ABSTRACT
UNLABELLED: This investigation was conducted to study whether warming up decreases myotonia (muscle stiffness) during speech production or causes adverse effects due to fatigue or exhaustion caused by intensive speech activity in patients with adult onset myotonic dystrophy. Thirty patients with adult onset myotonic dystrophy (MD) and ten healthy controls were examined, using a protocol that requires subjects, to speak continuously for at least 10 min. In MD patients, warming up led to an increase in speech rate and a decrease in speech variability without causing signs of fatigue or exhaustion as a result of prolonged and intensive use of the speech musculature. No significant changes were found in the controls. After warming up, MD patients achieved a habitual speech rate in reading and reciting similar to that of healthy controls. LEARNING OUTCOMES: As a result of this activity the reader will learn that 1. In contrast to most neuromuscular disorders, speech production in patients with adult onset myotonic dystrophy improves by activity. 2. Myotonia in speech musculature in patients with adult onset myotonic dystrophy can be reduced by instructing them to warm up their muscles by repetitive movements. 3. Warming up is a valuable intervention because it improves the velocity and fluency of speech production without aggravating the signs of flaccid dysarthria.
Subject(s)
Dysarthria/therapy , Muscle Fatigue/physiology , Muscle Stretching Exercises , Myotonic Dystrophy/therapy , Speech Production Measurement , Speech Therapy/methods , Adolescent , Adult , Aged , Dysarthria/diagnosis , Dysarthria/physiopathology , Facial Muscles/physiopathology , Female , Humans , Male , Middle Aged , Muscle Relaxation/physiology , Muscle Tonus/physiology , Myotonic Dystrophy/diagnosis , Myotonic Dystrophy/physiopathology , Phonation/physiology , Phonetics , Sound Spectrography , Speech Acoustics , Verbal Behavior/physiologyABSTRACT
BACKGROUND: Myotonia and weakness are the most important components of dysarthric speech in myotonic dystrophy. OBJECTIVE: To specify and quantify possible defects in speech execution in patients with adult onset myotonic dystrophy. METHODS: Studies on speech production were done on 30 mildly affected patients with myotonic dystrophy. Special attention was paid to myotonia. Because muscle activity can result in a decrease of myotonia, speech characteristics were measured before and after warm up. The possibility that warming up causes increased weakness was also assessed. RESULTS: As with other motor skills, a warm up effect was found in speech production, resulting in an increase in repetition rate and a decrease in variability of repetition rate. Signs of fatigue did not occur. CONCLUSIONS: Warming up is valuable for patients with myotonic dystrophy in reducing the influence of myotonia on speech production.
Subject(s)
Dysarthria/etiology , Myotonia/etiology , Myotonic Dystrophy/complications , Adolescent , Adult , Age of Onset , Child , Dysarthria/pathology , Female , Humans , Male , Middle Aged , Myotonia/pathology , Severity of Illness Index , Speech , Task Performance and AnalysisABSTRACT
Speech therapy in PD patients, focusing on an increase of phonatory-respiratory effort, has adverse effects because it raises vocal pitch and laryngeal muscle tension. The authors' approach, the Pitch Limiting Voice Treatment (PLVT), increases loudness but at the same time sets vocal pitch at a better level. In this study, the Lee Silverman Voice Treatment ("think loud, think shout") and PLVT ("speak loud and low") are compared. Both treatments produce the same increase in loudness, but PLVT limits an increase in vocal pitch and prevents a strained or pressed voicing.
