Department of Speech and Hearing Sciences, Portland State University, OR.
Northwest Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.
Am J Speech Lang Pathol. 2021 Jun 18;30(3S):1373-1381. doi: 10.1044/2020_AJSLP-20-00146. Epub 2021 Mar 2.
Purpose The use of noninvasive ventilation (NIV) is on the rise as an alternative to tracheostomy for individuals with neuromuscular disorders with life-prolonging and quality-of-life benefits. This pilot study was designed to determine if mouthpiece NIV (M-NIV) alters speech in individuals with muscular dystrophy (MD). Method Eight men (23-44 years), seven with Duchenne MD and one with Becker MD, who used daytime M-NIV, were asked to sustain phonation, count, and read under three conditions: (a) (no instructions), (b) (cued to use M-NIV with all speaking breaths), and (c) (as tolerated). Breath group and inspiratory durations, syllables/breath group, and relative sound pressure level were determined from audio and video recordings. Results Uncued condition: Participants used the ventilator for all inspirations that preceded sustained phonation and counting. During reading, four participants used M-NIV for all inspirations, one never used it, and three used it for some (19%-41%) inspirations. With- versus Without-M-NIV conditions: Breath group duration was significantly longer across all tasks, syllables per breath group were significantly greater during reading, and inspiratory pause duration during reading was significantly longer with M-NIV than without. Sound pressure level was significantly higher during the first second of sustained phonation with M-NIV (though not for counting and reading). Two participants were unable to complete the reading task audibly without using their M-NIV. Conclusions Speech may be better with M-NIV than without because it is possible to produce longer breath groups and some people with severe respiratory muscle weakness may not be able to speak at all without ventilator-supplied air. Nevertheless, the longer inspiratory pauses that accompany M-NIV may interrupt the flow of speech. Future research is needed to determine the most effective way to use M-NIV for speaking and whether training participants in its use can bring even greater speech benefits.
无创通气（NIV）作为延长生命和提高生活质量的替代方法，在神经肌肉疾病患者中的应用越来越多。本研究旨在确定口部通气（M-NIV）是否会改变肌营养不良症（MD）患者的言语。
8 名男性（23-44 岁），其中 7 名为杜氏肌营养不良症患者，1 名为贝克肌营养不良症患者，他们在白天使用 M-NIV 进行持续发声、计数和朗读，在三种条件下进行：（a）无指令，（b）提示使用所有说话呼吸的 M-NIV，（c）耐受。从音频和视频记录中确定呼吸组和吸气持续时间、音节/呼吸组和相对声压级。
无提示条件：参与者在持续发声和计数前的所有吸气中都使用了呼吸机。在阅读过程中，有 4 名参与者在所有吸气中都使用了 M-NIV，1 名参与者从未使用过，3 名参与者在某些（19%-41%）吸气中使用了 M-NIV。有无 M-NIV 条件下：在所有任务中，呼吸组持续时间均显著延长，阅读时每个呼吸组的音节显著增加，且 M-NIV 下的吸气暂停时间显著长于无 M-NIV。与计数和阅读相比，M-NIV 下的持续发声最初 2 秒的声压级显著升高。有 2 名参与者如果不使用呼吸机提供的空气，就无法完全用声音完成阅读任务。
M-NIV 可能比没有 M-NIV 时的言语更好，因为它可以产生更长的呼吸组，并且一些严重呼吸肌无力的人可能根本无法在没有呼吸机供气的情况下说话。然而，伴随 M-NIV 的更长的吸气暂停可能会打断言语的流畅性。需要进一步研究以确定使用 M-NIV 进行说话的最有效方法，以及培训参与者使用它是否可以带来更大的言语益处。
