La telerehabilitación durante la pandemia COVID-19: experiencia de las familias de niños con condiciones crónicas complejas / Telerehabilitation during the COVID-19 pandemic: experience of families of children with complex chronic conditions

La telerehabilitación ha sido una solución rápida y efectiva para la atención de pacientes durante la pandemia COVID-19. Nuestro objetivo ha sido describir la experiencia de las familias de niños con condiciones crónicas complejas (CCC) asistidos con la modalidad de telerehabilitación durante la pandemia. Materiales y métodos: Se ha realizado un estudio observacional, descriptivo y transversal de tipo encuesta online. Se encuestaron familias de niños (1 mes a 5 años de edad) con al menos una CCC que recibieron seguimiento interdisciplinario a distancia durante la pandemia de 2 o más áreas de rehabilitación (kinesiología, fonoaudiología y terapia ocupacional) pertenecientes al Servicio de Kinesiología del Hospital de Pediatría Juan P Garrahan, durante marzo a octubre de 2020. Resultados: El 88,3% de los participantes (n=43) se expresó satisfecho con la modalidad de telerehabilitación. Entre los facilitadores seleccionados por los participantes se mencionan la reducción de tiempos, mayor frecuencia de consultas, disminución de gastos por traslados y mayor comodidad, mientras que entre las barreras se destacaron: el no vínculo con profesionales, alargue en tiempos de tratamiento, problemas de conectividad. El análisis estadístico no indicó diferencias significativas entre quienes se reportaron como más satisfechos según su estrato social (alto o bajo), la disponibilidad de wifi propio, o respecto a la edad del niño. Se reportaron diferencias significativas en cuanto a la distancia al hospital (p=0.034). Conclusión: Esta forma de intervención ofreció nuevas posibilidades de atención que podrían considerarse a futuro en el seguimiento de nuestros pacientes. (AU)

Telerehabilitation has been a fast and effective solution in patient care during the COVID-19 pandemic. Our aim was to describe the experience of families of children with complex chronic conditions (CCC) treated through telerehabilitation during the pandemic. Materials and methods: An observational, descriptive, cross-sectional, online survey study was conducted. Families of children (1 month to 5 years of age) with at least one CCC who received interdisciplinary remote follow-up during the pandemic from two or more rehabilitation areas (physical therapy, speech therapy, and occupational therapy) belonging to the Department of Physical Therapy of Hospital de Pediatría Juan P Garrahan, from March to October 2020, were surveyed. Results: 88.3% of the participants (n=43) expressed satisfaction with the telerehabilitation modality. Among the facilitators selected by the participants, the following were mentioned: time saving, greater frequency of consultations, reduction of travel expenses and greater comfort, while among the barriers, the following stood out: no connection with the professionals, longer treatment times, connectivity problems. Statistical analysis did not show significant differences between those who reported being more satisfied according to socioeconomic level (high or low), availability of their own wifi connection, or age of the child. A significant difference was found for distance to the hospital (p=0.034). Conclusion: This type of intervention provided new possibilities of care that could be considered in the future follow-up of our patients (AU)

Vocal Pedagogy and the Alexander Technique: a reflection / La pedagogía vocal y la Técnica Alexander: una reflexión

This article is a reflection about the role of the Alexander Technique and its appli-cation and influence in vocal pedagogy. It is based on more than seventeen years of active teaching as a qualified Alexander Technique Teacher and as a professional singer, working alongside vocal pedagogues, teachers, students and professionals. Its objective is to reflect upon the role of body awareness, psychophysical and emotional consciousness, and wellbeing in the realms of vocal pedagogy and singing.

El presente artículo corresponde a una reflexión sobre la Técnica Alexander, su aplicación e influencia dentro del ámbito de la pedagogía vocal. Está basado en los últimos diecisiete años de carrera activa como profesora de Técnica Alexander y cantante profesional, trabajando con cantantes y profesores de canto con el objetivo de lograr una buena reflexión de la importancia del proceso de consciencia corporal, conexión sicofísica y bienestar en la pedagogía vocal

Microstomia: Aplicação da fotogrametria para mensurar a eficiência da órtese oral associada à terapia fonoaudiológica / Microstomy: Application of photogrammetry to measure the efficiency of oral orthosis associated with speech therapy

OBJETIVO: Esse estudo teve como propósito verificar, por meio da fotogrametria computadorizada, a eficácia do uso da órtese oral como auxiliar na terapia fonoaudiológica. MÉTODO: Após a documentação fotográfica, cada paciente foi submetido a terapia fonoaudiológica, por meio da terapia miofuncional orofacial, associada ao uso da órtese oral, confeccionada segundo Borges et al. (2011). Ao término do tratamento, foi realizado novo registro fotográfico, em seguida, a mensuração da dimensão vertical (distância entre lábio superior/inferior) e horizontal (distância entre comissuras direita/esquerda), com o uso do programa Corel Draw X3. RESULTADOS: As médias da abertura bucal aumentaram da avaliação inicial para a avaliação final, tendo aumentado 5,1 mm no sentido horizontal (67,3 mm para 72,4 mm) e 13,9 mm no sentido vertical (de 32,7 mm para 46,6 mm). Essas diferenças se revelam significativas para as avaliações (p <0,05). CONCLUSÃO: O uso da órtese oral associado a terapia fonoaudiológica demonstrou ser eficaz como mais um instrumento na prevenção da microstomia.

OBJECTIVES: The aim of this study was to through computerized photogrammetry, the efficacy of oral orthosis as an aid in speech therapy. METHODS: After the photographic documentation, each patient underwent speech therapy, through orofacial myofunctional therapy, associated with the use of an oral orthosis, made according to Borges et al. (2011). At the end of the treatment, a new photographic record was taken, then the vertical dimension measurement (distance between upper lip) and horizontal (distance between corners right/left), using the program Corel Draw X3. RESULTS: The mean mouth opening increased from the initial evaluation to the final evaluation, increasing 5.1 mm in the horizontal direction (67.3 mm to 72.4 mm) and 13.9 mm in the vertical direction (from 32.7 mm to 46.6 mm). These differences are significant for the evaluations (p<0.05). CONCLUSION: The use of oral orthosis associated with speech therapy proved to be effective as another tool in the prevention of microstomia.

Towards evidence-based practices in voice pedagogy / Prácticas vocales basadas en la evidencia

Voice pedagogy was initially based on an orally transmitted master-apprentice teaching-learning model, applying observational type of learning centred in the final artistic product. Since then, this model has been continuously replaced. Nowadays, the social organization of work in globalized economies has called for the need of rethinking education so that future generations can meet the demands of lifelong learners, who are skilful at using systems of information, who are flexible and adapt to the lack of stability at work, and who are able to make their own career opportunities. How can this be applied to voice pedagogy? This work aims at finding answers to these questions, further contributing to the discussion raised at the voice pedagogy round table of the 10th Pan-European Voice Conference, "Vocal Pedagogy - What do we need?". The rationale for reflective practices in voice education and for enhancing metacognitive skills in student's using evidence-based guided awareness is discussed. The provision of meaningful feedback and the use of a holistic approach to voice teaching are presented as means to meet individual needs of different types of learners. Problem-solving and student-centred teaching–learning models are proposed as key elements in developing reflective voice practitioners (AU)

Tradicionalmente la pedagogía de la voz se ha basado en un modelo de enseñanza-aprendizaje a partir de dominar la práctica transmitida oralmente, en la que se aplicaba un tipo de aprendizaje observacional centrado en el producto artístico final. Este modelo se ha ido sustituyendo constantemente con el tiempo. Actualmente, la organización social del trabajo en las economías globalizadas ha visto la necesidad de replantear la educación de forma que las generaciones futuras pueden responder a las necesidades de alumnos que aprenden de por vida, que destacan en el uso de habilidades de sistemas de información, que son flexibles y se adaptan a la falta de estabilidad en el trabajo, y que son capaces de manejar sus propias oportunidades de emprendimiento. ¿Cómo se puede aplicar todo esto a la pedagogía vocal? Este trabajo tiene como objetivo la búsqueda de respuestas a estas cuestiones, además de contribuir a la discusión que se generó en la 10th Pan European Voice Conference, «Pedagogía Vocal. ¿Qué necesitamos?». Se expone la lógica de usar prácticas reflexivas en la educación vocal y que realcen las habilidades metacognitivas del estudiante, al utilizar el conocimiento basado en la evidencia. La provisión de feedback significativo y el uso de un enfoque holístico en la enseñanza de la voz se presentan como los medios necesarios para responder a las necesidades individuales de los distintos aprendices. Los modelos de enseñanza basados en la resolución de problemas y en el aprendizaje centrado en el alumno se proponen como elementos clave a la hora de desarrollar profesionales de la voz conscientes, que son los que mejor cumplen con las demandas de conocimiento de las sociedades del siglo xxi (AU)

Vocal nodules in school age children / Los nódulos vocales en niños en edad escolar

Introduction. Vocal nodules are the most common organic and functional lesions among the paediatrics population, being the main cause of dysphonia during childhood. In Portugal, a few studies that describe the vocal parameters in school age children with this pathology were found. The objective of this paper is to analyse the perceptual and acoustic vocal parameters of school age children with vocal nodules and to compare them with a group of children without vocal nodules. Methodology. The perceptual and acoustic parameters of 5 children, of both genders, aged from 7 years and 2 months to 12 years and 10 months, where clinical diagnosis of vocal nodules were analysed. The following assessment instruments were used: software Praat, GRBASI scale, maximum phonation time and s/z coefficient. The obtained data was compared to children without vocal nodules. The Mann-Whitney U test, with p < .05 significance level, in SPSS Statistics, version 22.0 was used for statistical analysis. The results are presented as mean and standard deviations. Results. Statistically significant differences were registered between the group of vocal nodules vs. the group without vocal nodules, on the following parameters: fundamental frequency, shimmer, HNR, maximum phonation time for /a/ e /z/, s/z coefficient and GRBASI. On jitter and maximum phonation time for /s/ there were no statistically significant differences. Discussion and conclusions. This study underlines the importance of assessing the perceptual and acoustic parameters in children with vocal nodules (AU)

Introducción. Los nódulos vocales son las lesiones orgánicas funcionales más comunes en la población pediátrica, la principal causa de disfonía en la infancia. En Portugal se encontraron pocos estudios que describan los parámetros vocales de los niños en edad escolar con esta patología. El objetivo de este trabajo es analizar los parámetros acústico-perceptivos vocales de niños en edad escolar con nódulos vocales y compararlos con un grupo de niños sin nódulos vocales. Metodología. Se analizaron los parámetros acústico-perceptivos de 5 niños de ambos sexos, con edades entre 7 años y 2 meses y 12 años y 10 meses, con diagnóstico clínico de nódulos vocales. Se utilizaron los instrumentos de evaluación: software Praat, rango GRBASI, el tiempo máximo de fonación y el coeficiente s/z. Los datos obtenidos se compararon con los de los niños sin nódulos vocales. El análisis estadístico utilizando la prueba U de Mann-Whitney, con nivel de significación de p < .05, el SPSS Statistics, versión 22.0. Los resultados se presentan como medias y desviaciones estándar. Resultados. Hubo diferencias estadísticamente significativas entre el grupo de nódulos vocales frente al grupo sin nódulos vocales en los parámetros: frecuencia fundamental, shimmer, HNR, tiempo máximo de fonación de /a/ y /z/, el coeficiente s/z y GRBASI. En jitter y tiempo máximo de fonación de /s/, no hubo diferencias estadísticamente significativas. Discusión y conclusiones. Este trabajo subraya la importancia de la evaluación de los parámetros acústico-perceptivos en los niños con nódulos vocales (AU)

Eficacia de las intervenciones para el tratamiento de la dislexia: una revisión / Effectiveness of interventions for the treatment of dyslexia: a review

En este informe se revisa la investigación que respalda distintas intervenciones para el tratamiento de la dislexia, concretamente los trabajos de síntesis, en especial síntesis de las mejores evidencias, revisiones sistemáticas o metaanálisis publicados sobre cada tipo de intervención. En los casos en que no se ha publicado ningún trabajo de síntesis o estos trabajos son antiguos, se hace una revisión de la investigación primaria. Los trabajos localizados indican que los métodos fonológicos de intervención en la dislexia, es decir, aquellos en los que se combina el entrenamiento en habilidades fonológicas con el conocimiento de las letras y la práctica de la lectura, están ampliamente respaldados por la investigación. En cambio, la investigación sobre otros sistemas es sumamente escasa, ofrece resultados contradictorios o indica que se trata de sistemas ineficaces. Las intervenciones que están en estas situaciones son: la integración auditiva, el entrenamiento auditivo con soporte informático, la terapia visual, las lentes tintadas, el entrenamiento perceptivo-motor, las técnicas quiroprácticas, la integración sensorial, el método Davis, el neurofeedback, la musicoterapia y la educación musical o las dietas y suplementos alimenticios. A partir de esta revisión se realizan las siguientes recomendaciones: promocionar las intervenciones de tipo fonológico para el tratamiento de la dislexia, no utilizar o recomendar intervenciones que no estén respaldadas por la investigación científica, que los métodos de intervención que no hayan probado su eficacia no reciban el nombre de «terapia» o «tratamiento», y la creación y difusión de una guía sobre intervención en dislexia basada en evidencias científicas (AU)

In this report the research that supports various interventions for the treatment of dyslexia is revised, specifically the works of synthesis, especially synthesis of best evidence, systematic reviews or meta-analyses published about each type of intervention. A review of primary research is made in cases in which no synthesis work has been published or where these works are old. Localised works indicate that the phonological methods of intervention in dyslexia, i.e. those in which training in phonological skills is combined with knowledge of letters and the practice of reading, are widely supported by research. However, research on other methods is either extremely scarce or it offers conflicting results or it leads to the conclusion that they are inefficient methods. Interventions in this situation are: the auditory integration, the auditory training with computer support, visual therapy, the tinted lenses, motor-perceptual training, chiropractic techniques, sensory integration, the Davis method, neurofeedback, music therapy and music education or diets and dietary supplements. Promotion of phonological interventions is recommended; it is necessary to avoid recommendations of intervention methods for dyslexia which are not supported by scientific research; methods of intervention that have not proven their effectiveness may not be presented as therapies or treatments; and the creation and distribution of a guide on intervention in dyslexia based on scientific evidence is recommended (AU)

Freio lingual: abordagem clínica interdisciplinar da Fonoaudiologia e Odontopediatria / Lingual frenulum: interdisciplinary clinical approach of Speech Terapy and Pediatric Dentistry

Introdução: O freio lingual é uma estrutura anatômica cujo papel é muito importante para a sucção, fala e alimentação. Um freio curto e aderido pode impedir o movimento da língua e com isso causar impactos anatômicos e funcionais para o paciente. Objetivos: O objetivo deste relato de caso é demonstrar, com olhar clínico interdisciplinar, as ações conjuntas entre a Odontopediatria e a Fonoaudiologia frente à alteração de freio lingual em uma criança com alteração na fala. Foi realizado diagnóstico em conjunto e traçado o plano de tratamento que constou de frenectomia e acompanhamento fonoaudiológico no intuito de monitorar as evoluções e proporcionar tratamento global. Conclusão: O procedimento cirúrgico, realizado pela Odontopediatria trouxe ganhos anatômicos e de mobilidade de língua, entretanto os aspectos alterados da fala permaneceram imediatamente após a intervenção, enfatizando a necessidade do tratamento e do acompanhamento fonoaudiológico.

Introduction: The lingual frenulum is an important anatomic structure involved in the act of suction, speech and feeding. A short and adhered frenulum limits the tongue movement and therefore, can cause anatomic and functional impacts in the patient. Aim: The aim of this case report is to show, with an interdisciplinary approach, strategies implemented by the Speech Therapy and Pediatric Dentistry for alterations in a lingual frenulun of a child with speech problems. This alteration was diagnosed and the treatment plan defined by both professionals and the frenectomy was conducted. Speech therapist followed up the patient in order to provide global treatment. Conclusion: Surgical procedure, conducted by the pediatric dentist improved tongue mobility, however speech alterations still were present after the intervention, emphasizing the need of a speech monitoring and therapy.

Auditory implicit semantic priming in Spanish-speaking children with and without specific language impairment

We analyzed whether Spanish-speaking children with Specific Language Impairment (SLI) showed deficits in lexical-semantic processing/organization, and whether these lexical measures correlated with standardized measures of language abilities. Fourteen children with Typical Language Development (TLD) and 16 age-matched children with SLI (8;0-9;11 years) participated. In a Lexical Decision (LD) task with implicit semantic priming, children judged whether a given speech pair contained two words (semantically related/unrelated) or a word-pseudoword. Children received a comprehensive language and reading test battery. Children with TLD exhibited significant semantic priming; they were faster for semantically related word pairs than for unrelated (p < .001) and than for word-pseudoword pairs (p < .0002). The group with SLI did not exhibit significant semantic priming, despite showing more variability. Children with SLI made significantly slower LDs [F(1, 26) = 4.61, p < .05, partial η2 = .15] and more errors [F(1, 26) = 4.16, p < .05, partial η2 = .13] than children with TLD. Mean response time across all LD conditions and the receptive vocabulary (PPVT-III) were significantly negativity correlated for children with SLI (r = -.71, p = .004). Children with SLI, especially those with the poorest language scores, showed a semantic-lexical deficit and a weakness in lexical-semantic association networks. Their performance on the LD task was significantly slower and poorer than for children with TLD. Increasing a child’s vocabulary may benefit lexical access (AU)

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Theory of mind and language comprehension in schizophrenia / Teoría de la mente y comprensión del lenguaje en la esquizofrenia

Background: Theory of mind (ToM) is the natural ability to attribute/infer mental states about ourselves and others. The study of the limits of this capacity in autism-spectrum disorders has been projected more recently to the case of schizophrenia. Method: We review the studies on ToM deficiency in schizophrenia, based on the link observed by Chris Frith between psychotic symptoms and mentalizing anomalies, with particular attention to the implications of ToM in linguistic communication in the field of figurative language comprehension. Results: The data support a connection between ToM deficits and psychotic symptoms. In schizophrenia, the deficit in ToM appears to be specific and not dependent on more general cognitive abilities, and according to the evidence examined, it resembles a trait more than a state condition. The analysis of results shows that anomalies in ToM have projections on pragmatic aspects of language comprehension. Conclusions: ToM deficits showed by schizophrenic patients are especially linked to difficulties in understanding figurative language, beyond the influence of intelligence and executive functions (AU)

Antecedentes: la teoría de la mente (TM) es la capacidad natural que nos permite atribuir/inferir estados mentales respecto de nosotros mismos y de los demás. El estudio de los límites de dicha capacidad en los trastornos de espectro autista se ha proyectado más recientemente al caso de la esquizofrenia. Método: se revisan los estudios sobre el déficit de TM en la esquizofrenia partiendo del vínculo establecido por Chris Frith entre sintomatología psicótica y anomalías mentalistas, prestando especial atención a las implicaciones de la TM en la comunicación lingüística en el ámbito de la comprensión del lenguaje figurado. Resultados: los datos apoyan una conexión entre déficits mentalistas y síntomas psicóticos. En la esquizofrenia el déficit en TM se ha mostrado específico y no dependiente de capacidades cognitivas más generales y, por la evidencia examinada, parece que se asemeja más a una condición de rasgo que de estado. Los resultados analizados muestran que las anomalías mentalistas se proyectan en los aspectos pragmáticos de la comprensión del lenguaje. Conclusiones: los déficits en TM que muestran los pacientes con esquizofrenia están especialmente ligados a dificultades en la comprensión del lenguaje figurado, más allá de la influencia de la inteligencia y las funciones ejecutivas (AU)

Aplicación del protocolo de valoración del rango vocal en cantantes populares del Colegio de Música de Medellín, mediante el módulo Real Time Pitch / Implementation of a protocol to assess pitch range by the Real Time Pitch module in singers of popular music at the Medellin School of Music

Se presenta un estudio que cuantifica la señal acústica de la voz de un glissando cómodo y natural para determinar, con la aplicación del protocolo de valoración del rango vocal, valores de máxima y mínima frecuencia, semitonos correspondientes, frecuencia fundamental más utilizada y rango vocal antes y después de un calentamiento. Se evaluaron 35 cantantes populares de la ciudad de Medellín con una encuesta que permitió establecer 25 personas sin lesión laríngea manifiesta y con impresión diagnóstica de normalidad mediante laringoscopia indirecta. Se utilizó un diseño cuasiexperimental empleando pretest y postest en un solo grupo y comparando los resultados encontrados. Se evaluó la aplicación del protocolo y el comportamiento del rango vocal frente a la variable de calentamiento. Los resultados encontrados evidencian en forma cuantitativa que el 72% de los sujetos mejoran la cifra de rango vocal, así como la calidad y la comodidad de la producción del glissando, según los valores hallados en el postest. Finalmente se concluye que el rango vocal y los extremos mejoran después del calentamiento, ya que las medias presentan mejores resultados. En general se encuentra que el protocolo de valoración que ofrece el módulo Real Time Pitch del Visi-Pitch IV es una herramienta que complementa en forma notoria la valoración de la voz(AU)

We present a study that quantified acoustic voice signals over a comfortable and natural glissando to determine maximum and minimum frequencies, the corresponding semitones, the most used frequency, and vocal range before and after warm-up exercises. The assessment was carried out with a protocol for pitch range. Thirty-five singers of popular music in the city of Medellin were evaluated through a survey. Twenty-five persons with no evident laryngeal injuries and no abnormalities on indirect laryngoscopy were identified. The study design was quasi-experimental with pretest and posttest evaluations in a single group and comparison of the results. The application of the protocol and vocal range behavior were evaluated with respect to the variable of warm-up. The results showed quantitatively that vocal range and the quality and comfort of glissando production were increased in 72% of the subjects, according to the values found in the posttest. We conclude that vocal range and maximum and minimum frequencies improved after a warm-up since the means for these frequencies showed improved results. In general we found that the assessment protocol provided by the Real-Time Pitch of the Visi-Pitch IV module notably complemented voice evaluation(AU)

Rejuvenescimento facial por intervenção miofuncional estética. Revisão integrativa / Facial rejuvenation by aesthetics myofunctional intervention. A integrative review

INTRODUÇÃO: As técnicas de rejuvenescimento facial tem se aperfeiçoado na busca pela saúde e melhora da aparência física. A intervenção miofuncional estética, um novo campo de atuação da Motricidade Orofacial, promove o rejuvenescimento com a suavização das rugas, sulcos e o equilíbrio da tensão muscular da face. Esse estudo propôs analisar o rejuvenescimento facial decorrente da intervenção miofuncional estética. MATERIAL E MÉTODOS: Trata-se de uma revisão integrativa da literatura realizada na Biblioteca Virtual em Saúde (BVS), no United States National Library of Medicine (PubMed) e no Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), com publicações datadas entre 2001 e 2011. Foram encontrados 18 artigos, dos quais 06 atenderam aos critérios estabelecidos. Os dados coletados foram apresentados de forma descritiva. RESULTADOS: O rejuvenescimento facial foi representado por relatos de equilíbrio muscular e funcional, suavização das linhas de expressão, face descansada e harmônica, olhos mais abertos, redução de bolsas palpebrais e de medidas faciais, melhora do contorno facial e redução das olheiras, após a intervenção miofuncional estética. Houve a participação de profissionais e de pacientes na avaliação dos resultados da intervenção. Conclusão. Poucas são as publicações na área e apresentam, em comum, resultados que favorecem o rejuvenescimento facial e a participação dos pacientes e dos profissionais na avaliação dos resultados da intervenção. Pesquisas adicionais são necessárias para o aprofundamento do tema, de forma a contribuir para o conhecimento das suas técnicas, qualificar o serviço prestado e nortear condutas terapêuticas

INTRODUCTION: Facial rejuvenation techniques have been improved looking for the best health and physical appearance. The esthetics myofunctional intervention, a new field of procedure on orofacial motricity, promotes rejuvenation with the smoothing of wrinkles, furrows and balance of muscle tension of the face. This study proposes to analyze the facial rejuvenation resulting of esthetics myofunctional intervention. MATERIALS AND METHODS: This is an integrative literature review conducted in the Virtual Health Library (VHL), the United States National Library of Medicine (PubMed) and the Periodical Portal of the Coordination of Improvement of Higher Education Personnel (CAPES), with publications dating between 2001 and 2011. Were found 18 articles, which 6 of them attended the established criteria. The collected data were descriptively presented. RESULTS: There are few publications in this area and are characterized by studies with methodological shortcomings. The facial rejuvenation have been presented which criteria of muscular and functional balance, smoothing of wrinkles and harmonic facial expresion, more open eyes and improvement of facial contour after an aesthetic myofunctional intervention. Participation of different experts is mandatory for achieve a satisfactory results as well as the validation of these results by the patients. CONCLUSION: Facial rejuvenation, represented by the muscular balance, smoothing out fine lines, achive of an harmonious face, eyes more open, lower eyelid bags, improved facial contour and reduce dark circles, was noted by all patients and professional studies after esthetics myofunctional intervention. Additional research, using appropriate methodologies, are necessary for deepening on this subject, in order to contribute to the knowledge of these techniques

Acercamiento a la voz humana, su fisiología y rehabilitación / An aproach to the human voice, its physiology and rehabilitation

El presente estudio supone una aproximación a la voz, su fenomenología y rehabilitación, a través de la investigación de un caso único con diagnóstico de disfonía por presencia de quiste en cuerda vocal (CV) derecha debido a abuso y mal uso vocal en una mujer de 29 años profesora de Educación Primaria con especialidad en música. Lo que aquí se plantea es un tipo de intervención de entre todos los posibles para la rehabilitación de patología vocal. La terapia presentada en este estudio está basada y desarrollada a través de una concepción holística del ser humano, partiendo del propio diseño, para su rehabilitación. Para ello, se han diseñado: un protocolo de observación para el profesional logopeda, compuesto por una serie de ítems relativos a la anatomía y fisiología del cuerpo humano y su influencia en la fonación, y otro protocolo de autopercepción de la voz por parte del paciente y cómo esta afecta a la efectividad de la terapia. Se ha utilizado para este estudio, un diseño A-B-A-B y se han analizado los resultados. Se ha establecido un tratamiento en 2 fases: 1.- Intervención sobre la postura y la respiración, en base al protocolo de observación, y teniendo en cuenta las respuestas del paciente al protocolo de autopercepción de la voz. 2.- Intervención sobre la acústica de la voz, sobre la base de la postura y la respiración. La autopercepción de la voz por parte del paciente ha sido variable control para decidir la eficiencia de la rehabilitación (AU)

The present study focuses on an innovative approach to the human voice, its physiology and rehabilitation. We present a single case study of a 29-year-old woman with a diagnosis of dysphonia, who worked as a music teacher in an elementary school. The patient had a cyst on her right vocal cord due to voice abuse and misuse. In this article, a specific type of procedure is proposed for the rehabilitation of vocal disorders. This procedure is based on and developed by means of a holistic view of human beings for their rehabilitation. An observation protocol for the speech therapist was designed, which included a series of items related to the anatomy and physiology of the human body and their influence on phonation. Another protocol for vocal self-perception by the patient and its impact on the effectiveness of the therapy was designed. An A-B-A-B design methodology was applied and the results were fully analyzed. Two treatment phases were established: (1) posture and breathing rehabilitation therapy based on the observation protocol, and considering the patient's responses to the vocal self-perception protocol, and (2) voice acoustic rehabilitation therapy based on the patient's posture and breathing. Patient scores on the vocal self-perception evaluation were used to assess the effectiveness of the intervention (AU)

O sentido do psicodrama na clínica fonoaudiológica / The role of psychodrama in speech therapy clinic

Esta pesquisa, de natureza exploratória, teve como objetivo compreender o sentido do Psicodrama na clínica fonoaudiológica para, a partir disso, refletir sobre as possibilidades da abordagem psicodramática e suas técnicas, no contexto do trabalho clínico-terapêutico em Fonoaudiologia. Para isso, realizamos quatro entrevistas semi-estruturadas com fonoaudiólogas que atuam na clínica há pelo menos três anos, utilizando o Psicodrama. O método que adotamos para a análise do discurso está apoiado na proposta de Bardin (1994), que se refere à análise de conteúdo, e a técnica utilizada foi a análise categorial. A partir da apresentação e análise das entrevistas, buscamos selecionar, nas categorias encontradas, dados que revelassem o sentido que a abordagem psicodramática ganha na clínica fonoaudiológica. Dos discursos analisados, um primeiro aspecto que observamos é que a abordagem psicodramática aparece como um meio de promover maior aproximação do sujeito ao trabalho fonoaudiológico, favorecendo o vínculo terapeuta-paciente e gerando mudanças na subjetividade. Outro aspecto observado foi que no seu discurso, as entrevistadas dividiram o Psicodrama em Psicoterápico e Pedagógico ou Educacional. Assim, ao longo da pesquisa e pelas falas de nossas entrevistadas, pudemos colher dados que revelam que a abordagem do Psicodrama que se alinha à clínica fonoaudiológica é a psicoterápica, e que esse tipo de trabalho terapêutico se alinha com a vertente contextualizada da clínica.(AU)

The goal of this research is to understand the role of Psychodrama in a speech therapy clinic in order to reflect on the possibilities of the psychodramatic approach and its techniques in the context of the clinical-therapeutical work in Speech Therapy. In order to do that, we conducted four semi-structured interviews with speech therapists working in the clinic for at least three years and using Psychodrama. The method we adopted for the discourse analysis is based on Bardin s proposal (1994), which refers to content analysis, and the technique used was the category analysis. Based on the interview presentation and analysis, we tried to select, among the categories found, discourse that had information about the psychodramatic approach and its techniques being used in the speech therapy clinic. The first aspect noticed in the discourse analyzed is that the psychodramatic approach serves as a means to bring the subject closer to the speech therapy work, promoting therapist-patient bond and generating changes in the subjectivity. A second aspect noticed in the discourse was that the interviewees divided Psychodrama into Psychotherapic and Pedagogical or Educational. Thus, throughout the research and based on our interviewees discourse, it was clear that the speech therapy clinic supported by psychodramatic techniques is in line with the psychotherapic approach of Psychodrama, making for speech therapy work within the clinic contextualized approach.(AU)