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1.
PLoS One ; 15(3): e0229960, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160255

RESUMO

BACKGROUND/AIM: It is widely believed that 'creaky voice' ('creak', 'vocal fry', 'glottal fry') is increasingly prevalent among some English speakers, particularly among young American women. Motivated by the widespread and cross-disciplinary interest in the phenomenon, this paper offers a systematic review of peer-reviewed research (up to January 2019) on the prevalence of creaky voice in varieties of English. The review aimed to understand whose and what speech has been studied, how creaky voice prevalence has been measured, and what the findings collectively reveal. METHOD: Literature was located by searching four electronic databases (ProQuest, PubMed, SCOPUS, Web of Science) and the proceedings of two recurrent conferences ('ICPhS' and 'SST'). Studies were included if they reported the prevalence of creaky voice in naturalistic samples of English spoken by vocally-healthy speakers. Reference lists of included studies were cross-checked. RESULTS: Only ten studies meeting inclusion criteria were identified. All studies sampled a small number of speakers and/or short durations of speech. Nine were recent studies of American-English speakers, and many of these sampled young, female, college students. Across the ten studies, creaky voice was detected using three types of methods, and prevalence was calculated using five different formulae. The findings show that prevalence varies across groups, individuals, and contexts. However, the precise nature of this variability remains unclear due to the scarcity and methodological heterogeneity of the research. CONCLUSIONS: This paper illustrated the application of systematic literature review methods in sociophonetic research-a field in which such methods are not common. The review found that creaky voice prevalence in English is not well understood, and that widespread claims of its recent increase among young American women have not been empirically confirmed. A number of specific limitations in the existing research are highlighted, which may serve as a guide for future research design.


Assuntos
Percepção da Fala/fisiologia , Fala/fisiologia , Voz/fisiologia , Fatores Etários , Humanos , Idioma , Fonação/fisiologia , Fatores Sexuais , Acústica da Fala , Medida da Produção da Fala , Fatores de Tempo , Qualidade da Voz/fisiologia
2.
Codas ; 32(4): e20190074, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32049106

RESUMO

PURPOSE: To verify and compare the immediate effects of the voiced oral high-frequency oscillation (VOHFO) technique and the phonation into a silicone resonance tube in the elderly self-perception of vocal and laryngeal symptoms and in their voice quality. METHODS: 14 elderly women, over 60 years old, performed the VOHFO and phonation into a resonance tube technique (35cm in length and 9mm in diameter) with one-week interval between both to avoid carry-over effect. Initially, all participants answered questions regarding the frequency and intensity of their vocal/laryngeal symptoms. Recordings of the sustained vowel /a/ and counting numbers were performed for posterior perceptual and acoustic analyses of the voice quality. The maximum phonation time (MPT) for /a/, /s/, /z/ and counting numbers were also obtained. After that, a draw lot established which technique (VOHFO or resonance tube) would be initially applied for three minutes. After the exercise performance the same procedures were carried out and the elderly women answered a self-assessment questionnaire about the effect of the techniques in her voice, larynx, breathing and articulation. Comparison pre and post each technique were analyzed using ANOVA, Wilcoxon and Mann-Whitney tests. The sensations after the techniques were assessed using the Chi-square test (p<0.05). RESULTS: The comparison of both techniques showed decrease in roughness and improvement in resonance for counting numbers after the resonance tube and same outcomes post VOHFO. There were no significant differences for the other analyzed variables between groups. CONCLUSION: The phonation into a resonance tube exercise improves the vocal quality of elderly women. In addition, both exercises are similar regarding self-perception of vocal / laryngeal symptoms and sensations post three minutes of the technique, suggesting that VOHFO can be safely applied in voice therapy for this population.


Assuntos
Laringe/fisiopatologia , Fonação/fisiologia , Acústica da Fala , Qualidade da Voz/fisiologia , Treinamento da Voz , Idoso , Envelhecimento/fisiologia , Feminino , Ventilação de Alta Frequência/métodos , Humanos , Julgamento , Doenças da Laringe/complicações , Pessoa de Meia-Idade , Autoimagem , Autorrelato , Patologia da Fala e Linguagem/métodos , Distúrbios da Voz/fisiopatologia , Distúrbios da Voz/psicologia
3.
Exp Psychol ; 66(5): 355-360, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31696792

RESUMO

Words whose articulation resembles ingestion movements are preferred to words mimicking expectoration movements. This so-called in-out effect, suggesting that the oral movements caused by consonantal articulation automatically activate concordant motivational states, was already replicated in languages belonging to Germanic (e.g., German and English) and Italic (e.g., Portuguese) branches of the Indo-European family. However, it remains unknown whether such preference extends to the Indo-European branches whose writing system is based on the Cyrillic rather than Latin alphabet (e.g., Ukrainian), or whether it occurs in languages not belonging to the Indo-European family (e.g., Turkish). We replicated the in-out effect in two high-powered experiments (N = 274), with Ukrainian and Turkish native speakers, further supporting an embodied explanation for this intriguing preference.


Assuntos
Idioma , Fonação/fisiologia , Humanos
4.
Rev. chil. fonoaudiol. (En línea) ; 18: 1-10, nov. 2019. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1095040

RESUMO

El presente trabajo evalúa la efectividad de una intervención utilizando Praxias bucofonatorias con dispositivos bucales en conjunto con realidad virtual inmersiva (RVI), mediante programas diseñados para estimular estados de relajación e interacción en diferentes ambientes virtuales. Para ello, se aplicó la terapia integrada de vibro estimulación bucal palatina, ejercitación lingual y la exposición a imágenes y sonidos empleando RVI en un grupo de 6 niños con el diagnóstico de dislalia. Se comparó los resultados de esta intervención con el de una intervención utilizando únicamente la vibro estimulación bucal palatina en un grupo de 20 niños con diagnóstico de dislalia. Finalmente, se aplicó la terapia integrada de vibro estimulación bucal palatina, ejercitación lingual y RVI en un grupo de niños con autismo. Los resultados observados mostraron que la terapia con dispositivos bucales combinadas con RVI tendía a producir mayores avances que la terapia sin RVI. Además, se observó diferentes grados de avances individuales y grupales en el dominio fonético dependiendo las habilidades de hablainicial, los niños con mejores habilidades presentaban mayores avances. El grupo de niños con autismo presentó menores avances respecto de los otros dos grupos. A pesar de las limitantes del presente estudio (diferente cantidad de sujetos por grupo y distintas edades) puede considerarse esta propuesta como prometedora para futuros estudios.


This study assesses the effectiveness of a therapy using Bucco-phonatory training practices with buccal devices and immersive virtual reality (RVI) through programs designed to stimulate states of relaxation and interaction in different virtual environments. In order to do so, an integrated therapy based on Intra buccal stimulation by means of vibrations in the palatal area, daily lingual exercises with a lingual exerciser device, and exposure to images and sounds using RVI was applied to a group of 6 children diagnosed with dyslalia. The results of this intervention were compared with those obtained in an intervention based only on intra buccal stimulation by means of vibrations in the palatal area (conducted on a a group of 20 children diagnosed with dyslalia). Finally, the integrated therapy of intra buccal stimulation by means of vibrations in the palatal area, lingual exercises, and RVI was applied to a group of children with autism. The results showed that therapy with oral devices combined with RVI tended to produce greater advances than therapy without RVI. In addition, individual differences in group advances in the phonetic domain were observed depending on the initial speech skills, children with better abilities presented greater advances. The group of children with autism progressed less than the other two groups. Even considering the limitations of this study, such as the heterogeneity in terms of group size and age, results can be considered as promising for future studies.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Fonação/fisiologia , Distúrbios da Fala/terapia , Língua/fisiologia , Terapia por Exercício/instrumentação , Realidade Virtual , Transtorno Autístico/terapia , Projetos Piloto
5.
Medicine (Baltimore) ; 98(41): e17499, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593117

RESUMO

This retrospective study evaluated operative outcomes when using a supraclavicular artery island flap (SAIF) combined with a sternohyoid muscle flap (SHMF) to reconstruct defects after hypopharyngeal carcinoma resection. Reconstructive surgery for hypopharyngeal and laryngeal defects was performed with the SAIF + SHME combination in 6 patients during 2016 to 2018. Within 14 to 16 days after the surgery, all 6 patients could ingest food and block the tube (avoiding aspiration), with no pharyngeal fistulas. They then underwent irradiation up to a total of 60.5 Gy during the 4 weeks postoperatively. All 6 flaps survived, and there were no donor-site complications except minor dehiscence in 1 patient. Thus, the SAIF + SHMF combination can be used to reconstruct hypopharyngeal and laryngeal defects after hemi-laryngectomy in patients with hypopharyngeal carcinoma involving the unilateral larynx. This technique effectively preserved the swallowing function and phonation of the patients, thereby improving their quality of life.


Assuntos
Artérias/transplante , Músculos do Pescoço/transplante , Retalhos Cirúrgicos/transplante , Idoso , Cervicoplastia/métodos , Clavícula/irrigação sanguínea , Terapia Combinada/métodos , Deglutição/fisiologia , Humanos , Neoplasias Hipofaríngeas/radioterapia , Neoplasias Hipofaríngeas/cirurgia , Hipofaringe/cirurgia , Laringectomia/métodos , Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Fonação/fisiologia , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Deiscência da Ferida Operatória/epidemiologia
6.
Eur Arch Otorhinolaryngol ; 276(11): 3159-3164, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31485732

RESUMO

PURPOSE: Ultra-high-resolution computed tomography (UHRCT) is an emerging imaging technology that is able to achieve simultaneous 160 slices with super-thin 0.25 mm thickness. The purpose of this study was to assess the feasibility of UHRCT to visualize laryngeal structure and kinetics. METHODS: Three normal volunteers and three patients with unilateral vocal fold paralysis (UVFP) were incorporated in this case series. First, images were taken under five conditions in normal volunteers. Five tasks consisted of (1) air inspiration through the nose (IN), (2) breath holding (BH), (3) sustained vowel /i:/ phonation (IP), (4) humming phonation (HP), and (5) forced glottic closure during exhalation (FC). Three-dimensional CT images of arytenoid and cricoid cartilages, as well as virtual laryngoscopic images, were reconstructed using UHRCT data. Reconstructed images were compared among five conditions to assess the best tasks to picture laryngeal kinetics. Second, pre- and post-phonosurgical images were examined in UVFP patients to evaluate potential role of UHRCT to assess laryngeal pathology in hoarse patients. RESULTS: Among the five conditions, IN and IP conditions were considered suitable to visualize laryngeal structure at rest and during phonation, respectively. Kinetic abnormalities including asymmetric motion of arytenoid cartilages were elucidated in UVFP patients, and virtual endoscopy visualized the clinically invisible posterior three-dimensional glottic chinks. Furthermore, UHRCT was useful to understand changes in laryngeal structure achieved by phonosurgery. CONCLUSIONS: UHRCT is an emerging imaging technology that can be used for minimally invasive visualization and assessment of laryngeal structure and kinetics. Future studies to assess more number of patients with laryngeal dysfunction are warranted.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Laringe , Tomografia Computadorizada Multidetectores/métodos , Paralisia das Pregas Vocais , Adulto , Cartilagem Aritenoide/diagnóstico por imagem , Feminino , Humanos , Cinética , Laringoplastia/métodos , Laringoscopia/métodos , Laringe/diagnóstico por imagem , Laringe/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fonação/fisiologia , Reprodutibilidade dos Testes , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/fisiopatologia , Paralisia das Pregas Vocais/cirurgia
7.
Otolaryngol Pol ; 73(3): 16-25, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-31249149

RESUMO

INTRODUCTION: The aim of the study was to assess the acoustic and capacity analysis of singing voice using DiagnoScope Specialist software. MATERIAL AND METHODS: The study was conducted in 120 adults subjects, including 74 women and 46 men aged 21-5, were divided into 3 groups: I -40 subjects (treatment group) - professional vocalists, II- 40 subjects (treatment group) - semiprofessional vocalists, III- 40 subjects (control group) - students of The Military Medical Faculty at Medical University of Lodz - nonsingers. The research methodology included: primary medical history, physical examination (otolaryngological), vdeolaryngoscopic examination, the GRBAS scale for subjective voice evaluation, diagnostic voice acoustic and capacity analysis using DiagnoScope Specialist software, survey on lifestyle patterns which may affect voice quality. RESULTS: Average value of the fundamental frequency F0 was the highest in professional vocalists' group was 316,46 Hz in women and 165,09 Hz in men, in semiprofessional vocalists' group was accordingly 260,50 Hz and 149,26 Hz, in nonsingers' group was accordingly 261,23 Hz and 159, 27 Hz. Average value of Jitter parameter in professional vocalists' group was 0,30% in women and 0,54% in men, in semiprofessional vocalists' group was accordingly 0,31% and 0,57%, in nonsingers' group was 0,31% and 0,56%. Average value of Shimmer parameter in professional vocalists' group was 3,27% in women and 3,75% in men, in semiprofessional vocalists' group was accordingly 3,46% and 3,77%, in nonsingers' group was 4,33% and 4,39%. Average value of NHR index in professional vocalists' group was 3,28% in women and 6,00% in men, in semiprofessional vocalists' group was accordingly 3,23% and 6,72%, in nonsingers' group was 3,89% and 6,13%. CONCLUSIONS: Values of the parameters which are measuring the character of the voice, relative period-to-period fundamental frequency perturbations, relative period-to-period amplitude perturbation and level of buzzing together with other methods have diagnostic and predictive value in early detection of voice disorders. Capacity analysis in singing voice showed very low values of the following parameters: phonation time, true phonation time, no phonation coefficient, voice efficiency coefficient and voice capacity. Key words: The acoustic and capacity analysis, singing voice.


Assuntos
Fonação/fisiologia , Acústica da Fala , Medida da Produção da Fala/métodos , Qualidade da Voz/fisiologia , Voz/fisiologia , Adulto , Feminino , Humanos , Masculino , Canto
8.
Clin Neurophysiol ; 130(6): 1033-1040, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30930193

RESUMO

OBJECTIVE: Spasmodic dysphonia (SD) is a debilitating voice/speech disorder without an effective cure. To obtain a better understanding of the underlying cortical neural mechanism of the disease we analyzed electroencephalographic (EEG) signals of people with SD during voice production. METHOD: Ten SD individuals and 10 healthy volunteers produced 50 vowel vocalization epochs of 2500 ms duration. Two EEG features were derived: (1) event-related change in spectral power during vocalization relative to rest, (2) inter-regional spectral coherence. RESULTS: During early vocalization (500-1000 ms) the SD group showed significantly larger alpha band spectral power over the left motor cortex. During late vocalization (1000-2500 ms) SD patients showed a significantly larger gamma band coherence between left somatosensory and premotor cortical areas. CONCLUSIONS: Two atypical patterns of cortical activity characterize the pathophysiology of spasmodic dysphonia during voice production: (1) a reduced movement-related desynchronization of motor cortical networks, (2) an excessively large synchronization between left somatosensory and premotor cortical areas. SIGNIFICANCE: The pathophysiology of SD is characterized by an abnormally high synchronous activity within and across cortical neural networks involved in voice production that is mainly lateralized in the left hemisphere.


Assuntos
Disfonia/fisiopatologia , Córtex Motor/fisiologia , Fonação/fisiologia , Córtex Somatossensorial/fisiologia , Fala/fisiologia , Adulto , Idoso , Disfonia/diagnóstico , Eletroencefalografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Biomed Res Int ; 2019: 6932047, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30949506

RESUMO

It is well known that the phonatory process changes during the life span. However, detailed investigations on potential factors concerned are rare. To deal with this issue, we performed extended biomechanical, macro anatomical, and histological analyses of the contributing laryngeal structures in ex vivo juvenile sheep models. Altogether twelve juvenile sheep larynges were analyzed within the phonatory experiments. Three different elongation levels and 16 different flow levels were applied to achieve a large variety of phonatory conditions. Vocal fold dynamics and acoustical and subglottal signals could be analyzed for 431 experimental runs. Subsequently, for six juvenile larynges microcomputed tomography following virtual 3D reconstruction was performed. The remaining six juvenile larynges as well as six ex vivo larynges from old sheep were histologically and immunohistologically analyzed. Results for juveniles showed more consistent dynamical behavior compared to old sheep larynges due to vocal fold tissue alterations during the life span. The phonatory process in juvenile sheep seems to be more effective going along with a greater dynamic range. These findings are supported by the histologically detected higher amounts of elastin and hyaluronic acid in the lamina propria of the juvenile sheep. The 3D reconstructions of the thyro-arytenoid muscles (TAM) showed a symmetrical shape. Intraindividual volume and surface differences of the TAM were small and comparable to those of aged sheep. However, TAM dimensions were statistically significant smaller for juvenile larynges. Finally, topographical landmarks were introduced for later comparison with other individuals and species. This work resulted in detailed functional, immunohistological, and anatomical information that was not yet reported. This data will also provide reference information for therapeutic strategies regarding aging effects, e.g. laryngeal muscle treatment by functional electrical stimulation.


Assuntos
Fonação/fisiologia , Prega Vocal , Microtomografia por Raio-X , Animais , Elastina/metabolismo , Laringe , Membrana Mucosa/diagnóstico por imagem , Membrana Mucosa/metabolismo , Ovinos , Prega Vocal/diagnóstico por imagem , Prega Vocal/fisiologia
10.
J Speech Lang Hear Res ; 62(2): 215-228, 2019 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-30950696

RESUMO

Purpose Normative data for many objective voice measures are routinely used in clinical voice assessment; however, normative data reflect vocal output, but not vocalization process. The underlying physiologic processes of healthy phonation have been shown to be nonlinear and thus are likely different across individuals. Dynamic systems theory postulates that performance behaviors emerge from the nonlinear interplay of multiple physiologic components and that certain patterns are preferred and loosely governed by the interactions of physiology, task, and environment. The purpose of this study was to descriptively characterize the interactive nature of the vocalization subsystem triad in subjects with healthy voices and to determine if differing subgroups could be delineated to better understand how healthy voicing is physiologically generated. Method Respiratory kinematic, aerodynamic, and acoustic formant data were obtained from 29 individuals with healthy voices (21 female and eight male). Multivariate analyses were used to descriptively characterize the interactions among the subsystems that contributed to healthy voicing. Results Group data revealed representative measures of the 3 subsystems to be generally within the boundaries of established normative data. Despite this, 3 distinct clusters were delineated that represented 3 subgroups of individuals with differing subsystem patterning. Seven of the 9 measured variables in this study were found to be significantly different across at least 1 of the 3 subgroups indicating differing physiologic processes across individuals. Conclusion Vocal output in healthy individuals appears to be generated by distinct and preferred physiologic processes that were represented by 3 subgroups indicating that the process of vocalization is different among individuals, but not entirely idiosyncratic. Possibilities for these differences are explored using the framework of dynamic systems theory and the dynamics of emergent behaviors. A revised physiologic model of phonation that accounts for differences within and among the vocalization subsystems is described. Supplemental Material https://doi.org/10.23641/asha.7616462.


Assuntos
Fonação/fisiologia , Voz/fisiologia , Adolescente , Adulto , Fenômenos Biomecânicos , Feminino , Voluntários Saudáveis , Humanos , Kentucky , Medidas de Volume Pulmonar , Masculino , Pessoa de Meia-Idade , Respiração , Acústica da Fala , Prega Vocal/diagnóstico por imagem , Qualidade da Voz/fisiologia , Adulto Jovem
11.
J Speech Lang Hear Res ; 62(2): 283-296, 2019 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-30950701

RESUMO

Purpose Conversational entrainment, the phenomenon whereby communication partners synchronize their behavior, is considered essential for productive and fulfilling conversation. Lack of entrainment could, therefore, negatively impact conversational success. Although studied in many disciplines, entrainment has received limited attention in the field of speech-language pathology, where its implications may have direct clinical relevance. Method A novel computational methodology, informed by expert clinical assessment of conversation, was developed to investigate conversational entrainment across multiple speech dimensions in a corpus of experimentally elicited conversations involving healthy participants. The predictive relationship between the methodology output and an objective measure of conversational success, communicative efficiency, was then examined. Results Using a real versus sham validation procedure, we find evidence of sustained entrainment in rhythmic, articulatory, and phonatory dimensions of speech. We further validate the methodology, showing that models built on speech signal entrainment measures consistently outperform models built on nonentrained speech signal measures in predicting communicative efficiency of the conversations. Conclusions A multidimensional, clinically meaningful methodology for capturing conversational entrainment, validated in healthy populations, has implications for disciplines such as speech-language pathology where conversational entrainment represents a critical knowledge gap in the field, as well as a potential target for remediation.


Assuntos
Comunicação , Fala/fisiologia , Adulto , Eficiência/fisiologia , Feminino , Humanos , Masculino , Fonação/fisiologia , Qualidade da Voz/fisiologia , Adulto Jovem
12.
J Speech Lang Hear Res ; 62(2): 318-323, 2019 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-30950703

RESUMO

Purpose The aim of this study was to investigate secondary voice outcomes and detraining effects of 2 head and neck strengthening exercises, which have been used in swallowing rehabilitation, that is, the head-lift exercise (HLE) and the recline exercise (RE), in healthy older adults. Method Twenty-seven healthy older adults (between 60 and 85 years of age) were randomized to perform either the RE or the HLE for a 6-week period. Isometric and isokinetic portions of the exercise were performed 3 times daily. Patients were evaluated at baseline, postexercise, and following a 6-week detraining period. Acoustic outcome measures included the highest and lowest frequencies of vocal range on pitch glides (measured in hertz) and cepstral peak prominence on sustained vowels and connected speech. Self-perceptual measures included perceived phonatory effort. Results Twenty-two individuals completed their assigned exercise regimen. No significant differences between exercise groups were observed at baseline for age, body mass index, or body fat percentage. A significant postexercise increase was seen in the highest frequency of vocal range on pitch glide, t(2, 56.79) = -10.28, p ≤ .0001, for both groups. This increase was not fully maintained following the 6-week detraining period; however, data remained significantly above baseline at this time point, t(2, 57.01) = -4.70, p ≤ .0001. Seventeen of the individuals who made postexercise gains were followed postdetraining. On average, these 17 individuals maintained 51% of their postexercise gains in the highest frequency of vocal range. No differences were observed between exercise groups. In addition, no significant changes in the lowest frequency of vocal range, cepstral peak prominence on sustained vowels or connected speech, or perceived phonatory effort were observed following the exercise regimens. Conclusions Both the HLE and the RE produced gains in the highest frequency of vocal range in healthy older adults. This finding is promising; however, further research is required to understand how suprahyoid muscle strengthening influences upper pitch range and whether this relationship has potential clinical implications for patients with dysphonia.


Assuntos
Terapia por Exercício/métodos , Qualidade da Voz/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Cabeça , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Pescoço , Percepção , Fonação/fisiologia , Autoimagem , Acústica da Fala
13.
Ann Otol Rhinol Laryngol ; 128(3_suppl): 53S-70S, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30843434

RESUMO

OBJECTIVE:: Laryngeal paralysis of central or peripheral origin can potentially be treated using functional electrical stimulation (FES) of laryngeal muscles. Experiments in canines (dogs) were performed using implant prototypes capable of closed-loop FES to refine engineering designs and specifications, test surgical approaches for implantation, and better understand the in vivo effects of laryngeal muscle stimulation on short- and long-term glottic function. STUDY DESIGN:: Prospective, laboratory. METHODS:: We designed and tested a series of microprocessor-based implantable devices that can stimulate glottic opening or closing based on input from physiological control signals (real-time processing of electromyographic [EMG] signals). After acute device testing experiments, 2 dogs were implanted for 8 and 24 months, with periodic testing of closed-loop laryngeal muscle stimulation triggered from EMG signals. In total, 5 dogs were tested for the effects of laryngeal muscle stimulation on vocal fold (VF) posturing in larynges with nerve supplies that were intact (7 VFs), synkinetically reinnervated (2 VFs), or chronically denervated (1 VF). In 3 cases, the stimulation was combined with airflow-driven phonation to study the consequent modulation of phonatory parameters. RESULTS:: Initial device prototypes used inductive coupling for power and communication, while later iterations used battery power and infrared light communication (detailed descriptions are provided in the Part 1 companion paper). Two animals were successfully implanted with the inductively powered units, which operated until removed at 8 months in 1 animal or for more than 16 months in the second animal. Surgically, the encapsulated implants were well tolerated, and procedures for placing, attaching, and connecting the devices were developed. To simulate EMG control signals in anesthetized animals, we created 2 types of nerve/muscle signal sources. In one approach, a neck muscle had a cuff electrode placed on its motor nerve that was connected to transdermal electrical connection ports for periodic testing. In the second approach, the recurrent laryngeal nerve on one side of the larynx was stimulated to generate a VF EMG signal, which was then used to trigger FES of the paralyzed contralateral side (eg, restoring VF movement symmetry). Implant testing identified effective stimulation parameters and closed-loop stimulation artifact rejection techniques for FES of both healthy and paralyzed VFs. Stimulation levels effective for VF adduction did not cause signs of discomfort during awake testing. CONCLUSION:: Our inductive and battery-powered prototypes performed effectively during in vivo testing, and the 2 units that were implanted for long-term evaluation held up well. As a proof of concept, we demonstrated that elicited neck strap muscle or laryngeal EMG potentials could be used as a control signal for closed-loop stimulation of laryngeal adduction and vocal pitch modulation, depending on electrode positioning, and that VFs were stimulable in the presence of synkinetic reinnervation or chronic denervation.


Assuntos
Terapia por Estimulação Elétrica/instrumentação , Eletrodos Implantados , Músculos Laríngeos/fisiopatologia , Fonação/fisiologia , Paralisia das Pregas Vocais/terapia , Prega Vocal/fisiopatologia , Animais , Modelos Animais de Doenças , Cães , Eletromiografia/instrumentação , Feminino
14.
Eur Ann Otorhinolaryngol Head Neck Dis ; 136(3): 151-154, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30880033

RESUMO

OBJECTIVES: To develop an experimental protocol to study the vocal effort generated by introducing barriers to communication, and its relationship with certain personality traits. MATERIAL AND METHODS: The experimental protocol consisted of an interactive game in which the subject gave an investigator instructions to adopt various body positions (semi-directed communication situation). The Control situation included no constraints on communication. Then a Distance Constraint (increased distance between subject and investigator) and a Time Constraint (generation of performance stress by putting the subject in competition with others) were introduced. The vocal parameters studied comprised vocal intensity and fundamental frequency in the middle of the vowel of 3 target phonemes. Subjects also took the NEO FFI-R personality test. RESULTS: The study included 41 women aged between 18 and 52 years. Vocal intensity and fundamental frequency increased significantly with the introduction of the constraints (P<0.05), intensity passing from 75.5dB to 81.8dB and frequency from 249.4Hz to 335.8Hz. No correlations were found between these changes and results for the various personality traits. CONCLUSIONS: This ecological protocol enables the impact of both physical and emotional obstacles to communication to be studied. No correlations between vocal effort and personality traits emerged. A larger-scale study would be necessary to analyze the continuum between vocal effort and vocal forcing, to improve speech therapy for dysfunctional dysphonia.


Assuntos
Barreiras de Comunicação , Personalidade , Fonação/fisiologia , Voz/fisiologia , Adulto , Comunicação , Comportamento Competitivo , Feminino , Jogos Experimentais , Voluntários Saudáveis , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Postura , Estresse Psicológico/fisiopatologia , Tempo , Adulto Jovem
15.
Rev. logop. foniatr. audiol. (Ed. impr.) ; 39(1): 4-10, ene.-mar. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-176634

RESUMO

Introduction: Preterm and low-birth-weight newborns may present immaturity in the functions of sucking, swallowing and breathing, speech therapists inserted in the hospital focus on the development of newborns' oral sensorimotor system, promoting a safe transition from tube feeding to breastfeeding and contributing to improving the quality of life of the child population. The present study aimed to analyze the development of oral functions, oral feeding transition time and breastfeeding of preterm and low-birth-weight newborns under Speech-Language Pathology care. Methods: A prognostic study carried out at a maternity hospital, based on the data collected from 121 filed medical records of newborns attended between September 2015 to July 2017. The Kaplan-Meier method, the Log Rank test and the Pearson correlation test were used for data analysis, considering a significance level of 0.05 (95%). Results: It was observed that the lower the gestational age and the birth weight of newborns, the more speech therapy services were required until the establishment of exclusive OF; also, the transition time and the average time of using the orogastric tube were inversely proportional to the gestational age at birth. The non-nutritive sucking technique was the most used for stimulation, and 78.5% of the NBs were discharged from the hospital on exclusive breastfeeding. Conclusion: Moderate to late preterm and low-birth-weight newborns are able to more quickly acquire the oral sensorimotor system functional pattern, and there are indications that Speech-Language Pathology care reduces the transition time to oral feeding, thus increasing the success rate of exclusive breastfeeding


Introducción: Los recién nacidos (RN) prematuros y con bajo peso pueden presentar inmadurez en las funciones de succión, deglución y respiración. Los logopedas en los hospitales trabajan el desarrollo del sistema sensoriomotor oral de los RN, promoviendo una transición segura de la sonda a la lactancia materna, lo que contribuye a mejorar la calidad de vida de la población infantil. El objetivo del presente estudio era analizar el desarrollo de las funciones orales, el tiempo de transición a la alimentación por vía oral (VO) y la lactancia materna de los RN prematuros, y con bajo peso al nacer bajo el cuidado fonoaudiológico. Métodos: Este estudio de pronóstico se llevó a cabo en una maternidad, con base en la recopilación de datos en prontuarios archivados de 121 RN atendidos entre septiembre de 2015 y julio de 2017. En el análisis de los datos se aplicó el método de Kaplan-Meier, el test log-rank y la prueba de correlación de Pearson. Se consideró un nivel de significancia de 0,05 (95%). Resultados: Se observó que cuanto menores eran la edad gestacional y el peso de nacimiento del RN, más necesidad de servicios fonoaudiológicos había hasta el establecimiento de la VO exclusiva, y el tiempo de transición y el tiempo promedio de utilización de la sonda orogástrica eran inversamente proporcionales a la edad gestacional al nacimiento. La técnica de succión no nutritiva fue la más utilizada para la estimulación, y el 78,5% de los RN recibieron el alta hospitalaria con lactancia exclusiva. Conclusión: Los RN prematuros de moderados a tardíos y de bajo peso son capaces de adquirir el patrón funcional del sistema sensoriomotor oral con mayor rapidez, y hay indicios de que la atención fonoaudiológica reduce el tiempo de transición alimentaria a la VO, y aumenta la tasa de éxito de lactancia materna exclusiva


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Destreza Motora/fisiologia , Sensação/fisiologia , Fonação/fisiologia , Comportamento de Sucção/fisiologia , Deglutição/fisiologia , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Fonoaudiologia/estatística & dados numéricos , Intervenção Médica Precoce/organização & administração , Testes de Função Respiratória/estatística & dados numéricos , Lactação/fisiologia
16.
Rev. logop. foniatr. audiol. (Ed. impr.) ; 39(1): 20-26, ene.-mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-176636

RESUMO

Introducción: La terapia de voz es una práctica que no está ampliamente fundamentada en la evidencia investigativa; la valoración y el seguimiento de los programas de rehabilitación se apoyan casi exclusivamente en el análisis perceptual y pocas evaluaciones acústicas reportan medidas que no se han interrelacionado entre sí para determinar grados de riesgo vocal en diferentes poblaciones con disfonía. El objetivo de esta investigación fue valorar acústicamente el efecto de 2tipos de terapia vocal (mixta y directa) en personas con disfonía funcional empleando el índice de perturbación vocal integrado. Método: Se seleccionó una muestra de 20 personas entre los 20 y 60 años con disfonía funcional; se evaluó toda la muestra mediante análisis acústico con el software Anagraf y se fraccionó la muestra en 2grupos, el primero recibió terapia vocal mixta y el segundo únicamente terapia vocal directa. Se evaluaron acústicamente las voces, posterior a la terapia, y se comparó el efecto de los 2tipos de intervención propuestos. Resultados: El índice de perturbación vocal integrado se encontró alterado para la mayor parte de la muestra de ambos grupos, preterapia vocal. Finalizada la terapia tanto mixta como directa, se encontró que este índice clasificó voces en rangos de normalidad y voces en riesgo disminuyendo su grado de alteración. Conclusión: El índice de perturbación vocal integrado se modificó favorablemente para ambos grupos de terapia. No obstante, esta modificación fue estadísticamente significativa para el grupo que realizó terapia vocal mixta


Introduction: Voice therapy is a practice that is not extensively based on research evidence; the assessment and monitoring of rehabilitation programmes are generally based on perceptual analysis, and few acoustic measures have not been correlated with each other to determine the extent of vocal risk among different kinds of populations with dysphonia. The aim of this research was the acoustic assessment of the effect of 2types of voice therapy (mixed and direct) in individuals with functional dysphonia using the integrated vocal disturbance index. Method: A sample of 20 functional dysphonic individuals aged between 20 and 60 years was selected. The individuals were assessed through an acoustic analysis using Anagraf software. The sample was split into 2groups; the first one received mixed voice therapy and the second only received direct voice therapy. The post-therapy voices were acoustically assessed, comparing the effect of the techniques proposed. Results: The integrated vocal disturbance index was found to be altered for most of the individuals in both groups before receiving voice therapy. On completion of the mixed and direct voice therapy, it was found that the index classified the voices into normal and at risk, decreasing their extent of disturbance. Conclusion: The integrated vocal disturbance index was favourably modified for both therapy groups. However, this was statistically more significant for the group that received mixed voice therapy


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Qualidade da Voz , Treinamento da Voz , Distúrbios da Voz/reabilitação , Disfonia/reabilitação , Fonação/fisiologia , Resultado do Tratamento , Estudos Controlados Antes e Depois
17.
Eur Arch Otorhinolaryngol ; 276(2): 473-482, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30631899

RESUMO

PURPOSE: This study investigated the effects of straw phonation therapy on the aerodynamic and acoustic parameters of the vocal folds at different levels of elongation and subglottal pressure. METHODS: 20 excised canine larynges were used in both experimental (straw phonation therapy simulation) and control conditions. Aerodynamic parameters, including phonation threshold pressure (PTP), phonation instability pressure (PIP), phonation pressure range (PPR), phonation threshold flow (PTF), phonation instability flow (PIF), phonation flow range (PFR), were obtained at different levels of vocal fold elongation (0%, 10%, 20%). Acoustic parameters, including fundamental frequency (F0), jitter, shimmer, signal noise ratio (SNR) were detected at different levels of vocal fold elongation (0%, 10%, 20%) and subglottal pressure (15 cmH2O, 20 cmH2O, 25 cmH2O). RESULTS: Significant decreases in PTP and PTF and significant increases in PIP, PIF, PPR, and PFR occurred in experimental condition at all levels of elongation when compared with control condition. However, no significant changes of acoustic parameters were obtained between conditions at all levels. CONCLUSION: At different levels of vocal fold elongation, straw phonation not only lowered the onset of normal voice, but also elevated the onset of chaotic voice, indicating a better voice economy and voice control. Moreover, the improved phonatory range demonstrated that straw phonation had the potential to prevent voice users who have high voice demand from voice fatigue and vocal damage.


Assuntos
Laringe/fisiologia , Fonação/fisiologia , Distúrbios da Voz/fisiopatologia , Treinamento da Voz , Animais , Cães , Distúrbios da Voz/terapia
18.
Laryngoscope ; 129(7): 1520-1526, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30408173

RESUMO

OBJECTIVES/HYPOTHESIS: Phonation threshold pressure (PTP), the minimum subglottal pressure (Ps ) required for phonation, is sensitive to changes in laryngeal biomechanics and is often elevated with pathology. Little is reported on PTP in children; challenges with task performance and measurement reliability represent barriers to routine clinical assessment. STUDY DESIGN: Pilot study evaluating PTP and Ps measurement reliability in children using labial and mechanical interruption. METHODS: Twenty-two subjects aged 4 to 17 years (10.7 ± 3.9 years) participated. Ten trials were performed for each method; task order was randomized. For labial interruption, subjects produced /pα/ five times at softest (onset PTP) and comfortable amplitude. For mechanical interruption, subjects produced a sustained /α/ while a balloon valve interrupted phonation five times for 250 ms each; mechanical interruption was performed with a mouthpiece and mask. PTP was recorded as the difference between Ps and supraglottal pressure at phonation cessation (offset PTP). Mean PTP and Ps and intrasubject coefficients of variation were compared. Correlations with age were evaluated. RESULTS: Mean PTP (P < .001) and Ps (P = .005) were higher for labial interruption. Intrasubject coefficients of variation for PTP (P = .554) and Ps (P = .305) were similar across methods. Coefficient of variation was related to age for mechanical-mask trials only (r = -0.628, P = .00175). CONCLUSIONS: Differences in means are likely related to differences in task and PTP hysteresis effect. Reliability is comparable with all methods; using a mouthpiece may be preferable to a mask for mechanical interruption. Measurement of PTP is noninvasive, reliable, and may be a useful adjunct in pediatric voice assessment. LEVEL OF EVIDENCE: 3b Laryngoscope, 129:1520-1526, 2019.


Assuntos
Glote/fisiologia , Manometria/normas , Otolaringologia/normas , Fonação/fisiologia , Testes de Função Respiratória/normas , Adolescente , Fatores Etários , Fenômenos Biomecânicos , Criança , Pré-Escolar , Feminino , Humanos , Laringe/fisiologia , Masculino , Manometria/métodos , Otolaringologia/métodos , Projetos Piloto , Pressão , Reprodutibilidade dos Testes , Testes de Função Respiratória/métodos
19.
Laryngoscope ; 129(1): E26-E31, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30408175

RESUMO

OBJECTIVES/HYPOTHESIS: Various animal models have been employed to investigate vocal fold (VF) and phonatory function. However, biomechanical testing techniques to characterize vocal fold structural properties vary and have not compared critical properties across species. We adapted a nondestructive, automated indentation mapping technique to simultaneously quantify VF structural properties (VF cover layer and intact VF) in commonly used species based on the hypothesis that VF biomechanical properties are largely preserved across species. STUDY DESIGN: Ex vivo animal model. METHODS: Canine, leporine, and swine larynges (n = 4 each) were sagittally bisected, measured, and subjected to normal indentation mapping (indentation at 0.3 mm; 1.2 mm/s) with a 2-mm spherical indenter to quantify normal force along the VF cover layer, structural stiffness, and displacement at 0.8 mN; two-dimensional maps of the free VF edge through the conus elasticus were created for these characterizations. RESULTS: Structural stiffness was 7.79 gf/mm (0.15-74.55) for leporine, 2.48 gf/mm (0.20-41.75) for canine, and 1.45 gf (0.56-4.56) for swine. For each species, the lowest values were along the free VF edge (mean ± standard deviation; leporine: 0.40 ± 0.21 gf/mm, canine: 1.14 ± 0.49 gf/mm, swine: 0.89 ± 0.28 gf/mm). Similar results were obtained for the cover layer normal force at 0.3 mm. On the free VF edge, mean (standard deviation) displacement at 0.08 gf was 0.14 mm (0.05) in leporine, 0.11 mm (0.03) in canine, and 0.10 mm (0.02) in swine. CONCLUSIONS: Automated indentation mapping yielded reproducible biomechanical property measurement of the VF cover and intact VF. Divergent VF structural properties across canine, swine, and leporine species were observed. LEVEL OF EVIDENCE: NA Laryngoscope, 129:E26-E31, 2019.


Assuntos
Módulo de Elasticidade/fisiologia , Fonação/fisiologia , Prega Vocal/fisiologia , Animais , Fenômenos Biomecânicos , Cães , Técnicas In Vitro , Modelos Animais , Coelhos , Reprodutibilidade dos Testes , Especificidade da Espécie , Suínos , Prega Vocal/anatomia & histologia
20.
Folia Phoniatr Logop ; 71(1): 1-6, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30466101

RESUMO

OBJECTIVES: The present study investigated the articulatory contact pressure during the production of bilabial plosives by esophageal (ES), tracheoesophageal (TE), and laryngeal speakers. METHODS: The peak contact pressure (PCP) during bilabial plosive production of /CVCVCVCVCV/ syllable strings of /p/ and /ph/ was obtained from 10 ES, 10 TE, and 10 laryngeal speakers of Cantonese. PCP values were obtained by using a pressure transduction system (Iowa Oral Performance Instrument) during speech production. RESULTS: The results showed that ES speakers exhibited a significantly greater PCP value than TE and laryngeal speakers, as revealed by cheek muscle compression force. In addition, the unaspirated bilabial plosive /p/ was associated with a greater PCP than its aspirated counterpart /ph/. CONCLUSION: The current findings might support the hypothesis of over-exaggerated speech for better intelligibility among alaryngeal speakers. In addition, the increased oral muscular effort could be associated with a compensatory strategy for maintaining a high intraoral pressure or the unique air intake by ES speakers.


Assuntos
Fonação/fisiologia , Fonética , Voz Alaríngea , Adulto , Idoso , Bochecha , Músculos Faciais/fisiologia , Humanos , Laringectomia/reabilitação , Lábio , Masculino , Manometria , Pessoa de Meia-Idade , Boca , Pressão , Voz Esofágica , Traqueia , Transdutores de Pressão
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