Angélica Emygdio da Silva Antonetti

Purpose: This noninferiority randomized clinical trial aimed to analyze the effectiveness of water resistance therapy (WRT) delivered via telepractice compared to in-person therapy. Therapy adherence was also investigated. Method: Adults aged 18–50 years diagnosed with behavioral dysphonia, with little to no prior experience with vocal exercises and access to the internet, were included in the study. A total of 23 participants were randomly allocated through stratified randomization into either the in-person therapy group (IPG) or the telepractice therapy group (TPG). All participants underwent an eight-session WRT program using a silicone tube submerged in water, with each session lasting 30 min. Voice therapy in the TPG followed American Speech-Language-Hearing Association guidelines, with participants instructed to be in a quiet, private room and to use earphones during the sessions. Outcomes were assessed at three time points: baseline, posttreatment, and 1-month follow-up. The analysis included electroglottographic measures (vocal economy–quasi-output cost ratio), acoustic analysis, auditory-perceptual assessment, and self-assessment. Results: Vocal economy, acoustic, and perceptual measures demonstrated the noninferiority of telepractice compared with in-person therapy. However, in the self-assessment domain, improvements were observed only in the IPG. Treatment effects remained stable at follow-up in both groups. Conclusions: Vocal economy, acoustic, and perceptual measures support the noninferiority of delivering WRT via telepractice compared to in-person therapy. However, the lower improvement in self-perception among participants in the telepractice group suggests that in-person interactions may offer additional benefits in terms of subjective experience. Supplemental Material: https://doi.org/10.23641/asha.32160219

Purpose: this study aimed to verify the effects of indirect vocal therapy (IVT), via telehealth, in physical education professionals in voice self-assessment, as well as vocal quality. Methods: 16 physical education professionals, aged between 18 and 50 years, both sexes, participated in the study. All participants were submitted to eight IVT sessions twice a week, 30 minutes each, remotely. The assessments happened remotely, too. Vocal health was explained to modify vocal habits and general health, coping strategies, stress management, and therapeutic interaction. The following protocols were applied: Vocal Disorders Screening Index, Voice Symptoms Scale (VoiSS), Voice Handicap Index (VHI), and vocal recording (/a/ and counting) was performed, evaluating the general degree of vocal quality, pre and post-IVT. The Wilcoxon Test (p<0.05) was applied to verify the findings. Results: there was a significant decrease in the values of the VoiSS protocol (total p=0.041; limitation p=0.032), and VHI (total p=0.012; p=0.005), and in the general degree of vocal quality in vowel /a/ (p=0.011). Conclusion: IVT applied through telehealth in physical education professionals, has positive effects on vocal and laryngopharyngeal symptoms, improving the self-perception of voice handicaps. IVT significantly improved the general degree of vocal quality, only in the emission of the sustained vowel.

RESUMO Objetivo: este estudo objetivou verificar os efeitos da terapia vocal indireta (TVI), aplicada via telefonoaudiologia, em profissionais da educação física na autoavaliação e qualidade vocal. Métodos: 16 profissionais da Educação Física, com idades entre 18 e 50 anos, de ambos os sexos, participaram do estudo. Foram submetidos a oito sessões de TVI, duas vezes/semana, 30 minutos cada. As sessões e avaliações foram ministradas à distância. Foram trabalhados conhecimento sobre saúde vocal, para modificar hábitos vocais e de saúde geral, estratégias de enfrentamento, gerenciamento de estresse e interação terapêutica. Aplicaram-se protocolos: Índice de Triagem de Distúrbios Vocais, Escala de Sintomas Vocais (ESV), Índice de Desvantagem Vocal (IDV) e gravação vocal (/a/ e contagem), avaliando-se o grau geral da qualidade vocal, pré e pós TVI. Utilizou-se o Teste de Wilcoxon (p<0,05) nas comparações. Resultados: houve diminuição significante nos valores dos protocolos ESV (total p=0,041; limitação p=0,032), IDV (total p=0,012 e orgânico p=0,005), e no grau geral da qualidade vocal na vogal (p=0,011). Conclusão: a TVI aplicada por meio da telefonoaudiologia, em profissionais da Educação Física, tem efeitos positivos nos sintomas vocais/laringofaríngeos, melhorando a autopercepção da desvantagem vocal. A TVI melhorou significantemente o grau geral da qualidade vocal, apenas na emissão da vogal sustentada.

Objective: to compare the immediate effects of low-frequency TENS employment on vocal quality in women with behavioral dysphonia before and after vocal exercises. Methodology: 30 women (mean = 31.3 years old), diagnosed with behavioral dysphonia received low-frequency TENS before (TENS + VE Group) and after vocal exercises (VE + TENS Group) with a 1-week washout. They had their sustained vowel/a/and running speech recorded before and after each procedure for auditory-perceptual analysis and acoustic measures. The low-frequency TENS parameters applied were symmetrical biphasic quadratic pulse, 200 µs phase, 10 Hz frequency, intensity on the motor threshold, and the electrodes were positioned on the submandibular and superior fibers of the trapezius muscle region. The vocal exercises: tongue trill, humming, finger kazoo, and water resistance therapy were performed totalizing 20 min. Results: intragroup analysis of sustained vowel/a/showed reduction in both groups of strain parameter and increased the breathiness; only VE + TENS Group increased the instability parameter, decreased fundamental frequency, and increased in SPI values; the running speech analysis showed an increase in the overall degree, roughness, and breathiness parameters. However, in VE + TENS Group, there was a statistically significant decrease in the intensity of the strain and an increase in breathiness. The acoustic measures showed that VE + TENS Group had a higher variation than TENS + VE Group regarding NHR. Conclusion: vocal exercises followed by low-frequency TENS have more immediate positive effects on voice quality than the low-frequency TENS followed by vocal exercises. This is a preliminary immediate effects study, and these effects could be verified through long-term assessments.