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Proposals to promote health and prevent voice disorders in occupational voice users: A scoping review
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Martins, Glauciene Amaral

; Saito, Isabele Tiemi

; Viegas, Flávia

; Simões-Zenari, Marcia

; Nemr, Katia

Revista CEFAC

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2024, Volume 26 N. 1 elocation e11022

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT Purpose: to characterize the actions of vocal health promotion and/or prevention of vocal disorders applied to voice professionals. Methods: a scoping review following the PRISMA-ScR guidelines in SciELO and PubMed databases was conducted. Articles that had as participants voice professionals without concomitant vocal treatment, that described proposals for health promotion or vocal disorders prevention, published between 2010 and 2023, were included. They were grouped into categories and data were presented descriptively. Literature Review: eighteen articles with artistic and non-artistic voice professionals, mostly teachers, were included. Most of the studies focused on healthy voices, aiming at primary prevention. Many articles presented guidance on vocal hygiene and health and used resources such as vocal enhancement, voice workshop, voice amplifiers and apps. All the articles positively mentioned their results, especially with regard to self-perception in relation to voice, vocal quality and quality of life, awareness of positive and harmful practices to the voice. Conclusion: the proposals contemplated different levels of prevention, but most focused on primary prevention, including vocally healthy participants; all articles indicated positive results in voice self-perception, voice quality and quality of life, and awareness of positive and harmful voice practices.

RESUMO Objetivo: caracterizar as ações de promoção de saúde vocal e/ou prevenção de distúrbios vocais aplicadas em profissionais da voz. Métodos: foi conduzida uma revisão de escopo seguindo as diretrizes do PRISMA-ScR nas bases de dados SciELO e PubMed. Foram incluídos artigos que tivessem como participantes profissionais da voz sem tratamento vocal concomitante, que descrevessem propostas de promoção da saúde ou prevenção de distúrbios vocais, publicados entre 2010 e 2023. Os artigos foram agrupados em categorias e os dados apresentados de forma descritiva. Revisão da Literatura: foram incluídos 18 artigos com profissionais da voz artística e não-artística, em sua maioria professores. A maior parte dos estudos tinha como foco vozes saudáveis, visando a prevenção primária. Muitos artigos apresentaram orientações sobre higiene e saúde vocal e utilizaram recursos como aprimoramento vocal, oficina de voz, amplificadores de voz e aplicativos. Todos os artigos mencionam resultados benéficos, principalmente no que se refere à autopercepção em relação a voz, qualidade vocal e de vida, conscientização de práticas positivas e prejudiciais à voz. Conclusão: as propostas contemplaram diferentes níveis de prevenção, mas a maioria tinha como foco a prevenção primária, incluindo participantes vocalmente saudáveis; todos os artigos indicaram resultados favoráveis na autopercepção em relação à voz, qualidade vocal e de vida e conscientização de práticas benéficas e prejudiciais à voz.

https://doi.org/10.1590/1982-0216/202426111022

Acoustic Measurements of Speech and Voice in Men with Angle Class II, Division 1, Malocclusion
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Viegas, Flávia

; Camargo, Zuleica

; Viegas, Danieli

; Guimarães, Glaucio Serra

; Luiz, Ronir Raggio

; Ritto, Fabio

; Simões-Zenari, Marcia

; Nemr, Katia

International Archives of Otorhinolaryngology

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mar 2023, Volume 27 N. 1 Pages 10 - 15

Abstract: En | Text: En | PDF: En

Abstract Introduction The acoustic analysis of speech (measurements of the fundamental frequency and formant frequencies) of different vowels produced by speakers with the Angle class II, division 1, malocclusion can provide information about the relationship between articulatory and phonatory mechanisms in this type of maxillomandibular disproportion. Objectives To investigate acoustic measurements related to the fundamental frequency (F0) and formant frequencies (F1 and F2) of the oral vowels of Brazilian Portuguese (BP) produced by male speakers with Angle class II, division 1, malocclusion (study group) and compare with men with Angle class I malocclusion (control group). Methods In total, 60 men (20 with class II, 40 with class I) aged between 18 and 40 years were included in the study. Measurements of F0, F1 and F2 of the seven oral vowels of BP were estimated from the audio samples containing repetitions of carrier sentences. The statistical analysis was performed using the Student t-test and the effect size was calculated. Results Significant differences (p-values) were detected for F0 values in five vowels ([e], [i], [o], [o] and [u]), and for F1 in vowels [a] and [ɔ], with high levels for class II, division 1. Conclusion Statistical differences were found in the F0 measurements with higher values in five of the seven vowels analysed in subjects with Angle class II, division 1. The formant frequencies showed differences only in F1 in two vowels with higher values in the study group. The data suggest that data on voice and speech production must be included in the protocol’s assessment of patients with malocclusion.

https://doi.org/10.1055/s-0041-1730428

Risco de disfonia e qualidade vocal em estudantes de artes cênicas
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Ferrari, Eloisa Pinheiro

; Simões-Zenari, Marcia

; Master, Suely

; Nemr, Katia

CoDAS

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2023, Volume 35 N. 4 elocation e20220036

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT Purpose To analyse the relationship between the risk of dysphonia and vocal quality in undergraduate performing arts students. Methods Observational cross-sectional study with 38 undergraduate students in Performing Arts. We applied screening protocols for general and specific risk of dysphonia for actors and made recordings of sustained emission of the vowel /a/, spontaneous speech and reading a text, used for perceptual analysis performed by three evaluators using the GRBASI scale. After intra and inter-rater reliability tests it was obtained final classification of the general degree of vocal deviation parameter for each participant. Comparisons were made considering groups that had or did not have other profession/activity with the use of voice, and the groups were formed from the general grade. Results Most students were at high risk for dysphonia. All had vocal alteration, with a predominance of mild degree. Students who had another profession/activity with voice use scored higher in the specific protocol for actors, and in the sum of this protocol with the general screening protocol. There was no relationship between the degree of vocal alteration and the risk of dysphonia. Students who did not yet work professionally had more moderate or severe vocal alterations, and those who did work professionally had a higher frequency of mild vocal alterations. Conclusion Most students were at high risk for dysphonia. All had vocal alteration, with a predominance of mild alteration. There was no relationship between the risk of dysphonia and the degree of vocal alteration.

RESUMO Objetivo Analisar a relação entre o risco de disfonia e a qualidade vocal em estudantes de graduação em Artes Cênicas. Método Estudo transversal observacional com 38 estudantes de graduação em Artes Cênicas. Foram aplicados protocolos de rastreio de risco de disfonia geral e específico para atores, e realizadas gravações da emissão sustentada da vogal /a/, fala espontânea e leitura de texto, usadas para análise perceptivo-auditiva, efetuada por três avaliadores, com o uso da escala GRBASI. Após testes de confiabilidade intra e interavaliadores chegou-se à classificação final do grau geral do desvio vocal para cada participante. Foram feitas comparações entre grupos que tinham ou não outra profissão/atividade com o uso da voz e os grupos formados a partir do grau geral. Resultados A maioria dos estudantes apresentou alto risco para disfonia. Todos apresentaram alteração vocal, com predominância de grau leve. Os estudantes que tinham outra profissão/atividade com uso da voz obtiveram maior pontuação no protocolo específico para atores, bem como na soma desse protocolo com o de rastreio geral. Não houve relação entre o grau de alteração vocal e o risco de disfonia. Os estudantes que ainda não atuavam profissionalmente apresentaram mais alterações vocais de grau moderado ou severo, e os que atuavam profissionalmente apresentaram com maior frequência alteração vocal de grau leve. Conclusão A maior parte dos estudantes apresentou alto risco para disfonia. Todos apresentaram alteração vocal, com predomínio de grau leve. Não houve relação entre o risco de disfonia e o grau de alteração vocal.

https://doi.org/10.1590/2317-1782/20232022036pt

Reduzindo o GAP entre a ciência e a clínica: lições da academia e da prática profissional – parte A: julgamento perceptivo-auditivo da qualidade vocal, análise acústica do sinal vocal e autoavaliação em voz
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Behlau, Mara

; Almeida, Anna Alice

; Amorim, Geová

; Balata, Patrícia

; Bastos, Sávio

; Cassol, Mauricéia

; Constantini, Ana Carolina

; Eckley, Claudia

; Englert, Marina

; Gama, Ana Cristina Cortes

; Gielow, Ingrid

; Guimarães, Bruno

; Lima, Livia Ribeiro

; Lopes, Leonardo

; Madazio, Glaucya

; Moreti, Felipe

; Mouffron, Vanessa

; Nemr, Katia

; Oliveira, Priscila

; Padovani, Marina

; Ribeiro, Vanessa Veis

; Silverio, Kelly

; Vaiano, Thays

; Yamasaki, Rosiane

CoDAS

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2022, Volume 34 N. 5 elocation e20210240

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO No XXVIII Congresso Brasileiro da SBFa, 24 especialistas reuniram-se e, a partir de um posicionamento condutor sobre pesquisa científica como ferramenta de conexão entre laboratório e clínica, cinco frentes de conhecimento da especialidade de voz foram discutidas: 1. Julgamento perceptivo-auditivo da qualidade vocal; 2. Análise acústica do sinal vocal; 3. Autoavaliação em voz; 4. Técnicas tradicionais de terapia; 5. Técnicas modernas de eletroestimulação e fotobiomodulação em voz. A parte “a” desta publicação é a consolidação das análises dos três primeiros aspectos. A tendência no julgamento perceptivo-auditivo da qualidade vocal é o uso de protocolos padrão. A avaliação acústica do sinal vocal é acessível e pode ser feita de modo descritivo ou por extração de parâmetros, preferindo-se medidas multiparamétricas. Finalmente, a análise do próprio indivíduo fecha essa tríade de documentação fonoaudiológica, que será base para a conclusão da avaliação, referência para monitoramento do progresso e avaliação de resultado de tratamento.

ABSTRACT During the XXVIII Brazilian Congress of SBFa, 24 specialists met and, from a leading position on scientific research as a tool for connecting laboratory and clinic, five fronts of knowledge of the voice specialty were discussed as following: Perceptual-auditory judgment of vocal quality; 2. Acoustic analysis of the vocal signal; 3. Voice self-assessment; 4. Traditional techniques of therapy; 5. Modern techniques of electrostimulation and photobiomodulation (PBMT) in voice. Part “a” of this publication was associated with the consolidation of the analyses of the first three aspects. The trend in the perceptual-auditory judgment of vocal quality was related to the use of standard protocols. The acoustic evaluation of the vocal signal is accessible and can be done descriptively or by extraction of parameters, thus preferring multiparametric measures. Finally, the analysis of the individual himself closes this triad of voice documentation, which will be the basis for the conclusion of the evaluation, reference for monitoring progress, and evaluation of treatment results.

https://doi.org/10.1590/2317-1782/20212021240pt

Reduzindo o gap entre a ciência e a clínica: lições da academia e da prática profissional – parte B: técnicas tradicionais de terapia vocal e técnicas modernas de eletroestimulação e fotobiomodulação aplicadas à reabilitação vocal
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Behlau, Mara

; Almeida, Anna Alice

; Amorim, Geová

; Balata, Patrícia

; Bastos, Sávio

; Cassol, Mauriceia

; Constantini, Ana Carolina

; Eckley, Claudia

; Englert, Marina

; Gama, Ana Cristina Cortes

; Gielow, Ingrid

; Guimarães, Bruno

; Lima, Livia Ribeiro

; Lopes, Leonardo

; Madazio, Glaucya

; Moreti, Felipe

; Mouffron, Vanessa

; Nemr, Katia

; Oliveira, Priscila

; Padovani, Marina

; Ribeiro, Vanessa Veis

; Silverio, Kelly

; Vaiano, Thays

; Yamasaki, Rosiane

CoDAS

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2022, Volume 34 N. 5 elocation e20210241

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO O presente texto é a continuação da publicação referente ao XVIII Congresso da SBFa. Na parte “A” apresentamos análises sobre avaliação clínica vocal. O foco da parte “B” são aspectos de reabilitação vocal: 4. Técnicas tradicionais de terapia vocal; 5. Técnicas modernas de eletroestimulação e fotobiomodulação aplicadas à reabilitação. Os inúmeros estudos sobre os diversos programas, métodos ou técnicas tradicionais de reabilitação, muitos de elevada qualidade de evidência, permitem considerar tais procedimentos relativamente bem descritos, seguros e com efeitos conhecidos, dando conta do tratamento de diversos distúrbios vocais. As evidências científicas com as técnicas tradicionais são reconhecidas mundialmente. Novas frentes de evolução, como o uso da eletroestimulação ou fotobiomodulação em voz parecem ser promissoras como abordagens coadjuvantes. Há mais estudos sobre eletroestimulação em voz do que com fotobiomodulação, contudo, evidências científicas para essas duas técnicas modernas são ainda limitadas. Conhecimento e cautela são necessários para a aplicação de quaisquer técnicas.

ABSTRACT This text is the continuation of the XVIII SBFa Congress publication. In part “A” we presented the analyses on clinical vocal evaluation. Part “B” focuses on vocal rehabilitation: 4. Traditional techniques of vocal therapy; 5. Modern techniques of electrostimulation and photobiomodulation applied to vocal rehabilitation. The numerous studies on the various programs, methods, and techniques of traditional rehabilitation techniques, and many with high quality of evidence, allow us to consider such procedures relatively well described, safe, and with known effects, accounting for the treatment of various vocal disorders. The scientific evidence with traditional techniques is recognized worldwide. New fronts of evolution, with electrostimulation or photobiomodulation used to handle voice problems, seem to be promising as coadjutant approaches. There are more studies on electrostimulation in vocal rehabilitation than with photobiomodulation; however, scientific evidence for these two modern techniques is still limited. Knowledge and caution are required for the application of either technique.

https://doi.org/10.1590/2317-1782/20212021241pt

COVID-19 and the teacher's voice: self-perception and contributions of speech therapy to voice and communication during the pandemic
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Nemr, Katia

; Simões-Zenari, Marcia

; Almeida, Vanessa Cássia de

; Martins, Glauciene Amaral

; Saito, Isabele Tiemi

Clinics

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2021, Volume 76 elocation e2641

Abstract: En | Text: En | PDF: En

OBJECTIVES: We aimed to analyze the vocal self-perception of Brazilian teachers and their communication needs, vocal signs and symptoms, and voice-related lifestyles during the coronavirus disease (COVID-19) pandemic and, based on this information, to develop guidance materials intended for dissemination to these teachers and the general community. METHODS: An online questionnaire designed for this survey was distributed via the researchers' networks and was available for completion by any teacher, except those who were not working at the time. There were 1,253 teachers from all over Brazil, of both sexes, covering a wide age range, working at different levels of education, and most with more than ten years of experience. Descriptive and inferential analyses of the data were performed. RESULTS: On comparing the prepandemic period with the current one, participants indicated voice improvements. In contrast, they presented symptoms such as dry throat, effort in addressing remote classes, hoarseness after classes, and difficulties with the use of headphones, among others. They further indicated stress, general fatigue, impact of the pandemic on mental health, and the overlapping of many home tasks with professional tasks. Some smoked, and others hydrated insufficiently. CONCLUSION: Although teachers generally noticed voice improvements during the pandemic, a proportion of them perceived worsening of voices. Many indicated several factors in which speech-language pathologists could guide them with the aim of improving performance and comfort during remote and hybrid classes, an initiative that will positively impact not only their voice and communication but also their quality of life.

https://doi.org/10.6061/clinics/2021/e2641 1214 downloads

Protocolo de Rastreio do Risco de Disfonia para Atores de Teatro Musical: resultados preliminares
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Paulino, Lucas Cainan

; Simões-Zenari, Marcia

; Nemr, Katia

CoDAS

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2021, Volume 33 N. 1 elocation e20190112

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo Propor o Protocolo de Rastreio do Risco de Disfonia para Atores do Teatro Musical (PRRD-TM), verificar sua aplicabilidade em associação ao Protocolo de Rastreio do Risco de Disfonia Geral (PRRD-G), correlacionar escores finais de ambos, e desses com o escore total, e comparar o risco de disfonia entre atores com e sem queixa vocal. Método Estudo transversal observacional com 34 atores de teatro musical adultos, ambos os sexos, com e sem queixa vocal, profissionais ou estudantes. Os questionários foram aplicados individualmente. A análise estatística possibilitou verificar a correlação entre os escores de risco de disfonia e para comparação entre os grupos com e sem queixa vocal. Resultados A maioria dos participantes era do gênero masculino, jovens adultos, atores profissionais e sem queixa vocal. Observou-se elevado risco de disfonia, evidenciado pela aplicação do PRRD-G, com escores médios compatíveis com valores encontrados em indivíduos com disfonia, e reforçado pelos índices encontrados com aplicação do PRRD-TM. Observou-se correlação moderada e diretamente proporcional entre os escores dos dois questionários e desses com o escore total. Escores mais elevados do PRRD-G foram encontrados no grupo que apresentou queixa vocal. Conclusão O PRRD-TM mostrou-se viável e de fácil aplicabilidade e apresentou correlação positiva com o escore do PRRD-G e com o escore total. Elevado risco de disfonia foi evidenciado em indivíduos com queixa vocal. Apesar do escore específico do PRRD-TM não diferenciar atores de teatro musical com e sem queixa vocal, tanto o escore do PRRD-G quanto o escore total realizaram tal diferenciação.

ABSTRACT Purpose To propose the Dysphonia Risk Screening Protocol for Musical Theatre Actors (DRSP-MTA), to verify its applicability in association with the General Dysphonia Risk Screening Protocol (G-DRSP), to correlate the final scores of both, and these with the total risk score, and to compare the risk of dysphonia measured in musical theater actors with and without vocal complaint. Methods An observational cross-sectional study with 34 musical theater actors, adults, of both genders, with and without vocal complaints and regardless of whether they are professionals or students. The questionnaires were applied individually. Statistical analysis made it possible to verify the correlation between the dysphonia risk scores and to compare the groups with and without vocal complaint. Results Most of the participants were male, young adults, professional actors and without vocal complaint. There was a high risk of dysphonia, evidenced by the application of G-DRSP, with means scores compatible with values found in individuals with dysphonia, and reinforced by the indices found with DRSP-MTA application. There was a moderate and directly proportional correlation between the two questionnaire scores; and a correlation of both with the total risk score. Higher G-DRSP scores were observed in the vocal complaint group. Conclusion DRSP-MTA was feasible and easy to apply and was positively correlated with the total score and G-DRSP score. A high risk of dysphonia was evidenced in individuals with vocal complaints. Although the specific DRSP-MTA score did not differentiate musical theatre actors with and without vocal complaints, the G-DRSP score and the total risk score performed such differentiation.

https://doi.org/10.1590/2317-1782/20202019112 314 downloads

Qual o risco de disfonia em trabalhadores que usam a voz em ambiente universitário?
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Silva, Bruna Gabriela Mechi da

; Simões-Zenari, Marcia

; Nemr, Katia

Audiology - Communication Research

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2021, Volume 26 elocation e2429

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo avaliar o risco de disfonia e a presença de alteração vocal em profissionais de diferentes categorias que atuam em ambiente universitário. Métodos pesquisa transversal com uso do Protocolo de Rastreio de Risco de Disfonia para análise das variáveis gênero, idade, hidratação, tabagismo, categoria profissional e demanda vocal e para cálculo do escore final. A gravação da voz ocorreu no ambiente de trabalho, com uso do protocolo Consenso da Avaliação Perceptivo-Auditiva da Voz - CAPE-V. A análise perceptivo-auditiva foi feita por juízes. Os dados foram comparados entre os grupos alto/baixo risco de disfonia e presença/ausência de alteração vocal. Resultados participaram 80 indivíduos, média de idade de 47,7 anos, 84% do gênero feminino. Observou-se alto risco de disfonia em 70% deles e alteração vocal em 34%. Hidratação insuficiente e tabagismo foram frequentes. No grupo com risco elevado de disfonia e presença de alteração vocal destacaram-se os funcionários da área administrativa e, no grupo com menor risco e sem alteração, os funcionários da saúde. Idade mais avançada foi associada à presença de alteração vocal, independentemente dos grupos. Conclusão a identificação do alto risco de disfonia e a relevante presença de alterações vocais em indivíduos de diferentes categorias profissionais que fazem parte do ambiente universitário sugerem a necessidade de propostas de ações preventivas e de promoção de saúde do trabalhador.

ABSTRACT Purpose To assess the risk of dysphonia and presence of voice change in professionals from different categories working in a university environment. Methods Cross-sectional research using the Dysphonia Risk Screening Protocol to analyze the variables sex, age, hydration, smoking, professional category and vocal demand and to calculate the final score. Voice recording took place in the work environment using the CAPE-V protocol. Judges performed the auditory-perceptual analysis. Data were compared between the groups with high/low risk of dysphonia and presence/absence of voice disorders. Results 80 individuals participated, with an average age of 47.7 years, 84% female. There was a high risk of dysphonia in 70%, and voice change in 34%. Insufficient hydration and smoking were frequent. In the group with a high risk of dysphonia and who had voice disorders, the presence of employees from the administrative area stood out, and, in the group with lower risk and no changes, health employees were outstanding. Older age was associated with voice disorders, regardless of groups. Conclusion Identification of high risk of dysphonia and the relevant presence of voice changes in individuals from different professional categories who are part of the university environment suggest the need to propose preventive actions and promote workers' health.

https://doi.org/10.1590/2317-6431-2020-2429 177 downloads

Comparison of fundamental frequency and formants frequency measurements in two speech tasks
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Viegas, Flávia

; Viegas, Danieli

; Guimarães, Glaucio Serra

; Souza, Margareth Maria Gomes de

; Luiz, Ronir Raggio

; Simões-Zenari, Marcia

; Nemr, Katia

Revista CEFAC

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2019, Volume 21 N. 6 elocation e12819

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: comparar as medidas de frequência fundamental (F0) e frequência dos dois primeiros formantes (F1 e F2) das sete vogais orais do português brasileiro em duas tarefas de fala em adultos sem distúrbios de voz e fala. Métodos: oitenta participantes entre 18-40 anos pareados por gênero foram selecionados após avaliações orofacial, ortodôntica e perceptivo-auditiva da voz e fala. Os sinais de fala foram obtidos de sentenças-veículo e vogais sustentadas e foram estimados os valores de F0 e frequências de F1 e F2. As diferenças foram verificadas por meio do teste t e foi calculado o Effect Size. Resultados: foram encontradas diferenças nas medidas de f0 entre as duas tarefas de fala em duas vogais no gênero masculino e em cinco vogais no gênero feminino. Nas frequências de F1 foram notadas diferenças em seis vogais nos homens e em duas nas mulheres. Nas frequências de F2 houve diferença em quatro vogais nos homens e em três nas mulheres. Conclusão: a partir das diferenças encontradas, conclui-se que a tarefa de fala para avaliação de frequência fundamental e frequências dos formantes no português brasileiro pode demonstrar resultados distintos tanto em medidas glóticas como supraglóticas na produção das diferentes vogais orais deste idioma. Desta forma, sugere-se que os clínicos e pesquisadores considerem ambas formas de emissão para interpretação mais apurada das implicações destes dados na avaliação da comunicação oral e no direcionamento de condutas terapêuticas.

ABSTRACT Purpose: to compare the measurements of fundamental frequency (F0) and frequency of the first two formants (F1 and F2) of the seven oral vowels of the Brazilian Portuguese in two speech tasks, in adults without voice and speech disorders. Methods: eighty participants in the age range 18 and 40 years, paired by gender, were selected after orofacial, orthodontic and auditory-perceptual assessments of voice and speech. The speech signals were obtained from carrier phrases and sustained vowels and the values of the F0 and frequencies of F1 and F2 were estimated. The differences were verified through the t Test, and the effect size was calculated. Results: differences were found in the F0 measurements between the two speech tasks, in two vowels in males, and in five vowels, in females. In the F1 frequencies, differences were noted in six vowels, in men, and in two, in women. In the F2 frequencies, there was a difference in four vowels, in men, and three, in women. Conclusion: based on the differences found, it is concluded that the speech task for evaluation of fundamental frequency and formants’ frequencies, in the Brazilian Portuguese, can show distinct results in both glottal and supraglottal measures in the production of different oral vowels of this language. Thus, it is suggested that clinicians and researchers consider both forms of emission for a more accurate interpretation of the implications of these data in the evaluation of oral communication and therapeutic conducts.

https://doi.org/10.1590/1982-0216/201921612819 2900 downloads

10.

Voice deviation, dysphonia risk screening and quality of life in individuals with various laryngeal diagnoses
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Nemr, Katia

; Cota, Ariane

; Tsuji, Domingos

; Simões-Zenari, Marcia

Clinics

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2018, Volume 73 elocation e174

Abstract: En | Text: En | PDF: En

OBJECTIVES: To characterize the voice quality of individuals with dysphonia and to investigate possible correlations between the degree of voice deviation (D) and scores on the Dysphonia Risk Screening Protocol-General (DRSP), the Voice-Related Quality of Life (V-RQOL) measure and the Voice Handicap Index, short version (VHI-10). METHODS: The sample included 200 individuals with dysphonia. Following laryngoscopy, the participants completed the DRSP, the V-RQOL measure, and the VHI-10; subsequently, voice samples were recorded for auditory-perceptual and acoustic analyses. The correlation between the score for each questionnaire and the overall degree of vocal deviation was analyzed, as was the correlation among the scores for the three questionnaires. RESULTS: Most of the participants (62%) were female, and the mean age of the sample was 49 years. The most common laryngeal diagnosis was organic dysphonia (79.5%). The mean D was 59.54, and the predominance of roughness had a mean of 54.74. All the participants exhibited at least one abnormal acoustic aspect. The mean questionnaire scores were DRSP, 44.7; V-RQOL, 57.1; and VHI-10, 16. An inverse correlation was found between the V-RQOL score and D; however, a positive correlation was found between both the VHI-10 and DRSP scores and D. CONCLUSION: A predominance of adult women, organic dysphonia, moderate voice deviation, high dysphonia risk, and low to moderate quality of life impact characterized our sample. There were correlations between the scores of each of the three questionnaires and the degree of voice deviation. It should be noted that the DRSP monitored the degree of dysphonia severity, which reinforces its applicability for patients with different laryngeal diagnoses.

https://doi.org/10.6061/clinics/2018/e174 1270 downloads

11.

Programa terapêutico fonoaudiológico para abertura de boca em pacientes com câncer de boca e orofaringe em radioterapia adjuvante: estudo piloto
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Marrafon, Caroline Somera

; Matos, Leandro Luongo

; Simões-Zenari, Marcia

; Cernea, Claudio Roberto

; Nemr, Katia

CoDAS

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2018, Volume 30 N. 2 elocation e20160221

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo Analisar, por meio da comparação entre a abertura máxima mandibular, a efetividade de programa terapêutico miofuncional oral em pacientes com câncer de boca ou orofaringe submetidos à radioterapia adjuvante. Método Estudo prospectivo envolvendo cinco pacientes adultos e cinco idosos em pós-operatório de cirurgia de boca/orofaringe que aguardavam início da radioterapia ou até a quinta sessão. No início e no final do programa, os participantes tiveram suas medidas de abertura máxima mandibular mensuradas por meio de paquímetro e foram selecionados cinco exercícios – dois de mobilidade e três de tração mandibular – com controle presencial durante oito semanas, perfazendo um total de dez semanas. Dados descritivos e a comparação das medidas pré e pós-fonoterapia por meio do teste de Wilcoxon foram considerados na análise dos dados. Resultados Dez pacientes finalizaram o programa terapêutico (duas mulheres e oito homens), com média de idade de 58,4 anos, mediana de 57,0 anos. Apresentaram média de abertura máxima mandibular de 31,6 ± 11,7 mm antes do tratamento e 36,4 ± 8,0 mm no pós-terapia (p=0,021). Conclusão O programa terapêutico miofuncional oral proposto promoveu aumento da abertura máxima vertical da mandíbula de pacientes submetidos à radioterapia e/ou quimioterapia adjuvante para tratamento de câncer de boca e orofaringe.

ABSTRACT Purpose Assess the effectiveness of an orofacial myofunctional therapeutic program in patients with oral or oropharyngeal cancer submitted to adjuvant radiotherapy through pre- and post-program comparison of maximum mandibular opening. Methods Prospective study involving five adult patients and five elderly patients postoperatively to oral cavity/oropharynx surgery who were awaiting the beginning of radiotherapy or had undergone fewer than five treatment sessions. The study participants had their maximum jaw opening measured using a sliding caliper at the beginning and end of the program. Two mobility exercises and three mandibular traction exercises were selected and weekly monitored presentially for 10 weeks. Descriptive data and pre- and post-therapy comparative measures were statistically analyzed using the Wilcoxon test. Results Ten patients (two women and eight men) with mean age of 58.4 years, median of 57.0 years, completed the therapeutic program. They presented mean maximum mandibular opening of 31.6 ± 11.7 and 36.4 ± 8.0 mm pre- and post-therapy, respectively (p =0.021). Conclusion The proposed orofacial myofunctional therapeutic program increased the maximum jaw opening of patients referred to adjuvant radiotherapy for oral cavity or oropharynx cancer treatment.

https://doi.org/10.1590/2317-1782/20182016221 6555 downloads

12.

Dysphonia risk screening protocol
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Nemr, Katia

; Simões-Zenari, Marcia

; Duarte, João Marcos da Trindade

; Lobrigate, Karen Elena

; Bagatini, Flavia Alves

Clinics

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mar 2016, Volume 71 N. 3 Pages 114 - 127

Abstract: En | Text: En | PDF: En

OBJECTIVE: To propose and test the applicability of a dysphonia risk screening protocol with score calculation in individuals with and without dysphonia. METHOD: This descriptive cross-sectional study included 365 individuals (41 children, 142 adult women, 91 adult men and 91 seniors) divided into a dysphonic group and a non-dysphonic group. The protocol consisted of 18 questions and a score was calculated using a 10-cm visual analog scale. The measured value on the visual analog scale was added to the overall score, along with other partial scores. Speech samples allowed for analysis/assessment of the overall degree of vocal deviation and initial definition of the respective groups and after six months, the separation of the groups was confirmed using an acoustic analysis. RESULTS: The mean total scores were different between the groups in all samples. Values ranged between 37.0 and 57.85 in the dysphonic group and between 12.95 and 19.28 in the non-dysphonic group, with overall means of 46.09 and 15.55, respectively. High sensitivity and specificity were demonstrated when discriminating between the groups with the following cut-off points: 22.50 (children), 29.25 (adult women), 22.75 (adult men), and 27.10 (seniors). CONCLUSION: The protocol demonstrated high sensitivity and specificity in differentiating groups of individuals with and without dysphonia in different sample groups and is thus an effective instrument for use in voice clinics.

https://doi.org/10.6061/clinics/2016(03)01 1797 downloads

13.

Cognitive Vocal Program applied to individuals with signals presbylarynx: preliminary results
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Nemr, Katia

; Souza, Glaucia Verena Sampaio de

; Simões-Zenari, Marcia

; Tsuji, Domingos Hiroshi

; Hachiya, Adriana

; Cordeiro, Gislaine Ferro

; Nunes, Guilherme Pecoraro

; Dajer, María Eugenia

CoDAS

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dec 2014, Volume 26 N. 6 Pages 503 - 508

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Propor e verificar a exequibilidade de programa de intervenção fonoaudiológica para indivíduos com sinais de presbilaringe com ou sem queixa vocal. MÉTODO: Dentre 20 idosos integrantes da pesquisa, participaram deste piloto três idosas com média de 67 anos. Antes e após o programa, realizaram exame laringológico, gravação da voz com protocolo CAPE-V, responderam ao Protocolo de Rastreio de Risco de Disfonia (PRRD) e participaram do Programa Vocal Cognitivo para presbifonia elaborado com fundamentação teórica na epistemologia genética de Jean Piaget associado a técnicas vocais baseadas na literatura. É composto por seis sessões, cada uma com ênfase em diferentes aspectos da produção vocal. RESULTADOS: Após o programa, loudness, coordenação pneumofonoarticulatória, clareza articulatória, jitter e proporção harmônico-ruído melhoraram, ficando dentro do esperado para a faixa etária. Nas três participantes observou-se melhora da qualidade vocal, aumento da frequência fundamental e melhora dos tempos máximos de fonação. Em duas observou-se tensão associada à elevação da loudness e melhora no escore PRRD. Observou-se nas participantes redução dos sinais de presbilaringe observados ao exame de laringoscopia, com melhora da coaptação glótica e movimentação da onda mucosa. CONCLUSÃO: Os resultados preliminares apontam perspectivas animadoras em relação à proposta com melhora dos aspectos analisados. O programa proposto mostrou-se exequível e bem delineado, não sendo necessários ajustes para continuidade do projeto.

PURPOSE: To propose and verify the feasibility of a vocal program intervention in patients with presbylarynx signs with or without vocal complaints. METHOD: Among 20 elder participants of the current research, 3 female patients with median age of 67 years were chosen for the pilot study. Laryngological examination, vocal recording with CAPE-V (Consensus Auditory-Perceptual Evaluation of Voice) protocol, and Screening Protocol of Risk of Dysphonia (SPRD) were conducted before and after the program intervention. They joined the Cognitive Vocal Program for presbyphonia based on the genetic epistemology by Jean Piaget associated with vocal techniques based on scientific literature. This program is structured with six sessions and each one of them is focused in different aspects of vocal production. RESULTS: After the program intervention, some aspects such as loudness, coordination between breathing and speaking, accuracy in articulatory movements, jitter, and harmonics-to-noise ratio improved with parameters within the expected range for the age group. Three female participants were observed for better vocal quality, higher fundamental frequency, and better maximum phonation time. In two cases, tension related to loudness elevation and better scores on SPRD was observed. Using by high-speed laryngeal image, we also observed reduction of presbylarynx signs, and remarkable improvement in glottis closure competence and mucosal wave movement of the patients with and without vocal complaints. CONCLUSION: The preliminary results suggest encouraging prospects for the proposal with improvement in the aspects analyzed. This program was well designed and did not require any further adjustments.

https://doi.org/10.1590/2317-1782/20142014108 3806 downloads

14.

Speech language therapy for cancer patients and new tendencies
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Nemr, Katia

; Arakawa-Sugueno, Lica

CoDAS

Journal Metrics
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jun 2014, Volume 26 N. 3 Pages 256 - 256

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/2317-1782/201420140263 2777 downloads

15.

Gagueira e disfluência comum na infância: análise das manifestações clínicas nos seus aspectos qualitativos e quantitativos
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Merçon, Suzana Maria de Amarante

; Nemr, Katia

Revista CEFAC

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jun 2007, Volume 9 N. 2 Pages 174 - 179

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: analisar em seus aspectos qualitativos e quantitativos as manifestações clínicas da gagueira e da disfluência comum na faixa etária de dois a seis anos. MÉTODOS: revisão de Literatura Sistemática a partir de livros e artigos científicos de Fonoaudiologia indexados no LILACS e no MEDLINE de 1993 a 2005. RESULTADOS: as diferenças qualitativas mais importantes são: o tipo de unidade lingüística na qual as disfluências ocorrem, tipologias de disfluências, presença ou ausência de esforço físico durante a fala e possíveis dificuldades na linguagem. Pré-escolares com gagueira freqüentemente apresentam dificuldades em competências metalinguísticas, especialmente com as metafonológicas, sendo que mais estudos sobre este aspecto são necessários. A freqüência de sílabas disfluentes e a taxa de elocução verbal estão entre os parâmetros quantitativos significativos. CONCLUSÃO: diferenças na fala e na linguagem parecem ser fatores importantes para distinguir gagueira de disfluências comuns infantis.

PURPOSE: to examine the clinical manifestations of stuttering and common dysfluency in their qualitative and quantitative aspects, in children between the ages of two and six years old. METHODS: systematic literature review from books and indexed scientific articles on speech pathology in LILACS and MEDLINE from 1993 to 2005. RESULTS: the most important qualitative differences are: the kind of linguistic unit where dysfluency occur, dysfluency typologies, the presence or absence of physical effort during the speech and possible language difficulties. Preschoolers who stutter very often show difficulties in metalinguistic competencies, especially with the metaphonological ones and more studies about this aspect are needed. The frequency of diffluent syllables and the rate of verbal elocution are among the significant quantitative aspects. CONCLUSION: differences in the speech and in the language seem to be important factors to distinguish stuttering from dysfluency in the childhood.

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