Neurodegenerative motor disorders affect the neuromuscular system challenging daily life and normal activity. Parkinson's Disease (PD) is among the most prevalent ones, with a large impact and rising prevalence rates. Speech is most affected by PD as far as phonatory and articulatory performance is concerned. Neuromotor activity (NMA) alterations have an impact on larynx muscles responsible for vocal fold adduction and abduction, hampering phonation stability and regularity. The main muscular articulators involved in phonation control are the cricothyroid (tensor) and thyroarytenoid (relaxer) systems, regulated by two distinct direct neuromotor pathways, activated by the precentral gyrus laryngeal control areas. These articulations control the musculus vocalis, directly responsible for regular vocal fold vibration. An indirect estimation of the muscular tension produced by inverse filtering may split into two independent channels, assumed to be the tensor and relaxer neuromotor pathways such as the differential neuromotor activity (DNMA). The amplitude distributions of both DNMA channels allow comparing phonations from PD-affected persons (PDPs) and age-matched healthy control participants (HCPs) with respect to a set of reference mid-age normative participants (RSPs). The comparisons are carried out by Jensen-Shannon distributions of PDP and HCP phonations with respect to those of RSPs. A dataset of 96 phonation samples from participants balanced by gender is used to train a set of decision tree classifiers (DTCs) to distinguish PDP from HCP phonation. The best results from 10-fold cross-validation offered accumulated mismatches of 0.09 and 0.1292 for male and female subsets. The sensitivity, specificity, and accuracy of the classification results when separating PDP from HCP phonatios were 93.33%, 88.23%, and 90.63% (male PDP versus HCP) and 92.86%, 83.33%, and 87.50% (female PDP versus HCP), providing a stratification of PDPs and HCPs by objective disease grading from explainable AI (XAI) methods.
- MeSH
- Adult MeSH
- Phonation * physiology MeSH
- Laryngeal Muscles * physiopathology MeSH
- Larynx * physiopathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Parkinson Disease * physiopathology complications MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Estill Voice Training TM (EVT) je hlasová tréninková metoda založená na podrobném porozumění anatomii a fyziologii hlasového aparátu. Tato metoda nabízí efektivní přístup ke kultivaci, reedukaci a rehabilitaci hlasu, což ji činí zajímavou i pro logopedickou praxi. Článek představuje základy EVT, její principy a přínosy a poskytuje stručný přehled klíčových technik.
Estill Voice TrainingTM (EVT) is a voice training method based on the understanding of how the vocal mechanism works. This method offers an effective approach to voice development, re-education, and rehabilitation, making it valuable also in speech therapy practice. This article introduces the fundamentals of EVT, its principles and benefits, and provides a brief overview of the key techniques.
Voice registers are assumed to be related to different laryngeal adjustments, but objective evidence has been insufficient. While chest register is usually associated with the lower pitch range, and head register with the higher pitch range, here we investigated a professional singer who claimed an ability to produce both these registers at every pitch, throughout her entire singing range. The singer performed separated phonations alternating between the two registers (further called chest-like and head-like) at all pitches from C3 (131 Hz) to C6 (1047 Hz). We monitored the vocal fold vibrations using high-speed video endoscopy and electroglottography. The microphone sound was recorded and used for blind listening tests performed by the three authors (insiders) and by six "naive" participants (outsiders). The outsiders correctly identified the registers in 64% of the cases, and the insiders in 89% of the cases. Objective analysis revealed larger closed quotient and vertical phase differences for the chest-like register within the lower range below G4 (<392 Hz), and also a larger closed quotient at the membranous glottis within the higher range above Bb4 (>466 Hz), but not between Ab4-A4 (415-440 Hz). The normalized amplitude quotient was consistently lower in the chest-like register throughout the entire range. The results indicate that that the singer employed subtle laryngeal control mechanisms for the chest-like and head-like phonations on top of the traditionally recognized low-pitched chest and high-pitched head register phenomena. Across all pitches, the chest-like register was produced with more rapid glottal closure that was usually, but not necessarily, accompanied also by stronger adduction of membranous glottis. These register changes were not always easily perceivable by listeners, however.
- MeSH
- Acoustics * MeSH
- Video Recording MeSH
- Biomechanical Phenomena MeSH
- Adult MeSH
- Electrodiagnosis MeSH
- Phonation * MeSH
- Vocal Cords physiology MeSH
- Voice Quality * MeSH
- Laryngoscopy MeSH
- Larynx physiology MeSH
- Humans MeSH
- Vibration MeSH
- Singing * MeSH
- Sound Spectrography MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
INTRODUCTION: Vibratory positive expiratory pressure (PEP) devices are now commonly used as a resource for voice therapy. PEP devices promote improved vocal economy with the added benefit of producing a massage effect in the vocal tract. Although the benefits of PEP devices for voice have already been demonstrated, their impact on the vocal source is still not very clear. This study assesses the impact of phonation into the Acapella Choice (a type of PEP device) on the voice. METHODS: Three normophonic subjects underwent high-speed videoendoscopy assessment while pressure, flow and electroglottographic data was collected. RESULTS: Phonation into the Acapella device produces large changes in the pressure and flow profiles consequently affecting the voice source. In specific, when intraoral pressure increases as a consequence of the downward movement of the rocker arm in the Acapella device (reduction of the airflow outlet), phonation is hindered, demonstrated by the lower amplitude of vibration of the vocal folds and weaker modulation of the pressure and flow values by the glottal cycle. When the rocker arm in the Acapella device opens (increasing the airflow outlet), the opposite trend is observed where vocal fold vibration is aided and the modulation of pressure and flow by the vocal cycle increases. Based on the pressure and flow signals, we can assume that the impedance of the vocal tract alternates between two dominant regimes: increased inertive reactance (aided vibration) and increased resistance (hindered vibration). CONCLUSIONS: PEP devices, such as the Acapella device, are efficient in modulating the pressure and flow profiles in the vocal tract leading to the alternation of glottal vibration from aided to hindered. These changes in the glottal vibration can be considered an additional consequence of the massage effect caused by the Acapella device.
- MeSH
- Video Recording * MeSH
- Biomechanical Phenomena MeSH
- Time Factors MeSH
- Equipment Design * MeSH
- Adult MeSH
- Electrodiagnosis instrumentation MeSH
- Phonation * MeSH
- Glottis * physiology MeSH
- Vocal Cords physiology MeSH
- Voice Training * MeSH
- Voice Quality * MeSH
- Laryngoscopy instrumentation MeSH
- Humans MeSH
- Pressure * MeSH
- Positive-Pressure Respiration instrumentation MeSH
- Vibration * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Augmentace hlasivek je miniinvazivní fonochirurgický výkon, který se využívá ke zlepšení uzávěru hlasivek při fonaci při fonační insuficienci do 3 mm. Fonační insuficience vzniká nejčastěji při obrně zvratného nervu nebo jako následek úbytku hmoty hlasivky ve vyšším věku (presbyfonie). V článku je prezentována kazuistika pacientky s presbyfonií, u které byla provedena augmentace hlasivek autologním tukem. Cílem je zdůraznit možnost využití augmentace autologním tukem u pacientů s presbyfonií při neúspěšné konzervativní léčbě.
Lipoinjection of vocal cords is a minimally invasive phonosurgical treatment, which is used to increase the volume of vocal cords if the glottal gap is less than 3 mm. Glottic gap is usually caused by paresis of the recurrent laryngeal nerve or as a result of vocal cord muscle atrophy in the elderly (presbyphonia). In this article, a case report of a patient with presbyphonia who underwent lipoinjection of the vocal cords is presented. The aim of this case report is to highlight the use of lipoinjetion of vocal cords in elderly patients with presbyphonia in case of unsuccessful conservative treatment.
- Keywords
- presbyfonie, augmentace hlasivek,
- MeSH
- Apraxias diagnosis classification therapy MeSH
- Autografts classification transplantation MeSH
- Phonation * MeSH
- Glottis * surgery pathology MeSH
- Vocal Cords surgery pathology MeSH
- Humans MeSH
- Recurrent Laryngeal Nerve pathology MeSH
- Vocal Cord Paralysis diagnosis classification therapy MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
Parkinson's disease (PD) is a neurodegenerative condition with constantly increasing prevalence rates, affecting strongly life quality in terms of neuromotor and cognitive performance. PD symptoms include voice and speech alterations, known as hypokinetic dysarthria (HD). Unstable phonation is one of the manifestations of HD. Repetitive transcranial magnetic stimulation (rTMS) is a rehabilitative treatment thathas been shown to improve some motor and non-motor symptoms of persons with PD (PwP). This study analyzed the phonation functional behavior of 18 participants (13 males, 5 females) with PD diagnosis before (one pre-stimulus) and after (four post-stimulus) evaluation sessions of rTMS treatment, to assess the extent of changes in their phonation stability. Participants were randomized 1:1 to receive either rTMS or sham stimulation. Voice recordings of a sustained vowel [a:] taken immediately before and after the treatment, and at follow-up evaluation sessions (immediately after, at six, ten, and fourteen weeks after the baseline assessment) were processed by inverse filtering to estimate a biomechanical correlate of vocal fold tension. This estimate was further band-pass filtered into EEG-related frequency bands. Log-likelihood ratios (LLRs) between pre- and post-stimulus amplitude distributions of each frequency band showed significant differences in five cases actively stimulated. Seven cases submitted to the sham protocol did not show relevant improvements in phonation instability. Conversely, four active cases did not show phonation improvements, whereas two sham cases did. The study provides early preliminary insights into the capability of phonation quality assessment by monitoring neuromechanical activity from acoustic signals in frequency bands aligned with EEG ones.
In this tribute article to D.G. Miller, we review some historical and recent contributions to understanding the myoelastic-aerodynamic (MEAD) theory of phonation and the related acoustic phenomena in subglottal and vocal tract. At the time of the formulation of MEAD by van den Berg in late 1950s, it was assumed that vocal fold oscillations are self-sustained thanks to increased subglottal pressure pushing the glottis to open and decreased subglottal pressure allowing the glottis to close. In vivo measurements of subglottal pressures during phonation invalidated these assumptions, however, and showed that at low fundamental frequencies subglottal pressure rather tends to reach a maximum value at the beginning of glottal closure and then exhibits damped oscillations. These events can be interpreted as transient acoustic resonance phenomena in the subglottal tract that are triggered by glottal closure. They are analogous to the transient acoustic phenomena seen in the vocal tract. Rather than subglottal pressure oscillations, a more efficient mechanism of transfer of aerodynamic energy to the vocal fold vibrations has been identified in the vertical phase differences (mucosal waves) making the glottal shape more convergent during glottis opening than during glottis closing. Along with other discoveries, these findings form the basis of our current understanding of MEAD.
- MeSH
- Acoustics MeSH
- Biomechanical Phenomena MeSH
- Phonation * MeSH
- Glottis * MeSH
- Vocal Cords MeSH
- Humans MeSH
- Vibration MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Príspevok približuje starostlivosť o pacienta s karcinómom hrtanu. Iniciatívna spolupráca medzi pacientom, jeho rodinou, sestrou a zdravotníckymi pracovníkmi je dôležitá pre zdarné zvládnutie osobitostí vyskytujúcich sa pri ošetrovateľskej starostlivosti u pacienta s karcinómom hrtanu. Sestry pri poskytovaní ošetrovateľskej starostlivosti predstavuje oporu pre pacienta a jeho rodinu.
The contribution brings closer the care of a patient with cancer of the larynx. Proactive cooperation between the patient, his family, nurse and healthcare workers is important for successful management of the peculiarities occurring in the nursing care of a patient with laryngeal cancer. Nurses provide support for the patient and his family when providing nursing care.
PURPOSE: Laryngeal high-speed videoendoscopy (LHSV) has been recognized as a highly valuable modality for the scientific investigations of vocal fold (VF) vibrations. In contrast to stroboscopic imaging, LHSV enables visualizing aperiodic VF vibrations. However, the technique is less well established in the clinical care of disordered voices, partly because the properties of aperiodic vibration patterns are not yet described comprehensively. To address this, a computer model for simulation of VF vibration patterns observed in a variety of different phonation types is proposed. METHOD: A previously published kinematic model of mucosal wave phenomena is generalized to be capable of left-right asymmetry and to simulate endoscopic videos instead of only kymograms of VF vibrations at single sagittal positions. The most influential control parameters are the glottal halfwidths, the oscillation frequencies, the amplitudes, and the phase delays. RESULTS: The presented videos demonstrate zipper-like vibration, pressed voice, voice onset, constant and time-varying left-right and anterior-posterior phase differences, as well as left-right frequency differences of the VF vibration. Video frames, videokymograms, phonovibrograms, glottal area waveforms, and waveforms of VF contact area relating to electroglottograms are shown, as well as selected kinematic parameters. CONCLUSION: The presented videos demonstrate the ability to produce vibration patterns that are similar to those typically seen in endoscopic videos obtained from vocally healthy and dysphonic speakers. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20151833.
- MeSH
- Video Recording MeSH
- Phonation MeSH
- Vocal Cords * diagnostic imaging MeSH
- Laryngoscopy MeSH
- Larynx * diagnostic imaging MeSH
- Humans MeSH
- Vibration MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
