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- The agreement between a transducer and a microphone in the analysis of a synthesized vowel—Using a laboratory model as a preliminary experimentPublication . Pestana, Pedro; Byrne, Allison; Alegria, Rita; Araújo, André; Melo, Celso; Brasil, Christina César Praça; Manso, Maria Conceição; Guerreiro Martins Araújo, Pedro AndréThe objective of this study was to assess the agreement between the acoustic parameters of synthesized vowels, as measured by a piezoelectric transducer and a microphone. The central hypothesis posited that there would be a substantial degree of concordance between the acoustic parameters obtained by these two methods. A laboratory experiment was conducted using synthesized vowels. Acoustic parameters were recorded simultaneously using a microphone and a piezoelectric transducer. Vowels were synthesized using Madde software, with variations in fundamental frequency (fo) and amplitude level. Acoustic signals were captured by a Shure MX153 T microphone and a Shadow SH712 piezoelectric transducer. Signals were recorded using a Behringer FCA1616 audio interface and analyzed using Sopran and VOXplot software. Bland–Altman plots were used for statistical comparison of acoustic parameters. The degree of agreement between the microphone and the transducer varied according to acoustic parameters. Excellent agreement was observed for jitter, mean fo, fo standard deviation, and fo range. Good agreement was found for tilt, equivalent continuous sound level, harmonics-to-noise ratio from Dejonckere, high frequency noise, minimum fo, and maximum fo. Moderate agreement was observed for slope, amplitude difference H1–H2, shimmer, harmonics-to-noise ratio, smoothed cepstral peak prominence, and period standard deviation. While there was moderate to high agreement between the two methods for several acoustic parameters, discrepancies were noted. The microphone exhibited a tendency to record slightly higher values for the majority of the parameters; however, the transducer did demonstrate heightened sensitivity for certain parameters. The findings indicate that neither method can be universally interchanged with the other, and the selection of a method should be contingent on the particular requirements of the analysis.
- Electromyographic assessment of the extrinsic laryngeal muscles: Pilot and descriptive study of a vocal function assessment protocolPublication . Ribeiro, Jéssica; Araújo, André; Sousa, Andreia S. P.; Pereira, Filipa; Pinheiro de Sousa, Andreia Sofia; Guerreiro Martins Araújo, Pedro AndréThe aim of this study was to develop and test a surface electromyography (sEMG) assessment protocol to characterise the activity of the extrinsic laryngeal muscles (suprahyoid and infrahyoid) during phonatory tasks and vocal techniques. The protocol of assessment was based on electromyographic assessment guidelines and on clinical voice evaluation needs and was tested in six healthy adults with no vocal disorders. Surface electromyographic activity of suprahyoid and infrahyoid muscles was acquired during different reference tasks (rest, reading, maximum contractions) and six vocal tasks, including nasal sounds, fricatives, and semi-occluded vocal tract exercises. A laryngeal accelerometer was used for detecting the beginning and end of each exercise. The average activity during each task was normalised by the signal obtained in the incomplete swallowing task for the SHM and by the sniff technique for the IHM. The range of activation values varied across tasks, with higher percentages observed in plosive production and in the “spaghetti” technique, while nasal and fricative sounds tended to show lower activation values within the group. A consistent pattern of simultaneous activation of suprahyoid and infrahyoid muscles was observed during phonation. The protocol proved potential for clinical application in speech–language pathology as it enabled the characterisation of muscle activity in determinant muscles for vocal function. Larger samples and further validation of the time-marking system are needed. This study provides a foundation for integrating sEMG measures into functional voice assessment.
- Efeitos motores da eletroestimulação transcraniana por corrente contínua associada à fisioterapia em crianças com paralisia cerebral: revisão sistemáticaPublication . Horing, Maria Julia Oliveira Caldeira; Festas, Clarinda; Viana, Rui; Santos, Fátima; Santos, Ana Filipa; Santos, Ana FilipaA paralisia cerebral (PC) é uma das causas mais frequente de disfunções motoras, cognitivas, comunicativas e comportamentais em crianças, originando limitações nas suas vidas. A eletroestimulação transcraniana por corrente contínua (tDCS) é uma técnica nãoinvasiva que emprega uma corrente elétrica de baixa intensidade para modulação dos neurônios cerebraise pode ser aliada a fisioterapia.O objetivoda pesquisa foi analisar os efeitos motores da eletroestimulação transcraniana por corrente contínua em crianças e adolescentes com PC. Foi efetuada uma pesquisa nas bases de dados Pubmed, MEDLINE e Physiotherapy Evidence Database (PEDro). A qualidade metodológica dos diferentes tipos de estudos foi analisada segundo pela escala PEDro. Foram incluídos 4 estudos, com um total de 113 crianças, com idades entre os 5 e os 12 anos de ambos os sexos, com PC espástica em vários níveis, distintas classificações do Gross Motor Function Classification System (GMFCS) do I ao III e classificação funcional em nível I ou II do MACS. Os resultados foram positivos nos grupos de intervenção com a eletroestimulação transcraniana por corrente contínua (tDCS). A partir da pesquisa realizada, foi possível constatar que a eletroestimulação transcraniana por corrente contínua (tDCS), quando associada a outras técnicas da fisioterapia, promoveram melhorias significativas nas habilidades motoras de crianças com PC.
- Perceção dos profissionais acerca da participação das famílias no apoio pelas equipas de intervenção precocePublication . Pinto, Marta; Serrano, Ana Maria; de Sousa Pinto, Marta JoanaA participação da família no processo de apoio pelas equipas de intervenção precoce na infância é uma componente essencial para o desenvolvimento e inclusão da criança. Dada a implementação destas equipas em Portugal, pretendemos conhecer a participação das famílias no apoio prestado, pelas palavras dos profissionais, bem como os facilitadores à participação das famílias. Neste estudo de análise qualitativa, entrevistamos 18 profissionais de intervenção precoce na infância. Os dados obtidos revelam que os profissionais consideram promover a participação da família. Contudo, verificou-se que na maioria das vezes é o profissional que lidera todo o processo de apoio. Concluímos também que os profissionais desejam que as famílias participem mais no apoio de intervenção precoce na infância, reconhecem a componente relacional como a base de todo o seu trabalho com as famílias e começam a utilizar a componente participativa, particularmente as práticas que apoiam a escolha informada e a participação dos pais.
- Voice parameters in children with Down syndromePublication . Moura, Carla Pinto; Cunha, Luís Miguel; Vilarinho, Helena; Cunha, Maria João; Freitas, Diamantino; Palha, Miguel; Pueschel, Siegfried M.; Pais-Clemente, M.; Gonçalves, Maria João MoreiraDown syndrome (DS) is the most frequent chromosomal disorder. Commonly, individuals with DS have difficulties with speech and show an unusual quality in the voice. Their phenotypic characteristics include general hypotonia and maxillary hypoplasia with relative macroglossia, and these contribute to particular acoustic alterations. Subjective perceptual and acoustic assessments of the voice (Praat-4.1 software) were performed in 66 children with DS, 36 boys and 30 girls, aged 3 to 8 years. These data were compared with those of an age-matched group of children from the general population. Perceptual evaluations showed significant differences in the group of children with DS. The voice of children with DS presented a lower fundamental frequency (F0) with elevated dispersion. The conjunction of frequencies for formants (F1 and F2) revealed a decreased distinction between the vowels, reflecting the loss of articulatory processing. The DS vocalic anatomical functional ratio represents the main distinctive parameter between the two groups studied, and it may be useful in conducting assessments.
- Down syndrome: otolaryngological effects of rapid maxillary expansionPublication . Moura, C. Pinto de; Andrade, D.; Cunha, L. M.; Tavares, M. J.; Gonçalves, Maria João; Vaz, P.; Barros, H.; Pueschel, S. M.; Clemente, M. PaisPhenotypical Down syndrome includes pharyngeal and maxillary hypoplasia and, frequently, constricted maxillary arch with nasal obstruction. This clinical trial assessed the effects of rapid maxillary expansion on ENT disorders in 24 children with Down syndrome randomly allocated to receive either rapid maxillary expansion or not. Each group received ENT and speech therapy assessments before expansion and after the device had been removed. In the rapid maxillary expansion group, the yearly ENT infection rate was reduced when assessed after device removal (p < 0.01). The parents of rapid maxillary expansion children reported a reduction in respiratory obstruction symptoms. Audiological assessment revealed improvements in the rapid maxillary expansion group (p < 0.01). Cephalometry showed increased maxillary width in the rapid maxillary expansion group. Rapid maxillary expansion resulted in a reduction in hearing loss, yearly rate of ENT infections and parentally assessed symptoms of upper airway obstruction, compared with no treatment. These findings are probably related to expanded oronasal space, due to rapid maxillary expansion.
- Dosage, intensity and frequency of language therapy for aphasia: An individual participant data network meta-analysisPublication . Brady, Marian C.; Patrício, BrígidaOptimizing speech and language therapy (SLT) regimens for maximal aphasia recovery is a clinical research priority. We examined associations between SLT intensity (hours/week), dosage (total hours), frequency (days/week), duration (weeks), delivery (face to face, computer supported, individual tailoring, and home practice), content, and language outcomes for people with aphasia. Databases including MEDLINE and Embase were searched (inception to September 2015). Published, unpublished, and emerging trials including SLT and ≥10 individual participant data on aphasia, language outcomes, and time post-onset were selected. Patient-level data on stroke, language, SLT, and trial risk of bias were independently extracted. Outcome measurement scores were standardized. A statistical inferencing, one-stage, random effects, network meta-analysis approach filtered individual participant data into an optimal model examining SLT regimen for overall language, auditory comprehension, naming, and functional communication pre-post intervention gains, adjusting for a priori–defined covariates (age, sex, time poststroke, and baseline aphasia severity), reporting estimates of mean change scores (95% CI). Data from 959 individual participant data (25 trials) were included. Greatest gains in overall language and comprehension were associated with >20 to 50 hours SLT dosage (18.37 [10.58–26.16] Western Aphasia Battery–Aphasia Quotient; 5.23 [1.51–8.95] Aachen Aphasia Test–Token Test). Greatest clinical overall language, functional communication, and comprehension gains were associated with 2 to 4 and 9+ SLT hours/week. Greatest clinical gains were associated with frequent SLT for overall language, functional communication (3–5+ days/week), and comprehension (4–5 days/week). Evidence of comprehension gains was absent for SLT ≤20 hours, <3 hours/week, and ≤3 days/week. Mixed receptive-expressive therapy, functionally tailored, with prescribed home practice was associated with the greatest overall gains. Relative variance was <30%. Risk of trial bias was low to moderate; low for meta-biases. Greatest language recovery was associated with frequent, functionally tailored, receptive-expressive SLT, with prescribed home practice at a greater intensity and duration than reports of usual clinical services internationally. These exploratory findings suggest critical therapeutic ranges, informing hypothesis-testing trials and tailoring of clinical services.
- Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysisPublication . Brady, Marian C.; Patrício, BrígidaStroke rehabilitation interventions are routinely personalized to address individuals’ needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild–moderate/ moderate–severe based on language outcomes’ median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants’ greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3–4 SLT-h/week; ⩾ 50 hours). For moderate–severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild–moderate participants’ greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males’ greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week. We observed a treatment response in most subgroups’ overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild–moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate–severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.
- Risk factors for voice disorders among Fado singers: A cross-sectional studyPublication . Pestana, Pedro; Freitas, Susana Vaz; Manso, Maria ConceiçãoFado is an urban Portuguese musical style rooted in popular culture. Previously found data suggests that Fado singers may have an increased risk of developing voice disorders. To determine the risk factors for the development of voice disorders among Fado singers. A cross-sectional study was conducted through the administration of a questionnaire containing questions related to voice disorders in singers. The relationship between personal and social data, musical background, performance demands and habits, vocal health and wellbeing, and strategies to overcome voice problems are reported. Beyond a comprehensive characterization, odds ratios (ORs) and their 95% confidence intervals (CIs) for the association with voice disorders were calculated through univariate and multivariate logistic regression analyses. The significant risk factors for voice disorders were as follows in decreasing order: nose-related disorders; decongestants or antihistamines; oral contraceptives or hormone replacement therapy; previous smoking habits; and vocal fatigue after performances. These activities significantly increased the risk of developing voice disorders. The evidence from this study and the relative low prevalence of self-reported voice disorders suggest that these singers may develop a kind of protective combination of factors beyond the scope of this research.
- Evaluation of the ability to sing easily: Adaptation and validation to the European Portuguese languagePublication . Pestana, Pedro Melo; Freitas, Susana Vaz; Alegria, Rita; Manso, Maria ConceiçãoA number of voice assessment tools are currently in use in both clinical and research settings. The Evaluation of the Ability to Sing Easily offers a comprehensive self-assessment tool designed for singers. EASE captures subtle changes in vocal health by inquiring about the subject's current experience. This makes Evaluation of the Ability to Sing Easily a valuable tool for the early identification of vocal issues and the monitoring of a singer's overall vocal health. Objective: This study aimed to adapt and validate the Evaluation of the Ability to Sing Easily for European Portuguese and assess its psychometric properties. Methodology: A five-step cross-cultural adaptation process was followed, including forward translation, backward translation, committee review, pilot testing, and finalization. The Evaluation of the Ability to Sing Easily for European Portuguese was then administered to 120 singers (Fado and Choir) to evaluate internal consistency and known-groups validity. Results: The pilot test identified and resolved ambiguities in seven Evaluation of the Ability to Sing Easily for European Portuguese items. Internal consistency was high, with Cronbach's alpha exceeding 0.80 for the Evaluation of the Ability to Sing Easily scale and sub-scales in both Fado and Choir singers. Fado singers reported higher vocal fatigue scores, while Choir singers reported higher Pathologic Risk Indicators scores. A weak negative correlation between singing load and PRI scores was observed in Choir singers. Conclusion: The Evaluation of the Ability to Sing Easily for European Portuguese demonstrates good internal consistency and cultural relevance for Portuguese singers. Known-groups validity suggests potential differences in vocal function between Fado and Choir singers. Further research is needed to explore external validity, test-retest reliability, and applicability to other singing styles.
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