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Immediate effect of transcutaneous electrical nervous stimulation and semi-occluded vocal tract exercises in teachers
Efecto inmediato de la estimulación nerviosa eléctrica transcutánea y los ejercicios del tracto vocal semiocluido en profesores
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"titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Time comprehension through space: A research study on induced plasticity in children with developmental language disorder" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1520 "Ancho" => 2175 "Tamanyo" => 133257 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Diseño del experimento en E-prime.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Daniela Ruiz Sanhueza, Mabel Urrutia, Paola Alarcón Hernández, Hipólito Marrero" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Daniela" "apellidos" => "Ruiz Sanhueza" ] 1 => array:2 [ "nombre" => "Mabel" "apellidos" => "Urrutia" ] 2 => array:2 [ "nombre" => "Paola" "apellidos" => "Alarcón Hernández" ] 3 => array:2 [ "nombre" => "Hipólito" "apellidos" => "Marrero" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0214460320301108?idApp=UINPBA00004N" "url" => "/02144603/0000004200000001/v1_202202130636/S0214460320301108/v1_202202130636/es/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Immediate effect of transcutaneous electrical nervous stimulation and semi-occluded vocal tract exercises in teachers" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "35" "paginaFinal" => "40" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jazmín Pérez-Serey, Francisca Carrasco" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Jazmín" "apellidos" => "Pérez-Serey" "email" => array:1 [ 0 => "jazminpz@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Francisca" "apellidos" => "Carrasco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Doctora en ciencias de la Motricidad Humana, Universidad Pedro de Valdivia, Directora carrera de Fonoaudiología UPV-Chillán, Docente Universidad Adventista de Chile, Chile" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Magister en Didáctica y Pedagogía Musical, Docente Universidad Adventista de Chillán, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efecto inmediato de la estimulación nerviosa eléctrica transcutánea y los ejercicios del tracto vocal semiocluido en profesores" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The occupational voice refers to professionals who use their voice continuously to carry out their work without having received any training that allows protection from the risks associated with their professional performance (<a class="elsevierStyleCrossRef" href="#bib0095">Munier and Farrell, 2016</a>). Among them are teachers who use their voice daily as a work tool for prolonged periods of time that make them more vulnerable to vocal disorders (<a class="elsevierStyleCrossRefs" href="#bib0015">Cantor Cutiva, Vogel, & Burdoff, 2013; Cobeta, Núnez, & Fernández, 2013; Piwowarczyk, Oliveira, Lourenço, & Behlau, 2012</a>). This condition of the teacher has raised alerts regarding generating preventive care in this group that allows effective working methods that prevent reaching the feared dysphonia (<a class="elsevierStyleCrossRefs" href="#bib0115">Ruotsalainen, Sellman, Lehto, Jauhiainen, & Verbeek, 2007; Serey & Araya, 2013</a>). There are studies that have shown different therapeutic strategies to solve the voice problem of teachers with proposals ranging from Vocal Hygiene Education (<a class="elsevierStyleCrossRef" href="#bib0055">Gillivan-Murphy, Drinnan, O’Dwyer, Ridha, & Carding, 2006</a>) Voice Therapy (<a class="elsevierStyleCrossRef" href="#bib0115">Ruotsalainen et al., 2007</a>) and Vocal Fold Adduction Training (VFAT) (<a class="elsevierStyleCrossRef" href="#bib0145">Spielman, Hunter, Halpern, & Titze, 2015</a>), with variable results. In the last 20 years, research has focused on verifying the effectiveness of vocal exercises with tube phonation and other semi-occluded vocal tract (SOVT) exercises in order to explore changes in the vibration of the vocal folds in the configuration of the vocal tract, and in the aerodynamic variables (<a class="elsevierStyleCrossRefs" href="#bib0075">Guzman & Salfate, 2018; Guzmán et al., 2016</a>). <a class="elsevierStyleCrossRef" href="#bib0085">Maxfield, Titze, Hunter, & Kapsner-Smith, 2015</a>) support SOVT for vocal therapy because it encourages the development of voice production that is based on a greater interaction between the source (glottis) and the filter (supraglottic configuration), whose purpose is to lengthen and/or partially occlude the vocal tract, thus causing a change in the respiratory, resonance, and vibration pattern of the vocal folds (<a class="elsevierStyleCrossRef" href="#bib0010">Calvache, Guzmán, & Silverio, 2017</a>). The reported benefits of using SOVT are greater economy in the production of the voice and changes in the vibration pattern of the vocal folds such as, changes in the closing ratio, greater amplitude of vibration of the vocal folds, change in shape of the glottic pulse, decrease in the phonation pressure threshold, increase in intraglottic pressure and reduction of transglottic pressure, obtaining greater efficiency, with less vocal cord stress and decreased physical effort (<a class="elsevierStyleCrossRef" href="#bib0030">Croake, Andreatta, & Stemple, 2017</a>). This allows having a lowered larynx, a wider pharynx and a higher veil, causing positive acoustic and perceptual results (<a class="elsevierStyleCrossRef" href="#bib0075">Guzman & Salfate, 2018</a>), with adjustment of the vocal tract to improve voice performance (<a class="elsevierStyleCrossRef" href="#bib0150">Titze & Laukkanen, 2007</a>).</p><p id="par0010" class="elsevierStylePara elsevierViewall">Another resource that has begun to be used to create better conditions for the development of vocal therapy (<a class="elsevierStyleCrossRefs" href="#bib0035">De Lima Guimarães, 2000; Freed, Freed, Chatburn, & Christian, 2001; Ptok & Strack, 2008</a>) and increase the effects of therapy (<a class="elsevierStyleCrossRefs" href="#bib0025">Conde et al., 2018; De Lima Guimarães, 2000; Guirro et al., 2008; Silverio et al., 2015; Siqueira et al., 2017</a>) is Transcutaneous Electrical Nervous Stimulation (TENS). Among its potential is promoting analgesia, promoting muscle contractions, improving local circulatory flow, fluid drainage, muscle relaxation, promoting regeneration and healing of body tissues in <a class="elsevierStyleCrossRef" href="#bib0090">Melzack and Wall (1965)</a>. The application of TENS consists of placing electrodes on the skin in order to stimulate large diameter nerve fibers. This activation triggers, at a central level, the descending and inhibitory analgesic systems in nociceptive transmission, driven by small unmyelinated fibers, causing pain reduction and generating muscle relaxation (<a class="elsevierStyleCrossRef" href="#bib0005">Agne, 2013</a>). In addition, the positive effects on the quality of the voice may be related to strong but comfortable muscle contractions due to the action it exerts on efferent motor fibers, which not only relax the muscle, but also improve vascularity in the application area (<a class="elsevierStyleCrossRefs" href="#bib0060">Guirro et al., 2008; Silverio et al., 2015; Sluka & Walsh, 2003</a>).</p><p id="par0015" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#bib0045">Fowler, Gorham-Rowan, and Hapner (2011)</a> applied TENS to 10 men and 10 women without vocal pathology, and although no significant acoustic changes were found in the study, the data suggests possible mechanisms by which TENS may contribute to the physiological changes of the voice. For their part, <a class="elsevierStyleCrossRef" href="#bib0100">Oliveira et al. (2012)</a> studied the immediate effect of TENS on the acoustic parameters of men and women without vocal complaints, finding significant reduction in the fundamental frequency and decrease in noise in men, while in women there was no significant difference in acoustic parameters. Another investigation used TENS in 49 individuals of both sexes, without complaints of voice disturbance, finding a significant increase in Maximum Phonation Time (MPT) in women, while no difference was observed in men. They explain that the relaxation that electrostimulation produces improves the myoelastic and aerodynamic balance of the larynx in women.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Within the combination of techniques used in vocal therapy and TENS, <a class="elsevierStyleCrossRef" href="#bib0040">Fabron et al. (2017)</a> studied the effect of performing the tongue vibration technique associated with electrostimulation in women with normal laryngeal function. It turned out that the combination of these techniques produced a greater feeling of comfort and vocal quality and less muscle tension. For their part, <a class="elsevierStyleCrossRef" href="#bib0025">Conde et al. (2018)</a> investigated the immediate effect of TENS and manual laryngeal therapy (MLT), finding that the combined techniques decrease musculoskeletal pain, improve the quality of the voice, decrease the tension and causes positive signs in women with dysphonia. While <a class="elsevierStyleCrossRef" href="#bib0080">Mansuri et al. (2020)</a> combined voice therapy with TENS in patients with muscle tension dysphonia (MTD) and reported better results in reducing pain and vocal tract discomfort in patients with MTD compared to voice therapy alone. They infer that TENS can serve as an effective adjuvant therapy to reduce pain, vocal tract discomfort, and tension in patients with MTD.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Due to the above, in the present investigation the aim is to determine the immediate effect of Transcutaneous Electrical Nervous Stimulation (TENS) and semi-occluded vocal tract (SOVT) exercises on acoustic parameters in teachers.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">The design of this study is quasi-experimental, comparative descriptive level, of longitudinal quantitative type.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Participants</span><p id="par0035" class="elsevierStylePara elsevierViewall">Among a total of 68 teachers belonging to a Public School, 30 met the inclusion criteria which were: (1) have a teaching degree, (2) Have a minimum of 2 years of teaching experience, (3) Have a minimum of 30 teaching hours per week and (4) Sign the consent form. The exclusion criteria were (1) Age less than 28 years or over 60 years, (2) Have completed over 30 years of teaching, (3) Have a weekly workload of less than 30 teaching hours, (4) present base pathology, dysfunctional and/or organically diagnosed dysphonia, (5) Present acute or chronic respiratory pathology, (6) Have formal studies and knowledge of singing and/or vocal technique, (7) That the acoustic parameters are outside the normal range in the initial evaluation, (8) Present serious cardiac disturbances or carry a pacemaker (9) Present cutaneous hypersensitivity and/or (10) Be pregnant. Finally, the analysis unit consisted of 30 teachers between 28 and 60 years of age who were randomly assigned in two groups: (1) SOVT control group; (2) Experimental group SOVT<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>TENS. For the group assignment, each participant took a number from 1 to 30 and the even numbers were assigned to the control group and odd numbers to the experimental group. Each group was made up of 15 participants.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Outcomes measured acoustic voice analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">The teachers’ voices were analyzed with PRAAT software in the parameters Jitter, Shimmer, HNR and Maximum Phonation Time (MPT). To determine the acoustic parameters presented by each patient under study, an initial evaluation was carried out before starting the workday. Prior to the evaluation it was important to mention that these results did not constitute a medical diagnosis, since they represented a subjective view of their status. After the work day corresponding to 8 pedagogical hours, the teachers were subjected to a new evaluation of the acoustic parameters through PRAAT software and MPT. For these evaluations, the teacher was given a Shure SM58 microphone dynamic unidirectional type, with cardioid polar pattern connected by cable to the Lexicon Pro VST Reverg Plug-In audio interface, which in turn connects directly to the Notebook Hp Touch 10.1’2GB 32GB Win10 computer. Then the teacher was requested to take the microphone 10<span class="elsevierStyleHsp" style=""></span>cm away from their mouth to make a sustained “a” sound. An example was given and then a recording was made using the PRAAT software. For the analysis of the voice report, the beginning and the end of the vowel were discarded, leaving the most stable part of the broadcast, wichin this case considered the medial 3<span class="elsevierStyleHsp" style=""></span>s. For the measurement of the MPT, participants were asked to inhale deeply and emit the vowel “a” as long as possible, this was done 3 consecutive times using the resulting average of these 3 measurements.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">SOVT application</span><p id="par0045" class="elsevierStylePara elsevierViewall">The control group received 1 session of approximately 10<span class="elsevierStyleHsp" style=""></span>min of SOVT therapy, based on exercises already tested in a study by <a class="elsevierStyleCrossRef" href="#bib0065">Guzmán, Higueras, Fincheira, Muñoz, and Guajardo (2012)</a>. Each teacher sat comfortably and held a 5<span class="elsevierStyleHsp" style=""></span>mm plastic drinking bulb in diameter and 25.8<span class="elsevierStyleHsp" style=""></span>cm long (<a class="elsevierStyleCrossRef" href="#bib0070">Guzmán et al., 2016</a>). This material was selected due to conditions of availability and accessibility of the sample. The exercises were modeled by an expert voice speech-language pathologist with a focus on vibration and easy voice sensation. Participants are explained that there must be a complete seal of the lips around the tube, that each emission should be relaxed with comfortable tone and intensity and that the breath is executed whenever necessary. Each participant should focus on the sensation of vibration on the lips that expands to the facial region. Is delivered and prior preparation is done to show how to perform the exercises and the sensation they should perceive on the lips. The exercises lasted 2.5<span class="elsevierStyleHsp" style=""></span>min each according to the following sequence: (1) Tube phonation producing a maintained and comfortable frequency for each subject in intensity and height, (2) Tube phonation producing ascending and descending glissands, (3) Tube phonation making accents of intensity and frequency with the use of abdominal muscles, with ascending accents and (4) Production of the melody of a song of the subject's choice within the tube.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Throughout the session the volunteers were monitored and given feedback by the professional in charge.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">TENS application</span><p id="par0055" class="elsevierStylePara elsevierViewall">TENS was applied to the experimental group for 1 session of 10<span class="elsevierStyleHsp" style=""></span>min with the same SOVT sequence applied to the control group. TENS was performed with the Care Tec IV equipment that includes 4 waveforms: TENS, EMS, Interferential and Russian Wave. In addition, 4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm square electrodes were used. The electric wave used consisted of a two-phase pulse current in one direction between two electrodes through the tissue. The current was supplied, followed by a brief pause and then applied again in the opposite direction. The electrostimulator was programmed at a preset frequency of 30<span class="elsevierStyleHsp" style=""></span>Hz. Before electrode placement, the skin was cleaned and the electrodes were placed with conductive gel and secured with tape. During the session, the subjects remained seated comfortably. The 2 electrodes were placed horizontally in the cricothyroid space. The amplitude or intensity of stimulation was adjusted according to the patient's sensations. At low intensity, the patient felt a tingling and vibration. The intensity was increased until the user has the sensation of tightening using a maximum intensity of 10<span class="elsevierStyleHsp" style=""></span>mA.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Descriptive statistics that consisted of measures of central tendency of the mean and standard deviation were applied. Shapiro Wilk was used to demonstrate normality and the Levene test was applied to demonstrate homogeneity. The assumed error rate is 95% with a <span class="elsevierStyleItalic">p</span> value of .05. The statistic used to approve or reject hypotheses was <span class="elsevierStyleItalic">T</span>-Student.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Results.</span><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the normality analysis between the control group and the experimental group prior to the intervention, each group consists of 15 teachers. It is observed that both groups have normal distribution and are homogeneous in terms of the behavior presented in the acoustic parameters Jitter, Shimmer, HNR and MPT.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows that in all acoustic parameters there was a better post-intervention result for both groups. In Jitter and Shimmer there is a decrease in the score, while in HNR and MPT the voices show improvement when their score increases. This reveals that in both groups the values tended to show a better voice. It is noted that the experimental group had better mean differences compared to the control group, this is evidenced in Shimmer and HNR where the mean difference is doubled, while in MPT it is quadrupled. In the case of the standard deviation, the values in the experimental group for HNR tend to concentrate better on the average than in the control group where only SOVT is used. Finally, the <span class="elsevierStyleItalic">p</span> value for Jitter and MPT tends to decrease below 0.01, while Shimmer and HNR also tend to approach this minimum value.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows that there were statistically significant differences in the acoustic parameters Jitter, Shimmer, HNR and MPT after intervention in both the control and experimental groups, highlighting improvements in the experimental group since their values were closer to the arithmetic average in Jitter, Shimmer and HNR.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">In this investigation, the acoustic parameters had significant differences in both the control and experimental groups. In the control group, vocal tract therapy with resonance tube was used and reached a <span class="elsevierStyleItalic">p</span> value less than .05 in all the parameters studied. The same happened with the experimental group where said therapy was combined with TENS. It is noted that in both groups Jitter and MPT had a <span class="elsevierStyleItalic">p</span> value of less than .01. This is not consistent with what was found by <a class="elsevierStyleCrossRef" href="#bib0025">Conde et al. (2018)</a> who used a single TENS session in 30 women with dysphonia, where the reported parameters F0, Shimmer, Jitter and HNR had no significant differences. A similar result was obtained by <a class="elsevierStyleCrossRef" href="#bib0120">Santos, Silvério, Diniz, and Gama (2016)</a>, who studied 60 women with vocal nodules that were randomized in 2 groups. Group 1 received TENS and group 2 received tongue vibration and TENS. Both therapies were applied for 20<span class="elsevierStyleHsp" style=""></span>min but no they observed significant differences for the frequency vocal parameters Jitter and Shimmer.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In this study, when comparing the post-intervention results of the control and experimental group, it is observed that both the vocal tract with a resonance tube and the vocal tract with a resonance tube and TENS obtain significant differences in all the parameters studied; However, when comparing the two therapies, Jitter and MPT have a difference of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.01 that favors the experimental group. For their part, <a class="elsevierStyleCrossRef" href="#bib0080">Mansuri et al. (2020)</a>, studied 20 women with MTD, whom they divided into 2 groups of 10, with 10 sessions of vocal therapy for group 1 and 10 sessions of vocal therapy and TENS in group 2. The authors found that Jitter, Shimmer and HNR improved in both groups, but only significant differences obtained in group 2 for Shimmer. They explain this result reasoning that only Shimmer is more sensitive to fatigue due to MTD. Teachers are exposed to permanent vocal demand, therefore, although this study did not work with pathological voices, acoustic parameters tend to be affected and respond to therapy improving the user's vocal quality.</p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#bib0130">Silverio et al. (2015)</a> applied low frequency TENS for 12 sessions to 20 women with bilateral nodule. One group received TENS and another group combined TENS with Manual Therapy. The results indicate reduction of some vocal symptoms, but there were no significant changes in acoustic parameters after the application of both treatments. On the other hand, Guirro et al. (2008) also studied the effect of low frequency TENS in 10 women with nodules or thickening of bilateral mucous membrane in 10 sessions. Although it showed that the combination of TENS in therapy has better results, there are no significant differences in acoustic voice analysis and perceptual auditory evaluations. This indicates that vocal pathology becomes resistant to therapies that are demonstrated with immediate effectiveness; therefore, prevention can be a way forward in teacher training and in the annual vocal evaluation of this group as a permanent preventive measure.</p><p id="par0095" class="elsevierStylePara elsevierViewall">With this it is reported that, when comparing vocal therapy and TENS in non-pathological voices of teachers who actively occupy their voice in the classroom, significant improvements are obtained. However, in teachers with tension muscle dysphonia or vocal nodule, the effect is more discrete, since the results depend on the number of sessions used and the severity of the patients’ vocal pathology.</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Limitations</span><p id="par0100" class="elsevierStylePara elsevierViewall">Within the limitations of this study, we can mention a reduced sample size that prevents extrapolating the results to other similar populations. Due to having carried out a single session, it is not demonstrated that the effect of SOVT and TENS can be maintained over time. As it is a field study, the acoustic sampling does not have demanding control conditions as could be done in a sound-absorbed laboratory.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conclusion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Semi-occluded vocal tract exercises in resonance tubes combined with TENS have immediate positive effects on the MPT, Jitter, Shimmer and HNR acoustic parameters in teachers without vocal pathology. It is necessary to investigate the prolonged effects that TENS can have combined with vocal exercises as a preventive and therapeutic measure in teachers to avoid vocal pathology associated with the active exercise of their profession.</p><p id="par0110" class="elsevierStylePara elsevierViewall">It's necessary to continue investigating a larger sample to see if the results obtained can be extrapolated to a large population. Due to having carried out a single session, it is not demonstrated that the effect of SOVT and TNES can be maintained over time, therefore more studies are required to verify a prolonged over time.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflict of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">It is declared that there are no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1664926" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1479198" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1664927" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1479197" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Participants" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Outcomes measured acoustic voice analysis" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "SOVT application" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "TENS application" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results." ] 7 => array:3 [ "identificador" => "sec0045" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-03-31" "fechaAceptado" => "2020-09-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1479198" "palabras" => array:6 [ 0 => "Acoustic parameters" 1 => "Transcutaneous electrical nervous stimulation" 2 => "Semi-occluded vocal tract" 3 => "Teachers" 4 => "Speech therapy" 5 => "Voice" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1479197" "palabras" => array:6 [ 0 => "Parámetros acústicos" 1 => "Estimulación nerviosa eléctrica transcutánea" 2 => "Tracto vocal semi-ocluido" 3 => "Profesores" 4 => "Terapia del habla" 5 => "Voz" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The objective of this study was to determine the immediate effects of transcutaneous electrical nervous stimulation (TENS) and semi-occluded vocal tract (SOVT) exercises on acoustic parameters in teachers in the city of Chillán. The study was based on a quantitative methodological perspective, with a comparative descriptive scope and a quasi-experimental longitudinal design. The sample was composed of 30 teachers belonging to the Reyes de España School, who were evaluated using Praat software, pre and post treatment. The teachers were divided into 2 groups; control group (semi-occluded vocal tract therapy) and experimental group (semi-occluded vocal tract therapy and electrostimulation) who were treated during a single session of approximately 10<span class="elsevierStyleHsp" style=""></span>min. The values of the acoustic parameters were then compared [Jitter, Shimmer, Harmonic to Noise Ratio (HNR) and Maximum Phonation Time (MPT)] between both groups. The acoustic analysis showed statistically significant post-intervention changes in all the parameters evaluated for both study groups, however, in the experimental group the means showed a greater difference, with a p value less than .01. Semi-occluded vocal tract exercises in resonance tubes combined with TENS have immediate positive effects on TMF, Jitter, Shimmer and HNR acoustic parameters in teachers without vocal pathology.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue determinar los efectos inmediatos de la estimulación nerviosa eléctrica transcutánea (TENS) y los ejercicios del tracto vocal semiocluido, <span class="elsevierStyleItalic">semi-occluded vocal tract exercises</span> (SOVT), en los parámetros acústicos de profesores de la ciudad de Chillán, Chile. El estudio se basó en una perspectiva metodológica cuantitativa, con alcance descriptivo comparativo y diseño longitudinal cuasi-experimental. La muestra se compuso de 30 profesores pertenecientes a la Escuela Reyes de España, a quienes se evaluó utilizando el <span class="elsevierStyleItalic">software</span> Praat, pre y postratamiento. Los profesores fueron divididos en dos grupos: el grupo control (terapia del tracto vocal semiocluido) y el grupo experimental (terapia de vocal semiocluida y electroestimulación), que fueron tratados durante una única sesión de aproximadamente 10 minutos, comparándose a continuación los valores de los parámetros acústicos (<span class="elsevierStyleItalic">jitter</span>, <span class="elsevierStyleItalic">shimmer</span>, relación armónico-ruido [HNR] y tiempo máximo de fonación [TMF]), entre ambos grupos. El análisis acústico reflejó cambios postintervención estadísticamente significativos en todos los parámetros evaluados para ambos grupos de estudio; sin embargo, en el grupo experimental las medias reflejaron una mayor diferencia, con un valor p inferior a 0,01. Los ejercicios del tracto vocal semiocluido en tubos de resonancia combinados con TENS tienen efectos positivos inmediatos en los parámetros acústicos TMF, <span class="elsevierStyleItalic">jitter</span>, <span class="elsevierStyleItalic">shimmer</span> y HNR en profesores sin patología vocal.</p></span>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Shapiro–Wilk \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Shapiro–Wilk \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Levene groups \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Control group \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Experimental group \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Control & experimental \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">JITTER prior to intervention \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.420 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.963 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SHIMMER prior to intervention \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.152 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.113 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.624 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HNR prior to intervention \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.399 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.535 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.227 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TMF prior to intervention \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.140 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.321 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.317 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2834045.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Analysis of the Shapiro–Wilk normality tests and the Levene–Homogeneity Test prior to intervention.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">p</span> value with Student's <span class="elsevierStyleItalic">T</span> for samples related to mean and standard deviation before and after intervention. In the control group SOVT is used and in the experimental group SOVT<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>TENS.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Normal values \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Control groupMean Pre (SD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group controlMean post \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dif. medias \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group exp. Mean pre (SD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group exp. Mean post \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dif. mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">JITTER \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><1040% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.88 (0.08) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.79 (0.08) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.000<a class="elsevierStyleCrossRef" href="#tblfn0010">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.85 (0.08) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.69 (0.05) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.000<a class="elsevierStyleCrossRef" href="#tblfn0010">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SHIMMER \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><3.810% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.93 (0.38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.75 (0.35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.82 (0.40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.46 (0.23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HNR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>20<span class="elsevierStyleHsp" style=""></span>dB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.44 (1.11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.27 (1.16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.18 (0.87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.27 (0.86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.013 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TMF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15–25 seg. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.93 (1.39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.60 (1.45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.000<a class="elsevierStyleCrossRef" href="#tblfn0010">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.87 (2.12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.20 (2.37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.000<a class="elsevierStyleCrossRef" href="#tblfn0010">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2834047.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.01.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Comparison between groups with acoustic parameters before and after the intervention.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Control group post-intervention</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Exp. group post-intervention</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"><span class="elsevierStyleItalic">p</span> value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">JITTER \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">*</a>.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SHIMMER \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">*</a>.048 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HNR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">*</a>.018 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TMF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">*</a>.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2834046.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0010"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Comparative analysis of Student's <span class="elsevierStyleItalic">T</span>-test for independent samples.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "Agne, 2013" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eletrotermofototerapia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.E. 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