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PloS One 2024Deep brain stimulation (DBS) reliably ameliorates cardinal motor symptoms in Parkinson's disease (PD) and essential tremor (ET). However, the effects of DBS on speech,...
BACKGROUND
Deep brain stimulation (DBS) reliably ameliorates cardinal motor symptoms in Parkinson's disease (PD) and essential tremor (ET). However, the effects of DBS on speech, voice and language have been inconsistent and have not been examined comprehensively in a single study.
OBJECTIVE
We conducted a systematic analysis of literature by reviewing studies that examined the effects of DBS on speech, voice and language in PD and ET.
METHODS
A total of 675 publications were retrieved from PubMed, Embase, CINHAL, Web of Science, Cochrane Library and Scopus databases. Based on our selection criteria, 90 papers were included in our analysis. The selected publications were categorized into four subcategories: Fluency, Word production, Articulation and phonology and Voice quality.
RESULTS
The results suggested a long-term decline in verbal fluency, with more studies reporting deficits in phonemic fluency than semantic fluency following DBS. Additionally, high frequency stimulation, left-sided and bilateral DBS were associated with worse verbal fluency outcomes. Naming improved in the short-term following DBS-ON compared to DBS-OFF, with no long-term differences between the two conditions. Bilateral and low-frequency DBS demonstrated a relative improvement for phonation and articulation. Nonetheless, long-term DBS exacerbated phonation and articulation deficits. The effect of DBS on voice was highly variable, with both improvements and deterioration in different measures of voice.
CONCLUSION
This was the first study that aimed to combine the outcome of speech, voice, and language following DBS in a single systematic review. The findings revealed a heterogeneous pattern of results for speech, voice, and language across DBS studies, and provided directions for future studies.
Topics: Deep Brain Stimulation; Humans; Parkinson Disease; Speech; Voice; Language; Essential Tremor
PubMed: 38728329
DOI: 10.1371/journal.pone.0302739 -
Human Brain Mapping May 2024The global ageing of populations calls for effective, ecologically valid methods to support brain health across adult life. Previous evidence suggests that music can...
The global ageing of populations calls for effective, ecologically valid methods to support brain health across adult life. Previous evidence suggests that music can promote white matter (WM) microstructure and grey matter (GM) volume while supporting auditory and cognitive functioning and emotional well-being as well as counteracting age-related cognitive decline. Adding a social component to music training, choir singing is a popular leisure activity among older adults, but a systematic account of its potential to support healthy brain structure, especially with regard to ageing, is currently missing. The present study used quantitative anisotropy (QA)-based diffusion MRI connectometry and voxel-based morphometry to explore the relationship of lifetime choir singing experience and brain structure at the whole-brain level. Cross-sectional multiple regression analyses were carried out in a large, balanced sample (N = 95; age range 21-88) of healthy adults with varying levels of choir singing experience across the whole age range and within subgroups defined by age (young, middle-aged, and older adults). Independent of age, choir singing experience was associated with extensive increases in WM QA in commissural, association, and projection tracts across the brain. Corroborating previous work, these overlapped with language and limbic networks. Enhanced corpus callosum microstructure was associated with choir singing experience across all subgroups. In addition, choir singing experience was selectively associated with enhanced QA in the fornix in older participants. No associations between GM volume and choir singing were found. The present study offers the first systematic account of amateur-level choir singing on brain structure. While no evidence for counteracting GM atrophy was found, the present evidence of enhanced structural connectivity coheres well with age-typical structural changes. Corroborating previous behavioural studies, the present results suggest that regular choir singing holds great promise for supporting brain health across the adult life span.
Topics: Humans; Adult; Male; Middle Aged; Aged; Female; Young Adult; Singing; Aged, 80 and over; White Matter; Aging; Cross-Sectional Studies; Brain; Gray Matter; Diffusion Magnetic Resonance Imaging; Diffusion Tensor Imaging
PubMed: 38716698
DOI: 10.1002/hbm.26705 -
Perspectives on Medical Education 2024Collaboration between healthcare professionals from different backgrounds is a true art to be mastered. During interprofessional education (IPE), learners from different...
Collaboration between healthcare professionals from different backgrounds is a true art to be mastered. During interprofessional education (IPE), learners from different professions learn with, from and about each other. Landscape of Practice (LoP) theory can offer insight into social learning in IPE, but its application is rather complex. We argue that choir singing offers a helpful metaphor to understand different concepts in LoP ( and ) and how they are manifested in IPE. Based on similarities between choir singing and IPE, we present four lessons: 1) 2) 3) and 4) . Moreover, we reflect on differences between choir singing and IPE, and insights from these differences.
Topics: Humans; Singing; Interprofessional Education; Learning; Interprofessional Relations; Cooperative Behavior
PubMed: 38706453
DOI: 10.5334/pme.1182 -
Brazilian Journal of Otorhinolaryngology Apr 2024Identifying voice handicap and voice-related quality of life in patients presenting pulmonary impairment associated with COVID-19 infection, comparing pulmonary...
OBJECTIVES
Identifying voice handicap and voice-related quality of life in patients presenting pulmonary impairment associated with COVID-19 infection, comparing pulmonary parameters between these patients and individuals in the control group, as well as correlating pulmonary parameters to self-assessment questionnaires (IDV-10 and QVV).
METHODS
Thirty-five (35) patients presenting pulmonary impairment with COVID-19 infection were herein selected and compared to 35 individuals who were not affected by COVID-19 infection. Two self-assessment questionnaires were applied (vocal handicap index and voice quality of life protocol). Maximum phonation time Forced Expiratory Pressure (PEF) and Forced Inspiratory Pressure (PIF) were measured and videolaryngoscopy was performed.
RESULTS
There was statistically significant difference in scores recorded in voice self-assessment questionnaires (IDV-10 and QVV), Expiratory Pressure (PEF) and Forced Inspiratory Pressure (PIF) between patients with pulmonary impairment associated with COVID-19 infection and those in the control group. Correlation between PEF/PIF and scores recorded in voice self-assessment questionnaires was also observed.
CONCLUSION
Pulmonary impairment associated with COVID-19 infection has worsened voice handicap and voice-related quality of life in the assessed patients, as well as reduced their forced expiratory and inspiratory pressure in comparison to the control group.
PubMed: 38701618
DOI: 10.1016/j.bjorl.2024.101437 -
BMJ Open Respiratory Research May 2024Singing for lung health (SLH) is an arts-based breathing control and movement intervention for people with long-term respiratory conditions, intended to improve symptoms... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Singing for lung health (SLH) is an arts-based breathing control and movement intervention for people with long-term respiratory conditions, intended to improve symptoms and quality of life. Online, remotely delivered programmes might improve accessibility; however, no previous studies have assessed the effectiveness of this approach.
METHODS
We conducted an assessor-blind randomised controlled trial comparing the impact of 12 weeks of once-weekly online SLH sessions against usual care on health-related quality of life, assessed using the RAND 36-Item Short Form Health Survey (SF-36) Mental Health Composite (MHC) and Physical Health Composite (PHC) scores.
RESULTS
We enrolled 115 people with stable chronic obstructive pulmonary disease (COPD), median (IQR) age 69 (62-74), 56.5% females, 80% prior pulmonary rehabilitation, Medical Research Council dyspnoea scale 4 (3-4), forced expiratory volume in 1 s % predicted 49 (35-63). 50 participants in each arm completed the study. The intervention arm experienced improvements in physical but not mental health components of RAND SF-36; PHC (regression coefficient (95% CI): 1.77 (95% CI 0.11 to 3.44); p=0.037), but not MHC (0.86 (95% CI -1.68 to 3.40); p=0.504). A prespecified responder analysis based on achieving a 10% improvement from baseline demonstrated a response rate for PHC of 32% in the SLH arm and 12.7% for usual care (p=0.024). A between-group difference in responder rate was not found in relation to the MHC (19.3% vs 25.9%; p=0.403).
DISCUSSION AND CONCLUSION
A 12-week online SLH programme can improve the physical component of quality of life for people with COPD, but the overall effect is relatively modest compared with the impact seen in research using face-to-face group sessions. Further work on the content, duration and dose of online interventions may be useful.
TRIAL REGISTRATION NUMBER
NCT04034212.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Female; Male; Middle Aged; Quality of Life; Aged; Singing; Treatment Outcome; Lung; Forced Expiratory Volume; Breathing Exercises; Single-Blind Method
PubMed: 38697677
DOI: 10.1136/bmjresp-2024-002365 -
JTCVS Open Apr 2024The incidence of postoperative complications, including dysphagia, increases as the population undergoing cardiovascular surgery ages. This study aimed to explore the...
OBJECTIVE
The incidence of postoperative complications, including dysphagia, increases as the population undergoing cardiovascular surgery ages. This study aimed to explore the potential of maximum phonation time (MPT) as a simple tool for predicting postextubation dysphagia (PED) and major adverse cardiac and cerebrovascular events (MACCEs).
METHODS
This retrospective study included 442 patients who underwent elective cardiac surgery at a university hospital. MPT was measured before surgery, and patients were stratified into 2 groups based on normal and abnormal MPTs. Postoperative complications, including PED and MACCEs, were also investigated. Swallowing status was assessed using the Food Intake Level Scale.
RESULTS
MPT predicted PED with prevalence of 11.0% and 18.0% in the normal and abnormal MPT groups, respectively ( = .01). During the follow-up period, MACCEs developed in 17.0% of patients. Frailty, European System for Cardiac Operative Risk Evaluation II score, PED, and MPT were markedly associated with MACCEs (adjusted hazard ratios: 2.25, 1.08, 1.96, and 0.96, respectively). Mediation analysis revealed that MPT positively influenced PED and MACCEs, whereas PED positively influenced MACCEs. The trend in restricted cubic spline analysis indicated that the hazard ratio for MACCEs increased sharply when MPT was <10 seconds.
CONCLUSIONS
These findings underscore the potential of MPT as a valuable tool in the preoperative assessment and management of patients undergoing cardiac surgery. By incorporating MPT into routine preoperative evaluations, clinicians can identify patients at a higher risk of PED and MACCEs, allowing for targeted interventions and closer postoperative monitoring. This may improve patient outcomes and reduce the health care costs associated with these complications.
PubMed: 38690425
DOI: 10.1016/j.xjon.2024.02.002 -
ENeuro May 2024Singing-based treatments of aphasia can improve language outcomes, but the neural benefits of group-based singing in aphasia are unknown. Here, we set out to determine... (Randomized Controlled Trial)
Randomized Controlled Trial
Singing-based treatments of aphasia can improve language outcomes, but the neural benefits of group-based singing in aphasia are unknown. Here, we set out to determine the structural neuroplasticity changes underpinning group-based singing-induced treatment effects in chronic aphasia. Twenty-eight patients with at least mild nonfluent poststroke aphasia were randomized into two groups that received a 4-month multicomponent singing intervention (singing group) or standard care (control group). High-resolution T1 images and multishell diffusion-weighted MRI data were collected in two time points (baseline/5 months). Structural gray matter (GM) and white matter (WM) neuroplasticity changes were assessed using language network region of interest-based voxel-based morphometry (VBM) and quantitative anisotropy-based connectometry, and their associations to improved language outcomes (Western Aphasia Battery Naming and Repetition) were evaluated. Connectometry analyses showed that the singing group enhanced structural WM connectivity in the left arcuate fasciculus (AF) and corpus callosum as well as in the frontal aslant tract (FAT), superior longitudinal fasciculus, and corticostriatal tract bilaterally compared with the control group. Moreover, in VBM, the singing group showed GM volume increase in the left inferior frontal cortex (Brodmann area 44) compared with the control group. The neuroplasticity effects in the left BA44, AF, and FAT correlated with improved naming abilities after the intervention. These findings suggest that in the poststroke aphasia group, singing can bring about structural neuroplasticity changes in left frontal language areas and in bilateral language pathways, which underpin treatment-induced improvement in speech production.
Topics: Humans; Neuronal Plasticity; Male; Female; Middle Aged; Aphasia; Aged; Singing; Gray Matter; White Matter; Stroke; Chronic Disease; Brain; Magnetic Resonance Imaging; Treatment Outcome
PubMed: 38688718
DOI: 10.1523/ENEURO.0408-23.2024 -
Bioengineering (Basel, Switzerland) Mar 2024Voicing: requires frequent starts and stops at various sound pressure levels (SPL) and frequencies. Prior investigations using rigid laryngoscopy with oral endoscopy...
UNLABELLED
Voicing: requires frequent starts and stops at various sound pressure levels (SPL) and frequencies. Prior investigations using rigid laryngoscopy with oral endoscopy have shown variations in the duration of the vibration delay between normal and abnormal subjects. However, these studies were not physiological because the larynx was viewed using rigid endoscopes. We adapted a method to perform to perform simultaneous high-speed naso-endoscopic video while simultaneously acquiring the sound pressure, fundamental frequency, airflow rate, and subglottic pressure. This study aimed to investigate voice onset patterns in normophonic males and females during the onset of variable SPL and correlate them with acoustic and aerodynamic data.
MATERIALS AND METHODS
Three healthy males and three healthy females were studied by simultaneous high-speed video laryngoscopy and recording with the production of the gesture [pa:pa:] at soft, medium, and loud voices. The fiber optic endoscope was threaded through a pneumotachograph mask for the simultaneous recording and analysis of acoustic and aerodynamic data.
RESULTS
The average increase in the sound pressure level (SPL) for the group was 15 dB, from 70 to 85 dB. The fundamental frequency increased by an average of 10 Hz. The flow was increased in two subjects, reduced in two subjects, and remained the same in two subjects as the SPL increased. There was a steady increase in the subglottic pressure from soft to loud phonation. Compared to soft to medium phonation, a significant increase in glottal resistance was observed with medium-to-loud phonation. Videokymogram analysis showed the onset of vibration for all voiced tokens without the need for full glottis closure. In loud phonation, there is a more rapid onset of a larger amplitude and prolonged closure of the glottal cycle; however, more cycles are required to achieve the intended SPL. There was a prolonged closed phase during loud phonation. Fast Fourier transform (FFT) analysis of the kymography waveform signal showed a more significant second- and third-harmonic energy above the fundamental frequency with loud phonation. There was an increase in the adjustments in the pharynx with the base of the tongue tilting, shortening of the vocal folds, and pharyngeal constriction.
CONCLUSION
Voice onset occurs in all modalities, without the need for full glottal closure. There was a more significant increase in glottal resistance with loud phonation than that with soft or middle phonation. Vibration analysis of the voice onset showed that more time was required during loud phonation before the oscillation stabilized to a steady state. With increasing SPL, there were significant variations in vocal tract adjustments. The most apparent change was the increase in tongue tension with posterior displacement of the epiglottis. There was an increase in pre-phonation time during loud phonation. Patterns of muscle tension dysphonia with laryngeal squeezing, shortening of the vocal folds, and epiglottis tilting with increasing loudness are features of loud phonation. These observations show that flexible high-speed video laryngoscopy can reveal observations that cannot be observed with rigid video laryngoscopy. An objective analysis of the digital kymography signal can be conducted in selected cases.
PubMed: 38671756
DOI: 10.3390/bioengineering11040334 -
Scientific Reports Apr 2024This study aims to examine the relationship between the locations of Fovea Palatinae and the posterior vibrating line in different classes of soft palate angulation...
This study aims to examine the relationship between the locations of Fovea Palatinae and the posterior vibrating line in different classes of soft palate angulation (House Classification), accordingly determine its reliability as a landmark and a tool for determining the posterior limit of the maxillary complete denture. 280 completely edentulous patients with normal healthy mucosa from both genders were randomly selected. The House classification of the soft palate angulation was identified and recorded as Class I, II, or III. Phonation was used to determine the position of the vibrating line. The Fovea Palatinae was then marked. Then, the distance between the Fovea Palatinae and the vibrating line was measured and recorded. Finally, the relative position of the Fovea Palatinae to the vibrating line was recorded as being anterior, posterior, or on the vibrating line. The Chi Square test, the effect size measures (Eta and Cramer's V tests), The Spearman's Rho rank correlation test, and multinominal logistic regression analysis were utilized to analyse the data. House classification percentages were measured among people whose Fovea Palatinae was detectable; Class II palate was the most prevalent (47.14%), followed by Class I (43.93%), and then Class III (8.93%). Based on vibrating line position, 129 (58%) had a vibrating line anterior to Fovea Palatinae, 57 (26%) on the Fovea Palatinae, 36 (16%) posterior to Fovea Palatinae, and in 58 (21%) Fovea Palatinae were not detected. The mean distance between the vibrating line and Fovea Palatinae was 3.66 ± 1.6 mm anteriorly and 2.97 ± 1.36 mm posteriorly. No significant differences were found between males and females in regard to House classification and vibrating line position. The odds of having the fovea posterior to the vibrating line would increase by 5% for each year increase in the age (P = 0.035, odds ratio = 1.050). Class II House classification of the soft palate was found to be the most prevalent among the study participants. Also, the vibrating line was anterior to the Fovea Palatinae in the majority of cases. The odds of having the fovea posterior to the vibrating line would increase by age. The Fovea Palatinae could be considered a useful guide for locating the vibrating line.
Topics: Humans; Female; Male; Middle Aged; Palate, Soft; Aged; Jordan; Mouth, Edentulous; Adult; Vibration; Denture, Complete
PubMed: 38671220
DOI: 10.1038/s41598-024-60162-y -
German Medical Science : GMS E-journal 2024Rhinophonia aperta may result from velopharyngeal insufficiency. Neuromuscular electrical stimulation (NMES) has been discussed in the context of muscle strengthening....
INTRODUCTION
Rhinophonia aperta may result from velopharyngeal insufficiency. Neuromuscular electrical stimulation (NMES) has been discussed in the context of muscle strengthening. The aim of this study was to evaluate in healthy subjects whether NMES can change the velopharyngeal closure pattern during phonation and increase muscle strength.
METHOD
Eleven healthy adult volunteers (21-57 years) were included. Pressure profiles were measured by high resolution manometry (HRM): isolated sustained articulation of /a/ over 5 s (protocol 1), isolated NMES applied to soft palate above motor threshold (protocol 2) and combined articulation with NMES (protocol 3). Mean activation pressures (MeanAct), maximum pressures (Max), Area under curve (AUC) and type of velum reactions were compared. A statistical comparison of mean values of protocol 1 versus protocol 3 was carried out using the Wilcoxon signed rank test. Ordinally scaled parameters were analyzed by cross table.
RESULTS
MeanAct values measured: 17.15±20.69 mmHg (protocol 1), 34.59±25.75 mmHg (protocol 3) on average, Max: 37.86±49.17 mmHg (protocol 1), 87.24±59.53 mmHg (protocol 3) and AUC: 17.06±20.70 mmHg.s (protocol 1), 33.76±23.81 mmHg.s (protocol 3). Protocol 2 produced velum reactions on 32 occasions. These presented with MeanAct values of 13.58±12.40 mmHg, Max values of 56.14±53.14 mmHg and AUC values of 13.84±12.78 mmHg.s on average. Statistical analysis comparing protocol 1 and 3 showed more positive ranks for MeanAct, Max and AUC. This difference reached statistical significance (p=0.026) for maximum pressure values.
CONCLUSIONS
NMES in combination with articulation results in a change of the velopharyngeal closure pattern with a pressure increase of around 200% in healthy individuals. This might be of therapeutic benefit for patients with velopharyngeal insufficiency.
Topics: Humans; Adult; Male; Female; Phonation; Young Adult; Middle Aged; Pressure; Palate, Soft; Electric Stimulation Therapy; Manometry; Velopharyngeal Insufficiency; Muscle Strength; Healthy Volunteers
PubMed: 38651019
DOI: 10.3205/000329