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Breathing, vocal, and laryngeal aspects associated with voice therapy in individuals with Parkinson Disease: clinical trial

Abstract

Introduction: The characteristics of voice problems in Parkinson's disease are monotonous voice, with frequency and intensity restriction. The low intensity is one of first symptoms with poor speech modulation, breathing voice or hoarseness. There is inaccurate articulation speech, poor movements of thoracic and abdominal muscles with rigid and decrease movements of extrinsic and intrinsic laryngeal muscles. These characteristics are referred as hypokinetic dysarthria. The oropharyngeal dysphagia occurs between 50 to 80% of individuals with Parkinson's disease and can causes malnutrition and aspiration pneumonia. These alterations present a risk to healthy and longevity. Objective: to investigate the effectivity of Expiratory Muscle Strength Training (EMST) and voice therapy with straw phonation on breathing, vocal, laryngeal, and swallowing aspects in individuals with Parkinson's disease. There will be analyze: vocal and laryngeal symptoms, voice quality, acoustics measurements, vocal intensity, eletroglottography measurements, swallowing, respiratory measurements, voluntary cough, and quality of life. Method: clinical trial. After inclusion and exclusion criteria, the individuals will sign the consent form. The individuals will form the experimental group (EG) and control group (CG). Both group will form by the same participants: 25 individuals with Parkinson's disease, between 50 and 85 years old, both gender. The EG will receive the voice therapy and Expiratory Muscle Strength Training (EMST) in different moments. The CG will be form for the same participants of EG, but without treatment for four weeks. All individuals will receive a questionnaire, a vocal and laryngeal symptoms protocol, and a quality of life questionnaire to answer. All will be invite to voice record, laryngeal and swallowing evaluation, eletroglottography exam, respiratory and cough exams. All evaluation will happen in these moments: initial evaluation (Ev1); evaluation after four weeks, without treatment (Ev2); evaluation after voice therapy with straw phonation (Ev3); evaluation after four weeks, without treatment (Ev4); evaluation after Expiratory Muscle Strength Training (Ev5); evaluation after four weeks, without treatment (Ev6). The treatment sessions will be single, with 30 to 45 minutes, twice a week, eight sessions totally with the same therapist. To voice therapy will be use a glass tube with 27 centimeters' length, 9 millimeters' inner diameter, a plastic container with water until 10 centimeters' deep. It will be make exercises with flow phonation with some frequency and deep variation with the straw into the water. For the Expiratory Muscle Strength Training will be use the EMST 150TM dispositive. After the value obtained in expiratory maximum pressure test will be calculate the average of three maximum value and will be calculate 75% of this measurement. This value will determinate to start the EMST training with the EMST 150TM dispositive. Each participant will train five repetitions the exercise (to flow with strength until hear the dispositive signal), five times a day (total of 25 repetitions a day) for five days a week. The data will be analyzed to compare before and after evaluation, and the groups of treatments by statistical analysis. (AU)