Correlação entre o desvio vocal e a deglutição orofaríngea em indivíduos com Doença de Parkinson
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Data
2021-11-23
Autores
Binhardi, Vitor Della Rovere
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A Doença de Parkinson (DP) é degenerativa e progressiva, acomete a voz e a deglutição, entre outras funções. Objetivo: Correlacionar o desvio vocal com a deglutição orofaríngea em indivíduos com Doença de Parkinson. Método: Estudo clínico transversal. Pesquisa aprovada pelo Comitê de Ética em Pesquisa da Instituição (nº 4.009.750). Participaram 10 indivíduos com DP, sendo oito do sexo masculino e dois do feminino, entre 63 e 83 anos (média de 72 anos) e incapacidade leve e moderada, segundo a escala de Hoehn & Yahr. Todos frequentavam o Centro de Estudos da Educação e da Saúde/Centro Especializado em Reabilitação da UNESP/Marília-SP. Foi realizada avaliação vocal por meio de análise perceptivo-auditiva, análise acústica tradicional, análise acústica não linear e multiparamétrica. As gravações foram feitas no Laboratório de Análise Articulatória e Acústica - LAAC da UNESP/Marília-SP, em sala com tratamento acústico. A avaliação perceptivo-auditiva foi feita por escala visual analógica de 100mm com os parâmetros grau geral, rugosidade, soprosidade, tensão, pitch, loudness, instabilidade e ressonância. A partir do grau geral do desvio, as vozes foram classificadas em desvio vocal leve, moderado e grave. Foi utilizado o Software Praat para edição das gravações e extração de medidas acústicas (frequência fundamental - fo, jitter, shimmer, noise-to-harmonic ratio - NHR, harmonic-to-noise ratio - HNR, Proeminência do Pico Cepstral Suavizado - CPPS, e Acoustic Voice Quality Index - AVQI). Foram realizadas a avaliação clínica e videoendoscópica da deglutição, ambas por meio de protocolo específico, e a classificação com critérios clínicos e instrumentais para o grau de comprometimento da deglutição. Os dados foram analisados por estatística descritiva e Teste de Correlação de Spearman. Resultados: Na avaliação perceptivo-auditiva, verificou-se que 40% dos indivíduos apresentaram desvio vocal leve; 30%, moderado; e 30% não apresentaram desvio vocal. As médias das medidas acústicas extraídas foram para a fo: 165,067 hertz; jitter: 0,572%; shimmer: 2,18%; NHR: 0,014; HNR: 22,812dB; CPPS: 13,41dB; e AVQI: 2,17. Na classificação clínica da disfagia, verificou-se que 80% dos indivíduos apresentaram disfagia leve e 20%, disfagia moderada. Na videoendoscopia da deglutição, houve 57,14% de escape oral posterior, 57,14% de resíduos faríngeos e 42,86% de penetração e/ou aspiração laringotraqueal, com grau de disfagia leve para 28,57%, moderado para 42,86% e grave para 14,29%, havendo deglutição normal em 14,29%. Houve correlação positiva entre: o grau de comprometimento clínico da deglutição e o AVQI (p=0,025); o parâmetro soprosidade na avaliação perceptivo-auditiva da amostra de vogal (p=0,024); o parâmetro loudness na avaliação perceptivo-auditiva da amostra de contagem (p=0,032); e o grau de desvio vocal geral (p=0,044). Não houve correlação entre o grau de desvio vocal com o grau de disfunção da deglutição pela videoendoscopia da deglutição. Conclusão: Houve correlação entre o grau do desvio vocal, medida multiparamétrica AVQI, parâmetro soprosidade na avaliação perceptivo-auditiva da amostra de vogal e no do parâmetro loudness na avaliação perceptivo-auditiva da amostra de contagem de números com o grau de comprometimento clínico da deglutição orofaríngea em indivíduos com Doença de Parkinson, porém não houve correlação quando a disfunção foi classificada por meio de videoendoscopia da deglutição.
Introduction: Parkinson's Disease (PD) is a degenerative and progressive condition with voice and swallowing impairment (SI). Objective: To correlate vocal deviation with oropharyngeal swallowing in individuals with Parkinson's Disease. Method: Cross-sectional clinical study. Research approved by the Institution's Research Ethics Committee (number: 4.009.750). Participated in 10 individuals with PD, eight males and two females, ages ranging from 63 to 83 years, mean 72 years of age and mild to moderate disability by Hoehn & Yahr scale. All of them attended the Center for Education and Health Studies/Specialized Rehabilitation Center of UNESP/Marília-SP. Vocal evaluation was done by means of perceptual-auditory analysis, traditional acoustic analysis, non-linear acoustic analysis and multiparametric analysis. The recordings were registered in the Laboratory of Articulatory Analysis and Acoustics - LAAC, UNESP/Marília-SP, in a room with acoustic treatment. The perceptual-auditory evaluation was done using a 100mm visual analog scale with the parameters general degree, roughness, soprosity, tension, pitch, loudness, instability and resonance. Based on the general degree of deviation, the voices were classified as mild, moderate and severe vocal deviation. Praat software was used to edit the recordings and extract acoustic measurements (fundamental frequency - fo, jitter, shimmer, noise-to-harmonic ratio - NHR, harmonic-to-noise ratio - HNR, Smoothed Cepstral Peak Prominence - CPPS, and Acoustic Voice Quality Index - AVQI). A specific protocol was used for clinical and fiberoptic endoscopy evaluation of swallowing (FEES), and a classification using clinical and instrumental criteria was proposed for the degree of swallowing impairment. Data were analyzed by descriptive statistics and Spearman's Correlation Test. Results: In the perceptual-auditory evaluation it was found that 40% of the individuals had mild vocal deviation, 30% moderate and 30% had no vocal deviation. The mean acoustic measures extracted were for fo: 165.067 hertz, jitter: 0.572%, shimmer: 2.18%, NHR: 0.014, HNR: 22.812dB; CPPS: 13.41dB and AVQI: 2.17. The clinical assessment showed that 80% of the subjects had mild and 20% moderate SI. In FEES there was 57.14% of posterior oral spillage, 57.14% of pharyngeal residues and 42.86% of laryngotracheal penetration and/or aspiration of the individuals. We found in FEES 28.57% of mild, 42.86% of moderate and 14.29% of severe SI, with 14.29% of the individuals with normal swallowing.There was a positive correlation between the degree of clinical swallowing impairment and the AVQI (p=0.025), the soprosity parameter in the perceptual-auditory evaluation of the vowel sample (p=0.024), the loudness parameter in the perceptual-auditory evaluation of the count sample (p=0.032), and the degree of overall vocal deviation (p=0.044). There was no correlation between the degree of vocal deviation and the degree of SI by FEES. Conclusion: There was a correlation between the degree of vocal deviation, the AVQI multiparameter measure, the soprosity parameter in the perceptualauditory evaluation of the vowel sample and the loudness parameter in the perceptual-auditory evaluation of the counting numbers sample with the degree of clinical impairment of oropharyngeal swallowing in individuals with Parkinson's disease, but there was no correlation when the dysfunction was classified by means of videoendoscopy of the swallowing.
Introduction: Parkinson's Disease (PD) is a degenerative and progressive condition with voice and swallowing impairment (SI). Objective: To correlate vocal deviation with oropharyngeal swallowing in individuals with Parkinson's Disease. Method: Cross-sectional clinical study. Research approved by the Institution's Research Ethics Committee (number: 4.009.750). Participated in 10 individuals with PD, eight males and two females, ages ranging from 63 to 83 years, mean 72 years of age and mild to moderate disability by Hoehn & Yahr scale. All of them attended the Center for Education and Health Studies/Specialized Rehabilitation Center of UNESP/Marília-SP. Vocal evaluation was done by means of perceptual-auditory analysis, traditional acoustic analysis, non-linear acoustic analysis and multiparametric analysis. The recordings were registered in the Laboratory of Articulatory Analysis and Acoustics - LAAC, UNESP/Marília-SP, in a room with acoustic treatment. The perceptual-auditory evaluation was done using a 100mm visual analog scale with the parameters general degree, roughness, soprosity, tension, pitch, loudness, instability and resonance. Based on the general degree of deviation, the voices were classified as mild, moderate and severe vocal deviation. Praat software was used to edit the recordings and extract acoustic measurements (fundamental frequency - fo, jitter, shimmer, noise-to-harmonic ratio - NHR, harmonic-to-noise ratio - HNR, Smoothed Cepstral Peak Prominence - CPPS, and Acoustic Voice Quality Index - AVQI). A specific protocol was used for clinical and fiberoptic endoscopy evaluation of swallowing (FEES), and a classification using clinical and instrumental criteria was proposed for the degree of swallowing impairment. Data were analyzed by descriptive statistics and Spearman's Correlation Test. Results: In the perceptual-auditory evaluation it was found that 40% of the individuals had mild vocal deviation, 30% moderate and 30% had no vocal deviation. The mean acoustic measures extracted were for fo: 165.067 hertz, jitter: 0.572%, shimmer: 2.18%, NHR: 0.014, HNR: 22.812dB; CPPS: 13.41dB and AVQI: 2.17. The clinical assessment showed that 80% of the subjects had mild and 20% moderate SI. In FEES there was 57.14% of posterior oral spillage, 57.14% of pharyngeal residues and 42.86% of laryngotracheal penetration and/or aspiration of the individuals. We found in FEES 28.57% of mild, 42.86% of moderate and 14.29% of severe SI, with 14.29% of the individuals with normal swallowing.There was a positive correlation between the degree of clinical swallowing impairment and the AVQI (p=0.025), the soprosity parameter in the perceptual-auditory evaluation of the vowel sample (p=0.024), the loudness parameter in the perceptual-auditory evaluation of the count sample (p=0.032), and the degree of overall vocal deviation (p=0.044). There was no correlation between the degree of vocal deviation and the degree of SI by FEES. Conclusion: There was a correlation between the degree of vocal deviation, the AVQI multiparameter measure, the soprosity parameter in the perceptualauditory evaluation of the vowel sample and the loudness parameter in the perceptual-auditory evaluation of the counting numbers sample with the degree of clinical impairment of oropharyngeal swallowing in individuals with Parkinson's disease, but there was no correlation when the dysfunction was classified by means of videoendoscopy of the swallowing.
Descrição
Palavras-chave
Doença de Parkinson, Qualidade da voz, Transtornos da deglutição, Acústica, Endoscopia, Parkinson disease, Voice quality, Deglutition disorders, Acoustics, Endoscopy
Como citar
Binhardi, Vitor Della Rovere. Correlação entre o desvio vocal e a deglutição orofaríngea em indivíduos com Doença de Parkinson. Universidade Estadual Paulista (Unesp), 2021.