RESUMO
BACKGROUND: Adequate phonation is self-regulated by auditory feedback. Children with bilateral profound hearing loss (PHL) lack this feedback resulting in abnormal voice. Adequate hearing aid use and auditory-verbal therapy (AVT) may improve voice quality in deaf children. OBJECTIVE: To study whether hearing aid use and AVT approach improve acoustic parameters of voice of children with bilateral PHL. MATERIALS AND METHODS: Nineteen children with bilateral PHL were studied. Age range 2-5 years (Xâ¯=â¯53.04 months; SDâ¯=â¯9.54). All children were fitted with hearing aids according to auditory testing and they underwent a 1-year auditory habilitation period using the AVT approach. Acoustic analysis of voice including F0, shimmer, and jitter was performed at the onset and at the end of the auditory habilitation period. Final acoustic data were compared to a matched control group of 19 children, age range 2-5 years (Xâ¯=â¯52.85; SDâ¯=â¯9.74) with normal hearing. RESULTS: Mean fundamental frequency (F0) was significantly increased after AVT intervention. Shimmer and jitter significantly (P < 0.05) improved after the intervention period. However, despite the improvements, mean F0 at the end of the intervention period was still significantly (P < 0.05) decreased as compared to controls. Also, mean shimmer and jitter at the end of the habilitation period were still significantly (P < 0.05) higher as compared to controls. CONCLUSIONS: The results of this preliminary study suggest that hearing aid use and auditory habilitation with AVT approach improved acoustic voice parameters of children with PHL. However, acoustic parameters persisted abnormal as compared to matched normal hearing controls. AVT approach and regular hearing aid use seem to be safe and reliable clinical tools for improving voice quality of children with PFL.
Assuntos
Percepção Auditiva , Crianças com Deficiência/reabilitação , Auxiliares de Audição , Perda Auditiva Bilateral/reabilitação , Audição , Pessoas com Deficiência Auditiva/reabilitação , Fonação , Patologia da Fala e Linguagem/métodos , Qualidade da Voz , Fatores Etários , Estudos de Casos e Controles , Comportamento Infantil , Pré-Escolar , Crianças com Deficiência/psicologia , Retroalimentação Sensorial , Feminino , Perda Auditiva Bilateral/diagnóstico , Perda Auditiva Bilateral/fisiopatologia , Perda Auditiva Bilateral/psicologia , Humanos , Masculino , Pessoas com Deficiência Auditiva/psicologia , Comportamento VerbalRESUMO
BACKGROUND: Cleft lip and palate (CLP) is the most common craniofacial anomaly. CLP affects resonance, voice and speech. Besides the most frequently reported resonance and speech disorders, several reports have addressed acoustic abnormalities in the voice of patients with CLP. However, there are just a few reports focusing on vocal treatment in this population. OBJECTIVE: To study whether a Speech and Language Pathology (SLP) intervention including vocal rehabilitation for children with CLP and velopharyngeal insufficiency (VPI) provides significant improvement of abnormal acoustic parameters of voice. MATERIAL AND METHODS: Fifteen children with cleft lip and palate (CLP) and velopharyngeal insufficiency (VPI) were studied. Age ranged 4-5 years. A matched control group of children without craniofacial anomalies and adequate speech, resonance and voice was assembled. All children underwent acoustic analysis of voice at the onset and at the end of SLP intervention including vocal rehabilitation. RESULTS: Hypernasality persisted unchanged following SLP intervention. Mean Fundamental Frequency (F0) did not demonstrate a significant difference between the control and the active groups. At the onset of the intervention mean shimmer and jitter were significantly higher in all patients with CLP as compared to controls. At the end of the intervention shimmer and jitter significantly decreased in patients with CLP showing no differences as compared to controls. CONCLUSION: SLP intervention including vocal rehabilitation improves abnormal acoustic parameters of voice. Besides surgical treatment for VPI the SLP intervention in children with CLP should also address vocal rehabilitation.
Assuntos
Fenda Labial/complicações , Fissura Palatina/complicações , Acústica da Fala , Distúrbios da Voz/reabilitação , Qualidade da Voz , Pré-Escolar , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Feminino , Humanos , Masculino , Insuficiência Velofaríngea/complicações , Insuficiência Velofaríngea/cirurgia , Distúrbios da Voz/etiologiaRESUMO
Children with cleft palate frequently show speech and language disorders. In the related scientific literature, several reports have described the use of different strategies for treating speech disorders in children with cleft palate. However, only a few studies have addressed the use of these strategies within a meaningful linguistic context.Deliberate practice is a procedure or strategy, which proposes that the key for achieving high levels of expert performance is dedicating long time for practice. Deliberate practice has been studied mainly in the areas of sports and intellectual games. The purpose of this article is to study whether the use of a strategy originally designed for achieving expert performance in sports and intellectual games, can be useful for the speech intervention of children with cleft palate.For this project, 32 children with cleft palate were studied. The children were randomly assigned to 2 independent groups. Both groups received speech therapy based on the principles of the Whole Language Model. In addition, deliberate practice was used in the children included in the active group.After a speech intervention, although both groups of children demonstrated significant improvement in articulation placement, the active group demonstrated a significantly higher improvement as compared with the control group.In conclusion, these preliminary results seem to suggest that the use of deliberate practice can be effective for enhancing articulation in children with cleft palate.
Assuntos
Transtornos da Articulação , Fissura Palatina , Fonoterapia , Transtornos da Articulação/etiologia , Transtornos da Articulação/terapia , Criança , Fissura Palatina/complicações , Fissura Palatina/cirurgia , HumanosRESUMO
BACKGROUND: Laryngopharyngeal reflux (LPR) refers to the flow of gastric acid content into the laryngopharynx. It has been reported that 10% of the patients consulting an otolaryngologist present with this condition. Signs of LPR can be identified during flexible or rigid laryngoscopy. The Voice Handicap Index (VHI) is a reliable tool for detecting the impact of voice disorders, and acoustic assessment of voice including acoustic analysis of voice (AAV) and electroglottography (EGG) provide objective data of voice production and voice disorders. OBJECTIVE: This study aimed to describe changes in AAV, EGG, and VHI in patients who present with LPR compared with a matched control group of healthy subjects. MATERIALS AND METHODS: Seventeen patients with LPR were studied. A group of healthy subjects matched by age and gender without any history of voice disorder, LPR, or gastroesophageal reflux disease was assembled. Both groups of patients were studied by VHI, flexible laryngoscopy, AAV, and EGG. RESULTS: All patients with LPR demonstrated abnormal VHI values. Shimmer, jitter, open quotient, and irregularity were significantly increased in the patients with LPR. Nonsignificant correlations were found between VHI scores and abnormal acoustic parameters in patients with LPR. CONCLUSIONS: Although abnormal acoustic parameters of patients with LPR were not predictive of the overall VHI score, the abnormal acoustic parameters of patients with LPR suggest a decrease in adequate laryngeal control during phonation.
Assuntos
Acústica , Avaliação da Deficiência , Eletrodiagnóstico/métodos , Glote/fisiopatologia , Refluxo Laringofaríngeo/diagnóstico , Fonação , Inquéritos e Questionários , Distúrbios da Voz/diagnóstico , Qualidade da Voz , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/fisiopatologia , Laringoscopia , Masculino , Valor Preditivo dos Testes , Dados Preliminares , Distúrbios da Voz/etiologia , Distúrbios da Voz/fisiopatologia , Adulto JovemRESUMO
BACKGROUND: Acoustic analysis of voice (AAV) and electroglottography (EGG) have been used for assessing vocal quality in patients with voice disorders. The effectiveness of these procedures for detecting mild disturbances in vocal quality in elite vocal performers has been controversial. OBJECTIVE: To compare acoustic parameters obtained by AAV and EGG before and after vocal training to determine the effectiveness of these procedures for detecting vocal improvements in elite vocal performers. MATERIALS AND METHODS: Thirty-three elite vocal performers were studied. The study group included 14 males and 19 females, ages 18-40 years, without a history of voice disorders. Acoustic parameters were obtained through AAV and EGG before and after vocal training using the Linklater method. RESULTS: Nonsignificant differences (P > 0.05) were found between values of fundamental frequency (F0), shimmer, and jitter obtained by both procedures before vocal training. Mean F0 was similar after vocal training. Jitter percentage as measured by AAV showed nonsignificant differences (P > 0.05) before and after vocal training. Shimmer percentage as measured by AAV demonstrated a significant reduction (P < 0.05) after vocal training. As measured by EGG after vocal training, shimmer and jitter were significantly reduced (P < 0.05); open quotient was significantly increased (P < 0.05); and irregularity was significantly reduced (P < 0.05). CONCLUSIONS: AAV and EGG were effective for detecting improvements in vocal function after vocal training in male and female elite vocal performers undergoing vocal training. EGG demonstrated better efficacy for detecting improvements and provided additional parameters as compared to AAV.
Assuntos
Acústica , Eletrodiagnóstico , Glote/fisiologia , Fonação , Canto , Qualidade da Voz , Treinamento da Voz , Adolescente , Adulto , Feminino , Humanos , Masculino , Estudos Prospectivos , Processamento de Sinais Assistido por Computador , Adulto JovemRESUMO
INTRODUCTION: Mentoring programs can boost Speech & Language (SL) pathologists' satisfaction about their clinical skills, increasing their professional competence. A quality induction program provides a bridge for an efficient and comfortable transition between theoretical knowledge and clinical practice in front of clients. This transition can be especially difficult when the SL pathologist confronts patients with cleft palate. OBJECTIVE: To study whether a mentoring program can improve SL Pathology students' performance for treating patients with cleft palate. MATERIALS AND METHODS: 18 SL Pathology students coursing the third year of a SL Pathology graduate program volunteered for participating in the study. The students were divided in two groups. All SL students from both groups were equally supervised. The students were followed for two semesters during their participation in the SL Pathology intervention for patients with cleft palate. The only difference between the students from each group was that one group (active group) was mentored by an experienced SLP who had previously received specific training to become a mentor. All SL students were assessed at the onset and at the end of the study. The assessment was performed through an analysis according to a previously validated scale (Learning Continuum of Speech & Language pathologists). RESULTS: A Wilcoxon test demonstrated a significant improvement (P<0.05) in the levels of The Learning Continuum of Speech & Language Pathologists at the end of the follow-up period in both groups of students. When the levels of performance at the end were compared between groups, a Mann Whitney test demonstrated a significant difference (P<0.05). The students included in the active group who were receiving additional mentoring besides the usual clinical supervision, showed a greater improvement as compared with the students from the control group. CONCLUSIONS: Learning how to conduct an adequate and effective intervention in cleft palate patients from an integral stand point is not easy for SL students. The support and guidance of an experienced mentor seems to enhance self-confidence and improve students' performance confronting patients with cleft palate.
Assuntos
Fissura Palatina/reabilitação , Mentores , Fonoterapia/educação , Patologia da Fala e Linguagem/educação , Competência Clínica , Feminino , Humanos , Estudos Prospectivos , Fala , EstudantesRESUMO
BACKGROUND: Acoustic analysis of voice can provide instrumental data concerning vocal abnormalities. These findings can be used for monitoring clinical course in cases of voice disorders. Cleft palate severely affects the structure of the vocal tract. Hence, voice quality can also be also affected. OBJECTIVE: To study whether the main acoustic parameters of voice, including fundamental frequency, shimmer and jitter are significantly different in patients with a repaired cleft palate, as compared with normal children without speech, language and voice disorders. MATERIALS AND METHODS: Fourteen patients with repaired unilateral cleft lip and palate and persistent or residual velopharyngeal insufficiency (VPI) were studied. A control group was assembled with healthy volunteer subjects matched by age and gender. Hypernasality and nasal emission were perceptually assessed in patients with VPI. Size of the gap as assessed by videonasopharyngoscopy was classified in patients with VPI. Acoustic analysis of voice including Fundamental frequency (F0), shimmer and jitter were compared between patients with VPI and control subjects. RESULTS: F0 was significantly higher in male patients as compared with male controls. Shimmer was significantly higher in patients with VPI regardless of gender. Moreover, patients with moderate VPI showed a significantly higher shimmer perturbation, regardless of gender. CONCLUSION: Although future research regarding voice disorders in patients with VPI is needed, at the present time it seems reasonable to include strategies for voice therapy in the speech and language pathology intervention plan for patients with VPI.
Assuntos
Fissura Palatina/complicações , Acústica da Fala , Insuficiência Velofaríngea/complicações , Distúrbios da Voz/etiologia , Estudos de Casos e Controles , Criança , Fenda Labial/complicações , Estudos Transversais , Feminino , Humanos , Masculino , Distúrbios da Voz/diagnóstico , Qualidade da VozRESUMO
BACKGROUND: Although electrical stimulation of the larynx has been widely studied for treating voice disorders, its effectiveness has not been assessed under safety and comfortable conditions. This article describes design, theoretical issues, and preliminary evaluation of an innovative system for transdermal electrical stimulation of the larynx. The proposed design includes synchronization of electrical stimuli with laryngeal neuromuscular activity. OBJECTIVE: To study whether synchronous electrical stimulation of the larynx could be helpful for improving voice quality in patients with dysphonia due to unilateral recurrent laryngeal nerve paralysis (URLNP). MATERIALS AND METHODS: A 3-year prospective study was carried out at the Instituto Nacional de Rehabilitacion in the Mexico City. Ten patients were subjected to transdermal current electrical stimulation synchronized with the fundamental frequency of the vibration of the vocal folds during phonation. The stimulation was triggered during the phase of maximum glottal occlusion. A complete acoustic voice analysis was performed before and after the period of electrical stimulation. RESULTS: Acoustic analysis revealed significant improvements in all parameters after the stimulation period. CONCLUSION: Transdermal synchronous electrical stimulation of vocal folds seems to be a safe and reliable procedure for enhancing voice quality in patients with (URLNP).