Evaluation of Postural Changes Using Dynamic Posturography after Speech Rehabilitation in Patients with Voice Disorders: A Longitudinal Study

Abstract

Background: The association between voice and body posture is consensual across the scientific literature and seems to be established both ways. Any changes in normal posture can influence the mechanisms of vocal production; on the other hand, vocal rehabilitation can influence posture. Objectives: This study aimed to evaluate the postural pattern in subjects with organic voice disorders before and after speech rehabilitation, using computerised dynamic posturography (CDP). Methods: In this prospective cohort study, 21 patients affected by dysphonia caused by benign vocal fold lesions, never treated with speech therapy/vocal training, were submitted to a posturographic analysis using CDP before and after vocal rehabilitation/therapy. Each patient underwent an accurate voice and ear, nose, and throat (ENT) anamnesis, a general ENT examination, a rigid and flexible laryngoscopy, a videolaryngostroboscopy, an acoustic voice analysis including aerodynamic evaluation, and a perceptual evaluation of voice using the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale and the Voice Handicap Index (VHI) questionnaire, before and after vocal therapy. Fifteen healthy age- and sex-matched volunteers were also submitted to a posturographic analysis on the day of recruitment and 4 weeks later. Results: All patients showed an improvement in voice quality after vocal training. The VHI decreased in all subjects, and the GRBAS scale showed a decrease in all parameters in each vowel (/a/, /i/, /e/) and in spontaneous speech (p < 0.001 for all). Posturographic results showed an improvement in equilibrium score, in conditions 2–6 and composite score. Strategic analysis results showed an improvement in conditions 1–6. Conclusions: The posturographic analysis showed a significant difference in the visual, vestibular, and proprioceptive component of posture after voice therapy. These results showed that dysphonic patients changed their postural patterns after an effective voice treatment, with an improvement in postural performance. It seems like modifications of breathing pattern and voice production techniques led to objective and measurable postural changes.

Trattamento combinato della disfonia muscolo tensiva: terapia logopedica e riabilitazione posturale strumentale

“…However, in our results we also found that somatosensory and visual inputs improved slightly after therapy. Contrary to Caçador et al 6 , in our experience, the vestibular component did not change because the therapy itself did not improve a normal situation. The sitting position of the patients during the rehabilitation session justifies the greater improvement of visual inputs compared to the somatosensory ones found in our sample.…”

“…Our results are in agreement with those of Bruno et al 4 and Caçador et al 6 , 20 who showed that posturographic values in dysphonic patients at baseline were within normal ranges. On the contrary, Nacci et al 5 and Lobryeau-Desnus et al 9 found postural alterations in baseline conditions with a significant improvement in the stabilometric parameters after speech rehabilitation.…”

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

“…In a previous study, 29 these authors found the same results upon analyzing the postural pattern of hyperfunctional dysphonia patients (vocal fold nodule, cyst, and polyp) before and after a successful vocal rehabilitation.…”

“…In both studies, an improvement in the ability and strategy of equilibrium after vocal training was found. 29 It seems that vocal technique improvement acquired after speech therapy in dysphonic patients (organic vocal fold pathology and unilateral vocal fold paresis/paralysis) is accompanied by a more effective postural strategy, obtained by improving the proprioceptive, visual, and vestibular sensorial inputs. 29 As in the previous investigation, 29 posturographic results in the control group revealed no differences between the first and the second evaluation, 4 weeks later, proving that the improvement in postural parameters in the study group was not dependent on a learning process resulting from the repetition of the task.…”