Disfonia infantil: hábitos prejudiciais à voz dos pais interferem na saúde vocal de seus filhos?

Play-Based Strategies for Speech Therapy and Vocal Health Face-to-Face and Distance Learning Actions for Children: An Integrative Literature Review

INTRODUCTION

Diversifying voice therapy strategies is critical to get children and adolescents to adhere to the therapeutic process.

PURPOSE

To investigate the face-to-face and distance playful strategies have been used for vocal health education and voice therapy in children and adolescents.

METHODS

An integrative literature review was carried out based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). A search for full texts was conducted on the Virtual Health Library, Scientific Electronic Library Online (SCIELO) and PuBMed databases using the following descriptors, and their corresponding Medical Subject Headings (MeSH): voice (voz); voice quality (qualidade da voz); dysphonia (disfonia); voice disorders (distúrbios da fala); voice training (treinamento da voz); telemedicine (telemedicina); therapeutics (terapêutica); health promotion (promoção da saúde); group practice (prática de grupo); recreation therapy (terapia recreacional); child (criança); preschool (pré-escolar) and adolescent (adolescente).

RESULTS

After full reading of the studies, 15 articles were included and categorized into the following topics: face-to-face and distance playful strategies for voice therapy in children; playful strategies with gamification for education and for voice therapy in children; and vocal health educational actions in children.

CONCLUSION

The study found a higher number of studies that carried out educational actions and playful strategies, while fewer studies were related to the production of materials, gamification and online services for voice therapy in children. Given the proven benefits of this strategy for children, further studies focusing on the development and application of playful strategies, such as the use of gamification, should be conducted in order to stimulate the skills and adherence of this population to therapy.

[Aggravating factors of dysphonia in preschool children: differences between children with and without dysphonia]

OBJECTIVE

To determine if there are differences in factors favoring dysphonia in a group of preschool children with healthy voice and another with dysphonia.

METHOD

In this research a total of 96 children between 2 and 5 years old were evaluated, of which 17 had dysphonia and 79 had a healthy voice. The presence of factors favoring dysphonia was compared between both groups, by means of a questionnaire addressed to their parents or caregivers created and validated especially for this research. Statistical analysis was performed by independent samples analysis to extract the p value.

RESULTS

The results show a significant difference in the values of the questionnaire (p=0.000) between the two groups. The 91.6% of the questions behaved differently between the groups with and without dysphonia.

CONCLUSION

In this research, differences were found between the presence of factors favoring dysphonia in preschool children with and without dysphonia. The factors that have more differences are related to physical, environmental and psychological causes.

Auditory-perceptual evaluation of voice: comparing different speech tasks to identify children with and without laryngeal lesions

PURPOSE

To compare the vowel emission and number counting tasks in perceptual-auditory differentiation among children with and without laryngeal lesions.

METHODS

Observational, analytical, and cross-sectional methods were used. Medical records of 44 children were selected from a database of an otorhinolaryngology service at a University Hospital and they were divided into groups: without laryngeal lesion (WOLL), and with laryngeal lesion (WLL), with 33 and 11 children. For the auditory-perceptual evaluation, the vocal samples were separated according to the type of task. They were analyzed separately by a judge who analyzed the general degree of vocal deviation and assessed whether the child would pass or fail in the face of a screening situation.

RESULTS

There was a difference between the WOLL and WLL groups in terms of the overall degree of vocal deviation for the task of number counting, with a predominance of mild deviations in WOLL and moderate in WLL. In the screening, there was a difference between the groups during the number counting task, with more failures in the WLL. The groups were similar in the sustained vowel task, both in terms of the overall degree of vocal deviation and the vocal screening. Most children in the WLL failed in both tasks during vocal screening compared to the children in the WOLL who, in general, failed in only one task.

CONCLUSION

The task of number counting contributes to the auditory differentiation in children with and without laryngeal lesion, by identifying deviations of greater intensity in children with laryngeal lesion.

Auditory-perceptual evaluation of voice: comparing different speech tasks to identify children with and without laryngeal lesions

ABSTRACT Purpose To compare the vowel emission and number counting tasks in perceptual-auditory differentiation among children with and without laryngeal lesions. Methods Observational, analytical, and cross-sectional methods were used. Medical records of 44 children were selected from a database of an otorhinolaryngology service at a University Hospital and they were divided into groups: without laryngeal lesion (WOLL), and with laryngeal lesion (WLL), with 33 and 11 children. For the auditory-perceptual evaluation, the vocal samples were separated according to the type of task. They were analyzed separately by a judge who analyzed the general degree of vocal deviation and assessed whether the child would pass or fail in the face of a screening situation. Results There was a difference between the WOLL and WLL groups in terms of the overall degree of vocal deviation for the task of number counting, with a predominance of mild deviations in WOLL and moderate in WLL. In the screening, there was a difference between the groups during the number counting task, with more failures in the WLL. The groups were similar in the sustained vowel task, both in terms of the overall degree of vocal deviation and the vocal screening. Most children in the WLL failed in both tasks during vocal screening compared to the children in the WOLL who, in general, failed in only one task. Conclusion The task of number counting contributes to the auditory differentiation in children with and without laryngeal lesion, by identifying deviations of greater intensity in children with laryngeal lesion.

Pediatric Vocal Symptoms Questionnaire (PVSQ): Four new versions for parental evaluation and self-evaluation

OBJECTIVES

To elaborate reduced versions of the Pediatric Vocal Symptoms Questionnaire (PVSQ) protocol for the two forms of application of the instrument: self-evaluation (SE) and parental evaluation (PE).

METHODS

The Brazilian validation database of the PVSQ was used (Zip code: 758,309). Data were collected from 716 people, comprising 367 children and adolescents and 349 parents/guardians with and without voice complaint and/or vocal alteration. Three major procedures were adopted: 1. Verification of suitability of the database; 2. Determination of the extraction technique and the number of factors to be extracted, and 3. Decision on the type of factor rotation. For factor analysis, the Kaiser rule and Varimax rotation were used; Spearman's correlation analysis was used to verify the degree of relationship between the PVSQ variables, both of the SE and PE. The Mann-Whitney test was used to analyze the ROC curve of the general score of vocal symptoms of each version. A 5% significance statistical level was adopted.

RESULTS

Factor analysis made it possible to elaborate four new versions of the PVSQ, called: "common core of the PVSQ" (SE and PE), "common core of the PVSQ reduced version" (SE and PE), "PVSQ SE reduced version" and "PVSQ PE reduced version". The most complete version of the PVSQ has 7 domains in the SE and 5 in the PE. The common core of the PVSQ SE reduced version had a better area under the ROC curve (AUC), efficiency and sensitivity, and the PVSQ PE reduced version had better specificity.

CONCLUSIONS

Four new reduced PVSQ versions are available, containing 10 to 26 items. Aspects of specificity, efficiency and sensitivity, as well as discriminating capacity should be considered in the choice of the version and is a prerogative of the clinician who applies the instrument. As the questionnaire allows the comparison between the parental evaluation and the self-evaluation, it is recommended to apply the same version for parents and children.

Cut-off point for high dysphonia risk in children based on the Child Dysphonia Risk Screening Protocol: preliminary findings

OBJECTIVES

The objective of the study was to establish a cut-off point for high dysphonia risk in children using the Child Dysphonia Risk Screening Protocol (DRSP-C).

METHODS

Through a preliminary study, voice recordings of 59 children (4-12 years of age) were collected during an auditory-perceptual analysis using the Consensus Auditory-Perceptual Evaluation of Voice protocol. Thirty of the patients had voice disorders (patient group), and 29 did not (control group). A risk score for dysphonia was then calculated, and data were compared between groups. The relationship between overall degrees of deviation and questionnaire scores was analysed. The questionnaire's validity was verified from the area under the Receiver Operating Characteristic (ROC) curve, and cut-off points were obtained based on diagnostic criteria for screening procedures.

RESULTS

The DRSP-C score was found to be higher for the patient group, as was the partial score for vocal behaviour. No correlation was found between overall degrees of dysphonia and questionnaire scores. The area under the ROC curve was measured as 0.678, denoting limited diagnostic capacity. The cut-off point was set at 16.50. Thus, above this value, dysphonia risk is higher.

CONCLUSION

A cut-off point for high dysphonia risk was calculated. The DRSP-C proved to be a promising tool for children's clinical vocal and health promotion and should be used in conjunction with General Dysphonia Risk Screening.

Caracterização da saúde de idosos numa perspectiva fonoaudiológica

RESUMO Objetivo: estimar a prevalência de problemas da comunicação oral, memória, leitura, escrita, voz, audição e motricidade orofacial em idosos. Métodos: estudo transversal, com 75 idosos cadastrados em uma Clínica da Família carioca. Foram estimadas as prevalências por sexos e conjuntamente. Verificou-se a presença de diferenças entre os sexos por meio dos testes t e qui-quadrado. Resultados: os principais problemas de comunicação oral e memória foram "evita se comunicar" (20,5%) e "dificuldades em lembrar fatos recentes e passados" (34,7% e 26,4%, respectivamente). Observou-se elevada prevalência de dificuldade na leitura e escrita. Em relação à audição, 43,1% relataram "ver televisão e ouvir rádio muito alto". Quanto à voz, 71,2% referiam "falar alto ou gritando" e 23,6% "ficar roucos com frequência". Na motricidade orofacial, 24,7% apresentavam "dificuldades na mastigação em geral" e 54,8% "roncavam ao dormir". Conclusão: neste estudo, observou-se uma grande parcela de idosos que referia dificuldades relacionadas às habilidades de linguagem, audição, fonação e mastigação, que são funções relacionadas à socialização, bem-estar e manutenção da autonomia funcional, podendo interferir diretamente na sua qualidade de vida e saúde.

Proposta de acolhimento a pais de crianças disfônicas: relato de caso

RESUMO Objetivo: relatar a importância de um procedimento de acolhimento a pais de crianças disfônicas, participantes de um grupo de terapia fonoaudiológica. Métodos: trata-se de um relato de caso de caráter qualitativo e método de análise microgenética de gravações de vídeos de sessões de terapia fonoaudiológica com um grupo de pais de crianças disfônicas. Resultados: as análises foram descritas a partir de três categorias: a primeira relativa ao conhecimento dos pais acerca da voz, a aprendizagem das crianças sobre a voz no processo de terapia e os resultados do processo terapêutico. A segunda categoria envolvia os hábitos vocais e os usos da voz no cotidiano. E a terceira relativa à preocupação dos pais com as patologias respiratórias associadas. Conclusão: a proposta de grupos com os pais de crianças disfônicas é uma possibilidade terapêutica válida, pois se mostrou como um trabalho construtivo para todos os integrantes. Além disso, o acolhimento dos pais de crianças disfônicas é essencial visto que eles interferem diretamente na condução terapêutica.

Cross-cultural adaptation of the Brazilian version of the 'Questionnaire Des Symptômes Vocaux'

PURPOSE

This article aims to present the cultural equivalence of the Brazilian version of the 'Questionnaire des Symptômes Vocaux' (QSV).

METHODS

The questionnaire was translated into Portuguese by two Brazilian bilingual speech-language pathologists who were informed about the purpose of this research. The back translation was performed by a third bilingual Brazilian speech-language pathologist, who was also a French teacher and had not participated in the previous stage. After the comparison of translations, a final version of the questionnaire was produced and called 'Questionário de Sintomas Vocais Pediátrico (QSV-P)', which was administered to 32 individuals (16 children/adolescents with vocal complaints and their parents). The inclusion criterion was the vocal complaint and/or vocal quality altered on the perceptual auditory evaluation. The option "not applicable" was added to each item of the protocol.

RESULTS

During the process of translation and cultural adaptation, no item was changed and/or eliminated from the questions. The QSV-P kept the same structure as the original French version with 31 questions, which can be responded by children/adolescents (6-18 years) and their parents, regarding the physical, emotional and social functioning of the vocal problem.

CONCLUSION

The cultural equivalence of the Brazilian version of the 'Questionnaire des Symptômes Vocaux', entitled 'Questionário de Sintomas Vocais Pediátrico', was demonstrated. The QSV-P validation is currently being done.