Effect of Clinical Expertise on Efficacy of Vocal Function Exercises in Individuals With Typical Voice

OBJECTIVES/HYPOTHESIS

To determine the effect of clinical expertise on efficacy of Vocal Function Exercises (VFEs) as measured by change in percent of maximum phonation time goal attained. The hypothesis was that clinical expertise would result in greater increases in percent of maximum phonation time goal attained.

STUDY DESIGN

Randomized controlled trial.

METHODS

A convenience sample of 19 individuals with typical voice was recruited in a university academic clinic setting. All participants completed baseline assessment and 17 completed all study procedures. Participants were randomized to receive VFEs from an expert voice clinician with more than 40 years' experience (expert group (EG)) or from a master's student in Communication Sciences and Disorders trained in VFEs (novice group (NG)). The primary outcome measure was change in percent of maximum phonation time goal attained during VFE tasks 1 and 4.

RESULTS

Mean change scores for maximum phonation time were 27.71 (P = 0.001) and 25.31 (P = 0.003) for EG and NG, respectively. Both groups improved significantly on the primary outcome measure, but the difference between groups was not statistically significant (P = 0.759). A Hedges'-g effect size of -0.14 [-1.10, 0.81] was obtained comparing EG and NG groups, indicating a small negative effect of limited clinical expertise on VFE outcomes in individuals with typical voice.

CONCLUSIONS

Speech-language pathologists with varied levels of expertise are capable of efficaciously administering VFEs in individuals with typical voice.

The Effect of Maximum Phonation Time Goal on Efficacy of Vocal Function Exercises

OBJECTIVES/ HYPOTHESIS

To determine the effect of maximum phonation time goal on efficacy of Vocal Function Exercises (VFEs) as measured by percent of maximum phonation time goal attained. The hypothesis was that provision of a maximum phonation time goal would result in greater increases in percent of maximum phonation time goal attained.

STUDY DESIGN

Randomized controlled trial.

METHODS

A convenience sample of individuals with normal voice were recruited in a university academic clinic setting. Of 34 participants who volunteered for the study, 28 completed baseline assessment and 19 completed all study procedures. Participants were randomized to complete VFEs with knowledge of their maximum phonation time goal (standard goal, SG), with knowledge of their maximum phonation time goal after three weeks (delayed goal, DG), or without knowledge of their maximum phonation time goal (no goal, NG). The primary outcome measure was percent of maximum phonation time goal obtained during VFE tasks one and four.

RESULTS

Mean change scores for maximum phonation time were 32.50 (SG), 34.55 (DG), and 21.02 (NG). Hedges' g effect sizes of -0.10 (-1.19, 0.99) and 0.56 (-0.55, 1.67) were obtained comparing DG and SG groups, and NG and SG groups, respectively.

CONCLUSIONS

Absence of maximum phonation time goal attenuates VFE efficacy; maximum phonation time goal is an active ingredient within VFEs.

Vocal Function Exercises With and Without Maximally Sustained Phonation: A Randomized Controlled Trial of Individuals With Normal Voice

OBJECTIVES

To determine the effect of maximally sustained phonation on efficacy of Vocal Function Exercises as measured by percent of maximum phonation time goal attained. The hypothesis was that maximally sustained phonation would result in greater improvements in percent of maximum phonation time goal attained.

STUDY DESIGN

Randomized controlled trial.

METHODS

A convenience sample of individuals with normal voice were recruited in a university academic clinic setting. Of 34 participants who volunteered for the study, 31 completed baseline assessment and 23 completed all study procedures. Participants were randomized to complete Vocal Function Exercises (traditional group TG), modified Vocal Function Exercises with reduced requirement for maximally sustained phonation (midpoint group MG), or modified Vocal Function Exercises with removed requirement for maximally sustained phonation (baseline group BG). The primary outcome measure was percent of maximum phonation time goal obtained during Vocal Function Exercises.

RESULTS

The MG (p = 0.008) and TG (p = 0.001) groups significantly improved percent of maximum phonation time goal attained after six weeks of exercise, while the BG group (p = 0.0202) did not (ɑ = 0.0125). Difference among groups was not statistically significant (p = 0.67, ɑ = 0.0125). Hedges' g effect sizes of 0.29 (-0.66, 1.25) and 0.51 (-0.57, 1.58) were obtained comparing MG and TG groups, and BG and TG groups, respectively.

CONCLUSIONS

Greater requirements for maximally sustained phonation improved efficacy of Vocal Function Exercises in enhancing normal voice as measured by percent of maximum phonation time goal attained. Maximally sustained phonation may be modified to some extent while preserving efficacy of Vocal Function Exercises, however complete elimination of maximally sustained phonation may attenuate improvement. Additional research in a clinical population is warranted.

Resting-State Cortical Connectivity Underlying Cognitive-Motor Interactions in Gait and Postural Tasks in Young Adults

OBJECTIVE

The purpose of this study is to determine the relationship between intra- and internetwork connectivity and DTC of postural, gait, and cognitive performance in healthy, young adults.

BACKGROUND

Dual-task (DT) deficits persist after return to activity in those recovering from a sports related concussion. However, little is known about the relationship of cortical network function to DT capacity. Current evidence regarding the relationship between network connectivity and dual-task balance and gait performance is limited by focusing on older adults and those with cognitive impairments, using a condensed set of task demands, and neglecting the role of connectivity in the ability to adapt to minimize DT cost (DTC).

DESIGN/METHODS

Twelve adults (7 females; age: 23.41 ± 2.74 years; height: 1.73 ± 0.10 m; weight: 72.66 ± 11.25 kg) volunteered for this study. Participants completed resting-state functional magnetic resonance imaging, as well as single and DT variants of the Concussion Balance Test, Sensory Organization Test, and gait. Functional connectivity within and between the default mode (DMN), salience (SAL), and sensorimotor (SMN) networks were calculated for all subjects. Pearson's correlations were used to assess the association of connectivity to balance and gait speed DTC.

RESULTS

Inter-network connectivity between to DMN to the SAL and SMN demonstrated moderate to strong association to DTC of gait speed and postural control during tasks which perturbed sensory environments (r = -0.59 to 0.94, p < 0.05). There was no relationship between connectivity and DTC of cognitive performance during DT (r = -0.50 to 0.54, p > 0.05).

CONCLUSIONS

Our findings highlight the role of the SAL, SMN, and DMN in cognitive-motor interactions during gait and postural control. Furthermore, functional connectivity underlying DT gait and static postural control performance express inverse relationships, suggesting task-dependent differences in system level processing.

Implementation of In vivo exposure therapy to decrease injury-related fear in females with a history of ACL-Reconstruction: A pilot study

OBJECTIVE

The objective of this pilot study was to examine the preliminary feasibility and efficacy of in vivo exposure therapy (IVET) to decrease injury-related fear in females with history of ACLR.

DESIGN

Pilot Study.

SETTING

Sports Medicine Research Laboratory.

PARTICIPANTS

12 female participants with history of ACLR (≥ 1 year post-operative) were randomized into a 5-week IVET group (n = 6) or 5-week sham physical activity (PA) monitoring group (n = 6).

MAIN OUTCOME MEASURES

The independent variables were Group and Time. The dependent variables were the Photographic Series of Sports Activities for ACLR (PHOSA-ACLR) and the Tampa Scale of Kinesiophobia-11 (TSK-11) scores. A Group x Time repeated measures two-way analysis of variance was completed for the PHOSA-ACLR and the TSK-11. Partial η² effect sizes were used to examine clinically meaningful differences.

RESULTS

High retention and adherence rates were observed in the intervention group. The PHOSA-ACLR exhibited a significant main effect for Time (F_1,10 = 9.92, p = 0.01, partial η² = 0.50), but not for Group. No statistically significant or clinically meaningful differences were observed for the TSK-11.

CONCLUSION

Both groups exhibited decreased injury-related fear for specific functional tasks. Future research should further examine the efficacy of IVET and PA monitoring to decrease injury-related fear in patients after ACLR.

Neuroplasticity in Corticolimbic Brain Regions in Patients After Anterior Cruciate Ligament Reconstruction

CONTEXT

Fear has been cited as the primary barrier to return to sport (RTS) by athletes after anterior cruciate ligament reconstruction (ACLR). Understanding the neural factors that contribute to fear after ACLR may help us to identify interventions for this population.

OBJECTIVE

To characterize the underlying neural substrate of injury-related fear in patients after ACLR versus healthy matched control individuals during a picture imagination task (PIT) consisting of sport-specific images and images of activities of daily living (ADL).

DESIGN

Case-control study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 24 right-hand-dominant participants (12 with left-sided ACLR and 12 control individuals) were enrolled. Participants underwent full-brain functional magnetic resonance imaging.

MAIN OUTCOME MEASURE(S)

Functional data were acquired using blood oxygen level-dependent (BOLD) echoplanar imaging. Independent t tests were conducted to identify between-groups differences in BOLD signal changes during all images of the PIT. Paired t tests were computed to examine differences in BOLD signal change between sport-specific and ADL images in the ACLR group.

RESULTS

Increased activation in the inferior parietal lobule and the mediodorsal thalamus was observed during PIT in the ACLR group. An inability to suppress the default mode network in the ACLR group was noted. The ACLR group exhibited increased activation in the cerebellum and inferior occipital regions during the sport-specific images versus the ADL images, but no other regions of interest demonstrated differences.

CONCLUSION

After ACLR, patients may be more predisposed to fear, anxiety, and pain during sport-specific activities and ADLs. Psychosocial interventions may be warranted after ACLR to reduce injury-related fear and mitigate potentially maladaptive neuroplasticity.

Does a Systematic Vocal Exercise Program Enhance the Physiologic Range of Voice Production in Classical Singing Graduate-Level Students?

Purpose The purpose of this study was to assess the effects of vocal function exercises (VFEs) on the physiologic range of the operatic voice. The primary outcome measure was total voice range profile (VRP) area. Method Forty graduate-level opera majors were randomly assigned to experimental (training with VFE + vocal hygiene) and control (vocal hygiene only) groups. All participants underwent an acoustic voice assessment (modified VRP) pre and post 10 weeks of the assigned intervention. VRP total area was calculated and compared between and within the two groups. The total VRP area was subsequently divided into three area thirds (low, medium, and high). Results A significant improvement (increase) was observed in the VFE group for the primary outcome measure of VRP area when pre- and postvoice conditions were compared for total area, upper third, and middle third. No significant improvement was found in the vocal hygiene-only group. Conclusion Vocal training with VFEs over a 10-week period demonstrated positive effects on physiologic voice range as evidenced by an increase in the total VRP area and therefore may enhance the potential of those who already have professional voice training.

Mantra Meditation To Improve Chronically Impaired Attention After Stroke: An Ongoing Trial Using Single-Case Research Design

Date Presented 04/05/19

This pilot study investigated the effects of mantra meditation on attention and related daily life participation after stroke. The primary outcome was attention measured with a computerized neuropsychological test. Primary data indicated an effect for one subject only. More research on what client factors or other variables may influence attention- and participation-related outcomes of mantra meditation will lay groundwork for clinical translation studies of this intervention.

Primary Author and Speaker: Cheryl Carrico

Contributing Authors: Dana Howell, John Patterson, Richard Andreatta, Lumy Sawaki

Vocal function exercises for normal voice: The effects of varying dosage

PURPOSE

This study examined the effect of varying dosage of vocal function exercise (VFE) home practice on attainment of pre-established maximum phonation time (MPT) goals in individuals with normal voice. High dosage VFE practice was expected to result in greatest MPT. The overarching goal of this study was to contribute to a VFE dosage-response curve, potentially including a point of observable toxicity.

METHOD

Twenty-eight females ages 18-25 with normal voice participated in this pre-post longitudinal group study. Participants were randomly assigned to one of three experimental groups and completed a six-week VFE protocol with practice twice daily. The low dosage group performed each exercise once, the traditional group twice, and the high dosage group four times. The primary outcome measure was MPT as performed on the fourth VFE using the prescribed semi-occluded vocal tract posture.

RESULT

No toxic effects were observed. MPT increased for all participants, with significant improvement for traditional and high dosage groups.

CONCLUSION

High dosage VFEs may yield more rapid improvement in MPT, however benefits must be weighed against the risk of increased attrition. Low dosage VFEs insufficiently improved MPT. Further research on dosage is warranted, and should include individuals with disordered voice.

Biobehavioral Measures of Presbylaryngeus

OBJECTIVE

The objective of this observational study was to assess the relationship between established aging biobehavioral measures and voice decline in normally aging adults.

STUDY DESIGN

Cross-sectional study.

METHODS

Participants 60-85 years of age were divided into two age and sex-matched groups, based on the presence or absence of presbylaryngeus. Both groups underwent a battery of tests measuring anthropometric variables, inflammatory markers, general health measures, and vocal function parameters. Differences from the norm were calculated for all variables. Parametric and nonparametric tests were performed to assess group differences. In addition, variable selection analysis was performed to determine variables that were most influential in predicting the occurrence of presbylaryngeus in our current sample.

RESULTS

Fifty-three participants were divided into age and sex-matched groups of "presbylaryngeus" (n = 26) and "non-presbylaryngeus" (n = 27). The two groups were statistically different in select measures of inflammatory markers, general health measures, and vocal function parameters. Anthropometric measures were not statistically different. Based on variable selection, the variables most predictive of the presence of presbylaryngeus were measures of the Physical Activity Scale of the Elderly, C-reactive protein, laryngeal airway resistance, and vocal roughness.

CONCLUSIONS

In addition to group differences in vocal function measures, results for the presbylaryngeus group consistently trended sub-optimally on anthropometric measures, two inflammatory markers, and general health measures. These results suggest that this sample of individuals with presbylaryngeus demonstrated greater biobehavioral deficits associated with aging as compared to age and sex-matched non-presbylaryngeus individuals.

Dietary patterns and the risk of colorectal adenoma recurrence in a European intervention trial

The relations between individual foods and nutrients to colorectal tumours are conflicting. Few studies have taken into account the interdependence between individual components of diet and their possible interactions. The aim of the study was to examine the associations between dietary patterns and the risk of colorectal adenoma recurrence in the European fibre-calcium intervention trial. Among the 640 patients with confirmed adenomas at the index colonoscopy, 592 had an initial dietary assessment using a diet history questionnaire. The present analysis was restricted to 277 men and 165 women without history of adenoma prior to the index colonoscopy and who completed the study. The main end point was the 3-year recurrence of adenomas. Principal component analysis was used to identify dietary patterns from 50 food groups. Ninety-two patients presented new colorectal adenomas at the 3-year colonoscopy (65 men and 27 women). In men, three meaningful dietary patterns emerged from analysis, explaining 21.3% of variability. They were called 'Mediterranean', 'Sweets and snacks' and 'High fat and proteins' patterns. None of them were significantly related to the overall recurrence of colorectal adenomas either in univariate or multivariate analyses. Among women, the 'Mediterranean', the 'Western' and the 'Snacks' patterns explained 21.9% of variability. The 'Mediterranean' pattern characterized by a high consumption of olive oil, vegetables, fruit, fish and lean meat significantly reduced adenoma recurrence [second tertile: adjusted odds ratio (OR)=0.50, 95% confidence interval (CI)=0.18-1.42; third tertile: adjusted OR=0.30, 95% CI=0.09-0.98; P for linear trend=0.04]. The 'Western' and 'Snacks' patterns were not associated with recurrence among women. In conclusion, this study suggests that the Mediterranean dietary pattern may reduce the recurrence of colorectal adenomas, at least in women. These exploratory results need to be confirmed by larger studies.

Overweight and colorectal cancer risk

Epidemiological studies on risk factors for colorectal cancer have focused mainly on diet. Weight and height have also been studied, partly because they reflect the balance between energy intake and expenditure in different age periods. Energy intake, body size, physical activity and colorectal cancer risk will be reviewed in this paper focusing mostly on recent data coming from Italian, English and Scandinavian studies. Overweight has long been recognised as a risk factor for hormone related and other cancers, including colorectal cancer. In addition, the epidemiological evidence consistently shows that physical activity reduces the risk of colon cancer. On the contrary, evidence on rectal cancer is less impressive. In conclusion, body size control along all life and physical activity represent important factors to prevent colon cancer and a wide range of chronic conditions. Therefore, strategies to favour these goals through counselling from health-care providers, regulatory changes, and programs aimed at individuals and communities should be implemented.

Energy intake, overweight, physical exercise and colorectal cancer risk

Epidemiological studies on risk factors for CRC have focused mainly on diet. In any case, the results of these studies show several inconsistencies, except for the beneficial role of high intake of vegetables and, to some lesser extent, of fruit. Weight and height have also been studied, partly because they reflect the balance between energy intake and expenditure in different age periods. Energy intake, body size and physical activity will be reviewed in this paper focusing mostly on recent data coming from Italian, English and Scandinavian studies. Overweight has long been recognized as a risk factor for hormone related and other cancers and this is confirmed not simply from case-control studies but from large cohort studies as well. The major findings of recent Italian studies are that excessive weight at various ages predicts colorectal cancer risk in men while in women, abdominal obesity, as indicated by a high WHR, represents a more reliable risk indicator. If all men could reduce their BMI below 25, about 9% of male colorectal cancer might be avoided in Italy. A decrease of WHR below 0.82 might reduce colorectal cancer in women by 19%. In addition, the epidemiological evidence consistently shows that physical activity reduces the risk of colon cancer. On the contrary, evidence on rectal cancer is less impressive. Some uncertainty still exists in relation to the intensity and duration of physical activity. In conclusion, body size control along all life and physical activity represent important factors to prevent colon cancer and a wide range of chronic conditions. Therefore, strategies to favour these goals through counselling from health-care providers, regulatory changes and programs aimed at individuals and communities should be implemented.

Rectal carcinoma: preoperative staging and detection of postoperative local recurrence with transrectal and transvaginal ultrasound

Transrectal ultrasound (TRUS) was performed preoperatively in 35 patients with rectal carcinoma and the results were compared to histologic findings. In the same group, postoperative studies were performed in 22 patients; in women, transvaginal ultrasound (TVUS) was added to the transrectal study. According to Duke's classification modified by Astler-Coller, in relation to the "T" parameter, TRUS correctly staged 33 of 35 neoplasms (accuracy, 94.3%); one was overstaged and one was understaged. In detection of lymph node involvement, accuracy was 74% (sensitivity 69%, specificity 73.9%). Recurrent local tumors, histologically confirmed, developed in two of 22 postoperative patients who had undergone curative anterior resection. This study demonstrates that TRUS is an accurate method in preoperative staging of rectal carcinoma. In the prospective study, the role of follow-up TRUS and TVUS in detection of local recurrences is evaluated.

Effect of covalent dimer conjugates of angiotensin II on receptor affinity and activity in vitro

Angiotensin II [1-8 or 2-8] analogues and [4-8] fragments were dimerized through the amino- or carboxy-terminal groups in order to try to increase their potency as reported for other hormones. The binding affinity to the angiotensin II receptor subtypes A (A IIA) and B (A IIB) was tested and compared to the potency in rabbit aortic ring. The [2-8] dimers coupled through the N-terminus show no significant change in potency in aortic ring. The [4-8] fragments coupled through the N-terminus are inactive in the ring. They have however a significantly increased affinity for the A IIA receptor, the specific function of which has not yet been reported. When angiotensin II analogues or fragments are coupled through the C-terminus, there was a significant drop in affinity and potency, confirming the importance of the free carboxyl group in position 8 for binding and activity. It is concluded that binding to the A IIB receptor correlates well with the effectiveness in aortic ring. However, in contrast to the beneficial effect reported for a large number of other hormones, dimerization of angiotensin II or its fragments is not accompanied by an increased biological activity in aortic ring.

Synthetic C3a analogs as specific inhibitors of C3a activity

Various C3a-related C-terminal synthetic oligopeptides were investigated for their ability to induce a release of serotonin from guinea pig platelets. The results confirm earlier findings that expression of biological C3a activity requires the four to five C-terminal amino acids of the C3a primary structure and underlines the essential role of the C-terminal arginine. Besides their ability to induce a specific release reaction, these peptides--after short incubation with the platelets--lead to a specific desensitization of the cells for C3a or C3a-related stimuli. Expression of this inhibitory activity required concentrations of the peptides more than 100-fold lower than those that were necessary to induce secretion. The possibility of using C3a analogs as specific inhibitors for C3a offers a valuable tool for in vivo studies of biological C3a activity.