Voice therapy with a respiratory approach in older people: an integrative literature review

Leão, Rebeca Lins de Souza; Gomes, Adriana de Oliveira Camargo; Queiroz, Mariana Rebeka Gomes; Lucena, Jonia Alves

doi:10.1590/1982-0216/20222427721

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Sumário

REVIEW ARTICLES • Rev. CEFAC 24 (2) • 2022 • https://doi.org/10.1590/1982-0216/20222427721 copy

Voice therapy with a respiratory approach in older people: an integrative literature review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

to characterize voice therapy with a respiratory approach in dysphonic older people.

Methods:

a search made in PubMed, VHL, Scopus, Web of Science, and EMBASE. Original studies in English, Spanish, and Portuguese, addressing voice therapy in combination with a respiratory approach in the older population, were included. The analysis encompassed sex, age, associated etiology, session frequency and duration, exercise dosage, intervention, and benefits.

Results:

altogether, 1,425 articles were found, of which only nine were included in the review. In voice therapy for older people, the following strategies stood out: Vocal Function Exercises, Lee Silverman Voice Treatment^®, ParkinSong, and tubes immersed in water. These approaches change the laryngeal muscle function and respiratory impulse and support and increase vocal intensity. The main therapeutic findings included improved auditory-perceptual, acoustic, and aerodynamic parameters, maximum phonation time, phonatory effort level, and voice quality.

Conclusion:

voice therapy with a respiratory approach characteristically used strategies aimed at both the general older population and those with neurological dysphonia. Their results showed improvement in frequency, resonance, intensity control, and breathing/phonation coordination.

Keywords:
Aged; Voice; Training Voice; Respiration; Voice Disorders

Databases	Search strategies
PubMed	(Aged) AND (“Voice training”) AND (Respiration OR Breathing)
VHL in English	(Aged) AND (“Voice training”) AND (Respiration OR Breathing)
VHL in Spanish	(Anciano) AND ("Entrenamiento de la Voz") AND (Respiración)
VHL in Portuguese	(Idoso) AND ("Treinamento da Voz") AND (Respiração)
Scopus	(Aged) AND (“Voice training”) AND (Respiration OR Breathing)
Web of Science	Aged AND ''Voice training'' AND Respiration
EMBASE	Aged AND 'Voice training' AND 'Breathing'

Authors (Year)	Place of study	Type of study	Objectives	Sample/Age range	Therapeutic resource	Results
Tamplin et al. (2019)¹⁸	Australia	Controlled clinical trial	To explore the effects of an interdisciplinary therapeutic intervention based on singing (ParkinSong) on the voice and communication in people with PD.	71 older people - 61% men; with a mean age of 74 years, age range from 51 to 93 years.	ParkinSong	Increased vocal intensity, MEP, and voice-related quality of life.
Guzman et al. (2018)¹⁹	Chile	Quasi-experimental	To observe the influence of tube phonation in water on older people’s voices.	30 older people (20 women, 10 men). Mean age of 73 years, ranging from 70 to 77 years, with presbyphonia.	Phonation exercises with flexible tubes immersed in water	Improved older people’s voices by increasing vocal fold adduction and subglottal pressure in deep immersion.
Kaneko et al. (2015)⁹	Japan	Quasi-experimental	To make a multidimensional assessment of vocal function exercises regarding the results in the voice of older people with atrophy.	16 patients with vocal fold atrophy, aged 65 to 81 years, and 6 patients with vocal fold atrophy aged 65 to 85 years.	VFE	Improvements in older people with vocal fold atrophy, improving the amplitude of the mucosa, glottal insufficiency, jitter, MPT, VHI-10, and GBRAS
Tay et al. (2012)²⁰	Australia	Quasi-experimental	To investigate the effectiveness of a 5-week vocal function exercise program on vocal function measures in a sample of older singers from community choirs.	22 older choir singers (8 men, 14 women). Mean age of 76.41 years, ranging from 68 to 83 years.	VFE	Improved roughness before and after the therapy; MPT increased only in the VFE group after the therapy; there was a difference in shimmer between before and after the therapy, only in the experimental group.
Sauder et al. (2010)¹⁰	United States	Quasi-experimental	To examine the effects of vocal function exercises as a primary treatment for presbylarynx.	9 older people (2 men, 7 women) with presbylarynx, aged 67 to 90 years, with a mean age of 76 years.	VFE	Improved functional disability, severity of voice problem, effort level, breathiness, and strain after VFE in patients with presbylarynx.
Gorman et al. (2008)²¹	United States	Quasi-experimental	To measure the results of vocal function exercises in vocal aerodynamics regarding the glottis in older men.	19 older men aged 60 to 78 years with laryngeal myasthenia and/or presbylarynx in laryngeal examinations.	VFE	Improved MPT before and after the treatment; full glottal closure, diminishing breathiness; increased subglottal pressure; improved resonance.
Sapir et al. (2002)²²	United States	Quasi-experimental	To assess the long-term perceptive effects of two treatment methods.	35 older adults with PD, distributed into groups that received either LSVT^® (mean age of 63.23) or RET (mean age of 65.31).	LSVT^® and RET	The results revealed long-term perceptual evidence with positive effects for LSVT^® in speech volume and quality in people with PD.
Ramig et al. (2001)²³	United States	Quasi-experimental	To assess the impact of LSVT^® on vocal functions after 2 years of treatment.	33 older people with a mean age of 61.3 years in the LSVT^® group and 63.3 years in the RET group.	LSVT^® and RET	Patients with idiopathic PD treated with LSVT^® improved vocal function for up to 2 years after the treatment. Patients treated with RET did not have long-term effects.
Ramig et al. (2001)²⁴	United States	Quasi-experimental	To assess the impact of LSVT^® on vocal intensity in a group of dysarthric people with idiopathic Parkinson’s disease.	43 older people, divided into 3 groups: one group received LSVT^® (7 men, 7 women, with a mean age of 67.9 years); one group with PD that was not submitted to voice therapy (7 men, 8 women, with a mean age of 71.2 years); and a group of neurologically normal older people with no voice disorders (7 men, 7 women, with a mean age of 69.8 years).	LSVT^®	LSVT^® increased the voice SPL from the baseline to post-treatment, statistically significant and audibly noticeable for voice and speech.

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