.

RESUMO Objetivos: analisar se existem alterações miofuncionais orofaciais clínicas e autorreferidas em trombonistas, assim como comparar a atividade elétrica do músculo orbicular da boca antes e após o uso do trombone. Métodos: estudo transversal e observacional, cuja amostra foi composta por 20 universitários trombonistas. Foi utilizado um questionário que investiga algumas particularidades sobre o instrumentista, da Avaliação Miofuncional Orofacial Com Escores Ampliados - AMIOFE-A e análise eletromiográfica do músculo orbicular da boca antes e após execução de uma tarefa com o trombone. Foram calculadas: média, desvio padrão, frequência e porcentagem e utilizou-se o teste t-Student pareado na comparação das médias dos registros eletromiográficos pré e pós-execução do trombone, significância=5%. Resultados: setenta por centro dos trombonistas relataram algum sintoma de alteração miofuncional orofacial, sendo compensações musculares, tensão e dor. Na avaliação miofuncional encontrou-se alteração leve no volume de bochechas (90%) e comissuras labiais com assimetria (60%). Houve redução significante da atividade elétrica do músculo orbicular inferior após a execução de tarefa com trombone (p=0,04), enquanto a do superior permaneceu inalterada. Conclusão: trombonistas apresentam alterações oromiofuncionais clínicas e autorreferidas e diminuição da atividade elétrica do músculo orbicular inferior da boca após uso do trombone.