Abstract
Introduction: Voice disorders in Parkinson Disease are usually characterized for monotone voice due to pitch modulation and loudness restriction. Approximately 90% of patients have oral communication issues, but voice is affected faster than other systems, and may be the initial symptom. However, only 3 to 4% of these patients will receive some type of voice and speech treatment. The treatment has been a challenge to professionals, and the treatments are pharmaceutical treatment, surgery procedures, speech therapy or combination of those. Regardless the type of therapy adopted, more scientific data are important to be produced in order to better guide the illness treatment, increasing the therapeutic success and the mantainence of the obtained achievements. A type of modern speech therapy that has been studied lately is telepractice using the concepts of telehealth. Some studies, yet rare, about telepractice in speech therapy of Parkinson Disease's patients are described in literature. These studies have as purpose to assess the viability and efficacy of voice and speech treatment in hypokinetic dysarthria patients due to Parkinson Disease. Purpose: to investigate the effectiveness in voice therapy using telepractice, and to compare the effects with face-to-face therapy using tube phonation method in Parkinson's disease patients. Methods: Clinical trial, random and prospective. The research will be carried out at Teachers College, Columbia University, New York in the period of 12 months. Twenty patients, from both genders, with medical diagnose of Parkinson Disease (hypokinetic dysarthria) all from the New York city area are going to be invited to join the research recruited by the Columbia University neurology clinic hospital and hospitals of the area, followed by the Speech Language Therapy of the same university - Program in Communication Sciences and Disorders Department of Biobehavioral Sciences Teachers College, Columbia University. The participants will be randomly divided in to groups: G1 with 10 individuals that will receive vocal therapy with tube phonation by telepractice (internet); G2 with 10 individuals that will receive the same vocal therapy, but by face-to-face. The individuals will be invited to answer an identification questionnaire, history and specific data of Parkinson Disease, drugs and routine data, after signing the informed consent. All participants will have their voices recorded, laryngology assessment, evaluation of Maximum Expiratory Pressure, evaluation of pulmonary function procedure and measures of cough evaluation - respiratory airflow pattern during voluntary and reflex cough, quality of life and voice questionnaire addressed, and satisfaction questionnaire. All assessments are going to be repeated after voice therapy. All subjects will receive individual voice therapy: eigth sessions, two per week, 20 minutes of duration. Voice therapy of both groups will use telepractice, through internet, as interaction tool of patient-therapist. Telepractice system will consist of two computers that will be equipped with videoconference software (Skype, telephone network through internet) with web camera and microphone. The vocal therapy will be performed by the same therapist in clinical environment at Teachers College of Columbia University. After data collection the results are going to be organized in spreadsheets and statistically analyzed with significance level of 0.05. Voice therapy of G1 and G2 are going to be compared as the pre and post treatment of both groups.
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