Kinaesthetic Loss as a Marker for Spasmodic Dysphonia

动觉丧失是痉挛性发声障碍的标志

• 批准号: 8174808
• 负责人: JUERGEN KONCZAK
• 金额: $ 18.76万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8174808
• 关键词: Affect; Basal Ganglia; Behavior Therapy; Behavioral; Blepharospasm; Botulinum Toxins; Chronic; Classification; Clinical; Communication; Complement; Control Groups; Cranial Nerves; Data; Detection; Diagnosis; Diagnostic; Differential Diagnosis; Disabled Persons; Disease; Dysphonia; Dystonia; Evaluation; Focal Dystonias; Forearm; Generations; Gold; Head and neck structure; Health; Incidence; Injection of therapeutic agent; Involuntary Movements; Joints; Just-Noticeable Differences; Kinesthesis; Laryngeal muscle structure; Larynx; Lead; Limb structure; Link; Measures; Mediating; Methods; Motion; Motor; Muscle Tension; Muscle Tonus; One-Step dentin bonding system; Parkinson Disease; Patients; Pattern; Peripheral; Phonation; Positioning Attribute; Procedures; Process; Psychophysiology; Questionnaires; Research; Risk; Screening procedure; Secure; Signal Transduction; Spasm; Spastic Dysphonias; Staging; Stimulus; Swelling; Symptoms; System; Testing; Time; Tissues; Torticollis; Treatment Protocols; Upper Extremity; Voice; Voice Disorders; Voice Quality; Woman; arm; base; diagnosis standard; falls; handicapping condition; insight; middle age; response; tool; vocal cord

DESCRIPTION (provided by applicant): Spasmodic dysphonia (SD) is a voice disorder characterized by involuntary movement of laryngeal muscles that leads to voice breaks and a strained or strangled voice quality, and which can severely impair communication. SD is believed neurogenic in origin and shares some symptoms with focal dystonia (FD) of the head and neck. The diagnosis of SD has been proven to be difficult, because it often presents with symptoms similar to muscle-tension dysphonia (MTD). MTD is caused by abnormal phonation believed to be in response to swelling of vocal fold tissue. Misdiagnosis is not uncommon and can lead to inappropriate treatment. SD is treated primarily with botulinum toxin injections while MTD is treated with behavioral therapy. The current "gold" standard of diagnosis uses an elaborate, time-intensive, and costly 3-step approach involving questionnaire, a clinical-perceptual evaluation, and a nasoendoscopic evaluation. Recent research documented that patients with focal dystonia affecting head and neck musculature, such as blepharospasm and torticollis, reveal kinaesthetic deficits in the non-dystonic musculature of their upper limbs suggesting a central origin of these disorders. Thus, the central idea behind this proposal is to examine, if SD also presents with kinaesthetic deficits in non-dystonic limb systems that are clinically symptom-free. This link has never been established, but is suggested by our pilot data. If, in contrast, MTD patients have normal limb kinaesthesia, then kinaesthetic loss would be a potential marker for SD that could help to differentiate between SD and MTD. Our approach would be to examine kinaesthetic acuity by determining precise psychophysical thresholds for detecting arm motion or for discriminating between arm motion stimuli - a procedure that has never been applied to SD patients. The scientific impact of linking SD to a general kinaesthetic deficit would be increased evidence that FD and SD share a similar pathomechanism that alters the central process of integrating peripheral proprioceptive information with volitional motor commands. The health significance of showing that SD but not MTD is associated with a general kinaesthetic loss is that it opens the avenue to develop easy-to-administer, standardized, time-efficient clinical tests for the diagnosis of SD (and FD) that complements the current diagnostic arsenal and reduces the risk of a misdiagnosis. PUBLIC HEALTH RELEVANCE: Spasmodic dysphonia is a neurogenic voice disorder that can severely handicap communication. Differentially diagnosing SD from muscle-tension dysphonia (MTD) is difficult because they share similar vocal symptoms. This is especially problematic because the treatment regimens of SD and MTD are significantly different. Currently, the gold- standard for identifying SD uses a three-step approach. Relying upon the neurogenic origin of SD, the identification of kinaesthetic deficits in patients with SD could lead to a reliable one-step method for identifying whether a patient has SD.

描述(申请人提供)：痉挛性发声障碍(SD)是一种以喉部肌肉不自主运动为特征的语音障碍，导致声音中断和声音质量紧张或窒息，并可严重损害沟通。SD被认为是神经源性的，并与头颈部的局灶性肌张力障碍(FD)有一些共同的症状。SD的诊断已被证明是困难的，因为它经常表现出类似于肌肉紧张性发音困难(MTD)的症状。MTD是由异常发声引起的，据信是对声带组织肿胀的反应。误诊并不少见，并可能导致不适当的治疗。SD主要用肉毒杆菌毒素注射治疗，而MTD则用行为疗法治疗。目前的“黄金”诊断标准采用精细、耗时和昂贵的三步法，包括问卷调查、临床感知评估和鼻内窥镜评估。最近的研究表明，影响头颈部肌肉的局灶性肌张力障碍患者，如眼睑痉挛和斜颈，表现出上肢非肌张力障碍肌肉的运动感觉障碍，这表明这些疾病的中心起源。因此，这一建议背后的中心思想是检查SD是否也在临床上没有症状的非肌张力障碍肢体系统中表现出运动感觉缺陷。这种联系从未建立过，但我们的试点数据表明了这一点。相反，如果MTD患者的肢体运动感觉正常，那么运动感觉丧失将是SD的一个潜在标记物，有助于区分SD和MTD。我们的方法是通过确定精确的心理物理阈值来检测动觉敏锐度，以检测手臂运动或区分手臂运动刺激-这是一种从未应用于SD患者的程序。将SD与全身运动感觉缺陷联系起来的科学影响将增加证据，表明FD和SD具有相似的病理机制，改变了将外周本体感觉信息与意志运动命令整合的中枢过程。表明SD而不是MTD与全身运动感觉丧失相关的健康意义在于，它为开发易于管理的、标准化的、及时有效的诊断SD(和FD)的临床测试开辟了道路，这些测试补充了目前的诊断库，并减少了误诊的风险。 公共卫生相关性：痉挛性发音困难是一种神经性发音障碍，可严重阻碍沟通。由于SD和肌肉紧张性发音障碍(MTD)有着相似的发声症状，因此很难进行鉴别诊断。这尤其有问题，因为SD和MTD的治疗方案有很大的不同。目前，识别SD的黄金标准采用三步法。依靠SD的神经源性起源，识别SD患者的运动感觉缺陷可能导致一种可靠的一步法来识别患者是否患有SD。