| dc.description.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. | |
