Substitution Voice Rehabilitation After Open Partial Horizontal Laryngectomy Through the Proprioceptive Elastic Method (PROEL): A Preliminary Study

Abstract

Objective. The aim was to investigate the efficacy of the Proprioceptive Elastic Method (PROEL) in the rehabilitation of the substitution voice after open partial horizontal laryngectomy (OPHL). Study Design. Prospective outcome study.Methods. 15 patients surgically treated by OPHL type II or type III for laryngeal cancer were recruited (experimental group). Each patient underwent a specific program of voice rehabilitation based on the PROEL method with the same speech and language pathologist. Acoustic-aerodynamic analysis: maximum phonation time (MPT); spectrographic classification (Titze's modified classification), perceptual analysis (INFVo rating scale) and self assessments (SECEL questionnaire) were performed before the treatment (T0), after three months of rehabilitation (T1), and at the end of the 6-month rehabilitation program (T2).A control sample of other 15 patients who underwent OPHL type II or type III and who underwent a standard peri-operative rehabilitation was randomly extracted from an historical database and compared to the experimental group. Results.Significative voice improvements between T0-T1 and T2 were found for acoustic, aerodynamic, perceptual and self assessments analysis in the experimental group. Significative differences were found between the experimental group at T2 and the control sample for aerodynamic, self assessment and perceptual analysis. Conclusions.The results of the present study support PROEL method as an effective approach for substitution voice rehabilitation after OPHL type II and III. Randomized-controlled trials on larger groups of patients are needed in future in order to compare PROEL with other rehabilitative approaches.

Preoperative prognostic factors for functional and clinical outcomes after open partial horizontal laryngectomies

“…6,[15][16][17] Nevertheless, a satisfactory level of oral communication is generally achieved through a substitution voice. 18,19 Swallowing recovery after open partial laryngectomies is surely a challenging process and has been widely investigated by many authors. 8,[20][21][22][23] Swallowing function is always severely impaired immediately after surgery, but generally recovers in about 6 months, with patients finally reaching a free oral diet.…”

“…Voice quality is usually well preserved after Type I OPHLs, since vocal folds are spared, while is highly and similarly deteriorated after Type II and Type III OPHLs 6,15–17 . Nevertheless, a satisfactory level of oral communication is generally achieved through a substitution voice 18,19 . Swallowing recovery after open partial laryngectomies is surely a challenging process and has been widely investigated by many authors 8,20–23 .…”

Reduzindo o gap entre a ciência e a clínica: lições da academia e da prática profissional – parte B: técnicas tradicionais de terapia vocal e técnicas modernas de eletroestimulação e fotobiomodulação aplicadas à reabilitação vocal

“…Uma menor tensão muscular no corpo produz uma maior elasticidade do sistema fonatório, levando a um estado ecológico máximo. Pesquisas com delineamento do tipo intervenção antes-após evidenciou melhora da qualidade vocal de pacientes com disfonia funcional (39) e um estudo quasi-experimental a melhora da qualidade da voz de pacientes submetidos a laringectomia parcial horizontal (40) .…”

“…Reconhece-se ainda que as abordagens tradicionais de reabilitação vocal produzem efeito não somente sobre a voz, mas sobre a competência comunicativa e aspectos emocionais dos pacientes (6) . Tanto métodos específicos, como o LSVT, para indivíduos com Doença de Parkinson (9)(10)(11) , como holísticos, como o PROEL (39,40) produzem efeitos positivos imediatos e no curto-prazo. A maior concentração de evidências de qualidade sobre os efeitos da intervenção fonoaudiológica concentram-se sobre as abordagens tradicionais de reabilitação.…”

Multi Parametric Method for the Objective Acoustic Evaluation of the Voice Produced by Laryngectomy Patients

“…Makeieff et al [1] have shown that after such surgery, voice is a significant quality of life factor. Fantini et al [2] studied the rehabilitation of the substitution voice after open partial horizontal laryngectomy and identified the need for larger groups of patients to research voice discrepancy and rehabilitation. Schindler et al [3] reported that the findings showed a highly dysphonic voice after laryngectomies.…”