Browsing by Author "Alegria, Rita Feio da Gama"
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- Voice rehabilitation in an aquatic settingPublication . Alegria, Rita Feio da Gama; Maia, Fátima; Manso, M. ConceiçãoVoice disorders are any anatomical or functional issue that affects the vocal fords. Two of the more common voice disorders include bilateral vocal nodules (non-cancerous calluses) and vocal ford paralysis. The former related with voice abuse and misuse and the latter most often associated with surgery to the thyroid or thorax. In both pathologies, voice therapy has an important role in the treatment plan. The characteristics of the aquatic environment through the properties of buoyancy/floating, hydrostatic pressure, viscosity (resistance) and thermodynamics may give a valuable setting for a therapeutic intervention at the level of the voice. The purpose of this thesis is to provide a greater understanding of the assessment and voice therapy intervention in these two voice disorders, exploring the potential of its implementation in an aquatic environment. A systematic review and a meta-analysis of visual-perceptual outcomes measures was performed and aimed to estimate with a high precision the efficacy of voice treatment on the vocal fold motility in adult patients with unilateral vocal folds paralysis. A total of 10 studies containing morphofunctional evaluation results were included in the analysis. The pooled data analysis of the visual-perceptual measures revealed that vocal fold motility improved in 72% (95% CI:64.0-80.0) of all patients after the therapeutic interventions. A narrative review with a systematic search of the current literature about the effectiveness of voice therapy interventions in adults with vocal fold nodules was performed. The level of evidence based on the National Health and Medical Research Council guidelines, assessment, and critical appraisal were included. Regardless of receiving direct or indirect or a combination of both voice therapy contents, nearly all voice quality parameters were found to improve after treatment. Improved evidence is required to suggest that short period treatments are as beneficial as traditional therapy programs. Moreover, another literature review was performed by searching studies in adults, with bilateral vocal fold nodules who received voice therapy, and where voice quality was evaluated quantitatively using acoustic analysis, before and after treatment. Meta-analysis was performed using random-effects model. A total of four studies were selected with 147 participants for the meta-analysis. The pooled results showed significative positive effect of voice therapy on: 1) increased f0 [mean difference post-therapy was 33.00Hz (95%CI:20.26-45.74, p<0.001)]; 2) decreased jitter [mean difference post-therapy was 0.59% (95%CI:0.23%-0.94%, p=0.0012)] and 3) a non-significant decreased shimmer [mean difference post-therapy was 2.98% (95%CI:-0.03-6.00, p=0.052)]. A retrospective analysis was performed in 132 patients, mostly after thyroid surgery, who underwent voice therapy. Side and position of cord paralysis varied, 57.6% affecting the left vocal fold and 66.6% at the paramedian position. A significant improvement in voice and self-perceived quality of life after voice therapy was achieved. A retrospective analysis of multidimensional voice outcomes was performed in 17 patients with bilateral vocal fold nodules, who presented dysphonia and received voice therapy in a water-based setting. Vocal fold lesions disappeared in 82.3% of the patients after voice therapy. Compared pre- and post-therapy audio-perceptual and aerodynamic parameters were significantly improved up to normal range values in all parameters. There is a need for more studies in aquatic environment to ensure that voice therapy delivered in this setting, in patients with vocal fold problems, can be effective and efficient. The last study is a case report that looks at a voice therapy programme - delivered in a water-based setting - for a patient with unilateral vocal fold paralysis (UVFP) following surgery. Direct water-based exercises aimed to reduce vocal fold gap, reduce supra-glottic structures hyperfunction and improve voice quality. There was a positive change in the voice outcome measures after completion of treatment (visual perceptual, audio-perceptual, acoustic and self-perception). Further studies with larger samples are needed to draw any realistic conclusions on the efficacy of water-based voice therapy in patients with UVFP.