None listed
Conditions
Brief summary
Individuals with Parkinsons Disease typically experience changes to speech and voice associated with poor breath support. While it may be hypothesised that breathing exercises could improve communication function, available evidence does not support this. Expiratory Muscle Strength Training (EMST) devices encourage a specific style of breathing training, where individuals must use maximal strength of expiration to overcome a high level of resistance. It is hypothesised that this high challenge is more likely to lead to gains than training without a device. Training with EMST in isolation has seen improvements in voice and speech in some other populations. There is no known evidence to support its use for people with Parkinsons Disease. This case series (2 participants) study aims to determine if there perceptual change to voice volume/quality, or speech articulation following intensive training with an EMST device, with nil co-occurring therapy, in people with Parkinsons Disease.
Interventions
Participants will complete training with the ‘EMST 150™' (Aspire Products, LLC) device. This is a handheld respiratory training device, that targets strength of the expiratory muscles of breathing. The device requires users to exhale into the device with a high degree of effort, in order to overcome the resistance of a spring loaded way valve.
The 'EMST-150' device can be calibrated to individual users, to ensure a high degree of effort is required to achieve the exercise task. Throughout the
Participants will complete training with the ‘EMST 150™' (Aspire Products, LLC) device. This is a handheld respiratory training device, that targets strength of the expiratory muscles of breathing. The device requires users to exhale into the device with a high degree of effort, in order to overcome the resistance of a spring loaded way valve. The 'EMST-150' device can be calibrated to individual users, to ensure a high degree of effort is required to achieve the exercise task. Throughout the study, the device will be set to 75% of a participants maximal performance (i.e. 75% of the level of a resistance that the participant can overcome with maximal effort). This will be recalibrated as required on a weekly basis throughout the study. Participants will be asked to complete therapy 5 days a week for a total of 6 weeks, following a set treatment regimen. The treatment regimen will be 25x breaths into the device, with imposed breaks between each repetition (15 second rest between each breath until 5 breaths completed, followed by a one minute break, then complete this cycle until a total of 25 breaths completed). Breaks between each repetition are enforced in order to maintain optimised performance. Each daily set of practice is estimated to take approximately 20-25 mins. The therapy program will be overseen by the primary researcher (a speech pathologist with over 10 years experience working with people with Parkinsons Disease). Following initial demonstration of the training device, the treatment will be completed by participants independently at home (or with the assistance of a home based carer, if required). Participants will asked to keep a paper based log of their home practice so the researcher can monitor adherence to this treatment regimen, and gain insight into the participants subjective experience. This includes stating how many repetitions they did of the exercise each day, at what level of resistance the device was set, the time practiced, and any comments about their experience completing the treatment. In addition to home practice, participants will meet with the primary researcher on a weekly basis to review their progress, adjust the setting of the EMST device as needed, monitor adherence to the training schedule, and complete weekly assessment measures. These meetings will take place in an outpatient clinic, or via telehealth (based on participant preferences).
Sponsors
Illawarra Shoalhaven Local Health District
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
-Idiopathic Parkinsons disease, as diagnosed by a neurologist. -Presence of hypokinetic dysarthria as per perceptual speech pathology assessment, with characteristics including decreased volume and decline in speech articulation. To avoid ceiling effect, the study is only to include those with average conversational speaking volume lower than 70dB SLP (measured using a sound pressure meter, at 50cm distance), and with speech intelligibility (as measured on the ‘Frenchay Dysarthria’ assessment) under 90%. -Adults of any age, gender, or time post onset/diagnosis of Parkinsons Disease. -Considered by the primary researcher as cognitively able to follow the EMST treatment protocol (this may be with assistance from a carer). -Willingness to participate in the stated treatment program, to keep records of completed treatment, and to disclose any changes to medical status or interventions within the course of the treatment period.
Exclusion criteria
Participants will be excluded if they: -Are currently undergoing any other form of voice or speech treatment. -Have previously undergone intervention targeting hypokinetic dysarthria. -Have any medical interventions that may impact their voice, speech, or Parkinsons Disease symptoms (e.g. deep brain stimulation adjustment, phonosurgery, changes to their medication cycle), planned over the period of EMST treatment -Have any contraindications as per the ‘EMST-150’ device manual, i.e. suspected pregnancy, untreated hypertension, recent stroke or high risk of stroke, cardiac abnormalities, asthma or COPD, history of collapsed lung, head/neck surgery, untreated GORD.
Outcome results
None listed