L.N. Balatskaya, E.A. Krasavina, R.V. Mescheryakov, S.Yu. Chizhevskaya, E.L. Choinzonov
In article the new technology of the combined treatment and vocal rehabilitation for the patients, suffering by diseases voice formation the device is considered. A research objective is improvement of patients life quality after full removal of a throat by working out of modern methodical approaches to vocal rehabilitation. The technique of sonorous speech restoration of patients after full removal of a throat with use biocontrol technology on the basis of mathematical modelling is with that end in view developed. During vocal trainings with biocontrol use, the patient has a possibility is realized to operate parameters of a formed voice (duration phonation, fundamental frequency, fundamental frequency stability) which do not give in to the control in usual conditions.
52 patients have been included in research by a throat cancer III-IV of a tumoral stage process at the age from 40 till 70 years. Vocal rehabilitation was spent by a technique of restoration of sonorous speech with use biocontrol technology on the basis of mathematical modeling voice formation. The technique included 4 stages.
The first stage – preparatory. The primary goal was activization of the nervously-muscular device of external muscles of a throat and pharyngeal muscles, training of muscles of a neck and drinks for the purpose of training to pushing out of air from an oral cavity. The special attention was given to physiotherapy exercises for adaptation to new type of breath through throatdevice. The second stage – formation of a pseudo-vocal crack in I physiological narrowing of a gullet at level С5-С6, formation of a sound of a pseudo-voice.
At the third stage for vocal trainings the computer-program systems with application of an adaptive feedback on the basis of mathematical modeling voice formation is used. After the patient can freely cause a pseudo-voice sound in the reflected speech, it is offered to start vocal trainings by means of such complex. The training subsystem of a complex includes three types of trainings: sound formation of pseudo-voice, duration increase phonation, increase of fundamental frequency.
Problem of the fourth stage is improvement of a timbre, modulation esophagus voice and distinctness of sonorous speech. Ability to vary intensity and fundamental frequency, and also duration increase phonation is developed. At the given stage recitation, drawing up of stories on any theme interesting to the patient, dialogue by phone is recommended. Originally duration of vocal trainings makes 4-6 minutes 3-4 times a day in 45-60 minutes, in process of mastering by the patient by sonorous speech this time increased till 8-10 minutes 3-4 times a day in 30-45 minutes.
Efficiency of restoration of vocal function has made 92,6 % in terms from 8 days till 22 days. The estimation of application efficiency of the developed technique is proved by objective methods of functional researches: acoustic, elctromiograhy and life quality studying. Duration phonation, depending on quantity of trainings has on the average increased with 80 ms to 850 ms. Dynamics of fundamental frequency by results of trainings has made from 40 Hz to 120 Hz. Application of the developed technology has allowed to carry out quantitative monitoring of parameters of vocal function in process logoregenerative therapies that promotes the prompt inclusion compensatory possibilities and accelerates process of sonorous speech formation, and also to reduce terms of rehabilitation actions and considerably to improve patients life quality after full removal of a throat.