Banca de QUALIFICAÇÃO: RAFAELA OLIVEIRA DE FARIAS

Uma banca de QUALIFICAÇÃO de MESTRADO foi cadastrada pelo programa.
STUDENT : RAFAELA OLIVEIRA DE FARIAS
DATE: 25/09/2026
TIME: 09:00
LOCAL: Plataforma Google Meet
TITLE:

Immediate Effects of the Application Order of High-Frequency Transcutaneous Electrical Nerve Stimulation (TENS) and Vocal Exercises in Women With Behavioral Dysphonia

KEY WORDS:

Dysphonia; Transcutaneous Electrical Nerve Stimulation; Speech-Language Pathology; Selfassessment;
Acoustics.

PAGES: 60
BIG AREA: Ciências da Saúde
AREA: Fonoaudiologia
SUMMARY:

Introduction: The application of TENS electrotherapy combined with vocal exercises has gained
prominence in clinical voice practice, being used to promote relaxation of the muscles adjacent to the larynx,
reduce musculoskeletal pain, and optimize vocal function. However, available scientific evidence focuses
predominantly on the use of low-frequency TENS. Despite this, high-frequency TENS is frequently used in 

clinical practice, yet lacks scientific backing. Thus, there is a need for studies that support and guide
evidence-based practice. Objective: To compare the immediate effects of the application order of highfrequency
TENS electrotherapy combined with vocal exercises on the self-perception and vocal quality of
women with behavioral dysphonia. Method: A randomized, crossover clinical study. The study was
conducted with women diagnosed with behavioral dysphonia. Each participant underwent six intervention
stages, randomized regarding the order of application: (G1) high-frequency TENS only; (G2) sham TENS
only; (G3) high-frequency TENS concurrent with vocal exercises; (G4) sham TENS concurrent with vocal
exercises; (G5) vocal exercises followed by high-frequency TENS; and (G6) high-frequency TENS followed
by vocal exercises. A minimum interval of one week was observed between stages to avoid residual effects.
High-frequency TENS was applied using the following physical parameters: pulse duration of 50 μs,
frequency of 100 Hz, and intensity at the participant's comfort threshold. A single-channel pair of electrodes
was used, positioned bilaterally over the thyroid cartilage. The vocal exercises used were: tongue trill at
comfortable pitch and intensity; tongue trill with glissando; chewing-style humming; "ship whistle" at
comfortable pitch and intensity; and finger kazoo at comfortable pitch and intensity. ...and phonation into a
flexible resonance tube immersed 2 cm in water. Each exercise was performed for 3 minutes. Before and
after each intervention, self-assessment protocols were administered: the Vocal Comfort and Quality
Perception Scale and the Borg Scale of Perceived Vocal Effort. Voice samples were recorded for subsequent
auditory-perceptual judgment and acoustic analysis. Statistical analysis was performed using the Friedman
test, followed by the Durbin-Conover post hoc test (p<0.05). Preliminary results: No significant differences
were observed between time points or intervention conditions regarding acoustic parameters (CPPS:
p=0.655; AVQI: p=0.306; ABI: p=0.470; HNR: p=0.316; GNE: p=0.303; H1-H2 SV: p=0.744; H1-H2 CS:
p=0.753; f0: p=0.487). Regarding vocal self-perception, a significant time effect was found for vocal comfort
in groups G1 (p=0.025), G2 (p=0.015), G4 (p=0.008), and G6 (p=0.003), and for vocal quality in groups G1
(p=0.014), G2 (p=0.033), G3 (p=0.010), G4 (p=0.002), and G6 (p=0.004). When examining the magnitude
of changes between conditions, G6 (TENS followed by exercises) showed a greater change in vocal comfort
compared to G1 (p=0.017), G2 (p=0.004), and G5 (p<0.001); a difference was also observed in the G4 vs.
G5 comparison (p=0.013); Regarding vocal quality, there was no significant difference between conditions
according to the Friedman test (χ²(5)=9.70; p=0.084). As for vocal effort, G6 showed a greater magnitude of
change compared to all other groups (G1: p=0.003; G2: p<0.001; G3: p=0.004; G4: p<0.001; G5: p<0.001).
Thus, although the interventions did not promote significant changes in acoustic parameters, self-perception
results suggest immediate improvement following the different conditions, with no evidence of superiority
among them regarding vocal quality. Regarding comfort, however, the magnitude of change differed across
conditions; notable findings included TENS followed by exercises and, particularly, the potential effect of
the application order when compared to exercises followed by TENS.

COMMITTEE MEMBERS:
Externa à Instituição - KELLY CRISTINA ALVES SILVERIO - USP
Interna - 2305190 - JULIANA FERNANDES GODOY
Presidente - 3257296 - LARISSA THAIS DONALONSO SIQUEIRA