RESUMEN
Dysphagia is known to present a social and psychological burden with negative effects on quality of life. However, the psychosocial effect of an individual's dysphagia on those that care for them is less known. The purpose of this study was to develop a clinically efficient, statistically robust companion-reported outcomes measure to the Dysphagia Handicap Index (DHI) to better understand the impact of a patient's dysphagia on their companions as related to physical, emotional and functional domains of health-related quality of life. Seventy-seven initial statements describing companion perceptions of dysphagia were divided into physical, emotional and functional subscales. The statements were administered to 75 consecutive companions of individuals with dysphagia. Respondents replied never, almost never, sometimes, almost always and always to each statement and rated their companion's dysphagia severity on a 7-point equal appearing interval scale. Cronbach's α was performed to assess the internal consistency validation of the statements. The final questionnaire was reduced to 25 items and administered to 317 companions of individuals with dysphagia and 31 controls. Test-retest was performed on 29 companions of individuals with dysphagia. Cronbach's α was strong for the initial and final versions at r = 0.96 and r = 0.97 respectively. Significant differences occurred between companion responses of subjects with dysphagia and the control group. Test-retest reliability was strong (all ICC > 0.85). We present a statistically robust companion-reported outcomes measure to assess the handicapping effects of dysphagia on companions to further our understanding of the global effect of dysphagia and to guide treatment for successful swallowing outcomes.
RESUMEN
Cervical dystonia (CD) is the most common form of focal dystonia with Botulinum neurotoxin (BoNT) being a frequent method of treatment. Dysphagia is a common side effect of BoNT treatment for CD. Instrumental evaluation of swallowing in CD using standardized scoring for the videofluoroscopic swallowing study (VFSS) and validated and reliable patient-reported outcomes measures is lacking in the literature. (1) to determine if BoNT injections change instrumental findings of swallowing function using the Modified Barium Swallow Impairment Profile (MBSImP) in individuals with CD; (2) to determine if BoNT injections change self-perception of the psychosocial handicapping effects of dysphagia in individuals with CD, using the Dysphagia Handicap Index (DHI); (3) to determine the effect of BoNT dosage on instrumental swallowing evaluation and self-reported swallowing outcomes measures. 18 subjects with CD completed a VFSS and the DHI before and after BoNT injection. There was a significant increase in pharyngeal residue for pudding consistency after BoNT injection, p = 0.015. There were significant positive associations between BoNT dosage and self-perception of the physical attributes of the handicapping effect of dysphagia, the grand total score and patient self-reported severity of dysphagia on the DHI; p = 0.022; p = 0.037; p = 0.035 respectively. There were several significant associations between changes in MBSImP scores and BoNT dose. Pharyngeal efficiency of swallowing may be affected by BoNT for thicker consistencies. Individuals with CD perceive greater physical handicapping effects of dysphagia with increased amounts of BoNT units and have greater self-perceptions of dysphagia severity with increased amounts of BoNT units.
Asunto(s)
Toxinas Botulínicas Tipo A , Toxinas Botulínicas , Trastornos de Deglución , Tortícolis , Humanos , Tortícolis/complicaciones , Tortícolis/tratamiento farmacológico , Toxinas Botulínicas/efectos adversos , Deglución , Faringe , Toxinas Botulínicas Tipo A/efectos adversosRESUMEN
BACKGROUND: Vibrotactile Feedback (VF) using wearable devices is an emerging treatment option for hypophonia in Individuals with Parkinson's disease (IwPD). Studies evaluating the effectiveness of VF in improving conversational vocal intensity in real-life environment in IwPD are limited. OBJECTIVE: To determine the effect of VF on conversational vocal intensity and compare vocal intensity between a) clinic and real-life environment b) VF and Lee Silverman Voice Treatment (LSVT LOUD®)vs. VF alone in IwPD using a portable voice monitor (VocaLog2). METHODS: Eight individuals with hypophonia secondary to PD were randomly assigned to two treatment groups- VF and LSVT LOUD® (Group 1) and VF (Group 2). VF was provided using VocaLog2 device. Duration of treatment was 4 weeks for both groups. Vocal intensity was measured in the real-life environment at baseline, during treatment, and at one-month follow-up. Vocal intensity in clinic was obtained at baseline and one-month follow-up. Voice Handicap Index (VHI) questionnaire was administered at baseline and one-month follow-up. RESULTS: There was no significant difference in conversational vocal intensity between a) clinic and real-life environment at any point of time b) baseline and follow up for both treatment groups c) the two treatment groups at baseline, during each of the 4 weeks of treatment and at follow up d) VHI baseline and one month follow up scores. CONCLUSION: VF, including when combined with LSVT LOUD®, is limited in improving conversational vocal intensity in real-life in IwPD. The effects of frequency and duration of VF on conversational vocal intensity must be systematically investigated using large scale studies in IwPD.
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Disfonía , Enfermedad de Parkinson , Voz , Humanos , Disfonía/complicaciones , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson/terapia , Logopedia , Resultado del Tratamiento , Entrenamiento de la VozRESUMEN
INTRODUCTION: Whisper is known to be produced by different speakers differently, especially with respect to glottal configuration that influences glottal aerodynamics. Differences in whisper production and phonation types imply important linguistic information in many languages, are identified in vocal pathologies, are used to communicate mood and emotion, and are used in vocal performance. OBJECTIVE: The present study focused on investigating the aerodynamic differences between whisper and phonation at different loudness and adduction levels. METHODS: Three men and five women between 20 and 40 years of age participated in the study. Smooth syllable strings of the syllable /baep:/ were whispered and phonated at three different loudness levels (soft, medium, and loud) and three voice qualities (breathy, normal, and pressed). The voice qualities are associated with different adduction levels. This resulted in 18 treatment combinations (three adduction levels × three loudness levels × two sexes). RESULTS: A regression analysis was performed using a PROC MIXED procedure with SAS statistical software. Under similar production conditions, subglottal pressure was significantly lower in whisper than in phonation in 10 of 18 combinations, mean glottal airflow was significantly higher in whisper than in phonation in 13 of 18 combinations, and flow resistance was significantly lower in whisper than in phonation in 14 of 18 combinations, with the female subjects demonstrating these trends more frequently than the male subjects do. Of importance, in general, compared with phonation under similar production conditions, whisper is not always accompanied by lower subglottal pressure and higher airflows. CONCLUSION: Results from this study suggest that the typical finding of lower subglottal pressure, higher glottal airflow, and decreased flow resistance in whisper compared with phonation cannot be generalized to all individuals and depends on the "whisper type." The nine basic production conditions (three loudness levels and three adduction levels) resulted in data that may help explain the wide range of variation of whisper production reported in earlier studies.
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Glotis/fisiología , Percepción Sonora , Fonación , Acústica del Lenguaje , Percepción del Habla , Calidad de la Voz , Adulto , Resistencia de las Vías Respiratorias , Fenómenos Biomecánicos , Femenino , Glotis/anatomía & histología , Humanos , Masculino , Presión , Reología , Medición de la Producción del Habla , Factores de Tiempo , Adulto JovenRESUMEN
No instrument exists for the people of India to measure outcomes of voice disorders. The objective of this study was to develop a statistically robust tool for assessing voice disorder outcomes in the Indian population. A 32-item assessment tool called the Voice Disorder Outcome Profile (Voice-DOP) was developed after consultation with two different sets of speech-language pathologists and individuals with voice disorders. Voice-DOP measures voice disorder outcomes in three domains, physical, emotional, and functional. The questionnaire was given to 42 individuals with various voice disorders and 30 control subjects with no vocal pathology. The data obtained were subjected to measures of reliability (internal consistency and test-retest) and validity (content, construct, and concurrent). Results showed that Voice-DOP had high internal consistency (Cronbach's alpha levels from 0.49 to 0.84) and test-rest reliability (r=0.96-0.99). Voice-DOP differentiated the dysphonic group from the control group, and correlations of r=0.49-0.87 were obtained between the total Voice-DOP scores and the domain scores, findings suggesting adequate construct validity. Concurrent validity was supported by a significant correlation (r=0.51) between the Voice-DOP scores and the self-perception of severity by the individuals with dysphonia. A comparison of Voice-DOP scores between males and females revealed no significant difference in their outcomes. The conclusion of this study is that Voice-DOP is a sufficiently reliable and valid tool to measure voice disorder outcomes in the Indian population.