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      Effects of Lax Vox Voice Therapy on Respiration and Phonation in Patients with Parkinson’s Disease

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      https://www.riss.kr/link?id=A106393371

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      국문 초록 (Abstract)

      배경 및 목적: 파킨슨병은 운동기능에 영향을 미치는 중추신경계의 퇴행성 질환으로 자신의 음성을 자가 모니터링을 하지 못하여 음성의 강도와 음도 조절에 어려움을 보이는 감각장애이다...

      배경 및 목적: 파킨슨병은 운동기능에 영향을 미치는 중추신경계의 퇴행성 질환으로 자신의 음성을 자가 모니터링을 하지 못하여 음성의 강도와 음도 조절에 어려움을 보이는 감각장애이다. 반폐쇄성도훈련 중 Lax Vox는 튜브를 물에 넣어 발성하는 것으로 호흡, 공명, 발성의 상호작용에 초점을 맞추어 bio-feedback을 제공하는 총체적인 기법이다. 본 연구는 Lax Vox 음성치료가 파킨슨병 환자의 호흡 및 발성에 미치는 영향을 알아보고자 한다. 방법: 파킨슨병 환자 10명(남자 4명, 여자 6명)을 대상으로 Lax Vox 음성치료를 주 1회 간격으로 6주간 총 6회 실시하였다. 치료효과를 살펴보기 위해 음성치료 전후 공기역학적, 음향학적, 청지각적 평가, 전기성문파형 검사 및 한국어판 음성장애지수-10을 실시하였다. 결과: 음성치료 후 공기역학적, 음향학적 및 청지각적 평가 측정치와 음성장애지수가 유의하게 개선되었다. 특히, 폐활량, 음성 강도, 최대발성지속시간이 증가하였으며, 성문하압이 유의미하게 감소하였다. CPP와 음성범위프로파일, 발화 시 평균 강도가 유의하게 증가하였으며, sPPQ, vF0, shimmer, APQ, sAPQ, vAm가 감소하고, 한국어판 음성장애지수-10의 총점이 낮아졌다. 논의 및 결론: Lax Vox 음성치료는 파킨슨병 환자의 호흡 및 발성 능력에 긍정적인 효과가 있음을 확인하였으며, LSVT와 더불어 Lax Vox 음성치료는 파킨슨병 환자의 효과적인 치료법이 될 수 있음을 시사하였다.

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      다국어 초록 (Multilingual Abstract)

      Objectives: Parkinson’s disease (PD) is a degenerative disease of the central nervous system that mainly affects sensory and motor function. PD patients have difficulty in controlling their vocal pitch and loudness, and poor self-monitoring due to t...

      Objectives: Parkinson’s disease (PD) is a degenerative disease of the central nervous system that mainly affects sensory and motor function. PD patients have difficulty in controlling their vocal pitch and loudness, and poor self-monitoring due to their sensory disorder. Among semi-occluded vocal tract exercises, Lax Vox is a holistic method that provides bio-feedback by focusing on the interaction of breathing, resonance, and phonation by tube phonation in water. The purpose of this study was to investigate the effect of Lax Vox voice therapy on respiration and phonation in patients with PD. Methods: Ten patients with PD (4 males and 6 females) underwent Lax Vox voice therapy six times a week for 6 weeks. To assess the effectiveness of Lax Vox voice therapy, aerodynamic, acoustic evaluation, GRBAS scale, electroglottography, and Korean Voice Handicap Index (KVHI)-10 were performed before and after voice therapy. Results: Significant improvement in aerodynamic, acoustic, auditory-perceptual rating measures, and KVHI-10 score was yielded following Lax Vox voice therapy. After treatment, significantly increased vital capacity (VC) and maximum phonation time (MPT); and reduced subglottal pressure (Psub) were observed. Cepstral peak prominence (CPP) was significantly increased and smoothed pitch perturbation quotient (sPPQ), vF0, shimmer, amplitude perturbation quotient (APQ), smoothed APQ (sAPQ), peak-amplitude variation (vAm) were significantly decreased after treatment. Moreover, Voice Range Profile (VRP) was extended and KVHI-10 scored significantly lower. Conclusion: Current outcomes confirmed that significantly positive effects were found in respiration and phonation change following Lax Vox voice therapy for patients with PD. Therefore, Lax Vox voice therapy, in addition to Lee Silverman Voice Treatment, can be useful for an effective treatment option in patients with PD.

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      목차 (Table of Contents)

      • 연구방법 연구결과 논의 및 결론
      • 연구방법 연구결과 논의 및 결론
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      참고문헌 (Reference)

      1 김지성, "후두마사지와 반폐쇄성도훈련이 과기능적 음성장애 환자의 음성개선에 미치는 효과" 한국언어청각임상학회 22 (22): 806-817, 2017

      2 윤영선, "한국어판 음성장애지수(Voice Handicap Index, VHI)의 타당도 및 VHI-10의 임상적 유용성" 한국언어청각임상학회 13 (13): 216-241, 2008

      3 최성희, "음성장애 환자의 음질 평가를 위한 표준문장 개발" 한국청각언어재활학회 14 (14): 128-142, 2018

      4 임혜진, "연축성 발성장애 환자의 Lax Vox 음성치료 효과" 한국음성학회 8 (8): 57-63, 2016

      5 채혜림, "반폐쇄성도훈련이 기능적 실성증 환자의 음성 개선에 미치는 효과" 대한후두음성언어의학회 30 (30): 48-52, 2019

      6 Ramig, L., "Voice treatment for patients with Parkinson disease : development of an approach and preliminary efficacy data" 2 : 191-209, 1994

      7 Titze, I. R., "Voice training and therapy with a semi-occluded vocal tract: rationale and scientific underpinnings" 49 (49): 448-459, 2006

      8 Ramig, L., "Voice therapy: clinical case studies" Plural Publishing 281-291, 2019

      9 Ramig, L. O., "Voice therapy for neurologic disease" 3 (3): 174-182, 1995

      10 Kent, R. D., "Voice dysfunction in dysarthria : application of the Multi-Dimensional Voice Program" 36 (36): 281-306, 2003

      1 김지성, "후두마사지와 반폐쇄성도훈련이 과기능적 음성장애 환자의 음성개선에 미치는 효과" 한국언어청각임상학회 22 (22): 806-817, 2017

      2 윤영선, "한국어판 음성장애지수(Voice Handicap Index, VHI)의 타당도 및 VHI-10의 임상적 유용성" 한국언어청각임상학회 13 (13): 216-241, 2008

      3 최성희, "음성장애 환자의 음질 평가를 위한 표준문장 개발" 한국청각언어재활학회 14 (14): 128-142, 2018

      4 임혜진, "연축성 발성장애 환자의 Lax Vox 음성치료 효과" 한국음성학회 8 (8): 57-63, 2016

      5 채혜림, "반폐쇄성도훈련이 기능적 실성증 환자의 음성 개선에 미치는 효과" 대한후두음성언어의학회 30 (30): 48-52, 2019

      6 Ramig, L., "Voice treatment for patients with Parkinson disease : development of an approach and preliminary efficacy data" 2 : 191-209, 1994

      7 Titze, I. R., "Voice training and therapy with a semi-occluded vocal tract: rationale and scientific underpinnings" 49 (49): 448-459, 2006

      8 Ramig, L., "Voice therapy: clinical case studies" Plural Publishing 281-291, 2019

      9 Ramig, L. O., "Voice therapy for neurologic disease" 3 (3): 174-182, 1995

      10 Kent, R. D., "Voice dysfunction in dysarthria : application of the Multi-Dimensional Voice Program" 36 (36): 281-306, 2003

      11 Baker, K. K., "Thyroarytenoid muscle activity associated with hypophonia in Parkinson disease and aging" 51 (51): 1592-1598, 1998

      12 Kim, J. U., "The review of Parkinson’s Disease (PD) for physical therapist" 8 (8): 73-87, 2002

      13 Simberg, S., "The resonance tube method in voice therapy: description and practical implementations" 32 (32): 165-170, 2007

      14 Chu, I. S., "The effect of revised LSVT program on voice and speech intelligibility in patients with idiopathic Parkinson disease" Daegu University 1998

      15 Perez, K. S., "The Parkinson larynx : tremor and videostroboscopic findings" 10 (10): 354-361, 1996

      16 최성희, "The Effect of Lee Silverman Voice Treatment(LSVT®) on Parkinsonian Phonation: Nonlinear Dynamic, Perturbation, and Perceptual Analysis" 한국언어청각임상학회 16 (16): 335-345, 2011

      17 El Sharkawi, A., "Swallowing and voice effects of Lee Silverman Voice Treatment(LSVT) : a pilot study. Journal of Neurology" 72 (72): 31-36, 2002

      18 Sapir, S., "Speech loudness and quality 12 months after intensive voice treatment (LSVT) for Parkinson’s disease: a comparison with an alternative speech treatment" 54 (54): 296-303, 2002

      19 Solomon, N. P., "Speech breathing in able-bodied children and children with cerebral palsy : a review of the literature and implications for clinical intervention" 7 (7): 61-78, 1998

      20 Ghadah G. Alharbi, "Spectral/Cepstral Analyses of Phonation in Parkinson’s Disease before and after Voice Treatment: A Preliminary Study" S. Karger AG 71 (71): 275-285, 2019

      21 Koller, W. C., "Sensory symptoms in Parkinson’s disease" 34 (34): 957-959, 1984

      22 Choi, S. H., "Semi-occluded vocal tract exercise accent method, straw phonation, Lax Vox" 4 (4): 11-19, 2017

      23 Tyrmi, J., "Resonance tube or lax vox?" 31 (31): 430-437, 2017

      24 Titze, I. R., "Raising lung pressure and pitch in vocal warm-ups : the use of flow-resistant straws" 58 (58): 329-338, 2002

      25 Snider, S. R., "Primary sensory symptoms in parkinsonism" 26 (26): 423-423, 1976

      26 Dromey, C., "Phonatory and articulatory changes associated with increased vocal intensity in Parkinson disease: a case study" 38 (38): 751-764, 1995

      27 Jankovic, J., "Parkinson’s disease: clinical features and diagnosis" 79 (79): 368-376, 2008

      28 Sovijärvi, A., "Nya metoder vid behandlingen av röstrubbningar" 3 : 121-131, 1969

      29 Poewe, W., "Non‐motor symptoms in Parkinson’s disease" 15 (15): 14-20, 2008

      30 Hillen, M. E., "Nonmotor fluctuations in patients with Parkinson’s disease" 47 (47): 1180-1183, 1996

      31 Saffarian, A., "Lee Silverman voice treatment (LSVT) mitigates voice difficulties in mild Parkinson’s disease" 33 : 5-, 2019

      32 Sackley, C. M., "Lee Silverman Voice Treatment versus standard speech and language therapy versus control in Parkinson’s disease: a pilot randomised controlled trial (PD COMM pilot)" 4 (4): 30-, 2018

      33 Wight, S., "Lee Silverman Voice Treatment for people with Parkinson’s: audit of outcomes in a routine clinic" 50 (50): 215-225, 2015

      34 Sihvo, M., "Lax vox voice therapy technique"

      35 Brown, R. G., "Internal versus external cues and the control of attention in Parkinson’s disease" 111 (111): 323-345, 1988

      36 Spielman, J., "Intensive voice treatment(LSVT LOUD)for Parkinson’s disease following deep brain stimulation of the subthalamic nucleus" 44 (44): 688-700, 2011

      37 Halpern, A. E., "Innovative technology for the assisted delivery of intensive voice treatment(LSVT LOUD)for Parkinson disease" 21 (21): 354-367, 2012

      38 Martel Sauvageau, V., "Impact of the LSVT on vowel articulation and coarticulation in Parkinson’s disease" 29 (29): 424-440, 2015

      39 Fadel, C. B. X., "Immediate effects of the semi-occluded vocal tract exercise with LaxVox tube in singers" 28 (28): 618-624, 2016

      40 Titze, I. R., "How to use the flow resistant straws" 58 (58): 429-430, 2002

      41 Searl, J., "Feasibility of group voice therapy for individuals with Parkinson’s disease" 44 (44): 719-732, 2011

      42 Kang, Y. A., "Effects of the Lee Silverman Voice Treatment (LSVT) on voice quality of patients with Parkinson’s disease" Chungnam National University 2007

      43 Simberg, S., "Effects of speech therapy on voice and speech in Parkinson’s after a 15-day rehabilitation course : a pilot study" 19 (19): 273-285, 2012

      44 Schulz, G. M., "Effects of speech therapy and pharmacologic and surgical treatments on voice and speech in Parkinson’s disease : a review of the literature" 33 (33): 59-88, 2000

      45 Kim, J. S., "Effects of self voice care program for Korean speech-language pathologists" 1-4, 2018

      46 Arias, P., "Effects of rhythmic sensory stimulation(auditory, visual)on gait in Parkinson’s disease patients" 186 (186): 589-601, 2008

      47 Sapir, S., "Effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on vowel articulation in dysarthric individuals with idiopathic Parkinson disease: acoustic and perceptual findings" 50 (50): 899-912, 2007

      48 Laukkanen, A. M., "Effects of a semioccluded vocal tract on laryngeal muscle activity and glottal adduction in a single female subject" 60 (60): 298-311, 2008

      49 최성희, "Effects of Deep Brain Stimulation (DBS) on Speech and Voice in Parkinson’s Disease: Acoustic Measures of Vowels from Sustained Phonation and Running Speech Using Perturbation and Nonlinear Dynamic Analysis" 한국언어청각임상학회 17 (17): 143-155, 2012

      50 Whitehill, T. L., "Effect of LSVT on lexical tone in speakers with Parkinson’s disease" 2011 : 897494-, 2011

      51 Gelb, D. J., "Diagnostic criteria for Parkinson disease" 56 (56): 33-39, 1999

      52 Titze, I. R., "Current topics in voice production mechanisms" 113 (113): 421-427, 1993

      53 Fox, C. M., "Current perspectives on the Lee Silverman Voice Treatment(LSVT)for individuals with idiopathic Parkinson disease" 11 (11): 111-123, 2002

      54 Ramig, L. O., "Comparison of two forms of intensive speech treatment for Parkinson disease" 38 (38): 1232-1251, 1995

      55 Jeon, C. Y., "Comparison of the Lee Silverman Voice Treatment (LSVT LOUD) effects for patients with Parkinson’s disease versus Parkinson-plus syndrome" Daegu Catholic University 2017

      56 Darley, F. L., "Clusters of deviant speech dimensions in the dysarthrias" 12 (12): 462-496, 1969

      57 Aronson, A. E., "Clinical voice disorders: an interdisciplinary approach" Thieme 1990

      58 Sewall, G. K., "Clinical evaluation of Parkinson’s‐related dysphonia" 116 (116): 1740-1744, 2006

      59 Ramig, L. O., "Changes in vocal loudness following intensive voice treatment (LSVT) in individuals with Parkinson’s disease: a comparison with untreated patients and normal age‐matched controls" 16 (16): 79-83, 2001

      60 Guzman, M., "Changes in glottal contact quotient during resonance tube phonation and phonation with vibrato" 27 (27): 305-311, 2013

      61 Gath, I., "Analysis of vocal tract parameters in Parkinsonian speech" 84 (84): 1628-1634, 1988

      62 Guzmán, M., "Air pressure and contact quotient measures during different semioccluded postures in subjects with different voice conditions" 30 (30): 759.e1-759.e10, 2016

      63 Ramig, L. O., "Aerodynamic mechanisms underlying treatment-related changes in vocal intensity in patients with Parkinson disease" 39 (39): 798-807, 1996

      64 Jiang, J., "Aerodynamic measurements of patients with Parkinson’s disease" 13 (13): 583-591, 1999

      65 Lee, J. Y., "Acoustic analysis of speech in patients with idiopathic Parkinson’s disease" Chungnam National University 2007

      66 Berry, D. A., "A quantitative output-cost ratio in voice production" 44 (44): 29-37, 2001

      67 Rubow, R., "A microcomputer-based wearable biofeedback device to improve transfer of treatment in Parkinsonian dysarthria" 50 (50): 178-185, 1985

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