The clinical implication of the vocal cords-carina distance in anaesthetized Chinese adults during orotracheal intubation

Background. Previous studies have identified no strong correlation between patients' height and tracheal length in anaesthetized patients. We have attempted to compare vocal cords-carina distance (VCD) in Chinese patients with the dimensions of five commonly used tracheal tubes. In addition, we attempted to find a surface anatomy measurement that would identify patients with 'short tracheas'. Methods. We measured VCD in 130 anaesthetized Chinese patients with a fibreoptic bronchoscope. Also measurements were obtained of the distal ends of five commonly used tracheal tubes. We undertook various surface anatomy measurements on the patients' chest and neck region to predict those patients with short tracheas. Results. VCD averaged 12.6 ((SD) 1.4) cm. In seven patients (5%) this distance was particularly short (between 8.8 and 10.4 cm). Many of the commonly used tracheal tubes would be placed close to or beyond the carina when the black intubation guide mark(s) is (are) at the level of the vocal cords. The VCD of

ASPECTOS PSICODINÂMICOS E ADAPTATIVOS DE PAIS E MÃES DE CRIANÇAS DIAGNOSTICADAS COM PARALISIA CEREBRAL

Diante do sofrimento e das questões enfrentadas por pais e mães de crianças diagnosticadas com paralisia cerebral, o presente trabalho estudou aspectos psicodinâmicos e adaptativos. Para tanto, foi realizado estudo clínico, de recorte diagnóstico, em que participaram dois pais e duas mães de crianças com paralisia cerebral que contavam de 1 a 5 anos de idade. Os pais e mães passaram por entrevistas clínicas preventivas orientadas pela EDAO e pela técnica de Desenho-Estória com Tema. A análise do material obtido indicou que todos eles passaram por período de crise após a notícia do diagnóstico da criança e, na atualidade, foram classificados como tendo Adaptação Ineficaz, sendo que os dois pais e uma mãe tinham Adaptação Ineficaz Severa, uma mãe Adaptação Ineficaz Moderada. Com relação aos aspectos intra-píquicos, foram identificadas defesas primitivas nessa lida com o sofrimento ocasionado pela deficiência da criança. Concluiu-se que os recursos internos anteriores ao nascimento da criança e à própria personalidade de cada pai/mãe foi preponderante em sua adaptação e que a paralisia cerebral da criança afetou todos os setores adaptativos dos pais e mães.(AU)

USO DO BRINQUEDO NO ATENDIMENTO FISIOTERAPÊUTICO DE CRIANÇAS COM PARALISIA CEREBRAL

A paralisia cerebral, doença não progressiva, compromete movimentos e postura. A fisioterapia atual volta-se para um tratamento holístico. Brincar proporciona desenvolvimento neuropsicomotor. O presente estudo tem como objetivos investigar a opinião de fisioterapeutas que atuam em neuropediatria sobre a utilização do brinquedo em sua prática clínica e verificar sua possível utilização em intervenções junto a crianças com paralisia cerebral. Utiliza-se inicialmente de questionário de opinião junto a 50 fisioterapeutas das diversas clínicas da Associação de Apoio a Criança com Deficiência, AACD - SP, verificando a utilização de brinquedos face aos diversos objetivos fisioterapeuticos; a seguir, realiza observação de 60 atendimentos, em fisioterapia aquática e de solo, de crianças com paralisia cerebral, identificando a utilização de cada categoria de brinquedo relativo ao objetivo terapêutico. Os dados obtidos no questionário revelaram em ordem decrescente utilização de: brinquedos sensório-motores 57,4%, para ganho de equilíbrio (E); 22,2% para coordenação motora (CM); 18,5% para aquisições posturais (AP) e 2% para relaxamento muscular (RM). Em relação aos jogos de faz-de-conta: 37% (E); 39% (AP) e 24% (CM).Para os jogos de regras: 54% (E); 35% (CM); 11% (AP). Com os jogos de montagem: 52% (CM); 24% (E); 24% (AP). Os dados da observação revelaram que os principais objetivos terapêuticos visados com utilização de brinquedos foram: alongamento, primeiro 10 ; fortalecimento muscular, equilíbrio e treino de marcha de 10 a 40 . Quanto à modalidade de brinquedo observada houve predomínio do faz de conta no início e no fim da sessão e das demais categorias no meio, de forma intercalada. Os dados da observação coincidiram com os do questionário revelando utilização sistemática de brinquedos com objetivos fisioterapeuticos.(AU)

Extended program notes for a recital of selected vocal literature

The purpose of these extended program notes is to provide information that will assist the listening audience in comprehending the historical and biographical significance of the each vocal selection. A brief analysis of each selection, a historical interpretation of the work, a translation of the texts and a CD of the recital are included. The contents of the recital comprise of several selections from the soprano repertoire: The Georg Phillip Telemann cantata Lauter Wonne, lauter Freude; the Wolfgang Amadeus Mozart Laudate Dominum from the Vesperae solemnes de confessore; the Joaquin Nin y Castellano Diez Villancicos de Noel; Gabriel Faurd's art songs Dans le ruines d'une abbay, Les Berceaux, and Au bord e l'eau; Sergei Rachmaninov's three songs Oni otvechali, Zdes Khorosho, and Vocalise; and Libby Larsen's Cowboy Songs.

A criança com paralisia cerebral na educação infantil: um olhar sobre a prática docente

La inclusión de los niños con discapacidad en la educación infantil, además de ser un tema poco planteado en la comunidad científica, es un reto actual en lo que se refiere a la práctica docente. Basándose en este aspecto, nuestro objetivo en esta investigación realizada, que resultó en la elaboración de este trabajo, fue analizar cómo se procesa la práctica docente con vistas a la inclusión escolar de un niño con parálisis cerebral, en un Centro Municipal de Educación Infantil (CMEI), en la ciudad de Natal / RN. Más específicamente, buscamos: reflexionar sobre la práctica de la profesora responsable por la clase, en lo que se refiere al desarrollo del niño con parálisis cerebral; analizar las interacciones entre educador y niño con parálisis cerebral; observar la práctica docente en la perspectiva de favorecer la interacción entre el niño con parálisis cerebral y otros niños. Para ello, realizamos una pesquisa exploratoria, cualitativa, y así que optamos por el método del Estudio de Caso. Utilizamos como procedimientos metodológicos el análisis documental, la investigación bibliográfica, la entrevista semiestructurada, la observación y la filmación de escenas relacionadas a la práctica docente. Los sujetos de la investigación fueron la profesora y el niño con parálisis cerebral. Los datos construidos durante la investigación señalaron el hecho de que la práctica de la profesora no estaba encaminada a las necesidades específicas de la alumna con parálisis cerebral, todavía, se desarrollaba de una manera similar para todos los niños en la clase. La presencia de limitaciones significativas para la inclusión de la niña con parálisis cerebral en la educación infantil puede ser considerado como el resultado de la ausencia de una adecuada preparación docente, tanto en el nivel de la formación inicial, cuanto de una formación continua y también la escasez de directrices para el maestro, en proceso; directrices estas acerca de la educación de los niños con parálisis cerebral, lo que hacía imposible a la profesora contribuir de manera efectiva a su mayor desarrollo cognitivo y social.

Prevalência e fatores associados à alteração vocal em idosos institucionalizados com capacidade cognitiva preservada

Voice disorders (VD) in the elderly can interfere negatively in communication, emotional well-being and quality of life, conditions that correspond to greater exposure to illness and social isolation bringing consequent economic impact for the health system. It is assumed that institutionalized confinement, weakness and morbidity associated to nursing home (NH) contribute to transform VD an especially prevalent condition in institutionalized elderly, including those without cognitive impairment. Thus, the aim of this study was to determine the prevalence and associated factors of VD in NH elderly residents without cognitive impairment. There is no epidemiological diagnostic instruments of VD for elderly populations, so the first step of this study was dedicated to prepare and analyze the psychometric properties of a short, inexpensive and easy to use questionnaire named Screening for Voice Disorders in Older Adults (Rastreamento de Alterações Vocais em Idosos—RAVI). The methodological procedures of this step followed the guidelines of the Standards for Educational and Psychological Testing and contemplated validity evidence based on test content, based on response processes, based on internal structure and based on relations with other variables, as well as reliability analysis and clinical consistency. The result of the validation process showed that the RAVI final score generate valid and reliable interpretations for the epidemiological diagnosis of VD in the elderly, which endorsed the use of the questionnaire in the second stage of the study, performed in ten NH located in the city of Natal, Rio Grande do Norte. At this stage, data from socioeconomic and demographic variables, lifestyle, general health conditions and characterization of the institution were collected. It was performed a bivariate analysis and it was calculated the prevalence ratio as a magnitude association measure, with a confidence interval of 95%. The variables with p-value less than 0.20 were included in the multiple logistic regression model that followed the Forward selection method. The odds ratio found in the multivariate model was converted into prevalence ratio and the level of significance was 5%. The sample consisted of 117 subjects with predominance of females and average of 79.68 (± 7.92) years old. The prevalence of VD was 39.3% (95% CI: 30.4-48.1%). The multivariate model showed statistically significant association between VD and depressive symptoms, smoking for a year or more and selfreported hearing loss. In conclusion, VD is a prevalent health condition in NH elderly residents without cognitive impairment and is associated with factors involving psychosocial, lifestyle and communicative disability that require attention of managers and professionals involved with NH environment. Strategies to encourage communication and social integration, actions to combat smoking and minimizing the effects of hearing loss could stimulate the physical well-being, emotional and mental health of institutionalized elderly population, contributing to the vocal and communicative maintenance, a more effective social inclusion and better overall health condition.

Sociophonetic deception: the elements of vocal disguise

The focus of my research is vocal disguise within forensic linguistics. Specifically, I answer the question of what individuals are most likely to do with their voice when they do not want to be recognized by a listener. I also focus on whether specific sociolinguistic characteristics – gender and place of origin – have an effect on the disguise choices that individuals make. My research has found that participants show a preference for altering pitch and/or duration across conditions, as well as taking on a foreign accent. Gender and origin were found to be significant for respect to differences in duration, and significance was also found between origin and pitch. These results suggest that disguise might contain elements of style shifting, and that a speaker's choice is more systematic than random.

Associação entre comprometimento motor, mobilidade e qualidade de vida em crianças com paralisia cerebral espástica, nível I, II e III do Gross Motor Function Classification System

The objective of this study was to verify the association between some mobility items of the International Classification Functionality (ICF), with the evaluations Gross Motor Function Measure (GMFM-88), 1-minute walk test (1MWT) and if the motor impairment influences the quality of life in children with Cerebral Palsy (PC), by using the Paediatric Quality of Life Inventory (PedsQL 4.0 versions for children and parents). The study included 22 children with cerebral palsy spastic, classified in levels I, II, and III on the Gross Motor Function Classification System (GMFCS), with age group of 9.9 years old. Among those who have participated, seven of them were level I, eight of them were level II and seven of them were level III. All of the children and teenagers were rated by using check list ICF (mobility item), GMFM-88, 1-minute walk test and PedsQL 4.0 questionnaires for children and parents. It was observed a strong correlation between GMFM-88 with check list ICF (mobility item), but moderate correlation between GMFM-88 and 1-minute walk test (1MWT). It was also moderate the correlation between the walking test and the check list ICF (mobility item). The correlation between PedsQl 4.0 questionnaires for children and parents was weak, as well as the correlation of both with GMFM, ICF (mobility item) and the walking test. The lack of interrelation between physical function tests and quality of life, indicates that, regardless of the severity of the motor impairment and the difficulty with mobility, children and teenagers suffering of PC spastic, functional level I, II and III GMFCS and their parents have a varied opinion regarding the perception of well being and life satisfaction.

Pelo olhar de quem não sente a diferença : comparação dos Cores Sets da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) para a Paralisia Cerebral com a perspetiva de crianças/ jovens e cuidadores, de Portugal

Introdução: A CIF foi considerada, por alguns clínicos, como não sendo totalmente viável para a aplicação na rotina clínica, já que este sistema de classificação contém mais de 1400 categorias. Posto isto, o processo de desenvolvimento de Core Sets da CIF tem sido priorizado pela OMS, tornando a CIF acessível para a avaliação das cs específicas. Estes pretendem orientar uma avaliação multidisciplinar abrangente, incluindo as categorias da CIF para descrever, de uma forma suficiente, a funcionalidade e incapacidade dos indivíduos. Contudo, podem existir divergências entre a perspetiva de crianças e jovens portugueses com PC e cuidadores sobre a sua cs e os core sets da CIF estabelecidos para a mesma. Objetivo: Identificar os problemas percecionados pelas crianças e jovens com paralisia cerebral e pelos cuidadores em Portugal e analisar em que medida estes aspetos são representados pela versão atual do Comprehensive Core Set da CIF para esta cs. Metodologia: Este estudo é qualitativo, tendo-se utilizado uma amostra conveniente de crianças/jovens com PC e cuidadores. Todos os dados foram recolhidos por meio de entrevistas e posteriormente analisados segundo o protocolo de Coenen. Foi efetuado o linking dos conceitos obtidos das entrevistas para as categorias da CIF, tendo sido comparadas com os Core Sets da CIF para esta condição. Resultados: Este estudo tem uma amostra de 48 indivíduos, sendo que 28 eram crianças e jovens com PC e os restantes 20 eram cuidadores. A média de idades das crianças/jovens incluídos foi 13,04 (±3,26), sendo que a idade mínima incluída foi 8 anos e a idade máxima, 18 anos. A média de idades dos cuidadores incluídos foi de 35,20 (±8,01) anos, sendo que a idade mínima incluída foi 22 anos e a idade máxima 55 anos. Das 256 categorias identificadas, 101 estão contempladas nas categorias dos Comprehensive Core Set da CIF. Estas encontram-se presentes em 58 categorias de 2º nível dos Comprehensive Core Set de um total de 135, correspondendo a 43% dos mesmos. Conclusões: Tendo em conta os resultados obtidos, podemos concluir que os Comprehensive Core Set da CIF para a PC contemplam a grande maioria dos problemas percecionados pela população-alvo, ainda que integre várias categorias que não foram relevantes para esta população em estudo.

The sound of whiteness: early music vocal performance practice in Britain

American Musicological Society annual meeting, San Francisco, 10 Nov. 2011

Investigating Multiple Roles of Vocal Confidence in Persuasion

Although persuasion often occurs via oral communication, it remains a comparatively understudied area. This research tested the hypothesis that changes in three properties of voice influence perceptions of speaker confidence, which in turn differentially affects attitudes according to different underlying psychological processes that the Elaboration Likelihood Model (ELM, Petty & Cacioppo, 1984), suggests should emerge under different levels of thought. Experiment 1 was a 2 (Elaboration: high vs. low) x 2 (Vocal speed: increased speed vs. decreased speed) x 2 (Vocal intonation: falling intonation vs. rising intonation) between participants factorial design. Vocal speed and vocal intonation influenced perceptions of speaker confidence as predicted. In line with the ELM, under high elaboration, confidence biased thought favorability, which in turn influenced attitudes. Under low elaboration, confidence did not bias thoughts but rather directly influenced attitudes as a peripheral cue. Experiment 2 used a similar design as Experiment 1 but focused on vocal pitch. Results confirmed pitch influenced perceptions of confidence as predicted. Importantly, we also replicated the bias and cue processes found in Experiment 1. Experiment 3 investigated the process by which a broader spectrum of speech rate influenced persuasion under moderate elaboration. In a 2 (Argument quality: strong vs. weak) x 4 (Vocal speed: extremely slow vs. moderately slow vs. moderately fast vs. extremely fast) between participants factorial design, results confirmed the hypothesized non-linear relationship between speech rate and perceptions of confidence. In line with the ELM, speech rate influenced persuasion based on the amount of processing. Experiment 4 investigated the effects of a broader spectrum of vocal intonation on persuasion under moderate elaboration and used a similar design as Experiment 3. Results indicated a partial success of our vocal intonation manipulation. No evidence was found to support the hypothesized mechanism. These studies show that changes in several different properties of voice can influence the extent to which others perceive them as confident. Importantly, evidence suggests different vocal properties influence persuasion by the same bias and cue processes under high and low thought. Evidence also suggests that under moderate thought, speech rate influences persuasion based on the amount of processing.

Anthropogenic noise affects vocal interactions

Animal communication plays a crucial role in many species, and it involves a sender producing a signal and a receiver responding to that signal. The shape of a signal is determined by selection pressures acting upon it. One factor that exerts selection on acoustic signals is the acoustic environment through which the signal is transmitted. Recent experimental studies clearly show that senders adjust their signals in response to increased levels of anthropogenic noise. However, to understand how noise affects the whole process of communication, it is vital to know how noise affects the receiver’s response during vocal interactions. Therefore, we experimentally manipulated ambient noise levels to expose male European robins (Erithacus rubecula) to two playback treatments consisting of the same song: one with noise and another one without noise. We found that males responding to a conspecific in a noise polluted environment increased minimum frequency and decreased song complexity and song duration. Thus, we show that the whole process of communication is affected by noise, not just the behaviour of the sender.

An Interdisciplinary Approach to the Management of Vocal Cord Dysfunction in an Elite Female Swimmer: a Case Study

Acute pulmonary disorders are commonplace within the athletic population, with exercise induced bronchoconstriction (EIB), and vocal cord dysfunction (VCD) common diagnoses. VCD is a condition that causes the adduction of the vocal folds during inhalation, causing obstruction at the larynx and thereby a severely impaired sporting performance. VCD can be brought on by laryngeal irritants, emotional and psychological stress and asthma. The gold standard of treatment for VCD centres on an interdisciplinary approach from specialists that often include a respiratory consultant, speech and language therapist (SLT) and a psychologist. The present case study details the interdisciplinary approach to the treatment of an elite female swimmer with VCD with an intervention programme that lasted nine weeks, instigated by a local general practitioner (G.P.) who chose to engage a Sport Psychology Consultant (SPC) due to the sport-specific nature of the psychological stress experienced by the individual. The steps involved in the design of the sport psychology interventions are outlined and the relationship of those interventions to the work of the other specialists is discussed. The 9 week intervention programme was aimed at reducing perfectionist tendencies and competitive state anxiety using a combination of cognitive behavioural therapy (CBT), goal-setting and imagery. Overall, the treatment programme was deemed a success as perfectionism and competitive state anxiety levels reduced over time along with the frequency of VCD occurrence. This case study demonstrates the breadth of roles that can be undertaken by a SPC and raises awareness of a complex respiratory disorder that is not yet fully understood.