Group Therapeutic Singing via Telemedicine Improved Respiratory Function of Parkinson’s Patients in Rural Iowa, Study Finds

singing, telemedicine

Parkinson’s disease patients living in rural areas in Iowa show improved respiratory function with group therapeutic singing delivered via telemedicine, according to a pilot study.

The study, “The Feasibility of Group Therapeutic Singing Telehealth for Persons with Parkinson’s Disease in Rural Iowa,” was published in the journal Telemedicine and e-Health.

Voice impairment affects most patients with Parkinson’s, but only a small minority undergo speech therapy. That is why new approaches to help improve voice and respiratory impairments in Parkinson’s patients are needed, especially for those living in rural areas where access to care is limited.

Telemedicine may be an effective answer, as it has led to positive results in the treatment of depression in Parkinson’s patients, as well as in group therapy, and education and support sessions.

Previous studies have suggested that singing may ease voice and respiratory impairments in people with Parkinson’s. In particular, researchers at Iowa State University have shown that group therapeutic singing effectively maintains the voice and significantly improves respiratory control in these  patients. However, whether it can be delivered through telemedicine — and whether it would lead to similar results as in-person group therapeutic singing — remains to be determined.

Aiming to address this topic, researchers tested an eight-week prerecorded group therapeutic singing program in nine idiopathic (of unknown cause) Parkinson’s patients (eight men, age 67-82) living in the rural Iowa towns of Rockwell City and Storm Lake.

All participants were on a stable regimen of antiparkinsonian medications for 30 days, did not smoke, and had received no speech therapy within the past two years. None had significant cognitive impairment, major psychiatric disorders, history of head or neck cancer, asthma, chronic obstructive pulmonary disease, or untreated hypertension.

The group therapeutic singing program was filmed before recruitment, with Parkinson’s patients who attended weekly in-person sessions. Each session included vocal exercises followed by group singing of familiar songs. The intervention targeted breath support, vocal intensity, and frequency range.

The assessments were made one week prior and one week after the intervention at the same time of day to avoid fluctuations in medication. Voice outcome measures included phonation (vocalization) duration and range, and vocal intensity, each tested in three trials.

Specifically, phonation duration was assessed as the total time a participant sustained the vowel sounds ‘‘ah’’ and ‘‘ee.’’ To determine phonation range, the team recorded the lowest and highest pitch with an iPad app, then calculated the difference. The loudest sound produced on a sustained ‘‘ah’’ indicated vocal intensity.

Respiratory outcome measures included maximal inspiratory and expiratory pressures (breathing in or out as forcefully as possible for two seconds)   recorded with a portable respiratory pressure meter.

One participant dropped out at week three. Five attended all eight sessions, two completed seven sessions, and one participant attended six sessions. The overall compliance was 93.75%.

Analysis of the eight patients completing all sessions revealed that the changes in phonation range and vocal intensity were not statistically significant. However, both respiratory outcome measures improved significantly.

The results were in line with those of in-person sessions, suggesting similar effectiveness with the two approaches, the team noted. The different results seen in phonation duration — an increase with in-person, but a slight decrease with the pre-recorded program — may have been due to the small number of participants in the study using telemedicine, the team noted.

“This study has established that using a prerecorded GTS [group therapeutic singing] program is feasible and effective for persons with [Parkinson’s] in rural areas,” researchers wrote. “Thus, this pilot work suggests that the use of prerecorded GTS may be a viable treatment option for those with limited access to care,” they added.

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Vitamin D May Improve Balance in Younger Parkinson’s Patients, Pilot Study Suggests

Short-term supplementation of vitamin D in high doses may improve balance in people with Parkinson’s disease younger than 66, according to results of a Phase 2 pilot study.
The study, “A randomized, controlled pilot study of the effects of vitamin D supplementation on balance in Parkinson’s disease: Does age matter?” was published in Plos One.
Parkinson’s patients are at a high risk of falling mainly due to problems with balance — one of the primary symptoms of the disease. It is estimated that 70 percent of Parkinson’s patients fall at least once a year.
Falls are associated with substantial injury, disability, hospitalization, and reduced quality of life in Parkinson’s patients and in older people in general. However, no pharmaceutical or surgical intervention is currently known to significantly improve balance.
As a result, there is an unmet need to discover or develop therapeutic approaches to improve balance in Parkinson’s patients.
At the same time, individuals with Parkinson’s, particularly those with advanced disease, have lower levels of vitamin D, which is involved not only in bone health, but also in brain function.
Previous studies have shown that vitamin D supplementation reduces fall rates and improves balance in older people. While it has been suggested that higher doses of vitamin D are more effective than lower ones, more recent evidence suggests that higher doses in older populations may have the opposite effect, being associated with more frequent falls and fractures.
A randomized, double-blinded, placebo-controlled Phase 2 pilot study (NCT01119131) evaluated the safety and effectiveness of high-dose vitamin D supplementation on balance, gait, falls, strength, and cognition in Parkinson’s patients. Disease severity and quality of life were also assessed.
Researchers analyzed the data of 51 patients, at a mean age of 66.57 years, who were randomized to receive either a high dose of vitamin D (27 patients) or a placebo (24 patients), in addition to 1,000 mg of calcium, daily for four months.
Balance function was measured using the Sensory Organization Test (SOT), an objective test to measure impairments in postural stability or balance, which has been found to be the most suitable for assessing balance in relation to vitamin D levels.
Results showed that vitamin D supplementation doubled patients’ vitamin D blood levels after four months of treatment, while patients who received placebo showed no substantial changes in their levels.
Patients receiving the high dose of the supplement showed no significant improvements in balance, compared with those in the placebo group. In addition, no significant changes were found for gait, strength, cognition, disease severity, or quality of life between the two groups of patients.
However, when researchers divided the patients who received vitamin D into two age groups — those 66 or younger, and those 67 and older — the supplement was found to significantly improve the balance of patients in the younger group, compared with the older age group. No significant therapeutic effect of the supplement was found for any of the other measures.
High-dose vitamin D supplementation appeared to be safe, with no serious adverse events reported.
These findings highlight the possibility of an “age-dependent role for vitamin

Source: Parkinson's News Today

Dance Therapy May Help Improve Motor Function of Parkinson’s Patients, Pilot Study Reports

Using dance as a therapeutic strategy may benefit patients with Parkinson’s disease by improving their motor function, results of a pilot study suggest.
The study, “ ‘Dance Therapy’ as a psychotherapeutic movement intervention in Parkinson’s disease,” was published in Complementary Therapies in Medicine.
Parkinson’s disease is mainly recognized by its progressive motor symptoms including tremor, muscle rigidity, and impaired gait and balance. Several non-motor symptoms are also experienced by patients, including cognitive impairment, fatigue, mood disorders, and sleep disturbances, all of which can be disabling and lead to a significant decrease in quality of life.
Anti-parkinsonian therapies focus on easing and managing the motor symptoms of the disease, but their use can be limited by the presence of non-motor issues. In addition, effective treatments for non-motor symptoms are not always available.

Given the complex symptom-treatment landscape of the disease, there is increased interest from both patients and caregivers in pursuing mind-body interventions, such as dance therapy, which have the potential to simultaneously address both the motor and non-motor symptoms of the disease.

Dance requires the practice of fluid movements and postures while maintaining full body control, which can address many of the motor symptoms associated with Parkinson’s. In addition, dance can improve patients’ emotional, cognitive, and social well-being as a result of listening to music and interacting with other people, potentially reducing the common non-motor symptoms of Parkinson’s.
Dance therapy differs from traditional dance classes because it not only focuses on the aesthetic and recreational features of the activity, but also includes the biopsychological status of the subject.
According to the American Dance Therapy Association, “dance/movement therapy is the psychotherapeutic use of movement to promote emotional, social, cognitive and physical integration of the individual.”
A team led by researchers at Northwestern University in Illinois evaluated the benefits of dance therapy in nine Parkinson’s patients, and compared it with the effects of support group therapy in four patients, who served as the control group.
Patients enrolled in the dance group had a mean age of 66.4 and mean Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) motor score of 27.6 points. The control group was older, with a mean age of 75.5, and had worse motor scores, a mean of 40.8 points. The UPDRS is a comprehensive 50-question assessment of both motor and non-motor symptoms associated with Parkinson’s.
Dance therapy sessions lasted 60 minutes and were conducted once a week, over 10 weeks. The exercises were tailored on an individual basis to incorporate different levels of functional capacity. The sessions focused on an understanding of how movement influences mood and mental health; enhanced balance, gait, and coordination; and expression of thoughts, feelings, and emotions through movement and dance.
The certified dance therapist who conducted the dance therapy sessions also led the support group, “which involved education about how movement influences mood and mental health, ways to incorporate movement and dance into daily life, and exploration of feelings and emotions in a supportive group environment,” according to the researchers.
Seven of the nine patients in the dance group and all participants in the control group completed the study,

Source: Parkinson's News Today