International Journal of Phonosurgery & Laryngology

Register      Login

VOLUME 9 , ISSUE 2 ( July-December, 2019 ) > List of Articles


Is Computerized Dynamic Posturography Analysis in Dysphonic Patients Different after Vocal Rehabilitation Treatment? A Longitudinal Study

Maria CRC Caçador, Ana L Papoila, Carlos Brás-Geraldes, Carlos S Garcia, Tânia Constantino, Mafalda Almeida, Joâo Paâo

Keywords : Cohort study, Posture, Posturography, Speech rehabilitation, Unilateral vocal fold paresis/paralysis, Voice disorders

Citation Information : Caçador MC, Papoila AL, Brás-Geraldes C, Garcia CS, Constantino T, Almeida M, Paâo J. Is Computerized Dynamic Posturography Analysis in Dysphonic Patients Different after Vocal Rehabilitation Treatment? A Longitudinal Study. Int J Phonosurg Laryngol 2019; 9 (2):30-35.

DOI: 10.5005/jp-journals-10023-1172

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: Vocal pathology and vocal rehabilitation may influence posture, and changes in postural pattern can influence the mechanisms of vocal production. This study aimed to evaluate the postural pattern in subjects with unilateral vocal fold paresis/paralysis before and after speech rehabilitation, using computerized dynamic posturography (CDP). Materials and methods: This is a prospective cohort study, studying the posture pattern of 16 patients affected by dysphonia, caused by unilateral vocal fold paresis/paralysis, never treated with speech therapy, and by CDP before and after vocal rehabilitation. Each patient underwent videolaryngostroboscopy, acoustic voice analysis, aerodynamic evaluation, GRBAS scale, and voice handicap index questionnaire. Fifteen healthy volunteers were also submitted to a posturographic analysis as a control group. Results: All patients showed an improvement in voice quality after vocal training. The auditory-perceptual evaluation with the GRBAS scale showed a decrease in all parameters for both vowel (/a/, /i/, /e/) and spontaneous speech (p < 0.001 for all). Furthermore, the acoustic analysis showed an improvement in fundamental frequency, shimmer, harmonic-to-noise ratio, and normalized noise energy. Posturographic results showed an improvement in equilibrium score; conditions 1, 2, 4, 5, and 6; and composite score. Strategic analysis results showed an improvement in conditions 2, 5, and 6. Conclusion: Posturographic analysis showed a significant difference in the proprioceptive, visual, and vestibular component of posture, after voice therapy. These results confirmed an improvement in the postural performance of dysphonic patients after a successful voice treatment. Clinical significance: The results of this study indicate that modifications of voice production techniques lead to objective and measurable postural changes in dynamic posturographic analysis.

  1. Stager SV. Vocal fold paresis: etiology, clinical diagnosis and clinical management. Curr Opin Otolaryngol Head Neck Surg 2014;22(6): 444–449. DOI: 10.1097/MOO.0000000000000112.
  2. Syamal MN, Benninger M. Vocal fold paresis: a review of clinical presentation, differential diagnosis, and prognostic indicators. Curr Opin Otolaryngol Head Neck Surg 2016;24(3):197–202. DOI: 10.1097/MOO.0000000000000259.
  3. Sulica L, Blitzer A. Vocal fold paralysis. Berlin: Springer; 2010.
  4. Mattei A, Desuter G, Roux M, et al. International consensus (ICON) on basic voice assessment for unilateral vocal fold paralysis. Eur Ann Otorhinolaryngol Head Neck Dis 2018;135(1):11–15. DOI: 10.1016/j.anorl.2017.12.007.
  5. Estes C, Sadoughi B, Mauer E, et al. Laryngoscopic and stroboscopic signs in the diagnosis of vocal fold paresis. Laryngoscope 2017;127(9):2100–2105. DOI: 10.1002/lary.26570.
  6. Harris G, O'Meara C, Pemberton C, et al. Vocal fold paresis - a debilitating and underdiagnosed condition. J Laryngol Otol 2017;131(S2):S48–S52. DOI: 10.1017/S0022215117000810.
  7. Zuniga S, Ebersole B, Jamal N. Inpatient injection laryngoplasty for vocal fold immobility: when is it really necessary? Am J Otolaryngol 2017;38(2):222–225. DOI: 10.1016/j.amjoto.2017.01.016.
  8. Feldenkrais M. Body and Mature Behaviour. New York: International Universities Press; 1949. p. 167.
  9. Caçador M, Paço J. The influence of posture and balance on voice: a review. Gazeta Médica 2018;5(2):116–121. DOI: 10.29315/gm. v5i2.159.
  10. Bruno E, De Padova A, Napolitano B, et al. Voice disorders and posturography: variables to define the success of rehabilitative treatment. J Voice 2009;23(1):71–75. DOI: 10.1016/j.jvoice.2007.06.002.
  11. Giovanni A, Assaiante C, Galmiche A, et al. Vocal forcing and posture: experimental studies on normal subject. Rev Laryngol Otol Rhinol 2006;127(5):285–291.
  12. Giovanni A, Akl L, Ouaknine M. Postural dynamics and vocal effort: preliminary experimental analysis. Folia Phoniatr Logop 2008;60(2):80–85. DOI: 10.1159/000114649.
  13. Lagier A, Vaugoyeau M, Bouché C, et al. Postural study on healthy subjects during experimental vocal effort. Rev Laryngol Otol Rhinol 2009;130(1):11–16.
  14. Lagier A, Vaugoyeau M, Ghio A, et al. Coordination between posture and phonation in vocal effort behavior. Folia Phoniatr Logop 2010;62(4):195–202. DOI: 10.1159/000314264.
  15. Grini MN, Ouaknine M, Giovanni A. Forcing the voice and variance of speed: correlation between the speed of displacement of the center of gravity and the work of the postural muscles. Rev Laryngol Otol Rhinol 2000;121(5):319–323.
  16. Nacci A, Fattori B, Mancini V, et al. Posturographic analysis in patients with dysfunctional dysphonia before and after speech therapy/rehabilitation treatment. Acta Otorhinolaryngol Ital 2012;32(2): 115–121.
  17. Goebel JA. Pratical management of the dizzy patient. Philadelphia: Lippincott Williams & Wilkins; 2001.
  18. Lobryeau-Desnus C, Girard P, Daguenant C, et al. Rehabilitation strategies of dysfunctional dysphonia in relation to posture. Rev Laryngol Otol Rhinol 2010;131(1):69–72.
  19. Sataloff RT. Professional voice: The Science and Art of Clinical Care, 3rd ed., San Diego: Plural Publications; 2005.
  20. Koufman JA, Isaacson G. The spectrum of vocal dysfunction. Otolaryngol Clin North Am 1991;24(5):985–988.
  21. Hirano M. Clinical Examination of the Voice. New York: Springer-Verlag; 1981.
  22. Guimarães I, Abberton E. An investigation of the voice handicap index with speakers of portuguese: preliminary data. J Voice 2004;4(1):592–606.
  23. Rubin AD, Praneetvatakul V, Heman-Ackah Y, et al. Repetitive phonatory tasks for identifying vocal fold paresis. J Voice 2005;19(4):679–686. DOI: 10.1016/j.jvoice.2004.11.001.
  24. Sulica L, Blitzer A. Vocal fold paresis: evidence and controversies. Curr Opin Otolaryngol Head Neck Surg 2007;15(3):159–162. DOI: 10.1097/MOO.0b013e32814b0875.
  25. NeuroCom International Inc. EquiTest system operator's manual version 8.5. Clackamas: NeuroCom International Inc; 2004.
  26. Woo P. Stroboscopy. San Diego: Plural Publishing; 2010.
  27. Wu AP, Sulica L. Diagnosis of vocal fold paresis: current opinion and practice. Laryngoscope 2015;125(4):904–908. DOI: 10.1002/lary.25004.
  28. Koufman JA, Postma GN, Cummins MM, et al. Vocal fold paresis. Otolaryngol Head Neck Surg 2000;122(4):537–541. DOI: 10.1067/mhn.2000.102574.
  29. Caçador M, papoila A, Brás-Geraldes C, et al. Evaluation of postural changes using dynamic posturography after speech rehabilitation in patients with voice disorders: a longitudinal study. Folia Phoniatr Logop 2019;2:1–8. DOI: 10.1159/000500808.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.