Presentacin de PowerPoint

TERAPIA DE VOZ PARA EL MANEJO DE TRASTORNOS DE LA VOZUNIVERSIDAD AUTONOMA DE SINALOA

HOSPITAL CIVIL DE CULIACAN

CENTRO DE INVESTIGACIN Y DOCENCIA EN CIENCIAS DE LA SALUD

OTORRINOLARINGOLOGIA Y CIRUGIA DE CABEZA Y CUELLODR. ANGEL CASTRO URQUIZOR1 ORL

CULIACAN SINALOANOVIEMBRE 2016

10481

Introduccin

El otorrino suele ser el primero en el camino de un paciente con trastornos de vozEs necesario un manejo conjunto 2

Introduccin

Importante Abstenerce de decir: Quiero que pruebe la terapia de voz - plantan la semilla del fracaso.

Explicar que es algo muy prolongado--< es la premisa bsica para el EXITO

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Introduccin

illustrates the key categoriesof any voice therapy program: increase vocal hygiene,decrease phonotrauma. and increase coordinated voice production.Although the circles delineate separate entities, they are not mutually exclusive

Ver en que categora esta el paciente,

The third circle, increase coordinated vocal production,represents a direct approach to voice therapy; here,the speech-language pathologist directly alters the patient'sspeaking technique in an attempt to increase vocal qualityand efficienc4

Introduccin

Introduccin

Higiene vocalBase de la terapia de voz

Autocuidado de cuerdas vocales

Hidratacin e irritantes

Control activo

Disminucin de cicatrices

HidratacinRLF1

Hidratacin

Research has shown that hydrated vocal folds vibrate withless subglottic pressure than do nonhydrated vocal folds,especially at high pitches ( 10-14). Hydrated vocal folds areless predisposed to trauma than dry vocal folds and showmore resilience from trauma than dry vocal folds8

Initiating voice therapy with the healthiest vocal foldspossible is the launch pad of therapy.

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Reflujo laringofarngeo

Initiating voice therapy with the healthiest vocal foldspossible is the launch pad of therapy.10

Disminucin de fonotraumaVoz producida con esfuerzo por tiempo incrementado o volumen alto resultando en patologa de cuerda vocal.2

The second circle is entitled decrease phonotrauma(vocal abuse/overuse) and is defined as a voice producedwith too much effort for increased durations of time orat an inordinately high volume, often resulting in organicallybased vocal fold pathology. Phonotraumatic vocalbehaviors may result in benign vocal fold lesions (e.g.,nodules, cysts, fibrous mass, polyps) and scar. Suchvocal behaviors as screaming, yelling, throat clearing,continued voicing while sick, vocalization during vigorousexercising, vocal overuse, and speaking over backgroundnoise are examples. Although modem-day voicetherapy is much more than a '"do/don't" list. the prevailing"don't" recommendation in voice therapy is "don'tscream. High-pitched screaming may result in vocalfold hemorrhage. Vocal overuse may also cause vascularchanges (i.e., vascular permeability) in the vocal folds,which may predispose patients to have small and largehemorrhages, often recurrent in nature. Cumulativemicrotrauma to the vocal fold tissues may result in scarring,sulcus vocalis, or both. Voice therapy is often usedin conjunction with surgical intervention for phonotraumaticlesions in this circle.

Educar en las primeras dos sesiones

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Coordinacin de la vozVoz no coordinada: Sonido anormal resultante de desequilibrio de la respiracin, fonacin y resonancia. 3

Tcnicas de compensacin inapropiadas

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Abordajes en terapia de voz

No hay acuerdo general entre los patlogos del habla y el lenguaje Acerca de qu terapias de voz utilizar con voz especfica Trastornos.Most speech-language pathologists usea combination of the therapies listed and do not use onetherapy in particular. Although the following list defineseach specific therapy, voice therapy is not cookbook care. ..Each patient presents with individual needs, and sometherapies work better with some patients than others.13

Mtodo del acento

Proponents of this method report that patients acquire optimal respiratorysupport, coordination of exhalation and phonatory onset..and phonatory effort (19). Research investigating the efficacyof the accent method shows good outcomes ( 19 ,20).14

SOPORTE RESPIRATORIO OPTIMO

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EXPLICACION: APRENDEN NUEVOS PATRONES DE COMPORTAMIENTO,APLICACIN EN LESIONES BENIGNAS: NODULOS; DISFONIA TENSIONAL, FUNCION PARADOJICA

The accent method may be used to treat benign lesions,MID, vocal fatigue. paradoxical vocal fold motion, andmild glottal incompetence(cierre inadecuado).16

Voz confidencial

which results in smaller amplitudes of vibrationand decreased collision force/stress impact.MAS QUE NADA ES PARA DARLE TIUEMPO A SANAR

Aplicacion: LESIONES BENIGNAS; POSOPERATORIO; PERIODOS CORTOS DE TIEMPO, MTD

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EXPLICACION: LIGERA ABDUCCION CON MENOS TRAUMA Y PROTECCION DE NUEVA LESIONAPLICACIN: LESIONES BENIGNAS; POSOPERATORIO; PERIODOS CORTOS DE TIEMPO

Confidential voice therapy may be used to treat benignlesions, MTD, and it can be used during the postoperativeperiod of voice reinstatement It is not appropriate forpatients with voice problems related to glottal incompetence.Also, confidential voice is only used for a period oftime to promote vocal fold healing; once that period is finished,the voice production is shaped into a healthy vocalproduction by other therapies mentioned in this chapter.A soft, breathy voice is not an appropriate goal of any voicetherapy technique.18

Lee Silverman

EXPLICACION: LAS IDEAS MEJOR ESTRUCTURADAS SE DICEN EN SILENCIOAPLICACIONES: PREsBILARINGEA PARKINSON; NEUROLOGICAS

patients with Parkinson disease. The aging voice, and other conditions including stroke, multiplesclerosis, cerebral palsy. and Down sndrome

When patients are asked to speak loudly, not onlydoes vocal fold closure increase but articulatory precisionalso improves.19

LSVT LOUD

LSVT BIG

Tcnicas manuales crico-laringeasReposicionamiento manual directo de la laringe

Observacin de los cambios en voz durante fonacin

Usar cuando los Msculos contribuyen a anormalidades de voz

Tensin muscular desva laringe de posicin neutral

These techniquesare used when extrinsic and intrinsic laryngealmuscle dysregulation (imbalance) contribute to an abnormal-sounding voice.

AREAS dolorosas : TIROHIODEA CARTILAGO TIROIDES Y BORDE INF DE HIOIDES

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EXPLICACION: SE REACOMODA LARINGE A POSICION NEUTRAM MASAJE RELAJA LOS MUSCULOSAPLICACIONES: DISFONIA TENSIONAL; FUNCIONAL E HIPERFUNCIONAL; LESIONES ORGANICAS CON COMPENSACIONES INADECUADAS

The "push-back" maneuver uses digital compression in theposterior direction within the region of the hyoid bone.23

Roy and Leeper reportaron mejora en 93% de 17 pacientes con disfona hiperfuncional en 1 sesin

The "push-back" maneuver uses digital compression in theposterior direction within the region of the hyoid bone.The "pull-down" maneuver impedes laryngeal elevationby applying downward traction over the superior border ofthe thyroid cartilage. The medial compression and downwardtraction maneuver puts pressure directly over the posterioraspect of the thyroid cartilage and thyrohyoid space.Circumlaryngeal massage may directly stretch the laryngealmuscles and effect relaxation.24

Voz resonanteProduccin de sonidos nasales, zumbidos, fricativos

The Lessac-Madsen Resonant Voice Therapy (LMRVT) FisiologaAprendizajeApego 8 sesiones semanales

NASALES HUM, FRICATIVOS ZZZ O VVV PRODUCE UN HABLA BUCAL Y MEJORA LA RELACION DE FINACION CON ESFUERZO

Several studies show that easy, resonant voice is producedwith vocal folds that are barely touching or barely separatedvocal folds, which tend to optimize the relation betweenvoice output intensity and vocal fold impact intensityConsonantefricativa. Una consonantefricativaes la que se produce por un estrechamiento o constriccin de dos rganos articulatorios que modifican la corriente de aire, originando una friccin turbulenta25

Resonant voice may be used with patients who have benignvocal fold lesions, mild glottal incompetence, and hyperfunctional(e.g., MID) voice disorders.26

Reentrenamiento respiratorio

Usado en paradoxical vocal fold motion disorder (PVFMD)27

Open-throat breathingcan be achieved by inhaling through the nose with arelaxed tongue posture or inhaling with pursed lips (e.g.,like sucking a thick milk shake up through a straw) andprolonging audible exhalation through pursed lips on anunvoiced /u/ or by producing a voiceless fricative like /s/,If/ or "sh." Patients are taught both "rescue breathing techniques"when in an attack, as well as rhythmic breathingto "prevent" an attack28

Fonacin de flujoAdaptada de: Stretch and Flow PhonationAprender a no sostener respiracin durante el habla.

4 habilidades bsicas1.- Liberacin de flujo areo2.- Fonacin respirando 3.- Fonacin de flujo4.- Precisin de articulacin

patients recognize that they are not holding their breath is the key

Flow phonation may be used with patients with functionalaphonia. MTD, and mild atrophy and it also may be effectivein patients with benign vocal fold lesions.

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Ejercicios de funcin vocal1950, Briess

Tcnicas de fortalecimiento y coordinacin de cuerdas y msculos larngeos.

Equivalente de terapia fsica para cuerdas vocales

Mejoran la eficacia y relacin de fonacin/esfuerzo por flujo de aire, resonancia y vibracin vocal

Ejercicios de funcin vocal2 repeticiones 2 veces al da

1: EE EL MAYOR TIEMPO POSIBLE2:GLIDING DE NOTA MAS bAJA A MAS ALTA CON PALABRA KNOLL 3.-GLIDING DE LA NOTA MAS ALTA A LA MAS BAJA CON KNOLL4.-SOSTENER KNOLL EN CADA NOTA MUSICAL EL MAYOR TIEMPO POSIBLE

a) vocal warm-up by sustaining the vowel ee" for as long as possible, (b) stretching of the laryngeal muscles by gliding from the lowest note to thehighest note on the word '"knoll (c) contracting of the laryngeal muscles by gliding from the highest noteto the lowest note on the word "knoll," and (d) buildingmuscular power by sustaining musical notes for as long aspossible on the word "knoll" minus the "kn."31

VFEs may be used on patients with benign vocal fold lesions, mild glottal incompetence, and MTD.

EXPLICACION: MEJORA FUERZA Y DESEMPEO DE MUSCULOS Y COORDINACION DE RESPIRACION Y FONACIONAPLICACIONES: LESIONES BENIGNAS, DISFONIA POR TENSION MUSCULAR

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Terapias de tracto vocal semi-ocluido

Zumbido labio Burbujas, trinos de la lengua, fonacin de popote , fricativas sostenidas (/ Z /, / v /), etc.33

Almost all voice disorders can be helped by this generalgrouping of therapies, as well as the nonspecific complaintof vocal fatigue.34

Referencia apropiadas para terapia de voz

A QUIEN REFERIRMUCHOS PX TIENEN MEJORIA CON DOS SESIONESPACIENTE: MOTIVACION; GANAS DE MEJORAR; ACTITUD; APEGOLARINGE: ESTADO FUNCIONAL, En ocasiones con disminuir fonotrauma y humectar bastaPatient factors refer to such things as motivationfor change, positive attitude, compliance to behavioralmodification, adherence to homework, hearing loss, andaccepting responsibility for change.

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