Erin Silverman

Combined modality treatment of adductor spasmodic dysphonia.

INTRODUCTION The hallmark characteristic of adductor spasmodic dysphonia (ADSD) is irregular and uncontrollable spasms within the intrinsic laryngeal muscles, resulting in erratic disruption of normal voicing. METHODS Using a random assignment and the inclusion of a behavioral sham to determine the effect of voice therapy after initial botulinum toxin type A (BTX-A) injections for ADSD, this study examined duration of injection benefit, perceived vocal quality of life from the Voice-Related Quality of Life (V-RQOL) scale, acoustic measures of vocal instability, and perceptual ratings of voice quality. Measures of these variables were collected before initial injection; 3, 7, and 12 weeks postinjection; and immediately before reinjection. Thirty-one individuals with ADSD participated in this study. One-third received no further intervention after BTX-A injection, one-third received a standard 5-week course of voice therapy after BTX-A injection, and one-third received a 5-week course of sham voice therapy after BTX-A injection. RESULTS AND CONCLUSIONS Significant effects were observed on perceived quality of life and acoustic variables for all participants, over time. Participants who received voice therapy after BTX-A injection did not experience longer injection effect duration or significantly greater improvements in V-RQOL or acoustic variables than participants in BTX-A only or BTX-A plus sham therapy groups. Additionally, perceptual ratings of voice quality improved for all participants in response to BTX-A injection. For participants in this investigation, undertaking voice therapy did not appear to exert significant beneficial effects on the variables of interest.

Negative emotional stimulation decreases respiratory sensory gating in healthy humans

We tested the hypothesis that negative emotions decrease the respiratory-related evoked potentials (RREP) sensory gating (RSG). RREP were elicited by paired inspiratory occlusions. RSG was calculated as the difference in the averaged RREP peak N1 amplitude between the second (S2) and the first occlusion (S1). RSG was compared between unpleasant and neutral emotional conditions elicited by viewing affective pictures from the IAPS system in thirteen healthy adults. Results are expressed as median [min; max]. Compared to neutral pictures, viewing unpleasant pictures decreased the RREP N1(S1) amplitude (-3.37 μV [-4.62; -1.37] versus -4.59 μV [-6.08; -1.36]; p=0.017) but not the RREP N1(S2) amplitude (-0.26 [-3.24; 2.36] versus -0.7 [-1.54; 3.6]; p = 0.68), and reduced the difference score S2-S1 (3.73 μV [0; 5.82] versus 4.79 μV [3; 6.2]; p = 0.038). We concluded that a negative emotional stimulation could attract subjects attention to the detriment of the respiratory sensory inputs and produced an overall decrease in the RSG. This latter finding might participate in an over-perception of repeatedly presented respiratory stimuli.

The Contagious Head and Neck Cancer: The Role of Human PapillomavirusHPV

Summary Squamous cell cancer of the head and neck (HNSCC) is an evolving area of clinical and research focus with a rising prevalence of the disease in the female population. Some human papillomavirus (HPV) types act as carcinogens that contribute to the development of HNSCC. The purpose of this article is to discuss the role of HPV in the rise of HNSCC in women, with a focus on shifting clinical practice guidelines.

Virtual Environments and Virtual Humans for Military Mild Traumatic Brain Injury and Posttraumatic Stress Disorder: An Emerging Concept

From the U.S. Department of Veteran’s Affairs, North Florida/South Georgia Veterans Health System, Gainesville, Florida (CEL,EPS, LL); Department of Occupational Therapy (CEL) andDepartment of Computer and Information Science andEngineering, College of Engineering (SH, BCL), University ofFlorida, Gainesville; Department of Physiological Sciences,College of Veterinary Medicine (EPS), and Departments of Clinicaland Health Psychology (MM) and Occupational Therapy (LL),College of Public Health and Health Professions, University ofFlorida, Gainesville; and U.S. Department of Veteran’s Affairs,Charlotte, North Carolina (DO).Supported by (1) W81XWH-08-2-0194 PT073664 Design ofEffective Therapeutic Interventions for Mild TBI/PTSD usingInteractive Virtual World Environments, CDMRP/DoD9.15.08-9.14.09; (2) Development of Virtual Humans For PTSDand mTBI: Rehabilitation Outcomes Research Center 2010Y2011;and (3) 1I01RX000339-01A3, Virtual Environments forTherapuetic Solutions (VETS) mTBI/PTSD Phase II, VA RR&D,

Psychometric Properties of Voice Activity Participation Profile—Persian Version (VAPPP)

824,835, 4.1.13-3.30.16.Financial disclosure statements have been obtained, and noconflicts of interest have been reported by the authors or by anyindividuals in control of the content of this article.0894-9115/15/9404-e31American Journal of Physical Medicine & RehabilitationCopyright * 2015 Wolters Kluwer Health, Inc. All rights reserved.

Preliminary Evidence of Reduced Urge to Cough and Cough Response in Four Individuals following Remote Traumatic Brain Injury with Tracheostomy

OBJECTIVES Individuals with voice disorders may experience limits in activity and restricted participation in daily activities. The aim of this study was to investigate the psychometric properties of the Voice Activity Participation Profile-Persian Version (VAPPP), a questionnaire which specifically investigates activity limitation and participation restriction in Persian-speaking individuals with voice disorders. METHOD We completed a translation procedure according to World Health Organization guidelines, prior to administering the questionnaire to 208 participants (156 patients with dysphonia and 52 controls), each of whom completed the questionnaire. We examined various psychometric properties including item analysis, factor analysis, internal consistency, discriminant validity, criterion-related validity, and test-retest reliability were investigated for this questionnaire. RESULTS Confirmatory factor analysis revealed that the 27 items on the VAPPP were distributed across four factors and that the first question, which assesses self-perceived dysphonia severity, was grouped separately. All the four subscales and total VAPPP have high internal consistency and test-retest reliability based on Cronbachs alpha coefficients and the intraclass correlation coefficient (ICC). Job effects (α = 0.85; ICC = 0.96), daily communication effects (α = 0.96; ICC = 0.83), social communication effects (α = 0.91; ICC = 0.93), emotional effects (α = 0.94; ICC = 0.76), and total score (α = 0.97; ICC = 0.88) are presented. VAPPP scores in patients with dysphonia were significantly different from those of the healthy control group (P < 0.001). The VAPPP total score has a high correlation to the Voice Handicap Index (r = 0.86; P < 0.001) CONCLUSION: The VAPPP is a reliable and valid tool for evaluating the quality of life of patients with dysphonia in Iran.

Quantifying Laryngopharyngeal Reflux in Singers: Perceptual and Objective Findings

Cough and swallow protect the lungs and are frequently impaired following traumatic brain injury (TBI). This project examined cough response to inhaled capsaicin solution challenge in a cohort of four young adults with a history of TBI within the preceding five years. All participants had a history of tracheostomy with subsequent decannulation and dysphagia after their injuries (resolved for all but one participant). Urge to cough (UTC) and cough response were measured and compared to an existing database of normative cough response data obtained from 32 healthy controls (HCs). Participants displayed decreased UTC and cough responses compared to HCs. It is unknown if these preliminary results manifest as a consequence of disrupted sensory (afferent) projections, an inability to perceive or discriminate cough stimuli, disrupted motor (efferent) response, peripheral weakness, or any combination of these factors. Future work should attempt to clarify if the observed phenomena are borne out in a larger sample of individuals with TBI, determine the relative contributions of central versus peripheral nervous system structures to cough sensory perceptual changes following TBI (should they exist), and formulate recommendations for systematic screening and assessment of cough sensory perception in order to facilitate rehabilitative efforts. This project is identified with the National Clinical Trials NCT02240329.

Measurement of Voluntary Cough Production and Airway Protection in Parkinson Disease

This study examines the relationship between laryngopharyngeal reflux (LPR) symptoms and oropharyngeal pH levels in singers. We hypothesized that reported symptoms would correlate with objective measures of pH levels from the oropharynx, including the number and total duration of reflux episodes. Twenty professional/semiprofessional singers completed the Reflux Symptom Index (RSI) and underwent oropharyngeal pH monitoring. Mild, moderate, or severe pH exposure was recorded during oropharyngeal pH monitoring. Correlations were performed to examine potential relationships between reflux symptoms and duration of LPR episodes. Symptom severity did not correlate with pH levels; however, we found a number of covariances of interest. Large sample sizes are necessary to determine if true correlations exist. Our results suggest that singers may exhibit enhanced sensitivity to LPR and may therefore manifest symptoms, even in response to subtle changes in pH. This study emphasizes the importance of sensitive and objective measures of reflux severity as well as consideration of the cumulative time of reflux exposure in addition to the number of reflux episodes.

Psychophysiology of respiratory disease : clinical considerations for the advanced practice nurse

OBJECTIVE To examine relations between peak expiratory (cough) airflow rate and swallowing symptom severity in participants with Parkinson disease (PD). DESIGN Cross-sectional study. SETTING Outpatient radiology clinic at an acute care hospital. PARTICIPANTS Men and women with PD (N=68). INTERVENTIONS Participants were cued to cough into an analog peak flow meter then swallowed three 20-mL thin liquid barium boluses. Analyses were directed at detecting potential relations among disease severity, swallowing symptom severity, and peak expiratory (cough) airflow rate. MAIN OUTCOME MEASURES Peak expiratory (cough) airflow rate and swallow symptom severity. RESULTS Peak expiratory (cough) airflow rate varied significantly across swallowing severity classifications. Participants with more severe disease displayed a significant, linear decrease in peak expiratory (cough) airflow rate than those participants with earlier stage, less severe disease. Swallowing symptom severity varied significantly across groups when comparing participants with less severe PD with those with more severe PD. Participants with early stage PD demonstrated little to no swallowing symptoms and had the highest measures of peak expiratory (cough) airflow rate. In contrast, participants with the most severe swallowing symptoms also displayed the lowest measures of peak expiratory (cough) airflow rate. CONCLUSIONS Relations existed among PD severity, swallowing symptom severity, and peak expiratory (cough) airflow rate in participants with PD. Peak expiratory (cough) airflow rate may eventually stand as a noninvasive predictor of aspiration risk in those with PD, particularly those with later stage disease. Inclusion of peak expiratory (cough) airflow rates into existing clinical swallowing assessments may increase the sensitivity and predictive validity of these assessments.

Effects of expiratory muscle strength training on maximal respiratory pressure and swallow-related quality of life in individuals with multiple sclerosis:

The purpose of this article is to describe the psychophysiology of dyspnea in chronic obstructive pulmonary disease (COPD), identify the unique impact of respiratory disease on the female patient, and discuss the relationship of anxiety and depression in disease manifestation. Current COPD assessment and treatment guidelines published by the United States Department of Health and Human Services, the World Health Organization as well as the National Institute for Health and Care Experience (NICE) will be presented along with implications for the Advanced Practice Nurse (APN). Practitioners treat COPD patients with advanced physiological complications along with psychological comorbidities that worsen the disease perception and progression. Therefore, a recommendation will be made to integrate assessment and evaluation of psychological comorbidities in COPD patients, with particular consideration given to the female patient. Utilizing a holistic, int egrated treatment plan will serve to enhance patient care, alleviate disease burden and impact overall quality of life in the patient with COPD.