The Acute Effects of a Single Session of Expiratory Muscle Strength Training on Blood Pressure, Heart Rate, and Oxygen Saturation in Healthy Adults

Expiratory muscle strength training (EMST) is a rehabilitative program that has been tested for outcomes related to respiratory muscle strength, cough, swallow, and voice function in healthy young adult, elderly individuals, and in patients with progressive neurodegenerative disease. Because EMST has been used in patient care, the associated cardiovascular responses during EMST are of importance. This study investigated the changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and oxygen saturation (SpO2) during one session of EMST in healthy, young adults as a preliminary study of device safety. Thirty-one participants completed a single session of 25 trials with the EMST device. Valsalva maneuvers were performed at the beginning and at the end of the EMST trials for task comparison. The SBP, DBP, HR, and SpO2 were recorded at the baseline and after completing the following tasks: a Valsalva maneuver, 12 trials using the EMST device, 13 trials using the EMST device, and 5 min of rest following the EMST session. A mixed linear model tested for changes across the six time points. The results indicated no significant change of SBP, DBP, HR, or SpO2 during or following the EMST trials or after performing the Valsalva maneuver. The results suggest that EMST does not elicit significant fluctuations of blood pressure, HR, and SpO2 in healthy young adults even when considering the effects of covariates on the outcomes measures

The Role of the Speech-Language Pathologist in the Schools for the Treatment of Voice Disorders: Working within the Framework of the Individuals with Disabilities Education Improvement Act

The role of the speech-language pathologist (SLP) has developed considerably over the past 20 years given the medical and technological advances in life-sustaining procedures. Children born with congenital, surgical, or medically fragile conditions become mainstreamed into regular school-based settings, thus extending the traditional role of the treating SLP and multidisciplinary team. Understanding the impact of associated voice disorders on educational performance requires dissemination of additional and important information, as eligibility decisions for students in school-based settings must be made within the framework of the federal legislation and regulations governing the provision of services for students with disabilities. This article discusses how to identify children with voice disorders under the Individuals with Disabilities Education Improvement Act (IDEA), the role of the SLP in various triaging scenarios, and how models of voice therapy can be integrated in a school-based setting

Effects of western classical vocal training on physiological measures during speaking voices

Comunicação apresentada no 20th World Congress of the International Federation of Oto-Rhino-Laryngological Societies, 1-5 junho 2013, Seul, Coreia do Su

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Treating Voice Disorders In The School-Based Setting: Working Within The Framework Of Idea

The role of the speech-language pathologist (SLP) has developed considerably over the last 10 years given the medical and technological advances in life-sustaining procedures. Over time, children born with congenital, surgical, or medically fragile conditions have become mainstreamed into regular school-based settings, thus extending the traditional role of the SLP and multidisciplinary team. Understanding the impact of these voice disorders on the child\u27s educational performance has been a struggle for many clinicians because the eligibility decisions for students in school-based settings must be made within the framework of federal legislation and regulations governing the provision of services for students with disabilities. This article discusses how to identify children with voice disorders under the Individuals With Disabilities Education Act (IDEA) definition, the role of the SLP in assigning priority in various voice management scenarios, and how models of therapy can be incorporated in the school-based setting

Inspiratory Pressure Threshold Training For Upper Airway Limitation: A Case Of Bilateral Abductor Vocal Fold Paralysis

A single subject design was used to determine if pressure threshold training strengthens the inspiratory muscles in a subject with a limited glottal airway as well as diminish dyspnea and improve parameters of speech. The subject was a 19-year-old woman whose glottal airway was limited due to bilateral abductor vocal fold paralysis following a thyroidectomy. A 5-week inspiratory muscle strength-training program was implemented using a pressure-threshold trainer to strengthen the inspiratory muscles with the intent of enabling the generation of higher inspiratory pressures. The pressure threshold on the trainer was set at 75% of the subject\u27s maximum inspiratory pressure (MIP). The subject was required to generate sufficient inspiratory pressure to bring air through the trainer during an inspiratory maneuver. MIP was the dependent variable used as an indication of inspiratory muscle strength. MIP increased by 47% following the training program. Maximal minute ventilation and oxygen uptake increased posttraining. Dyspnea during exercise and speech decreased as reported by the subject. Total reading duration and pause duration demonstrated a declining trend during connected speech. The results indicated that inspiratory muscle training using a pressure threshold device improves functional tasks such as exercise and speech in a subject with upper airway limitation

Laryngeal Structure And Function In The Pediatric Larynx: Clinical Applications

This article presents an overview of the normal anatomy and physiology of the pediatric larynx, followed by some examples of pediatric voice disorders that were chosen to exemplify the alterations to the laryngeal anatomy and the subsequent modifications to laryngeal function. Vocal fold nodules are primarily reviewed due to their high incidence in the pediatric population. Three other disorders, including laryngeal hyperfunction, unilateral vocal fold paralysis, and bilateral abductor vocal fold paralysis, are discussed because of their more common occurrence and the uniqueness of their etiology and intervention, particularly for the case of bilateral abductor vocal fold paralysis

Preliminary Evidence Of Reduced Urge To Cough And Cough Response In Four Individuals Following Remote Traumatic Brain Injury With Tracheostomy

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