Manual Therapy with Neural Mobilization: Immediate Effect on the Vocal Quality of Women with Dysphonia.

Abstract

To evaluate the immediate effect of neural mobilization on the voice quality, self-perceived phonatory effort, and laryngeal muscles of women with behavioral dysphonia. This is an intrasubject comparative study. The research included 21 women aged 18 to 59 years with vocal complaints. Therefore, the selection of this sample excluded the lower limit of the voice change period and the upper limit of presbyphonia. The participants were assessed by voice acoustic and auditory-perceptual analysis, self-reported vocal effort, and laryngeal palpation performed at three moments: at baseline, after 10 minutes of vocal resting, and after manual therapy. The participants were divided into two groups: the group with 10 minutes of vocal resting (G1) and the group with intervention (G2). The patients in the intervention group underwent manual therapy using neural mobilization in the laryngeal region. For the statistical analysis, a descriptive analysis of the data was performed first with measures of central tendency and dispersion. Subsequently, the Anderson-Darling test was used to verify sample normality. To analyze the difference between three groups were used the parametric One-Way ANOVA or the non-parametric Friedman's test. The McNemar's or chi-squared tests were used to compare categorical variables and to compare an ordinal variable a non-parametric Wilcoxon test was used. The Gwet's AC1 test was used to assess intra-rater agreement in the auditory-perceptual analysis response. Neural mobilization in the laryngeal region showed no positive effects on the acoustic voice parameters and voice quality of women with dysphonia. Phonatory effort improved after neural mobilization in the laryngeal region (p=0.004). There was no significant change in supralaryngeal resistance, lateral laryngeal resistance, and laryngeal position after neural mobilization in the laryngeal region. Neural mobilization improved phonatory comfort but did have any effect on the voice quality and laryngeal musculature of women with dysphonia.