Independent exercise for glottal incompetence to improve vocal problems and prevent aspiration pneumonia in the elderly: a randomized controlled trial

Abstract

Objectives:To evaluate the effect of a self-controlled vocal exercise in elderly people with glottal closure insufficiency.Design:Parallel-arm, individual randomized controlled trial.Methods:Patients who visited one of 10 medical centers under the National Hospital Organization group in Japan for the first time, aged 60 years or older, complaining of aspiration or hoarseness, and endoscopically confirmed to have glottal closure insufficiency owing to vocal cord atrophy, were enrolled in this study. They were randomly assigned to an intervention or a control group. The patients of the intervention group were given guidance and a DVD about a self-controlled vocal exercise. The maximum phonation time which is a measure of glottal closure was evaluated, and the number of patients who developed pneumonia during the six months was compared between the two groups.Results:Of the 543 patients enrolled in this trial, 259 were allocated into the intervention group and 284 into the control; 60 of the intervention group and 75 of the control were not able to continue the trial. A total of 199 patients (age 73.9 ±7.25 years) in the intervention group and 209 (73.3 ±6.68 years) in the control completed the six-month trial. Intervention of the self-controlled vocal exercise extended the maximum phonation time significantly (p < 0.001). There were two hospitalizations for pneumonia in the intervention group and 18 in the control group, representing a significant difference (p < 0.001).Conclusion:The self-controlled vocal exercise allowed patients to achieve vocal cord adduction and improve glottal closure insufficiency, which reduced the rate of hospitalization for pneumonia significantly.Clinical Trial.gov Identifier-UMIN000015567

Exploring the Relation between Glottal Closure and Plasma Substance P: A Study Protocol

“…Based on our RCT showing that NHOEx contributes to strengthened glottal closure (Fujimaki et al 2017), we propose that the exercises should also contribute to prevention of pneumonia by improving glottal closure for both cough and voice. Also, considering basic and clinical research about SP, we propose that strengthened glottal adduction will cause an increase of plasma SP.…”

“…The purpose of this study is to develop an early marker for predicting the risk of aspiration pneumonia using SP and to verify the validity and reliability of SP as an indicator for glottal closing function and swallowing function. Using NHOEx (Fujimaki et al 2017), we will examine the transition of SP from before to after treatment of dysphonia/ dysphagia and clarify its use as an objective indicator for glottal closure. Glottal closure is one of the most preventable factors for aspiration pneumonia, and NHOEx is effec-tive to improve the glottal closure by strengthening the laryngeal adduction muscles.…”

“…We have shown in a previous randomized controlled trial (RCT) that National Hospital Organization self-controlled vocal exercise (NHOEx) improves glottal closure by strengthening the laryngeal adduction muscles (Fujimaki et al 2017). MPT was significantly increased after a 6-month course of NHOEx, and the incidence of pneumonia was also significantly reduced.…”

Sarcopenic Dysphagia as a New Concept

“…In adults aged 60 years or older, with atrophy of the vocal cords or sulcus vocalis with aging, self-controlled vocal exercise in the sitting position that consists of counting out loud from 1 to 10 while pulling up firmly on both sides of the seat reduced the frequency of hospitalization for aspiration pneumonia (2/199 in the intervention group and 18/216 in the control group) [95]. Subjects in the intervention group exercised for a total of two sets, both in the morning and in the evening for 6 months.…”

Trends and practices in dysphagia rehabilitation training methods

“…NMES device: VitalStim # $ % Plus インターリハ株式会社の許可を得て掲載 カレイド株式会社の許可を得て掲載 Figure 7. Self-controlled vocal exercise method 24) . 1.…”