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

• 批准号: 7883967
• 负责人: Michael J Hammer
• 金额: $ 14.85万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7883967
• 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

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（由申请人提供）：与帕金森病（PD）相关的死亡和疾病的主要原因是呼吸道感染或阻塞，这是由于一般不能有效咳嗽以保护气道而导致的。PD患者很难产生足够的呼吸驱动压力和声带闭合来产生强烈有效的咳嗽，并且通常不知道他们的气道缺陷，这表明这些缺陷可能与感觉功能受损有关。我们之前证实了这一建议，并证明与健康对照相比，PD患者存在显著的喉体感觉缺陷。然而，医学和神经外科干预措施仍然不足，使大多数PD患者无法获得适当的、基于证据的干预措施来改善气道保护。目前改善PD患者言语和声音的护理标准是强化语音治疗（IVT），也称为Lee Silverman语音治疗。在IVT中，伴随着呼吸压力增加、声带闭合和声音变大的运动和感觉体验的增加，以及对感觉自我意识增加的特别关注，可能会对检测和有效咳嗽以排出侵入气道的物质的能力产生重要的好处。然而，IVT对喉感觉功能的影响和其他气道保护机制尚不清楚。我们的初步实验表明，IVT后声音和气道功能得到改善，包括咳嗽的强度和速度增加，接近正常功能。这些改进对于改善PD患者的健康和生活质量，以及提高患者的独立性具有很大的潜力。因此，我们将验证IVT会改善中重度PD患者的咳嗽、呼吸和气道感觉功能的假设。拟议的研究有三个具体目标。在Aim 1中，我们将测试IVT将提高准备咳嗽的进气口效率的假设，以及强烈和有效地排出空气以清除侵入气道的物质的能力。这一目标是创新的，具有临床相关性，并将确定IVT对PD患者咳嗽效率和强度的影响。在Aim 2中，我们将测试IVT将提高PD患者有效获取和移动肺气量以及产生呼吸驱动压力的能力的假设。这个目标是创新的，重要的，并将评估可用于气道保护的呼吸机制的潜在能力。这些措施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Aim 3中，我们将使用我们实验室开发的内窥镜评估装置来测试IVT将改善喉感觉功能的假设。这个目标是高度创新的，临床相关的，并将直接评估喉部检测和响应感官刺激的能力。在这项工作中，我们将对气道感觉运动控制，IVT等康复策略如何影响神经退行性疾病中的这些功能，以及感觉变化如何与呼吸，咳嗽和声音相关等方面进行更全面的研究。