Chief Clinical Officer, Applied Clinical Scientist, Southeastern Biocommunication Associates, LLC., Birmingham, Alabama.
Consulting Voice Scientist, Southeastern Biocommunication Associates, LLC., Birmingham, Alabama.
J Voice. 2023 Jul;37(4):529-538. doi: 10.1016/j.jvoice.2021.03.014. Epub 2021 May 13.
Although dysphonia is less prevalent than dysphagia following cerebrovascular accidents, dysphonia does contribute to the burden of disease resulting from stroke. Strengthening muscles of the larynx and respiratory tract through respiratory muscle training (RMT) has proven effective in improving voice after neurological insult. However, approaches to strengthen only the expiratory muscle groups (EMST) dominate the clinical study literature, with variable outcomes. By focusing on exhalation, the contribution of inspiratory muscles to phonation may have been overlooked. This study investigated the effect of combined respiratory muscle training (cRMT) to improve voice function in stroke patients.
Recorded data of twenty patients with dysphonia following stroke were allocated to an intervention (IG) or a control group (CG) based upon whether they chose cRMT or not while awaiting pro bono voice therapy services. The intervention group (n = 10) was treated daily with three 5-minute sessions of combined resistive respiratory muscle training for 28 days, while the control group (n = 10) received no cRMT or other exercise intervention. Perceptual and acoustic measurements as well as a pulmonary function test were assessed pre-and post-intervention.
The intervention group demonstrated significant improvements after 28 days of cRMT in peak flow (127%), patient self-perception of voice improvement (84.41%), as well as in all categories of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V): overall severity (63.22%), roughness (54.76%), breathiness (61.06%), strain (63.43%), pitch range (48.11%) and loudness (57.51%), compared to the control group who did not receive treatment. Furthermore, cRMT also led to significant improvements in maximum phonation time (212.5%), acoustic parameters of vocal intensity, and total semitone range (165.45%).
This pilot study shows promise of the feasibility and effectiveness of cRMT to lessen the signs and symptoms of dysphonia while simultaneously improving breath support.
虽然脑血管意外后发生的声音障碍比吞咽障碍少见，但声音障碍确实增加了中风造成的疾病负担。通过呼吸肌训练（RMT）增强喉和呼吸道的肌肉，已被证明可有效改善神经损伤后的声音。然而，强化呼气肌群（EMST）的方法主导了临床研究文献，其结果各不相同。通过专注于呼气，可能忽略了吸气肌对发声的贡献。本研究调查了综合呼吸肌训练（cRMT）对改善中风患者声音功能的效果。
根据患者是否选择接受 cRMT 以等待免费的语音治疗服务，将 20 名中风后出现声音障碍的患者的记录数据分配到干预组（IG）或对照组（CG）。干预组（n=10）每天接受 3 次 5 分钟的综合阻力呼吸肌训练，共 28 天，而对照组（n=10）不接受 cRMT 或其他运动干预。在干预前后评估了感知和声学测量以及肺功能测试。
干预组在接受 28 天的 cRMT 后，峰值流量（127%）、患者自我感知的声音改善（84.41%）以及共识听觉-感知嗓音评估（CAPE-V）的所有类别均有显著改善：整体严重程度（63.22%）、粗糙（54.76%）、气息声（61.06%）、紧张度（63.43%）、音高范围（48.11%）和响度（57.51%），而未接受治疗的对照组则没有改善。此外，cRMT 还导致最长发声时间（212.5%）、嗓音强度和全半音阶范围的声学参数（165.45%）的显著改善。
这项初步研究表明，cRMT 具有可行性和有效性，可减轻声音障碍的迹象和症状，同时改善呼吸支持。
