摘要
目的:观察高频重复经颅磁刺激(rTMS)联合嗓音训练对帕金森病(PD)患者嗓音功能的影响。方法:选择2019年10月-2021年7月在上海市第五康复医院康复医学科和老年医学科进行治疗的帕金森病嗓音障碍患者30例,按照Excel RAND函数分为对照组和观察组,每组15例。对照组接受常规的抗PD药物治疗和常规嗓音训练,包括腹式呼吸训练、呼吸与发声协调训练、呼吸支持能力训练、嗓音实时重读训练、音调训练、声带放松训练、音质训练、共鸣放松训练等,训练时间为40 min/次,1次/d,共治疗30 d。观察组在对照组基础上进行高频rTMS刺激。采取高频(5 Hz)rTMS刺激双侧初级运动皮质区(M1区),刺激时间为每侧10 min,20 min/次,1次/d,共治疗30 d。于治疗前、治疗后(治疗30 d后)、随访(治疗结束后30 d)采用嗓音言语功能检测与矫治仪、嗓音功能检测与矫治仪进行ICF框架下的嗓音功能检测,主要包括最长声时(MPT)、最大数数能力(cMCA)、言语基频(F_(0))、基频震颤(F_(0)t)、声带接触率(CQ)、接触率微扰(CQP)、频段能量集中率(Ec)等嗓音产生指标和基频微扰(Jitter)、幅度微扰(Shimmer)、声门噪音(NNE)、/u/的第2共振峰频率(F_(2)/u/)、/i/的第2共振峰频率(F_(2)/i/)等嗓音音质指标。采用嗓音障碍指数(VHI)问卷进行患者自身嗓音障碍的主观感受评估。结果:2组治疗前MPT、cMCA、F_(0)t、Ec、F_(0)、CQ、CQP、Jitter、Shimmer、NNE、F_(2)/i/、F_(2)/u/、VHI评分均无明显区别,差异均无统计学意义(P>0.05)。与治疗前比较,2组治疗后MPT、cMCA、F_(0)t、Ec、F_(2)/i/均明显提高,F_(0)、NNE、VHI评分均明显降低(P<0.05);观察组随访MPT、cMCA、F_(0)t、Ec、F_(2)/i/均明显提高,F_(0)、NNE、VHI评分均明显降低(P<0.05)。与治疗后比较,观察组随访MPT、cMCA明显降低(P<0.05)。与对照组同一时间点比较,观察组治疗后、随访时MPT、cMCA、F_(0)t、Ec、F_(2)/i/均明显更高,CQP
Objective:To observe the effect of high frequency repetitive transcranial magnetic stimulation(rTMS)combined with voice training on voice function of patients with Parkinson's disease(PD).Methods:A total of 30 patients of Parkinson's dis‐ease with voice disorder were treated in the department of rehabilitation medicine and the department of geriatrics of Shanghai Fifth Rehabilitation Hospital from October 2019 to July 2021,which were randomly divided into the control group and the observation group according to Excel RAND function,with 15 cases in each group.The control group were treated with routine anti PD drugs and routine voice training,including abdominal breathing training,respiratory and vocal coordination training,breathing support ability training,voice real-time stress therapy,tonal training,vocal cord relaxation training,tone quality training,resonance relaxation training,etc.The training time was 40 minutes a time,once a day,continuous training for 30 days.The observation group received high-frequency rTMS stimulation on the basis of the control group.High frequency(5 Hz)rTMS was used to stimulate bilateral pri‐mary motor cortex(M1 area).The stimulation time was 10 minutes,20 minutes a time,once a day,continuous training for 30 days.Before treatment,after treatment(after treatment for 30 days)and follow-up(30 days after the end of treatment),voice function de‐tection and correction instrument,voice function detection and correction instrument were used to detect voice function under the framework of ICF,mainly including voice production index[(maximum phonation time,MPT),(maximum counting ability,cMCA),(fundamental frequency,F_(0)),(contact quotient,CQ),(contact quotient perturbation,CQP),(fundamental frequency tremor,F_(0)t),(fre‐quency band energy concentration rate,Ec)]and voice quality index[Jitter,Shimmer,(normalized noise energy,NNE),F_(2)/u/,F_(2)/i/].Voice handicap index(VHI)questionnaire were used to evaluate the subjective feelings of patients with voice disorders.Results:Be‐fore
作者
王晓雯
朱青青
陈艳
钱红
袁海新
赵刚
刘杰
张凤娇
WANG Xiaowen;ZHU Qingqing;CHEN Yan;QIAN Hong;YUAN Haixin;ZHAO Gang;LIU Jie;ZHANG Fengjiao(Shanghai Fifth Rehabilitation Hospital,Shanghai 201699,China;Shanghai First People's Hospital,Shanghai 200080,China)
出处
《康复学报》
CSCD
2022年第2期155-161,共7页
Rehabilitation Medicine
基金
上海市卫生和计划生育委员会科研课题资助项目(20194Y0467)。
关键词
帕金森病
嗓音障碍
高频重复经颅磁刺激
嗓音训练
嗓音功能
嗓音声学
Parkinson’s disease
voice disorder
high frequency transcranial magnetic stimulation
voice training
voice function
voice acoustics
