JMIR Publications

ABSTRACT

Background:

Patients with Parkinson's disease (PD) often experience a decline in their voice and swallowing abilities, which can significantly impact their quality of life (QOL). Traditional face-to-face voice/swallowing therapy, involving long-term and repetitive training, is commonly used. However, challenges related to time and access to suitable facilities limit its effectiveness. In this study, we used the “A Successful Swallowing with Effortful Training (ASSET)” protocol of the mobile healthcare (mHealth) at-home training application.

Objective:

To identify variables within the voice and swallowing domains that improved after 4- or 8-week of training. In addition, the usability of the mHealth application was assessed.

Methods:

Overall, 15 participants (males:females = 5:10; mean age = 62.3±9.2 years) were randomly assigned to either a 4-week (n=8) or an 8-week (n=7) training group. The experimental tasks consisted of Effortful Prolonged Swallow, Effortful Pitch Glide, and Effortful Tongue Rotation components at home using an application installed in a tablet for 2 sessions per day, 5 days per week. The voice outcome measures for the acoustic analysis included F0 and Flo (Lowest F0). Swallowing was measured as the number of repetitions of the Repetitive saliva swallowing test (RSST). Subjective voice/swallowing evaluations were administered using Voice Handicap Index (VHI)-10, Brief Inventory of Swallowing Ability (BISA)15+, Swallowing Quality of Life (SWAL-QOL), and Telehealth Usability Questionnaire.

Results:

The training effects on voice function revealed increased maximum sustained vowel phonation /a/ time, improved acoustic parameters (F0, jitter, shimmer, and NHR) for the sustained vowel /a/(p<0.5), and improved acoustic measures (F0, Fhi, and Flo) during paragraph reading. We also observed improvements in the VHI-10 questionnaire (p<0.05). Significant training effects on swallowing function were noted in the RSST (p<.05), and in certain variables of the SWAL-QOL (p<.05). Analysis based on the duration of training (that is, 4-week vs. 8-week) did not demonstrate a significant difference in therapeutic outcomes.

Conclusions:

The high-intensity at-home mHealth training program strengthened the muscles involved in laryngeal closure and elevation, leading to favorable effects on voice, swallowing, and overall QOL of patients with PD. A 4-week training dosage was sufficient to induce improvements in all outcome measures. This study is novel, in that, it is the first to pave the way for delivering digital therapeutics to debilitated PD patients with voice and swallowing impairments.