Cardiovascular Conditioning in the Treatment of Vocal Fatigue

项目摘要 考虑到教师的职业需求，他们是嗓音障碍的高危人群。在一次教学中 职业生涯中，在经历的所有发声症状中，一种常见的衰弱症状是发声疲劳。其影响 发声疲劳的经历有三个方面，因为这种症状：(A)预示并导致慢性发声 问题，(B)影响职业表现，(C)影响学生学习和学业成绩。 因此，发声疲劳会导致一种慢性疾病的更广泛的医疗费用负担，即 教育[和教育者]，以及学生学习。虽然在发声文献中进行了调查，但声音疲劳 缺乏明确的定义、基本机制和具体的治疗或预防方法。匮乏 这种清晰度可以归因于这样一个事实，即发声疲劳反映了一系列机制，所有这些机制 表现为声音疲惫。相反，疲劳在运动生理学文献中有很好的记载。 包括潜在的机制和治疗选择。我们利用了描述良好的练习中的原则 与任务中使用的氧气消耗和代谢燃料模式有关的生理学文献 检查与发声任务相关的发声疲劳的表现。我们的初步数据 关于发声疲劳的潜在机制提出了与这种发声症状有关的两个因素：1)更大的 依靠厌氧资源为声乐表演提供燃料(即减少或不使用有氧[氧气] 资源)，以及2)发声任务的生理恢复较差。嗓音健康心血管健康 在发声任务中，受限制的个体表现出更多对氧气资源的依赖，并表现出更快的 恢复后任务。传统上，发声练习被广泛用于提高发声技能和 增强神经肌肉效率，缓解发声疲劳。相反，心血管调节是 广泛用于提高耐力和减少神经运动任务表现中的早期疲劳， 但还没有被系统地应用于声音疲劳问题的潜在治疗。在一个 初步测试，对发声患者进行为期四周的次极量心血管调节治疗 疲劳(使用发声疲劳指数-VFI的不同因素的分数来招募)导致了 发声任务的代谢燃料来源从以无氧为主转变为更多的有氧资源 参与者，3名参与者中有1名自我报告的疲劳症状有所改善。语音制作 锻炼缓解了三分之二参与者自我报告的发声疲劳症状。这项拟议研究的 目的：(A)探讨心血管训练对发声生理的影响。 任务表现、任务后恢复和自我报告的发声疲劳症状与发声的比较 制作练习和(B)根据基线分数预测嗓音疲劳的不同治疗方案 在VFI上。我们将招募52名患有发声疲劳的女教师，年龄在21-45岁之间，随机分配到 两个研究组：次极量持续心血管调理训练方案或发声 锻炼养生法。在这些个体中，干预前和干预后说话的生理成本，模式 氧摄取和恢复动力学，以及自我报告的声音疲劳都将被记录下来，以确定 心血管调理与发声训练组在发声生理任务上的比较 性能。研究结果将用于(A)心血管调节的发展。 方案，以加强生理性发声任务管理，(B)确定不同的影响 心血管调理和发声训练对发声任务管理和发声缓解的影响 (C)根据基线VFI评分预测不同的治疗方法。

Project Summary Teachers are a population at high risk for voice disorders given their occupational demands. In a teaching career, a common debilitating symptom among all vocal symptoms experienced is - vocal fatigue. The impact of the experience of vocal fatigue is three fold, as this symptom: (a) predicts and leads to chronic voice problems, (b) affects occupational performance, and (c) impacts student learning and academic performance. Thus, vocal fatigue leads to a broader burden on healthcare costs of a chronic disorder, the economy of education [and the educator], and student learning. Although investigated in the voice literature, vocal fatigue lacks clarity in the definition, underlying mechanisms, and specific treatment or prevention approaches. A lack of such clarity can be attributed to the fact that vocal fatigue reflects a constellation of mechanisms which all manifest as tiredness of voice. On the contrary, fatigue is well documented in the exercise physiology literature including potential mechanisms and treatment options. We utilized principles from the well-described exercise physiology literature pertaining to the pattern of oxygen consumption and metabolic fuel used during task performance to examine the manifestation of vocal fatigue associated with a vocal task. Our preliminary data on potential mechanisms of vocal fatigue suggest two factors associated with this vocal symptom: 1) a greater reliance on anaerobic resources for fuel for vocal performance (i.e. less or no use of aerobic [oxygen] resources), and 2) poor physiological recovery from the vocal task. Vocally healthy cardiovascularly conditioned individuals showed greater reliance on oxygen resources during a vocal task and a more rapid recovery post task. Traditionally, voice production exercises are widely used to improve vocal skill and enhance neuromuscular efficiency to alleviate vocal fatigue. On the contrary, cardiovascular conditioning is widely used to increase endurance and decrease the early onset of fatigue in neuromotor task performance, but has not been systematically applied as a potential treatment for the problem of vocal fatigue. In a preliminary test, four-weeks of submaximal cardiovascular conditioning treatment in individuals with vocal fatigue (recruited using scores on the different factors of the Vocal fatigue Index-VFI) resulted in a shift in the metabolic source of fuel for a vocal task from predominantly anaerobic to greater aerobic resources in all three participants, with improvement of self-reported fatigue symptoms in 1 of 3 participants. Voice production exercises alleviated the symptoms of self-reported vocal fatigue in 2/3 participants. The proposed study's objective is (a) to determine the influence of cardiovascular conditioning exercise on the physiology of vocal task performance, post task recovery and self-reported symptoms of vocal fatigue in comparison to voice production exercises and (b) to predict differential treatment options for vocal fatigue based on baseline scores on the VFI. We will recruit 52 female teachers with vocal fatigue, ages 21-45 years, to be randomized to one of the two study arms: submaximal continuous cardiovascular conditioning exercise regimen or voice production exercises regimen. In these individuals, pre- and post-intervention physiologic cost of speaking, pattern of oxygen uptake and recovery kinetics, and self-reported vocal fatigue will all be recorded to determine impact of cardiovascular conditioning compared to the voice production exercise group on the physiology of vocal task performance. The outcomes will be used (a) to inform the development of a cardiovascular conditioning regimen to enhance physiologic vocal task management, (b) to determine the differential impact of cardiovascular conditioning and voice production exercise on vocal task management and alleviation of vocal fatigue symptoms and (c) to predict differential treatment approaches based on baseline VFI scores.