Analysis of vocal quality during water resistance therapy sessions with a resonance tube in individuals with Parkinson's Disease

Abstract

Parkinson's disease causes changes in the central nervous system and in the respiratory and phonatory systems. Vocal alterations are also present, such as reduced vocal intensity, changes in vocal quality and monotonous voice. As a form of treatment, the literature shows the use of resonance tubes to promote improvement in vocal quality and intensity. Therefore, it is believed that session-to-session response control will enable therapeutic observation and allow verifying whether there is a plateau, from which session there are more prominent results and if the proposed number of sessions is sufficient. Proposition: analyze the effects of water resistance therapy with resonance tube, session by session, on the vocal quality of participants with Parkinson's disease. Methodology: the data will be analyzed from a database composed of 13 individuals of both sexes, 10 men and 3 women with a neurological medical diagnosis of Parkinson's disease (hypokinetic dysarthria) and a score level above 21 in the MOCA (Montreal Cognitive Assessment) protocol. Participants with cognitive disorders, neurological alterations concomitant with PD, respiratory diseases and with diagnosis and treatment for head and neck cancer, as well as individuals who did not participate in all voice therapy sessions were excluded from the database. Participants diagnosed with PD, stable condition in relation to medications and absence of benign lesions of the laryngeal mass were included in the database. The therapeutic sessions were performed twice a week with 50 minutes of duration during four weeks of intervention, totaling eight therapy sessions. The volunteers had the emission of the vowel /a/ in a sustained way and chained speech recorded, as well as the sound pressure level measured before and after each session. The vocal recording data, before and after each therapeutic session; the acoustic, auditory-perceptual analysis and the vocal intensity (sound pressure level) of each participant will be analyzed. In the acoustic analysis, the measures related to the fundamental frequency (number of glottic cycles per second), the prominence of the cepstral peak prominence will be extracted, in which it reflects the regularity of the vibration of the vocal folds, the difference L1-L0 that evidences the degree of adduction of the vocal folds and alpha ratio (spectral decline). For the auditory-perceptual analysis of the voice, the general degree of vocal quality will be evaluated using the visual analog scale (VAS) of 100 millimeters. The recorded samples will be presented to three judges with experience, the recordings will be randomized to blind regarding the moment of evaluation. To calculate the intra-rater agreement, 20% of the sample will be repeated. The data will be analyzed using statistical tests comparing the outcome variables obtained before and after each session and also comparing the variation (difference between pre and post) of the outcome variables session by session. (AU)