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Liou HH, Hsieh MHC, Hung DSY, Liu HL, Lee I, Lin YC, Hsiao JR, Huang CC, Ou CY, Chang CC, Lee WT, Tsai ST, Tsai SW. The Additive Effectiveness of Inspiratory Muscle Training on Glottic Closure and Subjective Voice Outcomes of Patients With Benign Lesion After Hyaluronic Acid Laryngoplasty. J Voice 2022:S0892-1997(22)00343-5. [PMID: 36513561 DOI: 10.1016/j.jvoice.2022.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES For patients with glottic insufficiency disease, injection laryngoplasty is a rapid and efficient management option that complements voice therapy. Some studies have indicated that respiratory muscle training may also show promise in patients with voice disorders. However, the effect of respiratory muscle training in patients with glottic insufficiency was reported to be limited, and whether it provides additional benefit after standard management requires further evaluation. We aimed to investigate the effectiveness of inspiratory muscle training on glottis closure and patient-reported voice quality in glottic insufficiency patients who had been treated with hyaluronic acid injection. STUDY DESIGN Retrospective observational study. METHODS We included 46 patients with glottic insufficiency who had undergone hyaluronic acid injection. Twenty of them had undergone inspiratory muscle training during three months. We measured patients' changes in glottic status according to the normalized glottal gap area and bowing index, as well as voice quality of life according to the voice handicap index 10 and the voice outcome survey, before and after training. RESULTS Patients who underwent inspiratory muscle training had higher odds of experiencing better improvement in all scores. The range of odds ratios ranged from 2.5 to 6.3 for changes in scores, and from 3.8 to 22.2 for changes in score percentages. Of note, the effect of training on percentage changes in the normalized glottal gap area score was significant (P= 0.0127) after adjustment for the duration of vocal disease, body mass index and BMI, and history of gastroesophageal reflux disease. CONCLUSIONS Inspiratory muscle training can improve the glottal gap after injection laryngoplasty, and may be applied in clinical practice.
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Affiliation(s)
- Hsin-Hao Liou
- Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Miyuki Hsing-Chun Hsieh
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - David Shang-Yu Hung
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Hui-Ling Liu
- Respiratory treatment room,Department of internal medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ishan Lee
- Respiratory treatment room,Department of internal medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Chih Lin
- Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Jenn-Ren Hsiao
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Cheng-Chih Huang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Chun-Yen Ou
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Chan-Chi Chang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Wei-Ting Lee
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Sen-Tien Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Shu-Wei Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan.
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Di Pietro DA, Olivares A, Comini L, Vezzadini G, Luisa A, Petrolati A, Boccola S, Boccali E, Pasotti M, Danna L, Vitacca M. Voice Alterations, Dysarthria, and Respiratory Derangements in Patients With Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3749-3757. [PMID: 36194769 DOI: 10.1044/2022_jslhr-21-00539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Almost 90% of people with Parkinson's disease (PD) develop voice and speech disorders during the course of the disease. Ventilatory dysfunction is one of the main causes. We aimed to evaluate relationships between respiratory impairments and speech/voice changes in PD. METHOD At Day 15 from admission, in consecutive clinically stable PD patients in a neurorehabilitation unit, we collected clinical data as follows: comorbidities, PD severity, motor function and balance, respiratory function at rest (including muscle strength and cough ability), during exercise-induced desaturation and at night, voice function (Voice Handicap Index [VHI] and acoustic analysis [Praat]), speech disorders (Robertson Dysarthria Profile [RDP]), and postural abnormalities. Based on an arbitrary RDP cutoff, two groups with different dysarthria degree were identified-moderate-severe versus no-mild dysarthria-and compared. RESULTS Of 55 patients analyzed (median value Unified Parkinson's Disease Rating Scale Part II 9 and Part III 17), we found significant impairments in inspiratory and expiratory muscle pressure (> 90%, both), exercise tolerance at 6-min walking distance (96%), nocturnal (12.7%) and exercise-induced (21.8%) desaturation, VHI (34%), and Praat Shimmer% (89%). Patients with moderate-severe dysarthria (16% of total sample) had more comorbidities/disabilities and worse respiratory pattern and postural abnormalities (camptocormia) than those with no-mild dysarthria. Moreover, the risk of presenting nocturnal desaturation, reduced peak expiratory flow, and cough ability was about 11, 13, and 8 times higher in the moderate-severe group. CONCLUSIONS Dysarthria and respiratory dysfunction are closely associated in PD patients, particularly nocturnal desaturation and reduced cough ability. In addition, postural condition could be at the base of both respiratory and voice impairments. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21210944.
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Affiliation(s)
- Davide Antonio Di Pietro
- Neurorehabilitation Unit of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - Adriana Olivares
- Scientific Direction of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - Laura Comini
- Scientific Direction of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - Giuliana Vezzadini
- Neurorehabilitation Unit of the Institute of Castel Goffredo, Istituti Clinici Scientifici Maugeri IRCCS, Mantova, Italy
| | - Alberto Luisa
- Neurorehabilitation Unit of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - Anna Petrolati
- Neurorehabilitation Unit of the Institute of Castel Goffredo, Istituti Clinici Scientifici Maugeri IRCCS, Mantova, Italy
| | - Sara Boccola
- Neurorehabilitation Unit of the Institute of Castel Goffredo, Istituti Clinici Scientifici Maugeri IRCCS, Mantova, Italy
| | - Elisa Boccali
- Neurorehabilitation Unit of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - Monica Pasotti
- Neurorehabilitation Unit of the Institute of Castel Goffredo, Istituti Clinici Scientifici Maugeri IRCCS, Mantova, Italy
| | - Laura Danna
- Neurorehabilitation Unit of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - Michele Vitacca
- Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
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Zhuang J, Jia J. Effects of Respiratory Muscle Strength Training on Respiratory-Related Impairments of Parkinson's Disease. Front Aging Neurosci 2022; 14:929923. [PMID: 35847666 PMCID: PMC9281879 DOI: 10.3389/fnagi.2022.929923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Abstract
In addition to typical motor dysfunction, Parkinson's disease is also characterized by respiratory-related dysfunction. As a means of rehabilitation, respiratory muscle strength training (RMST) has been applied to restore Parkinson's disease (PD) functions. However, the current clinical value of RMST in the application for PD has not been widely established. This article aims to review the research progress of the application of RMST in PD rehabilitation to provide new sight into respiratory-related impairments management in people with PD.
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Affiliation(s)
- Jinyang Zhuang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- *Correspondence: Jie Jia
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Vitacca M, Olivares A, Comini L, Vezzadini G, Langella A, Luisa A, Petrolati A, Frigo G, Paneroni M. Exercise Intolerance and Oxygen Desaturation in Patients with Parkinson's Disease: Triggers for Respiratory Rehabilitation? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312298. [PMID: 34886018 PMCID: PMC8656612 DOI: 10.3390/ijerph182312298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
The role that oxygen desaturation plays in exercise tolerance and its rehabilitative implications in patients with Parkinson's disease (PD) are unclear. We aimed to test exercise tolerance and oxygen saturation levels both during exercise and at night in PD patients to better define their rehabilitative needs. In clinically stable PD patients, undergoing inpatient rehabilitation, and in "ON" phase, we prospectively assessed clinical data, sleepiness, comorbidities, PD severity (Hoehn&Yahr, HY), motor function (ADLs, UPDRSII and UPDRSIII, Barthel Index, Functional Independence Measure), balance, spirometry, respiratory muscles (MIP/MEP), peak cough expiratory flow (PCEF), continuous night oxygen monitoring, and meters at 6MWT. Of 55 patients analyzed (28 with moderate-severe PD, HY ≥ 2.5), 37% and 23% showed moderate-severe impairment on UPDRSII and UPDRSIII, respectively; 96% had reduced exercise tolerance and severe respiratory muscles impairment (MIP/MEP < 45% pred.); 21.8% showed desaturations during exercise; and 12.7% showed nocturnal desaturations. At multiple regression, low exercise tolerance and low mean nocturnal and exercise-induced saturation correlated with several respiratory and motor function and disability indices (all p < 0.03). Exercise tolerance, exercise-induced desaturations, and nocturnal desaturations were extremely frequent in PD patients and were worse in more severe PD patients. This suggests considering a combined role for motor and respiratory rehabilitation in these patients.
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Affiliation(s)
- Michele Vitacca
- Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy;
- Correspondence:
| | - Adriana Olivares
- Scientific Direction of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy; (A.O.); (L.C.)
| | - Laura Comini
- Scientific Direction of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy; (A.O.); (L.C.)
| | - Giuliana Vezzadini
- Neurorehabilitation of the Institute of Castel Goffredo, Istituti Clinici Scientifici Maugeri IRCCS, 46042 Castel Goffredo, Italy; (G.V.); (A.P.); (G.F.)
| | - Annamaria Langella
- Neurorehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy; (A.L.); (A.L.)
| | - Alberto Luisa
- Neurorehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy; (A.L.); (A.L.)
| | - Anna Petrolati
- Neurorehabilitation of the Institute of Castel Goffredo, Istituti Clinici Scientifici Maugeri IRCCS, 46042 Castel Goffredo, Italy; (G.V.); (A.P.); (G.F.)
| | - Gianluigi Frigo
- Neurorehabilitation of the Institute of Castel Goffredo, Istituti Clinici Scientifici Maugeri IRCCS, 46042 Castel Goffredo, Italy; (G.V.); (A.P.); (G.F.)
| | - Mara Paneroni
- Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy;
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Al-Jarrah MD, Erekat NS. Endurance exercise training suppresses Parkinson disease-induced overexpression of apoptotic mediators in the heart. NeuroRehabilitation 2021; 48:315-320. [PMID: 33814475 DOI: 10.3233/nre-201650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUNDWe have shown elevated levels of p53 and active caspase-3 in the heart with Parkinson disease (PD). The main aim of this study is to examine the effect of treadmill training on the cardiac expression of p53 and active caspase-3 in the mouse with induced Parkinsonism. METHODS Thirty randomly selected normal albino mice were equally divided into the following 3 groups: sedentary control (SC), sedentary Parkinson diseased (SPD), and exercised Parkinson diseased (EPD). 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine and probenecid (MPTP/p) were used to induce chronic Parkinson disease in the SPD and EPD animals. The expression of p53 and active caspase-3 was investigated, using immunohistochemistry, in the heart in each animal group. RESULTS Both p53 and active caspase-3 expression was significantly (p value < 0.05) reduced in the PD heart following endurance exercise training. CONCLUSION Our present data suggest that chronic exercise training reduced PD-induced upregulation of p53 and active caspase-3 in the heart. Thus, our study suggests that inhibiting p53 and/or active caspase-3 may be considered as a therapeutic approach to ameliorate PD cardiomyopathy.
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Affiliation(s)
- Muhammed D Al-Jarrah
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Nour S Erekat
- Department of Anatomy. Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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van de Wetering-van Dongen VA, Kalf JG, van der Wees PJ, Bloem BR, Nijkrake MJ. The Effects of Respiratory Training in Parkinson's Disease: A Systematic Review. JOURNAL OF PARKINSONS DISEASE 2020; 10:1315-1333. [PMID: 32986684 PMCID: PMC7683068 DOI: 10.3233/jpd-202223] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Signs of respiratory dysfunction can be present already early in the course of Parkinson's disease (PD). Respiratory training could alleviate this, but its effectiveness is not well understood. OBJECTIVE The purpose of this systematic review is to review the efficacy of different respiratory training interventions in PD. METHODS A search strategy was performed in four databases: PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Methodological quality of original full-text articles was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for the controlled trials (CTs). Levels of evidence were rated by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. RESULTS Six papers reporting on four randomized controlled trials and another four controlled trials were included. Positive effects were reported for inspiratory muscle strength training (IMST), expiratory muscle strength training (EMST), air stacking, breath-stacking, incentive spirometry and postural training on respiratory muscle strength, swallowing safety, phonatory aspects and chest wall volumes. Best methodological quality was found for breath-stacking and incentive spirometry. Best levels of evidence were found for EMST, IMST and EMST plus air stacking. CONCLUSION Respiratory training shows positive effects and should be considered when people with PD experience respiratory dysfunction. Future studies should focus on standardizing both training devices, instruments to measure outcomes and intervention protocols to further increase the level of evidence.
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Affiliation(s)
- Veerle A van de Wetering-van Dongen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Nijmegen, the Netherlands
| | - Johanna G Kalf
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Nijmegen, the Netherlands
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation and IQ Healthcare, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology; Center of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| | - Maarten J Nijkrake
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Nijmegen, the Netherlands
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Padkao T, Boonla O. Relationships between respiratory muscle strength, chest wall expansion, and functional capacity in healthy nonsmokers. J Exerc Rehabil 2020; 16:189-196. [PMID: 32509705 PMCID: PMC7248446 DOI: 10.12965/jer.2040080.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 02/29/2020] [Indexed: 12/31/2022] Open
Abstract
Chest wall expansion determines lung volume and functional capacity. Factors determining chest wall expansion include respiratory muscle strength. Accordingly, there may be association among respiratory muscle strength, chest wall expansion, and functional capacity. Thusly, this cross-sectional study identified the relationship between respirato-ry muscle strength, chest wall expansion, and functional capacity. Seventy-six healthy male and female participants aged between 20 to 59 years exhibiting a body mass index of 18.5 to 22.9 kg/m2 were enrolled. Inspiratory and expiratory muscle strength were evaluated via maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), respectively. Chest wall expansion was measured through thoracic circumferences at three different levels; upper, middle, and lower levels with diaphragmatic movement also measured utilizing the circumference of the lower edge of the 10th rib. Functional capacity was evaluated through distance obtained from a 6-min walk test. Results showed that both MIP and MEP were significantly correlated with chest wall expansion at the middle (P=0.005 and P=0.006) and lower (P=0.012 and P=0.020) thoracic levels as well as diaphragmatic movement (both P<0.001). Moreover, both MIP and MEP were significantly related amid the 6-min walk distance (P=0.025 and P<0.001). In conclusion, respiratory muscle strength is positively associated with chest wall expansion, diaphragmatic movement, and functional capacity in healthy participants.
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Affiliation(s)
- Tadsawiya Padkao
- Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand.,Exercise and Nutrition Sciences and Innovation Research Unit, Burapha University, Chonburi, Thailand
| | - Orachorn Boonla
- Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand.,Exercise and Nutrition Sciences and Innovation Research Unit, Burapha University, Chonburi, Thailand
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