The Effect of Combined Respiratory Muscle Training on Dysarthric Speech Following Single Cerebrovascular Accident: A Retrospective Pilot Study
Main Article Content
Robert J Arnold, SLP.D, CCC-SLP
Nina Bausek, PhD
Christopher S Gaskill, PhD, CCC-SLP
http://orcid.org/0000-0002-7384-7750
Tarek Midani, BSBME, M.Eng.
http://orcid.org/0000-0002-7384-7750
Tarek Midani, BSBME, M.Eng.
Abstract
Background: Dysarthria frequently occurs as a result of stroke and adversely impacts speech sound production, making it more difficult for the listener to understand what the person with dysarthria is attempting to communicate. This in turn may lead to social isolation, depression, and increased cost of care. Some studies have underscored the importance of respiratory muscle strengthening as it relates to improvement of speech intelligibility. This retrospective investigation examined the effects of a combined Respiratory Muscle Training (cRMT) protocol upon speech intelligibility in persons post single cerebrovascular accident (CVA).
Methods: The clinical data of 10 patients who requested pro bono speech therapy for the diagnosis and treatment of dysarthria following a single stroke was utilized for this study. The intervention group was treated with three 5-minute sessions with cRMT each day for 28 consecutive days. The control group received no cRMT and no other therapeutic exercise intervention during the time period. Respiratory and speech intelligibility were assessed pre- and post-intervention in terms of peak expiratory flow, subject self-perception of intelligibility, and word level intelligibility.
Results: After 28 days of cRMT, the intervention group (IG) exhibited significant gains compared to the control group (CG) in peak expiratory flow (PEF) (IG: 73.12% vs CG: 4.66%), Self-Perception of Intelligibility (IG: 72.38% vs CG: 0.83%), and the word task of the Assessment of Intelligibility of Dysarthric Speech (AIDS) (IG: 43.92% vs. CG: 0%).
Conclusion: These data suggest cRMT is a feasible and effective treatment for improving breath support and speech intelligibility in persons with dysarthric speech.
Article Details
How to Cite
ARNOLD, Robert J et al.
The Effect of Combined Respiratory Muscle Training on Dysarthric Speech Following Single Cerebrovascular Accident: A Retrospective Pilot Study.
Medical Research Archives, [S.l.], v. 11, n. 6, july 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3990>. Date accessed: 03 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i6.3990.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Kunst AE, Amiri M, Janssen F. The decline in stroke mortality: exploration of future trends in 7 Western European countries. Stroke. 2011;42: 2126–2130.
2. Arboix A, Martí-Vilalta JL, García JH. Clinical study of 227 patients with lacunar infarcts. Stroke. 1990;21: 842–847.
3. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al. Executive summary: heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation. 2010;121: 948–954.
4. Enderby P, Emerson J. Speech and language therapy: does it work? BMJ. 1996;312: 1655–1658.
5. Lawrence ES, Coshall C, Dundas R, Stewart J, Rudd AG, Howard R, et al. Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke. 2001;32: 1279–1284.
6. Miller N, Bloch S. A survey of speech--language therapy provision for people with post-stroke dysarthria in the UK. Int J Lang Commun Disord. 2017;52: 800–815.
7. Brady MC, Clark AM, Dickson S, Paton G, Barbour RS. The impact of stroke-related dysarthria on social participation and implications for rehabilitation. Disabil Rehabil. 2011;33: 178–186.
8. Dickson S, Barbour RS, Brady M, Clark AM, Paton G. Patients’ experiences of disruptions associated with post-stroke dysarthria. Int J Lang Commun Disord. 2008;43: 135–153.
9. Wilson RD. Mortality and cost of pneumonia after stroke for different risk groups. J Stroke Cerebrovasc Dis. 2012;21: 61–67.
10. Bowen A, Hesketh A, Patchick E, Young A. … and service users’ perceptions of early, well-resourced communication therapy following a stroke: a randomised controlled trial (the ACT NoW Study). Health Technol. 2012. Available: https://europepmc.org/books/nbk97269
11. Park EJ, Kim JH, Choi YH, Son JE, Lee SA, Yoo SD. Association between phonation and the vowel quadrilateral in patients with stroke: A retrospective observational study. Medicine . 2020;99: e22236.
12. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36: 2756–2763.
13. Martino R, Pron G, Diamant N. Screening for oropharyngeal dysphagia in stroke: insufficient evidence for guidelines. Dysphagia. 2000;15: 19–30.
14. Darley FL, Aronson AE, Brown JR. Clusters of Deviant Speech Dimensions in the Dysarthrias. Journal of Speech and Hearing Research. 1969. pp. 462–496. doi:10.1044/jshr.1203.462
15. Darley FL, Aronson AE, Brown JR. Differential Diagnostic Patterns of Dysarthria. Journal of Speech and Hearing Research. 1969. pp. 246–269. doi:10.1044/jshr.1202.246
16. Darley FL, Aronson AE, Brown JR. Motor speech disorders. WB Saunders Company; 1975.
17. Johns DF. Clinical Management of Neurogenic Communicative. Prentice Hall; 1985.
18. DWORKIN, P J. Motor Speech Disorders. A Treatment Guide. 1991; 85–132.
19. Weismer G. Motor Speech Disorders: Essays for Ray Kent. Plural Publishing; 2006.
20. Duffy JR. Motor Speech Disorders: Substrates, Differential Diagnosis, and Management. Elsevier Mosby; 2005.
21. Robin DA, Yorkston KM, Beukelman DR. Disorders of motor speech: Assessment, treatment, and clinical characterization. Paul H Brookes Publishing Company; 1996.
22. Till JA, Yorkston KM, Beukelman DR. Motor Speech Disorders: Advances in Assessment and Treatment. P.H. Brooks Publishing Company; 1994.
23. Yorkston KM, Beukelman DR. Assessment of Intelligibility of Dysarthric Speech. C.C. Publications; 1981.
24. Robin DA, Luschei ES. Patent. 5,119,831.
25. Arnold RJ. Patent. 6,050,961.
26. Robbins JA et al. Patent. 6,702,765.
27. Arnold RJ, Mann GD. An Introdution to the Oromotor Dynanometer. Annual Meeting of the American Speech-Language-Hearing Association; 2004.
28. Hardy JC. Intraoral breath pressure in cerebral palsy. J Speech Hear Disord. 1961;26: 309–319.
29. Hardy JC. Suggestions for Physiological Research in Dysarthria. Cortex. 1967;3: 128–156.
30. Hardy JC. Respiratory physiology: implications of current research. ASHA. 1968;10: 204–206.
31. Nicholson P, Covelli JL. Better Breathing - a self teaching manual, 4th edition. PAL-Medical, Inc; 1989.
32. McConnell A. Respiratory Muscle Training E-Book: Theory and Practice. Elsevier Health Sciences; 2013.
33. Chaitow L, Bradley D, Gilbert C. Recognizing and Treating Breathing Disorders E-Book. Elsevier Health Sciences; 2014.
34. Sapienza CM, Troche MS. Respiratory Muscle Strength Training: Theory and Practice. Plural Publishing; 2011.
35. Sapienza C, Hoffman B. Respiratory Muscle Strength Training. Plural Publishing; 2020.
36. Arnold RJ, Bausek N. Effect of respiratory muscle training on dysphagia in stroke patients—A retrospective pilot study. Laryngoscope Investigative Otolaryngology. 2020;n/a. doi:10.1002/lio2.483
37. Arnold RJ, Gaskill CS, Bausek N. Effect of Complete Respiratory Muscle Training (cRMT) on Dysphonia following Single CVA: A retrospective pilot study. medRxiv. 2020. Available: https://www.medrxiv.org/content/10.1101/2020.12.20.20248589v1.abstract
38. Sapienza C, Hoffman B. Voice Disorders, Fourth Edition. Plural Publishing; 2020.
39. Ramig L, Halpern A, Spielman J, Fox C, Freeman K. Speech treatment in Parkinson’s disease: Randomized controlled trial (RCT). Mov Disord. 2018;33: 1777–1791.
40. Mahler LA, Ramig LO. Intensive treatment of dysarthria secondary to stroke. Clin Linguist Phon. 2012;26: 681–694.
41. Jones HN, Donovan NJ, Sapienza C, Shrivastav R, Rosenbek JC. Expiratory Muscle Strength Training in the Treatment of Mixed Dysarthria in a Patient with Lance-Adams Syndrome. J Med Speech Lang Pathol. 2006;14: 207–217.
42. Beukelman DR, Fager S, Ball L, Dietz A. AAC for adults with acquired neurological conditions: a review. Augment Altern Commun. 2007;23: 230–242.
43. Yamagishi J, Veaux C, King S, Renals S. Speech synthesis technologies for individuals with vocal disabilities: Voice banking and reconstruction. Acoust Sci Technol. 2012;33: 1–5.
44. VocaliD – Your voice AI company, bringing things that talk to life. [cited 27 Feb 2021]. Available: https://vocalid.ai/
45. Mills T, Bunnell HT, Patel R. Towards personalized speech synthesis for augmentative and alternative communication. Augment Altern Commun. 2014;30: 226–236.
46. Pollock RD, Rafferty GF, Moxham J, Kalra L. Respiratory muscle strength and training in stroke and neurology: a systematic review. Int J Stroke. 2013;8: 124–130.
47. Liaw M-Y, Hsu C-H, Leong C-P, Liao C-Y, Wang L-Y, Lu C-H, et al. Respiratory muscle training in stroke patients with respiratory muscle weakness, dysphagia, and dysarthria - a prospective randomized trial. Medicine . 2020;99: e19337.
48. Nicholson MK. Respiratory Exerciser. Patent. 4,739,987 , 1988.
49. Shaikh S, Vishnu Vardhan GD, Gunjal S, Mahajan A, Lamuvel M. Effect of Inspiratory Muscle Training by Using Breather Device in Participants with Chronic Obstructive Pulmonary Disease (COPD). Available: http://www.ijhsr.org/IJHSR_Vol.9_Issue.4_April2019/12.pdf
50. Shaikh S, Gunjal S. EFFECTIVENESS OF BREATHER DEVICE IN CERVICAL SPINAL CORD INJURY- A CASE REPORT. EPRA International Journal of Multidisciplinary Research. 2019;5: 191–193.
51. Bausek N, Havenga L, Aldarondo S. Respiratory Muscle Training Improves Speech and Pulmonary Function in COPD Patients in a Home Health Setting - a Pilot Study. bioRxiv. 2019. p. 523746. doi:10.1101/523746
52. Ramig LO, Dromey C. Aerodynamic mechanisms underlying treatment-related changes in vocal intensity in patients with Parkinson disease. J Speech Hear Res. 1996;39: 798–807.
53. Dromey C, Ramig LO, Johnson AB. Phonatory and articulatory changes associated with increased vocal intensity in Parkinson disease: a case study. J Speech Hear Res. 1995;38: 751–764.
54. Stockbridge MD, Bunker LD, Hillis AE. Reversing the Ruin: Rehabilitation, Recovery, and Restoration After Stroke. Curr Neurol Neurosci Rep. 2022;22: 745–755.
55. Arnold RJ, Gaskill CS, Bausek N. Effect of Combined Respiratory Muscle Training (cRMT) on Dysphonia following Single CVA: A Retrospective Pilot Study. J Voice. 2021. doi:10.1016/j.jvoice.2021.03.014
56. Massery M, Hagins M, Stafford R, Moerchen V, Hodges PW. Effect of airway control by glottal structures on postural stability. J Appl Physiol. 2013;115: 483–490.
57. Jung J-H, Kim N-S. The effect of progressive high-intensity inspiratory muscle training and fixed high-intensity inspiratory muscle training on the asymmetry of diaphragm thickness in stroke patients. J Phys Therapy Sci. 2015;27: 3267–3269.
58. Aydoğan Arslan S, Uğurlu K, Sakizli Erdal E, Keskin ED, Demirgüç A. Effects of Inspiratory Muscle Training on Respiratory Muscle Strength, Trunk Control, Balance and Functional Capacity in Stroke Patients: A single-blinded randomized controlled study. Top Stroke Rehabil. 2022;29: 40–48.
59. Janssens L, McConnell AK, Pijnenburg M, Claeys K, Goossens N, Lysens R, et al. Inspiratory muscle training affects proprioceptive use and low back pain. Med Sci Sports Exerc. 2015;47: 12–19.
2. Arboix A, Martí-Vilalta JL, García JH. Clinical study of 227 patients with lacunar infarcts. Stroke. 1990;21: 842–847.
3. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al. Executive summary: heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation. 2010;121: 948–954.
4. Enderby P, Emerson J. Speech and language therapy: does it work? BMJ. 1996;312: 1655–1658.
5. Lawrence ES, Coshall C, Dundas R, Stewart J, Rudd AG, Howard R, et al. Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke. 2001;32: 1279–1284.
6. Miller N, Bloch S. A survey of speech--language therapy provision for people with post-stroke dysarthria in the UK. Int J Lang Commun Disord. 2017;52: 800–815.
7. Brady MC, Clark AM, Dickson S, Paton G, Barbour RS. The impact of stroke-related dysarthria on social participation and implications for rehabilitation. Disabil Rehabil. 2011;33: 178–186.
8. Dickson S, Barbour RS, Brady M, Clark AM, Paton G. Patients’ experiences of disruptions associated with post-stroke dysarthria. Int J Lang Commun Disord. 2008;43: 135–153.
9. Wilson RD. Mortality and cost of pneumonia after stroke for different risk groups. J Stroke Cerebrovasc Dis. 2012;21: 61–67.
10. Bowen A, Hesketh A, Patchick E, Young A. … and service users’ perceptions of early, well-resourced communication therapy following a stroke: a randomised controlled trial (the ACT NoW Study). Health Technol. 2012. Available: https://europepmc.org/books/nbk97269
11. Park EJ, Kim JH, Choi YH, Son JE, Lee SA, Yoo SD. Association between phonation and the vowel quadrilateral in patients with stroke: A retrospective observational study. Medicine . 2020;99: e22236.
12. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36: 2756–2763.
13. Martino R, Pron G, Diamant N. Screening for oropharyngeal dysphagia in stroke: insufficient evidence for guidelines. Dysphagia. 2000;15: 19–30.
14. Darley FL, Aronson AE, Brown JR. Clusters of Deviant Speech Dimensions in the Dysarthrias. Journal of Speech and Hearing Research. 1969. pp. 462–496. doi:10.1044/jshr.1203.462
15. Darley FL, Aronson AE, Brown JR. Differential Diagnostic Patterns of Dysarthria. Journal of Speech and Hearing Research. 1969. pp. 246–269. doi:10.1044/jshr.1202.246
16. Darley FL, Aronson AE, Brown JR. Motor speech disorders. WB Saunders Company; 1975.
17. Johns DF. Clinical Management of Neurogenic Communicative. Prentice Hall; 1985.
18. DWORKIN, P J. Motor Speech Disorders. A Treatment Guide. 1991; 85–132.
19. Weismer G. Motor Speech Disorders: Essays for Ray Kent. Plural Publishing; 2006.
20. Duffy JR. Motor Speech Disorders: Substrates, Differential Diagnosis, and Management. Elsevier Mosby; 2005.
21. Robin DA, Yorkston KM, Beukelman DR. Disorders of motor speech: Assessment, treatment, and clinical characterization. Paul H Brookes Publishing Company; 1996.
22. Till JA, Yorkston KM, Beukelman DR. Motor Speech Disorders: Advances in Assessment and Treatment. P.H. Brooks Publishing Company; 1994.
23. Yorkston KM, Beukelman DR. Assessment of Intelligibility of Dysarthric Speech. C.C. Publications; 1981.
24. Robin DA, Luschei ES. Patent. 5,119,831.
25. Arnold RJ. Patent. 6,050,961.
26. Robbins JA et al. Patent. 6,702,765.
27. Arnold RJ, Mann GD. An Introdution to the Oromotor Dynanometer. Annual Meeting of the American Speech-Language-Hearing Association; 2004.
28. Hardy JC. Intraoral breath pressure in cerebral palsy. J Speech Hear Disord. 1961;26: 309–319.
29. Hardy JC. Suggestions for Physiological Research in Dysarthria. Cortex. 1967;3: 128–156.
30. Hardy JC. Respiratory physiology: implications of current research. ASHA. 1968;10: 204–206.
31. Nicholson P, Covelli JL. Better Breathing - a self teaching manual, 4th edition. PAL-Medical, Inc; 1989.
32. McConnell A. Respiratory Muscle Training E-Book: Theory and Practice. Elsevier Health Sciences; 2013.
33. Chaitow L, Bradley D, Gilbert C. Recognizing and Treating Breathing Disorders E-Book. Elsevier Health Sciences; 2014.
34. Sapienza CM, Troche MS. Respiratory Muscle Strength Training: Theory and Practice. Plural Publishing; 2011.
35. Sapienza C, Hoffman B. Respiratory Muscle Strength Training. Plural Publishing; 2020.
36. Arnold RJ, Bausek N. Effect of respiratory muscle training on dysphagia in stroke patients—A retrospective pilot study. Laryngoscope Investigative Otolaryngology. 2020;n/a. doi:10.1002/lio2.483
37. Arnold RJ, Gaskill CS, Bausek N. Effect of Complete Respiratory Muscle Training (cRMT) on Dysphonia following Single CVA: A retrospective pilot study. medRxiv. 2020. Available: https://www.medrxiv.org/content/10.1101/2020.12.20.20248589v1.abstract
38. Sapienza C, Hoffman B. Voice Disorders, Fourth Edition. Plural Publishing; 2020.
39. Ramig L, Halpern A, Spielman J, Fox C, Freeman K. Speech treatment in Parkinson’s disease: Randomized controlled trial (RCT). Mov Disord. 2018;33: 1777–1791.
40. Mahler LA, Ramig LO. Intensive treatment of dysarthria secondary to stroke. Clin Linguist Phon. 2012;26: 681–694.
41. Jones HN, Donovan NJ, Sapienza C, Shrivastav R, Rosenbek JC. Expiratory Muscle Strength Training in the Treatment of Mixed Dysarthria in a Patient with Lance-Adams Syndrome. J Med Speech Lang Pathol. 2006;14: 207–217.
42. Beukelman DR, Fager S, Ball L, Dietz A. AAC for adults with acquired neurological conditions: a review. Augment Altern Commun. 2007;23: 230–242.
43. Yamagishi J, Veaux C, King S, Renals S. Speech synthesis technologies for individuals with vocal disabilities: Voice banking and reconstruction. Acoust Sci Technol. 2012;33: 1–5.
44. VocaliD – Your voice AI company, bringing things that talk to life. [cited 27 Feb 2021]. Available: https://vocalid.ai/
45. Mills T, Bunnell HT, Patel R. Towards personalized speech synthesis for augmentative and alternative communication. Augment Altern Commun. 2014;30: 226–236.
46. Pollock RD, Rafferty GF, Moxham J, Kalra L. Respiratory muscle strength and training in stroke and neurology: a systematic review. Int J Stroke. 2013;8: 124–130.
47. Liaw M-Y, Hsu C-H, Leong C-P, Liao C-Y, Wang L-Y, Lu C-H, et al. Respiratory muscle training in stroke patients with respiratory muscle weakness, dysphagia, and dysarthria - a prospective randomized trial. Medicine . 2020;99: e19337.
48. Nicholson MK. Respiratory Exerciser. Patent. 4,739,987 , 1988.
49. Shaikh S, Vishnu Vardhan GD, Gunjal S, Mahajan A, Lamuvel M. Effect of Inspiratory Muscle Training by Using Breather Device in Participants with Chronic Obstructive Pulmonary Disease (COPD). Available: http://www.ijhsr.org/IJHSR_Vol.9_Issue.4_April2019/12.pdf
50. Shaikh S, Gunjal S. EFFECTIVENESS OF BREATHER DEVICE IN CERVICAL SPINAL CORD INJURY- A CASE REPORT. EPRA International Journal of Multidisciplinary Research. 2019;5: 191–193.
51. Bausek N, Havenga L, Aldarondo S. Respiratory Muscle Training Improves Speech and Pulmonary Function in COPD Patients in a Home Health Setting - a Pilot Study. bioRxiv. 2019. p. 523746. doi:10.1101/523746
52. Ramig LO, Dromey C. Aerodynamic mechanisms underlying treatment-related changes in vocal intensity in patients with Parkinson disease. J Speech Hear Res. 1996;39: 798–807.
53. Dromey C, Ramig LO, Johnson AB. Phonatory and articulatory changes associated with increased vocal intensity in Parkinson disease: a case study. J Speech Hear Res. 1995;38: 751–764.
54. Stockbridge MD, Bunker LD, Hillis AE. Reversing the Ruin: Rehabilitation, Recovery, and Restoration After Stroke. Curr Neurol Neurosci Rep. 2022;22: 745–755.
55. Arnold RJ, Gaskill CS, Bausek N. Effect of Combined Respiratory Muscle Training (cRMT) on Dysphonia following Single CVA: A Retrospective Pilot Study. J Voice. 2021. doi:10.1016/j.jvoice.2021.03.014
56. Massery M, Hagins M, Stafford R, Moerchen V, Hodges PW. Effect of airway control by glottal structures on postural stability. J Appl Physiol. 2013;115: 483–490.
57. Jung J-H, Kim N-S. The effect of progressive high-intensity inspiratory muscle training and fixed high-intensity inspiratory muscle training on the asymmetry of diaphragm thickness in stroke patients. J Phys Therapy Sci. 2015;27: 3267–3269.
58. Aydoğan Arslan S, Uğurlu K, Sakizli Erdal E, Keskin ED, Demirgüç A. Effects of Inspiratory Muscle Training on Respiratory Muscle Strength, Trunk Control, Balance and Functional Capacity in Stroke Patients: A single-blinded randomized controlled study. Top Stroke Rehabil. 2022;29: 40–48.
59. Janssens L, McConnell AK, Pijnenburg M, Claeys K, Goossens N, Lysens R, et al. Inspiratory muscle training affects proprioceptive use and low back pain. Med Sci Sports Exerc. 2015;47: 12–19.