EmpowerHER: A Pilot Study to Increase Physical Activity and Strength Through Powerbuilding.

Engaging in empowering exercise develops movement competency (MC) and strength and supports physical health, mental well-being, and quality of life. Powerbuilding combines powerlifting and bodybuilding to increase physical activity (PA), MC, and strength. To our knowledge, powerbuilding has not been explored as an exercise intervention. This pilot study investigated the impact of an eight-week powerbuilding intervention on women's PA, MC, strength, and empowerment. Eighteen women aged 25.1±9.8 with no powerbuilding experience participated in the intervention, meeting three times weekly for one hour. PA and MC were assessed pre- and post-intervention. Three-repetition maximum (3-RM) tests in the squat, bench press, and deadlift were completed in weeks one and eight of the intervention. Data were checked for normality; the Wilcoxon signed-rank test was used for non-normally distributed data. The McNemar test was used to analyze differences in dichotomous variables. Effect size was calculated and interpreted as follows small (r=0.1, d=0.2, ω=0.1), medium (r=0.3, d=0.5, ω=0.3), and large (r=0.5, d=0.8, ω=0.5) Total PA ([t(17)=3.52, p=0.003, d=0.83]) and participants who met the PA guidelines (Z=6.13, p=0.008, ω=0.82) increased significantly from pre- to post-intervention. Participants' MC scores improved significantly from pre- (24.3±3.5) to post-intervention (29.5±2.5; [t(17)=10.04, p<0.001; d=2.37]). Significant increases in strength were observed (squat [Z=-3.73, p<0.001, r=0.88], bench press [Z=-3.73, p<0.001, r=0.88], and deadlift [t(17)=16.41, p<0.001; d=3.87]). Empowerment in exercise scores averaged 56.3±6.6 (on a scale of 5-65). The intervention significantly increased total PA, improved MC, increased strength, and facilitated empowerment. Women's participation in powerbuilding may enhance their quality of life.

Voice Improvement in Patients with Functional Dysphonia Treated with the Proprioceptive-Elastic (PROEL) Method.

The objective of the study was to analyze the outcome of the proprioceptive-elastic (PROEL) voice therapy method in patients with functional dysphonia (FD). Fifty-two patients with FD were involved in the study; they were composed of three subgroups of patients with (1) FD without glottal insufficiency (n = 28), (2) FD and glottal insufficiency (n = 9), and (3) FD, glottal insufficiency, and vocal nodules (n = 15). A multidimensional assessment protocol including videolaryngostroboscopy; maximum phonation time; perceptual evaluation of dysphonia with the Grade, Instability, Roughness, Breathiness, Asthenia, and Strain (GIRBAS) scale; and 10-item version of the Voice Handicap Index was conducted before and after 15 sessions of voice therapy. All voice therapy sessions were conducted by the same speech-language pathologist. The comparison between voice assessment before and after voice therapy with the PROEL method in patients with FD, in all the three subgroups, revealed a statistically significant improvement in periodicity and the mucosal wave in the laryngostroboscopy, maximum phonation time, GIRBAS scale scores, and VHI-10. Voice of patients with FD improved after treatment with the PROEL method. Further studies are needed to analyze the efficacy of the PROEL method with randomized double-blind clinical trials using different methods for voice therapy. At present, the PROEL method represents an alternative tool for the speech pathologist to improve voice in patients with FD.

Efficacy of targeted supradose cisplatin and concomitant radiation therapy for advanced head and neck cancer: the Memphis experience.

PURPOSE/OBJECTIVE: To evaluate the feasibility, response rates, and toxicity of a Phase II study using targeted supradose cisplatin and concurrent radiation therapy in unresectable Stage III-IV head and neck squamous cell carcinoma. METHODS AND MATERIALS: Sixty patients presenting between 6/93-9/94 were enrolled, 44 (73%) of whom had T4 and/or N2-N3 nodal disease. All patients were treated with rapid targeted superselective intraarterial infusions of cisplatin (150 mg/m2 weekly x 4) and simultaneous sodium thiosulfate intravenously (9 g/m2) for systemic neutralization of cisplatin. Concurrent (day 1) daily radiation therapy was delivered to the primary tumor and overt nodal disease to 66-74 Gy while the uninvolved lower neck received 50 Gy, at 2.0 Gy/fraction. RESULTS: Fifty-one (85%) patients completed the full RADPLAT protocol as planned. Fifty-seven of 60 patients were evaluable for response. Histological (n = 50) or clinical (n = 7) assessment of primary site revealed a complete response (CR) in 52 patients, partial response (PR) in 4, and stable disease (SD) in 1. Of the 40 patients presenting with nodal metastases, pathological (n = 31) or clinical (n = 6) assessment revealed a CR in 25, PR in 11, and SD in 1, while 3 were unevaluable. Overall, for both primary site and nodal disease, CR was attained in 44 (75%), PR in 12 (23%), and SD in 1 (2%) of the 57 evaluable patients. Only 2 (4%) of 57 evaluable patients have recurred above the clavicle, 1 in the primary site and 1 in the regional lymph nodes. Twelve patients (23%) have failed in distant sites. Grade III/VI toxicity has included gastrointestinal in 6, hematologic in 6, mucosal in 12, vascular in 4, and neurological in 4 patients. CONCLUSION: Concurrent radiation therapy and targeted supradose cisplatin (i.e., RADPLAT) can be safely delivered with high response rates and excellent loco-regional control in advanced Stage III/IV head and neck squamous cell carcinoma.

The effects of 17 alpha-methyltestosterone on myocardial function in vitro.

Testosterone analogs have been used as performance enhancers by athletes for more than 40 yr. We asked whether the anabolic steroid 17 alpha-methyl-4-androstene-17-ol-3-one (17 alpha-MT) would affect intrinsic contractile function of the heart. Male Sprague-Dawley rats, 125-150 g, were treated with 17 alpha-MT either parenterally or orally for up to 8 wk. Intrinsic contractile function of the hearts was assessed utilizing both the isolated working heart and isovolumic perfused heart preparations. Isolated working hearts from 17 alpha-MT-treated rats had a 45% decrease in heart work attributable largely to a similarly decreased stroke volume. Isovolumic perfused hearts from treated animals had elevated left ventricular systolic and diastolic pressures at similar interventricular volumes compared to controls. Rates of ventricular pressure development (+dP/dT) or relaxation (-dP/dT) were unchanged as a result of the treatment. However, static elastance was reduced in potassium-arrested hearts from the 17 alpha-MT treatment (63% increase in interventricular pressure), consistent with a limitation being imposed on stroke volume by a decreased myocardial compliance. Hydroxyproline content of the hearts was not altered by 17 alpha-MT treatment suggesting that increased stiffness was not a consequence of collagen proliferation. Treatment of the steroid rats with beta-aminopropionitrile, a compound that inhibits lysyl oxidase, restored the left ventricular volume-pressure relationship (elastance curve) to that of control hearts. Thus, chronic treatment with anabolic steroids appears to reduce left ventricular compliance, possibly related to an enhanced activity of lysyl oxidase, and results in increased crosslink formation between collagen strands in the extracellular matrix.

Acoustic characteristics of speech following uvulopalatopharyngoplasty.

Selective uvulopalatopharyngoplasty has resulted in the improved management of sleep apnea; however, the effect of the surgery on speech has not been systematically evaluated. In this study, the speaking fundamental frequency, reading rate, and first and second formants of the vowels of four patients were measured acoustically presurgically and postsurgically. The results indicate that the length of time needed to read a passage was reduced in all four patients 2 weeks following surgery compared to the presurgical duration. In addition, the second formant of nine vowels studied was lower postsurgically. No changes in speaking fundamental frequency were found in three of the four patients; in the fourth, the speaking fundamental frequency was lower by approximately one semitone. Based on the reduced reading rates from the presurgical to the postsurgical conditions, changes in respiratory parameters in addition to vocal tract parameters warrant assessment when evaluating the speech of individuals prior to and following uvulopalatopharyngoplasty.

Aerodynamic relationships associated with normal phonation and paralytic dysphonia.

Physiological differences between normal speakers and those with unilateral vocal cord paralysis are presented. Pressure readings taken intraorally and subglotically are compared during phonation of consonants requiring laryngeal closure and those not requiring cord approximation. From our studies, it is apparent that: (1) a significant difference in air pressure patterns exists between normal speakers and those with vocal cord paralysis, (2) the respiratory apparatus tends to alter normally constant airflow in cases of vocal fold paralysis and (3) either voice therapy or teflon cord injection will significantly alter the aerodynamic relationships from the untreated paralyzed state.

Effects of botulinum toxin therapy in patients with adductor spasmodic dysphonia: acoustic, aerodynamic, and videoendoscopic findings.

Botulinum toxin has been previously reported to be successful in the treatment of spasmodic dysphonia. To objectively document results, 11 patients with adductor spasmodic dysphonia who received unilateral treatment of the thyroarytenoid muscle were studied. Acoustic analyses and airflow rates during sustained phonation and flexible videoendoscopy were performed prior to, 1 week and 1 month after injection. 1. Acoustic parameters demonstrated significant voice improvement, although abnormal characteristics remained. 2. Mean airflow rates were increased 1 week after injection with almost normal values 1 month later. 3. Videolaryngoscopy showed an effective reduction of intrinsic laryngeal muscle hyperfunction with less effect on extrinsic muscle activity. Interrelations between videolaryngoscopic rating scores, acoustic results and aerodynamic results are discussed.

Spasmodic dysphonia. Emotional status and botulinum toxin treatment.

The objectives of this study were to determine the effects of botulinum toxin injection on measures of depression, anxiety, and somatic complaints in patients diagnosed as having spasmodic dysphonia. Patients were asked to complete preinjection questionnaires with self-ratings of depression, state and trait anxiety, and somatic complaints. Approximately 1 week and 2 months following injection, patients were again asked to complete the questionnaires. The spasmodic dysphonic subjects exhibited significantly elevated mean levels of depression and anxiety. These levels were significantly reduced approximately 1 week after injection. Two months later, depression and anxiety measures did not change significantly from their 1-week postinjection values. The results suggest that patients with spasmodic dysphonia who demonstrate significantly elevated measures of depression and anxiety show a reduction in those measures following treatment with botulinum toxin.

Eating and weight changes following chemoradiation therapy for advanced head and neck cancer.

OBJECTIVE: To describe the functional outcomes of weight loss and eating following a targeted chemoradiation protocol consisting of a selective supradose of intra-arterial cisplatin (150 mg/m2 per week for 4 weeks) with parenteral sodium thiosulfate and external-beam irradiation (1.8-2.0 Gy per fraction per day for 35 days). SUBJECTS AND DESIGN: Forty-seven patients with advanced head and neck cancer treated with a targeted chemoradiation protocol were monitored for weight and eating status before treatment and as long as 18 months after treatment. RESULTS: A statistically significant weight loss (P<.001) occurred during the targeted chemoradiation protocol, with a mean weight ratio of 90% of the starting weight. The ability to eat also declined, with an increase in reported swallowing difficulties and a need for percutaneous endoscopic gastrostomy tubes from 4 (9%) to 12 (26%). There were no significant changes in weight after the initial weight loss. Tumor stage and nodal involvement had no effect on weight loss. At the start of treatment, 18 patients (38%) reported normal eating and 4 (8%) required a feeding tube. By 18 months after treatment, 41 (87%) were eating normally, 34 (72%) reported normal eating, and 6 (13%) required a percutaneous endoscopic gastrostomy tube. CONCLUSIONS: Patients undergoing a targeted chemoradiation protocol for head and neck cancer lost about 10% of their pretreatment weight and had a decline in eating ability. Difficulty swallowing during the treatment may be due to adverse effects such as mucositis and nausea. By 18 months after therapy, most were able to eat normally and maintain their weight.

Assessing vocal function after chemoradiation for advanced laryngeal carcinoma.

OBJECTIVE: To identify objective parameters that could serve as valid indicators of vocal function in evaluating patients treated at multiple centers for head and neck cancer. DESIGN: Objective measures of voice were validated against functional outcome measures of voice and communication. SETTING: A multidisciplinary university-based ambulatory head and neck cancer clinic. SUBJECTS: Fifteen patients at varying posttreatment intervals after chemoradiation therapy for head and neck cancer and 5 volunteers with no cancer but with a history of heavy smoking and drinking. MAIN OUTCOME MEASURES: Acoustic and aerodynamic parameters were measured in patients with head and neck cancer after treatment with combined chemotherapy and irradiation and in control subjects. Communicative function was assessed by perceptual assessment of recorded voice samples, by a clinician-based communication score, and by patient self-rating of voice and communication. RESULTS: Both perceptual analysis and communication score were concordant with patient self-rating of voice and communication ability. Acoustic measures were abnormal in patients, and jitter scores correlated with listener ratings of perceived voice quality. However, acoustic measures did not relate to communication function, as assessed by either the patient or the clinician. Laryngeal resistance demonstrated a significant correlation with both patient and observer assessments of voice quality and communication function. Laryngeal resistance was on average twice as high in patients who complained of voice fatigue, but this difference was not statistically significant. CONCLUSIONS: Laryngeal resistance, determined during standardized phonation, is a reliable objective parameter of vocal function after chemoradiation therapy for head and neck cancer. A standardized clinician-based communication scale holds promise as a useful tool. Acoustic measures reflect the sound of the voice but not the ability to communicate effectively.

A novel organ preservation protocol for advanced carcinoma of the larynx and pharynx.

OBJECTIVE: To pilot a targeted chemoradiation protocol for patients with advanced carcinoma of the larynx and pharynx that would circumvent upper aerodigestive tract dysfunction related to major oncologic surgery. DESIGN: Weekly intra-arterial infusions of supradose cisplatin (150 mg/m2 per week x 4) rapidly delivered to the tumor bulk, simultaneous intravenous sodium thiosulfate for systemic drug neutralization, and conventional external-beam irradiation (1.80-2.00 Gy per fraction x 35) were used. Between February 1991 and April 1994, 42 patients were treated who would otherwise have required a major resection of the tongue base, pharyngeal wall, or larynx. MAIN OUTCOME MEASURES: Tumor response, toxic effects, disease control above the clavicle, preservation of the larynx, maintenance of oral nutrition, and overall and disease-related 2-year survival. RESULTS: Three complications were related to the weekly transfemoral superselective intra-arterial procedures performed 160 times. Grade 3 to 4 chemotoxic effects were infrequent, occurring in 9 (5.5%) of 160 cycles, and only 1 patient required a radiotherapy break because of severe mucositis. A complete response in the primary site was obtained in 36 (86%) of 42 patients, 2 of whom had residual disease in the neck. Median follow-up was 13 months (range, 3-46 months). To date, there have been 5 recurrences: 2 regional and 3 distant. The 2-year overall and disease-related survival was 64% and 76%, respectively. The rate of disease control above the clavicle at 2 years was 86%. CONCLUSIONS: We believe this chemoradiation protocol represents an effective management scheme for patients with advanced head and neck cancer while minimizing dysfunction and possibly improving survival.

Voice onset time production and perception in apraxic subjects.

This study explored the relationship between the perception and production of voice onset time (VOT) in apraxic subjects. Spectrograms of the words, "bees" and "peas" spoken by apraxic subjects were acoustically analyzed to obtain a measure of VOT. The subjects also identified the initial cognate ("b" or "p") from synthetically generated speech spanning a voiced to voiceless time continuum. The results suggest that apraxic subjects have production as well as perceptual errors in the voicing feature but no significant relationship was found between the two measures.

Aspiration: cause and implications.

The purpose of this investigation was to determine the overall prevalence of aspiration in dysphagic individuals referred for a modified barium swallow and the underlying anatomic and/or physiologic causes. A total of 166 patients were seen during a 1-month period at 5 participating institutions. Aspiration was detected in 51.2% of the patients. The most common causes were decreased laryngeal elevation and delayed triggering of the pharyngeal motor response. A history of aspiration pneumonia was significantly associated with the presence of aspiration on modified barium swallow study. The presence of a protective cough was present in only 53% of patients who aspirated, reinforcing the need for appropriate radiologic assessment in patients with suspected dysphagia.

Acoustic, aerodynamic, and videostroboscopic features of bilateral vocal fold lesions.

Successful treatment of bilateral vocal fold lesions depends on the accuracy of the diagnosis. For example, the preferred treatment for vocal fold nodules is voice therapy: in contrast. treatment for a unilateral vocal fold lesion with a contralateral reactive vocal fold lesion (UVFL/RL) usually involves phonosurgery and voice therapy. Differentiation between vocal fold nodules and a UVFL/ RL is often challenging. The purpose of this study was to facilitate diagnostic accuracy and improve treatment for patients with bilateral vocal fold lesions by attempting to identify distinct features of patients with either vocal fold nodules or a UVFL/RL with acoustic, aerodynamic, stroboscopic, and patient self-perception measures. The objective voice analysis, Voice Handicap Index, and laryngovideostroboscopic examinations of 85 patients with bilateral vocal fold lesions were reviewed. The results indicated that the patients with a UVFL/RL presented a diagnostic profile that was significantly different from that of patients with vocal fold nodules. Statistically significant differences were found for 1) symmetry of vocal fold vibration, 2) amplitude perturbations, 3) estimated subglottic pressure, and 4) Voice Handicap Index. These results suggest that a composite assessment of acoustic, aerodynamic, and videostroboscopic phonatory features facilitates differentiation between patients with vocal fold nodules and those with a UVFL/RL. The improved diagnostic accuracy afforded by multiparametric assessment provides a comprehensive framework for the treatment of these two distinct vocal fold disorders.

Diagnostic laryngeal endoscopy.

Diagnostic laryngeal endoscopy is a crucial part of the evaluation of patients with dysphonia. Multiple methods are available, and often several are required to provide a comprehensive physiologic and anatomic evaluation. The pros and cons of each method are discussed and the development of a standardized examination protocol is reviewed.

Outcome measurements and quality of life in voice disorders.

Although outcome research in the area of voice is truly in its beginning stages, the clinician who treats voice disorders should be aware of its potential usefulness. It is possible to identify a patient's perception of severity using one of several voice-specific outcome measures. Using these measures may also direct treatment in a more specific manner. For example, although a patient may have a vocal fold polyp or cyst, a low Voice Handicap Index may indicate that immediate surgery is unnecessary. A more conservative treatment approach or observation only may be appropriate. In this way, medical resources and time can be used most appropriately. Certainly one must never compromise treatment when significant disease is suspected. In the absence of significant disease, however, the patient's perceived severity and need to recover vocal function may determine treatment.

Nomenclature of voice disorders and vocal pathology.

An improved nomenclature framework is crucial to improve communication regarding voice problems and to advance the field of voice disorders. The subjective nature of the voice evaluation process does not lend itself readily to uniformity and most voice-disordered patients demonstrate multiple pathologic processes. In this article, the authors offer a broad-based nomenclature paradigm for the classification of voice disorders and vocal pathology. Four major categories of voice disorders are identified based on pathophysiology and auditory-perceptual and visual-perceptual observations. As the understanding of vocal fold biomechanics and pathophysiology evolves, it is expected that this nomenclature system will also increase in specificity.

Vocal education for the professional voice user and singer.

Providing education on voice-related anatomy, physiology, and vocal hygiene information is the responsibility of every voice care professional. This article discusses the importance of a vocal education program for singers and professional voice users. An outline of a vocal education lecture is provided.

Voice therapy methods in dysphonia.

Voice therapy, the behavioral approach to the treatment of disorders of voice, can take many forms. The intent of this article is to provide informative, useful, and usable information about a selected number of therapy techniques and methods. Some methods are all-inclusive and stand alone in the belief that they are adequate and appropriate for treatment of certain conditions or many conditions. The article presents a description, the rationale, key points in manner of use, concerns, and expectations for the methods and techniques described.

Laryngeal electromyography: diagnostic and prognostic applications.

Laryngeal electromyography is a crucial diagnostic test in laryngology. Laryngeal electromyography is important for the diagnosis of vocal fold paresis and cricoarytenoid joint pathology (e.g., arytenoid dislocation). In addition, laryngeal electromyography offers prognostic information regarding potential vocal fold paralysis recovery, which can improve the management strategies for vocal fold paralysis.