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Yuen CWN, Ma EPM. Systematic Review: Singing-Based Interventions to Improve Physical Functions Related to Aging Voice in Older Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:2139-2158. [PMID: 38875480 DOI: 10.1044/2024_jslhr-23-00641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
PURPOSE This systematic review aimed to evaluate the effects of singing as an intervention for aging voice. METHOD Quantitative studies of interventions for older adults with any medical condition that involves singing as training were reviewed, measured by respiration, phonation, and posture, which are the physical functions related to the aging voice. English and Chinese studies published until April 2024 were searched using 31 electronic databases, and seven studies were included. The included articles were assessed according to the Grading of Recommendations, Assessment, Development, and Evaluations rubric. RESULTS Seven studies were included. These studies reported outcome measures that were related to respiratory functions only. For the intervention effect, statistically significant improvements were observed in five of the included studies, among which three studies had large effect sizes. The overall level of evidence of the included studies was not high, with three studies having moderate levels and the rest having lower levels. The intervention activities included trainings other than singing. These non-singing training items may have caused co-intervention bias in the study results. CONCLUSIONS This systematic review suggests that singing as an intervention for older adults with respiratory and cognitive problems could improve respiration and respiratory-phonatory control. However, none of the included studies covers the other two of the physical functions related to aging voice (phonatory and postural functions). The overall level of evidence of the included studies was not high either. There is a need for more research evidence in singing-based intervention specifically for patient with aging voice.
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Affiliation(s)
- Crystal W-N Yuen
- Voice Research Laboratory, Faculty of Education, The University of Hong Kong
| | - Estella P-M Ma
- Voice Research Laboratory, Faculty of Education, The University of Hong Kong
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Govender R, Gilbody N, Simson G, Haag R, Robertson C, Stuart E. Post-Radiotherapy Dysphagia in Head and Neck Cancer: Current Management by Speech-Language Pathologists. Curr Treat Options Oncol 2024; 25:703-718. [PMID: 38691257 PMCID: PMC11222272 DOI: 10.1007/s11864-024-01198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 05/03/2024]
Abstract
OPINION STATEMENT Dysphagia, difficulty in eating and drinking, remains the most common side effect of radiotherapy treatment for head and neck cancer (HNC) with devastating consequences for function and quality of life (QOL). Over the past decade, 5-year survival has improved due to multiple factors including treatment advances, reduction in smoking, introduction of the human papillomavirus (HPV) vaccine and more favourable prognosis of HPV-related cancers. Increased prevalence of HPV-positive disease, which tends to affect younger individuals, has led to an elevated number of people living for longer with the sequelae of cancer and its treatment. Symptoms are compounded by late effects of radiotherapy which may lead to worsening of dysphagia for some long-term survivors or new-onset dysphagia for others. Speech-language pathology (SLP) input remains core to the assessment and management of dysphagia following HNC treatment. In this article, we present current SLP management of dysphagia post-radiotherapy. We discuss conventional treatment approaches, the emergence of therapy adjuncts and current service delivery models. The impact of adherence on therapy outcomes is highlighted. Despite treatment advancements, patients continue to present with dysphagia which is resistant to existing intervention approaches. There is wide variation in treatment programmes, with a paucity of evidence to support optimal type, timing and intensity of treatment. We discuss the need for further research, including exploration of the impact of radiotherapy on the central nervous system (CNS), the link between sarcopenia and radiotherapy-induced dysphagia and the benefits of visual biofeedback in rehabilitation.
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Affiliation(s)
- Roganie Govender
- Head & Neck Academic Centre& UCL Division of Surgery & Interventional ScienceGround Floor Central, University College London Hospital, 250 Euston Road, London, NW1 2PQ, UK.
| | - Nicky Gilbody
- North Middlesex University Hospital NHS Trust, London, UK
| | | | | | - Ceri Robertson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Emma Stuart
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
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Liu Y, Hou R, Yu Q, Niu Q. Effect of voice training intervention on swallowing function in patients with head and neck cancer undergoing radiotherapy: A randomized controlled trial. Eur J Oncol Nurs 2024; 70:102551. [PMID: 38642524 DOI: 10.1016/j.ejon.2024.102551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/13/2024] [Accepted: 03/03/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE We aimed to evaluate the effect of voice training in patients with head and neck cancer who were undergoing radiotherapy. METHOD This study used a randomized controlled trial design. IBM SPSS 26.0 was used to randomly divide 74 patients into a control group and an experimental group. The control group followed a swallowing exercises program, and the experimental group additionally received ABCLOVE voice training. Both training programs continued throughout the entire radiotherapy cycle. We compared standardized swallowing assessment (SSA), maximum phonation time (MPT), the Voice Handicap Index-10, and incidence of complications such as difficulty opening the mouth, malnutrition, and aspiration between the two groups at T1 (0 radiotherapy sessions, before radiotherapy), T2 (15-16 radiotherapy sessions, middle of radiotherapy), and T3 (30-32 radiotherapy sessions, end of radiotherapy). RESULTS 70 participants completed this study. Swallowing function and MPT intergroup and interaction effects were statistically significant between the two groups (P < 0.05). At the end of radiotherapy (T3), the SSA score (20.77 ± 1.96) and MPT (10.98 ± 1.75) s in the experimental group were superior to those in the control group (SSA: 22.06 ± 2.38 and MPT: 9.49±1.41 s), with statistical significance (P<0.05). Moreover, the incidence of malnutrition and aspiration in the experimental group was lower than that in the control group (P < 0.05). CONCLUSION Voice training can improve swallowing function and MPT and reduce complications related to swallowing disorders in patients with head and neck cancer.
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Affiliation(s)
- Yan Liu
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Ran Hou
- Department of Otolaryngology Head and Neck Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China.
| | - Qinqin Yu
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Qiaohong Niu
- Department of Nursing Unit, Shanxi Cancer Hospital, Taiyuan, China
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Horyacheva A, Boyce K, Badesha M, Kerr C, Najeeb H, Namasivayam-MacDonald A. Identifying Non-Traditional Approaches to Swallowing Rehabilitation: A Scoping Review. Dysphagia 2024; 39:321-347. [PMID: 37853297 DOI: 10.1007/s00455-023-10622-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023]
Abstract
In recent years, dysphagia care has shifted toward a more patient-centered approach. This means that dysphagia clinicians are considering more factors in the treatment process including the goals of care, quality of life, and cultural values. The purpose of this scoping review was to examine relevant research and identify dysphagia interventions outside of those traditionally used by dysphagia clinicians that may improve swallowing function. A review of relevant studies was conducted using search terms related to swallowing and treatment. The search yielded 8439 unique studies. Of the 283 articles that underwent a full-text review, 37 articles were included in the final review. These articles highlighted three potential areas of non-traditional dysphagia intervention that may serve to provide holistic care, while also aiming to improve swallowing mechanisms: acupuncture and Eastern medicine interventions, vocal exercises, and physical function exercises. The results suggest that dysphagia clinicians should work collaboratively with other allied health professionals and consider non-traditional approaches to dysphagia care. Through the identification of potentially effective but non-traditional or non-Eurocentric interventions for dysphagia care, clinicians may promote a culturally relevant, patient-centered approach, in turn increasing patient acceptance of treatment plans and compliance. Future research should explore the efficacy and feasibility of these interventions in dysphagia rehabilitation, as well as their effectiveness compared to more traditional approaches.
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Affiliation(s)
- Angela Horyacheva
- School of Rehabilitation Science, McMaster University, 1280 Main Street West, IAHS 403, Hamilton, ON, L8S 4L8, Canada
| | - Keara Boyce
- School of Rehabilitation Science, McMaster University, 1280 Main Street West, IAHS 403, Hamilton, ON, L8S 4L8, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Maneetpal Badesha
- School of Rehabilitation Science, McMaster University, 1280 Main Street West, IAHS 403, Hamilton, ON, L8S 4L8, Canada
| | | | - Hiba Najeeb
- School of Rehabilitation Science, McMaster University, 1280 Main Street West, IAHS 403, Hamilton, ON, L8S 4L8, Canada
- St. Mary's General Hospital, Kitchener, ON, Canada
| | - Ashwini Namasivayam-MacDonald
- School of Rehabilitation Science, McMaster University, 1280 Main Street West, IAHS 403, Hamilton, ON, L8S 4L8, Canada.
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Yeo MS, Hwang J, Lee HK, Kim SJ, Cho SR. Therapeutic singing-induced swallowing exercise for dysphagia in advanced-stage Parkinson's disease. Front Neurol 2024; 15:1323703. [PMID: 38628693 PMCID: PMC11018993 DOI: 10.3389/fneur.2024.1323703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Background With longer life spans and medical advancements, the rising number of patients with advanced-stage Parkinson's disease (PD) warrants attention. Current literature predominantly addresses dementia and fall management in these patients. However, exploring the impact of swallowing function on patients with advanced PD is crucial. Previous research has demonstrated notable enhancements in the quality of life related to voice for participants following a group singing-intervention program. To further elucidate the effect of individual singing-induced swallowing exercises, our study aimed to investigate the quantitative and qualitative effects of therapeutic singing on swallowing function in patients with advanced PD in comparison to a matched usual care control group. The hypothesis of this study is that therapeutic singing-induced swallowing exercises can assist to maintain swallowing function in patients with advanced PD. Methods This prospective matched control study compared the effects of a 6-week therapeutic singing-based swallowing intervention on swallowing function and quality of life in patients with advanced PD. The intervention group received individual sessions with a music therapist and conventional individual physical therapy. The control group received the same standard physical therapy for 6 weeks without music intervention. The primary outcome measure was Video Fluoroscopic Dysphagia Scale (VDS). Results The study revealed that the intervention group maintained swallowing function, whereas the control group experienced deterioration, indicating significant time-dependent changes in Penetration-Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety Scale (NIH-SSS), and VDS. Analysis of PAS and NIH-SSS liquid food scores in both groups showed significant time effects. However, the intervention group exhibited no significant differences between the pre- and post-tests, indicating preservation of the swallowing function. VDS of liquid food indicated an interaction effect between time and group in the pharyngeal phase and total scores. The Swallowing-Quality of Life showed significant time-effect improvement in the intervention group. Conclusion Therapeutic singing exercises may help maintain swallowing function in advanced PD patients, potentially enhancing quality of life related to swallowing in those with advanced-stage diseases. Clinical trial registration https://cris.nih.go.kr/cris/search/listDetail.do, identifier KCT0008644.
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Affiliation(s)
- Myung Sun Yeo
- Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, Republic of Korea
| | - Jihye Hwang
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Kyoung Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo Ji Kim
- Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, Republic of Korea
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kim SJ, Yeo MS, Kim SY, Kang SY. A scoping review of music-based interventions for swallowing difficulties: implications for treating older adults with presbyphagia. Front Med (Lausanne) 2023; 10:1285835. [PMID: 38034547 PMCID: PMC10687455 DOI: 10.3389/fmed.2023.1285835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives Presbyphagia refers to age-related changes in the swallowing mechanism (e.g., reduced skeletal muscle strength that decreases bolus control). If left untreated, these changes can lead to dysphagia, which refers to impaired swallowing (e.g., coughing or choking when eating). Given that swallowing difficulties are common among older adults that they make up the fastest growing age group globally, the need for interventions to address presbyphagia is gaining urgency. To begin to address this need, we conducted a scoping review to analyze music therapy research aimed at enhancing swallowing function. The objective was to identify key intervention characteristics and propose clinical implications for treating presbyphagia using music therapy. Methods This review followed the methodological frameworks outlined by Arksey and O'Malley and Levac et al. and used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews for analysis and reporting. Four electronic databases (i.e., ProQuest, PubMed, RISS, Web of Science) were searched for quantitative and qualitative studies in English or Korean that used music-based interventions to address swallowing function in older adults. Content analysis was conducted to identify and compare the main features of music interventions for swallowing difficulties among older adults. Results Ten articles were identified and analyzed. It was found that three core components-respiration, vocalization, and singing-were employed to enhance swallowing function in populations with neurological impairments, dementia, or head and neck cancer. Notably, actions closely linked to swallowing function, such as laryngeal elevation and oral movements, were utilized therapeutically to speak or sing. Based on these characteristics, clinical implications are proposed to address presbyphagia. Conclusion Singing entails a systematic and focused incorporation of stepwise activities that can be used to address swallowing disorders. In this context, critical clinical implications that music therapists should consider when treating individuals with presbyphagia include warmup breathing, vocalizing targeting laryngeal control, and singing targeting oral motor control. This review can contribute to the expansion of music therapy with older adults and the advancement of music therapy techniques.
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Affiliation(s)
- Soo Ji Kim
- Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, Republic of Korea
| | - Myung Sun Yeo
- Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, Republic of Korea
| | - So Yeon Kim
- Department of Music Therapy, Graduate School, Ewha Womans University, Seoul, Republic of Korea
| | - Seo Yeon Kang
- Department of Music Therapy, Graduate School, Ewha Womans University, Seoul, Republic of Korea
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Niu C, Zhou W, Wang H, Zhang Y, Cai J, Lu N, Wang Y. The effect of voice training interventions on patients with oropharyngeal dysphagia: a systematic review. Eur Arch Otorhinolaryngol 2023; 280:973-984. [PMID: 36342516 PMCID: PMC9899714 DOI: 10.1007/s00405-022-07719-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Voice training has been proposed as an intervention to improve swallowing function in patients with dysphagia. However, little is known about the effects of voice training on swallowing physiology. OBJECTIVES This systematic review investigates the effect of voice training on the swallowing function of patients with oropharyngeal dysphagia and provides the theoretical basis for improving the swallowing function and life quality of patients with oropharyngeal dysphagia. DATA SOURCES A systematic review using a narrative synthesis approach of all published studies was sought with no date restrictions. Five electronic databases (EMBASE, PubMed, CINAHL, Web of Science, and The Cochrane Library) were searched from inception to April 2022. STUDY SELECTION Eight studies were included. Two researchers screened the literature according to inclusion and exclusion criteria, extracted data, and carried out quality control according to the Cochrane handbook5.1.0. Data were analyzed narratively and descriptively. CONCLUSIONS In general, statistically significant positive therapy effects were found. Voice training improves the oral and pharyngeal stages of swallowing in patients with neurological causes of dysphagia, such as stroke, and in patients with non-neurological causes of dysphagia, such as head and neck cancer. However, the current literature is limited and further primary research is required to provide more evidence to support voice training intervention in dysphagia. Future studies could further refine the content of voice training interventions, increase the number of patients enrolled, assess the long-term effects of voice training interventions and add associated assessments of the quality of life after treatment.
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Affiliation(s)
- Chunyan Niu
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Wenyan Zhou
- Changshu Second People's Hospital, Changshu, 215500, China
| | - Haifang Wang
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Yingying Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Jianzheng Cai
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Nini Lu
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yalan Wang
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
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