Terapija poremećaja glasa kod osoba s Parkinsonovom bolesti

master's thesis

• Title (english): Therapy of voice disorders in people with Parkinson’s disease
• Author: Tena Grah
• Mentor: Ana Bonetti (mentor)
• Committee member: Ana Bonetti (predsjednik povjerenstva)
• Committee member: Jasmina Ivšac Pavliša (član povjerenstva)
• Committee member: Ana Leko Krhen (član povjerenstva)
• Granter: University of Zagreb; Faculty of Education and Rehabilitation Sciences; Zagreb
• Defense date and country: 2021-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: SOCIAL SCIENCES; Speech Therapy

Abstract

Parkinsonova bolest je progresivna neurodegenerativna bolest koja nastaje propadanjem dopaminergičkih neurona u bazalnim ganglijima mozga. Pogađa 1-2% svjetske populacije starije od 60 godina. S obzirom na trendove starenja stanovništva u svijetu pa tako i u Hrvatskoj, očekuje se porast broja osoba s Parkinsonovom bolesti. Iako ovu bolest karakteriziraju primarni motorički simptomi, velika većina oboljelih razvija i poremećaj glasa i govora. Multidisciplinarni pristup terapiji stoga uključuje i logopedsku terapiju. Karakteristični simptomi hipokinetičke dizartrije koji se javljaju kod osoba s Parkinsonovom bolesti su smanjena glasnoća govora, šuman i promukao glas, tremor u glasu, neprecizna artikulacija konsonanta, monotonost glasa, promjene u brzini govora te palilalija i netečnosti u govoru. Promjene u kvaliteti glasa i govornoj produkciji rezultat su rigiditeta mišića, senzomotoričkih deficita i teškoća samomonitoriranja. Napredovanjem bolesti simptomi se pogoršavaju što negativno utječe na kvalitetu života, socijalne kontakte i komunikaciju osoba s Parkinsonovom bolesti. Farmakološka terapija i kirurško liječenje se nisu pokazali uspješnima kod većine pacijenata, te je danas fokus na logopedskoj terapiji. Ona može biti usmjerena na sve razine, ali je najčešće sumjerena na respiracijsku, fonacijsku ili artikulacijsku razinu govorne produkcije. Najučinkovitije terapije su one intenzivnog karaktera, s jednostavnim i jasnim uputama, koje u obzir uzimaju deficite senzorne obrade, osvještavaju razinu napora tijekom govora te potiču osobe s Parkinsonovom bolesti na monitoriranje vlastite govorne produkcije. S obzirom na gore navedene karakteristike, Lee Silverman Voice Treatment (LSVT) je trenutačni zlatni standard u pružanju logopedske terapije. Iako se logopedska terapija pokazala uspješnom u ublažavanju simptoma hipokinetičke dizartrije, mali broj osoba s Parkinsonovom bolesti je uopće upoznat s mogućnostima uključivanja u terapiju. Stoga je važno podizanje razine svijesti u općoj populaciji te među stručnjacima koji se bave ovim područjem o važnosti prepoznavanja i dijagnosticiranja simptoma poremećaja glasa i govora te pravovremenog uključivanja u terapiju.

Abstract (english)

Parkinson’s disease is a progressive, neurodegenerative disease resulting from a reduction of dopamine levels within the basal ganglia. It affects 1-2 % of the world’s population over the age of sixty. Number of people affected with Parkinson’s disease is expected to rise in relation to the aging population. Although Parkinson’s disease is mainly characterized by the primary, motor symptoms, a large majority of the patients will develop hypokinetic dysarthria, a motor speech disorder affecting voice quality and speech production. Multidisciplinary approach in treating patients with Parkinson’s disease includes speech and language therapy. Hypokinetic dysarthria is characterized by reduced loudness of speech, breathy and harsh voice, imprecise consonants, monotonous voice, variable speech rate and disfluency. These changes are a result of muscle rigidity, sensory processing deficits and troubles with self monitoring of output. Symptoms of hypokinetic dysarthria worsen with progression of the disease and have a negative impact on quality of life, social contact and communication of people with Parkinson’s disease. Pharmacological and surgical treatment were shown to have very limited impact on speech symptoms, so the focus switched to speech therapy. Speech therapy can target all levels of speech production process, but it usually focuses on respiration, fonation and articulation. The most effective interventions are intensive in nature, with simple and clear instructions. They consider the sensory processing deficits in people with Parkinson’s disease, impairment of self monitoring and focus on attention-to-effort in voice production. Lee Silverman Voice Treatment (LSVT) is currently considered the golden standard in speech therapy of patients with Parkinson’s disease. Even though speech therapy is successful in treating symptoms of hypokinetic dysarthria, only a small percentage of people diagnosed with Parkinson’s disease are referred to a speech language pathologist for an assessment and treatment. Raising awareness of the general public and experts included in the diagnosis and treatment of Parkinson’s disease is therefore important for effective and timely treatment of voice and speech symptoms in patients diagnosed with Parkinson’s disease.

• Keywords: hipokinetička dizartrija; Lee Silverman Voice Treatment; samomonitoriranje; intenzivnost terapije
• Keywords (english): Hypokinetic dysarthria; Lee Silverman Voice Treatment; self-monitoring; intensive therapy
• Language: croatian
• URN:NBN: urn:nbn:hr:158:022229
• Study programme: Title: Graduate study of Speech and Language Pathology; Study programme type: university; Study level: graduate; Academic / professional title: magistar/magistra logopedije (magistar/magistra logopedije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-01-26 12:14:49