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Does Intensive Voice Therapy Improve Airway Protection in Parkinsons Disease

强化发声治疗可以改善帕金森病的气道保护吗

基本信息

批准号：
8307234
负责人：
Michael J Hammer
金额：
$ 14.37万
依托单位：
UNIVERSITY OF WISCONSIN-MADISON
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-01 至 2014-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8307234
关键词：
Acceleration Accounting Aging Air Automobile Driving Breathing Cause of Death Cessation of life Coughing Detection Devices Environmental air flow Evidence based intervention Excision Exhibits Failure Health Health Care Costs Individual Intake Intervention Invaded Laboratories Larynx Left Literature Loudness Lung Measures Medical Motor Neurodegenerative Disorders Obstruction Parkinson Disease Patients Perception Phase Physical Efforts Preparation Quality of life Reflex action Rehabilitation therapy Research Respiration Respiratory Tract Infections Risk Self Perception Sensory Societies Speech Speed Spirometry Suggestion System Testing Tidal Volume Training United States Vital capacity Voice Work clinically relevant cost experience improved innovation nervous system disorder pressure programs public health relevance pulmonary function research study respiratory sensory stimulus somatosensory standard of care vocal cord voice therapy

项目摘要

DESCRIPTION (provided by applicant): The primary cause of death and illness related to Parkinson's Disease (PD) is respiratory infection or obstruction resulting from a general failure to effectively cough to protect the airway. Individuals with PD exhibit substantial difficulty generating sufficient respiratory driving pressure and vocal fold closure to generate a strong effective cough, and are generally unaware of their airway deficits, suggesting that these deficits may be related to impaired sensory function. We previously confirmed this suggestion and demonstrated significant laryngeal somatosensory deficits in individuals with PD compared with healthy controls. However, medical and neurosurgical interventions remain inadequate, leaving most PD patients without access to an appropriate, evidence-based intervention to improve airway protection. The current standard of care for improving speech and voice in PD is intensive voice therapy (IVT), also known as Lee Silverman voice treatment. The increased motor and sensory experience accompanying increased respiratory pressure, vocal fold closure, and voice loudness, and the particular focus on increased sensory self-awareness in IVT may yield important benefits to the ability to detect and effectively cough to expel a substance from invading the airway. However, the effects of IVT on laryngeal sensory function and other mechanisms of airway protection are unknown. Our preliminary experiments demonstrated improved voice and airway function, including increased strength and speed of cough that approximated normal function following IVT. These improvements have great potential to improve health and quality of life, and to increase independence of individuals with PD. Therefore, we will test the hypothesis that IVT will result in improved cough, breathing, and airway sensory function in individuals with moderately severe PD. The proposed research has 3 specific aims. In Aim 1, we will test the hypothesis that IVT will improve the efficiency of air intake in preparation for a cough, and the ability to strongly and efficiently expel air for removal of a substance from invading the airway. This aim is innovative, clinically relevant, and will determine the impact of IVT on the efficiency and strength of cough in PD. In Aim 2, we will test the hypothesis that IVT will improve the ability of individuals with PD to efficiently access and move lung air volume and to generate respiratory driving pressures. This aim is innovative, important, and will assess the underlying capacity of the respiratory mechanism available for airway protection. These measures also enable us to account for underlying covariates in pulmonary function that may impact cough. In Aim 3, we will use an endoscopic assessment device developed in our laboratory to test the hypothesis that IVT will improve laryngeal sensory function. This aim is highly innovative, clinically relevant, and will directly assess the ability of the larynx to detect and respond to a sensory stimulus. In this work, we will develop a more comprehensive view of airway sensorimotor control, how a rehabilitative strategy such as IVT impacts these functions in a neurodegenerative disease, and how sensory changes correlate with breathing, cough, and voice. PUBLIC HEALTH RELEVANCE: Parkinson's Disease (PD) afflicts more than two million individuals in the United States, and more than seven million worldwide, leading to a total annual cost of PD in the United States of about $38 billion, and an estimated annual cost to society of as much as $6,000 per capita. Given that the vast majority of individuals with PD may eventually experience increased risk of illness or death due to an increasing failure to protect the airway and that most currently do not have access to an appropriate, evidence- based intervention to improve airway function, the purpose of this study is to examine the effects of an intensive voice therapy program on mechanisms of airway protection including cough, breathing, and airway sensory function. Results from the proposed study may have great potential to improve health and quality of life, to decrease individual and societal health care costs, to increase independence of individuals with PD, and to inform our understanding of the mechanisms of airway sensorimotor control, with important implications for aging and other neurological disease.

描述(申请人提供)：与帕金森氏病(PD)相关的死亡和疾病的主要原因是呼吸道感染或梗阻，原因是普遍未能有效咳嗽以保护呼吸道。帕金森病患者在产生足够的呼吸驱动压力和声带闭合以产生强烈的有效咳嗽方面表现出很大的困难，并且通常不知道他们的呼吸道缺陷，这表明这些缺陷可能与感觉功能受损有关。我们先前证实了这一建议，并证明与健康对照组相比，帕金森病患者的喉部躯体感觉明显缺陷。然而，内科和神经外科干预措施仍然不足，使得大多数帕金森病患者无法获得适当的循证干预来改善呼吸道保护。目前改善帕金森病患者语音和嗓音的标准是强化嗓音治疗(IVT)，也被称为Lee Silverman嗓音治疗。随着呼吸压力、声带闭合和声音响度的增加而增加的运动和感觉体验，以及在IVT中特别关注感觉自我意识的增强，可能会对检测和有效咳嗽以从侵入呼吸道的物质中排出物质的能力产生重要的益处。然而，IVT对喉感觉功能和其他呼吸道保护机制的影响尚不清楚。我们的初步实验表明，IVT后嗓音和呼吸道功能得到改善，包括咳嗽强度和速度增加，接近正常功能。这些改进在改善健康和生活质量以及提高帕金森病患者的独立性方面具有巨大的潜力。因此，我们将检验这样的假设，即静脉注射将改善中度重度帕金森病患者的咳嗽、呼吸和呼吸道感觉功能。这项拟议的研究有三个具体目标。在目标1中，我们将检验这样一种假设，即IVT将提高准备咳嗽时的进气效率，以及强烈而有效地排出空气以清除侵入呼吸道的物质的能力。这一目标具有创新性和临床相关性，将决定IVT对帕金森病患者咳嗽的效率和强度的影响。在目标2中，我们将检验IVT将改善帕金森病患者有效获取和移动肺空气量并产生呼吸驱动压力的能力的假设。这一目标是创新的、重要的，并将评估可用于呼吸道保护的呼吸机制的潜在能力。这些测量也使我们能够解释可能影响咳嗽的肺功能的潜在协变量。在目标3中，我们将使用我们实验室开发的内窥镜评估设备来验证IVT将改善喉部感觉功能的假设。这一目标具有很高的创新性和临床相关性，将直接评估喉部对感官刺激的检测和反应能力。在这项工作中，我们将更全面地了解呼吸道感觉运动控制，康复策略(如IVT)如何影响神经退行性疾病的这些功能，以及感觉变化如何与呼吸、咳嗽和声音相关。公共卫生相关性：帕金森氏症(PD)在美国有200多万人，在全球有700多万人，导致美国每年帕金森氏病的总成本约为380亿美元，估计每年给社会造成的人均成本高达6000美元。鉴于绝大多数帕金森病患者最终可能会因为保护呼吸道的失败而增加患病或死亡的风险，而且大多数人目前还无法获得适当的循证干预来改善呼吸道功能，因此本研究的目的是检验强化语音治疗计划对包括咳嗽、呼吸和呼吸道感觉功能在内的呼吸道保护机制的影响。这项研究的结果可能对改善健康和生活质量，降低个人和社会保健成本，提高帕金森病患者的独立性，以及帮助我们理解呼吸道感觉运动控制的机制具有巨大的潜力，对衰老和其他神经疾病具有重要意义。