Siqueira Larissa Thais Donalonso, Ribeiro Vanessa Veis, Moreira Pamela Aparecida Medeiros, Brasolotto Alcione Ghedini, de Jesus Guirro Rinaldo Roberto, Alves Silverio Kelly Cristina
Universidade Estadual do Centro-Oeste - UNICENTRO, Irati, Paraná, Brazil.
Centro Universitário do Cerrado Patrocínio - UNICERP, Patrocínio, Minas Gerais, Brazil.
J Commun Disord. 2019 Nov-Dec;82:105923. doi: 10.1016/j.jcomdis.2019.105923. Epub 2019 Jul 30.
Recently, electrical stimulation in vocal rehabilitation has been the subject of studies. This treatment has shown promising results regarding the decrease of vocal/laryngeal symptoms, pain and the improvement of vocal tension. In addition to decreasing pain symptoms, TENS treatments may lead to muscle relaxation. There is no data on the effects of this resource as a vocal therapy in women with behavioral dysphonia. Research in this area may provide evidence to assist the clinical decision related to the treatment of women with complaints of behavioral dysphonia and musculoskeletal pain.
To verify the effects of low-frequency TENS in association with vocal therapy on musculoskeletal pain in women with behavioral dysphonia.
Participants included 27 women with vocal nodules randomized into two groups. The experimental group (EG) - 13 women received 12 sessions of TENS (pulse of 200 μs, frequency at 10 Hz, in motor threshold) with electrodes placed bilaterally on the trapezius muscle and submandibular area for 20 min followed by 30 min of vocal therapy, and the control group (CG) - 14 women received 12 sessions of 20 min of a placebo TENS followed by 30 min of vocal therapy. We investigated the frequency and intensity of the musculoskeletal pain in several body regions, as well as the intensity of pain at rest and in the application of pressure with an algometer applied to the descending fibers of the trapezius muscle. The pressure-pain threshold (PPT) was also investigated. All evaluations occurred before, immediately after, and at one and three months after treatment in both groups.
We observed a reduction in the frequency of pain in the larynx after treatment of both groups, but only the EG showed a decrease in pain intensity in this region. It was verified with an algometer to the trapezius muscle that the electrical stimulation associated with the vocal therapy decreased the intensity of pain during the application of pressure and increased the PPT. There were no significant differences with regard to variables investigated in the comparison between the interventions. On the other hand, there was decreased pain in the trapezius muscle for the EG in comparison to the pre- and post-intervention.
The vocal therapyprogram reduced the frequency and intensity of the musculoskeletal pain in the regions proximal to the larynx of women with behavioral dysphonia. In addition, TENS followed by vocal therapy increased the threshold of sensitivity to muscular pain in the trapezius, demonstrating that it is a good resource to use in conjunction with traditional vocal therapy in cases of behavioral dysphonia associated with pain and muscle tension.
最近，电刺激在嗓音康复中一直是研究的主题。这种治疗在减轻嗓音/喉部症状、疼痛以及改善嗓音紧张度方面已显示出有希望的结果。除了减轻疼痛症状外，经皮电刺激神经疗法（TENS）治疗可能会导致肌肉放松。目前尚无关于这种方法作为行为性发声障碍女性嗓音治疗效果的数据。该领域的研究可能会为协助临床决策提供证据，这些决策涉及治疗有行为性发声障碍和肌肉骨骼疼痛主诉的女性。
验证低频TENS联合嗓音治疗对行为性发声障碍女性肌肉骨骼疼痛的影响。
参与者包括27名患有声带小结的女性，她们被随机分为两组。实验组（EG）——13名女性接受12次TENS治疗（脉冲宽度200μs，频率10Hz，处于运动阈值），电极双侧置于斜方肌和下颌下区域，持续20分钟，随后进行30分钟的嗓音治疗；对照组（CG）——14名女性接受12次每次20分钟的安慰剂TENS治疗，随后进行30分钟的嗓音治疗。我们调查了几个身体区域肌肉骨骼疼痛的频率和强度，以及静息时和用压力痛觉计按压斜方肌下行纤维时的疼痛强度。还调查了压力疼痛阈值（PPT）。两组在治疗前、治疗后即刻、治疗后1个月和3个月均进行了所有评估。
我们观察到两组治疗后喉部疼痛频率均降低，但只有实验组该区域的疼痛强度有所下降。用压力痛觉计测量斜方肌发现，与嗓音治疗相关的电刺激在施加压力时降低了疼痛强度，并提高了PPT。在干预措施之间的比较中，所调查的变量没有显著差异。另一方面，与干预前和干预后相比，实验组斜方肌的疼痛有所减轻。
嗓音治疗方案降低了行为性发声障碍女性喉部近端区域肌肉骨骼疼痛的频率和强度。此外，TENS联合嗓音治疗提高了斜方肌对肌肉疼痛的敏感度阈值，表明在伴有疼痛和肌肉紧张的行为性发声障碍病例中，它是一种与传统嗓音治疗联合使用的良好方法。
