Síndrome de tensão musculoesquelética, musculatura laríngea extrínseca e postura corporal: considerações teóricas

Abstract

O tema deste estudo é a Síndrome de tensão musculoesquelética, musculatura laríngea extrínseca e postura corporal. Tem como objetivo descrever, a partir de revisão de literatura,as características da musculatura extrínseca da laringe; postura corporal; Síndrome de tensão musculoesquelética e suas implicações vocais; avaliação e tratamento fisioterapêutico e fonoaudiológico. Foi realizado levantamento bibliográfico dos últimos 13 anos em que foram incluídos artigos cujo objetivo e/ou corpo do texto estivessem em consonância com os objetivos do estudo. A pesquisa foi realizada nos bancos de dados das bases Literatura Latino-Americana e do Caribe em Ciências da Saúde, Biblioteca Regional de Medicina, PublicMedline, Medical Literature Analysis and Retrieval System on Line, Scientific Electronic Library Online e Google Schoolar. Estabeleceram-se relações importantes do âmbito fisioterapêutico e fonoaudiológico, dentre as quais se destacam as relações musculares, posturais e funcionais na sinergia do aparato vocal. Na fisioterapia para redução da tensão muscular, a literatura aponta uso de eletroterapia transcutânea, laser de baixa intensidade, laser acupuntura, crioterapia, bem como terapia manual com tração, massagens, manipulações e mobilizações cervicais, associadas ou não a exercícios, alongamentos, relaxamento isométrico, mobilização assistida dos tecidos moles, exercícios terapêuticos visando à correção e equilíbrio muscular, reeducação respiratória diafragmática e terapia com flexão craniocervical. Na fonoaudiologia, foram encontrados apenas estudos com a manipulação digital da laringe e exercícios de trato vocal semiocluído.

Terapia vocal e sons nasais: efeitos sobre disfonias hiperfuncionais

“…The vocal hyperfunction or hypertension is one of the main features of the functional and organofunctional dysphonia, it generates increased tension in the laryngeal muscles and also affects external muscles 3,4,8,9 . Overall, the loss in vocal production is related to inadequate respiratory function, misuse of sounding boards, hypertension lingual, laryngeal and perilaryngeal and cervical muscles 6,19,20 . In such cases, they are common the presence of edema or nodules, glottal gaps and high larynx, and these features more commonly found in women [15][16][17] .…”

“…We believe that the work of guidance on the postural adaptation, associated with the nasal sound, that is also relaxing to be offered subject to improvement in blood pressure and body balance, it also helps to release tension of the vocal apparatus, the cervical muscles and waist scapular. Disharmony posture generally is related to the vocal change of hyperfunctional purpose and it can be related to the vocal change as a result of imbalances in the craniocervical muscles 3,4,6,8,9,19,21 . Thus, upright posture allows greater freedom of vertical movements of the larynx and avoids the tension of cervical muscles and shoulder girdle, improving vocal production as a whole 3,4,[6][7][8]9,21 .…”

“…The technique of nasal sounds is a semi-ocluded vocal tract exercise is considered a facilitator of phonation balance, providing the interaction between source and filter, once the voiced retroflex energy, besides minimizing the impact suffered by the vocal folds during phonation and reducing the risk of trauma, it improves the resonance and vocal projection 1,2 . This technique, also named humming, resonance technique or voice placement "in mask" and it is also used in the resonant voice method, being indicated for the treatment of dysphonias, especially the hyperfunctional ones, characterized by excessive muscle tension [1][2][3][4][5][6] . The main benefits of the nasal sound technique are the resonant balance; the enrichment of the harmonic energy of the glottal signal; reduction and balance of laryngeal and mandibular pressure, as well as of all the vocal apparatus; smoothing of the emission; vocal projection improvement; balance of vocal attack; increase of the maximum phonation time (MPT); improvement of vocal self-monitoring [1][2][3][4][5] .…”

Effects of a Voice Therapy Program for Patients with Muscle Tension Dysphonia

“…This hyperfunctional musculature pattern leads to abnormal larynx elevation in the neck and greater participation of the extrinsic musculature during phonation [4], which causes increased force or tension in this region and excessive glottal and supraglottal compression [1, 2, 5]. …”

“…Studies have reported complaints, such as hoarseness, throat irritation, frequent choking, pain in the neck and cervical region, discomfort when speaking, and vocal fatigue [8-10]. In perceptual-auditory and acoustic assessments, studies have described the presence of hoarseness, breathiness, roughness, vocal strain, hard glottal attack, laryngopharyngeal resonance, and fundamental frequency (F 0 ), jitter, and shimmer above normal levels [1, 4, 9, 11]. In addition, there are reports of elevation and tension in the cervical region during inhaling movement, besides reduced maximum phonation times (MPTs) [12-14].…”