Métodos perceptivos e instrumentais na avaliação da disartria e resultados de uma proposta de intervenção fonoaudiológica com biofeedback instrumental

Abstract

Introduction: Dysarthrias are motor speech disorders, of a neurogenic nature, which compromise the neuromuscular control of speech subsystems. They are perceptually very heterogeneous, making diagnosis and treatment complex. Objectives: to compare the results of maximum phonation time of /a/ (MPT/a/), acoustic vocal measurements from glottic source and physiological assessments of dysarthric patients; to develop a treatment protocol using visual biofeedback instruments for people with different types of progressive dysarthria; and to apply and to verify the effects of this treatment on speech subsystems and on intelligibility. Methods: In the first study, thirteen patients were classified according to the type of dysarthria and divided according to the functional profile, and underwent assessment of MPT/a/, acoustic vocal analysis of glottal source, electroglottography and nasometry. Results were compared between groups using ANOVA and Tukey tests. In the second study, the elaboration of the protocol consisted of a behavioral, multisystem and physiological approach based on the principles of motor learning, including the provision of instrumental visual biofeedback, in order to sequentially intervene in the speech subsystems usually affected in dysarthrias. The instruments selected for visual biofeedback were the nasometer, the electroglottograph and the ultrasound. The application of the protocol consisted of a multiple case study with adults or elderly people with progressive dysarthria. All were evaluated for breathing, voice, articulation, intelligibility and prosody before and at the end of treatment. Results: In the first study, it was found that the highest fundamental frequency showed a significant difference in the means of the groups, being greater in the hyperfunctional group. MPT/a/ were reduced, several acoustic measurements of the glottic source and electroglottographic measurements were altered in all groups, with no significant difference between groups. As for the results of the elaboration and application of the treatment protocol, improvement in MPT was observed, and some accidents obtained practically normal values, with improvement in glottic efficiency. Most had improvement in vocal parameters. All improved coordination, strength, speed and refinement of the motor act. There was also an improvement in speed, rhythm, tremor and a decrease in the variety of altered parameters, as well as in intonation, pitch, loudness and speed. Breathing pauses were adequate and monopitch and monoloudness were reduced. All achieved intelligibility above 90% in both word and sentence production, and some reached 100%. Conclusion: The results of the first study indicate that the reduction in MPT/a/ in all the functional profiles analyzed suggests air leakage during phonation; deviation of various glottic and electroglottographic source acoustic measures in all groups suggests noise, tremor, and vocal instability; and the increase in fundamental frequency in the hyperfunctional group reinforces vocal instability. Although the characteristics evaluated are expected in dysarthric patients, it is difficult to make a differential diagnosis based on acoustic and physiological vocal parameters. Regarding the treatment protocol, the significant improvement in intelligibility and speech subsystems shows that the protocol is effective in the treatment of people with progressive dysarthria, capable of anticipating worsening and promoting longer communication through speech.