Muzikoterapeutická intervencia zameraná na komunikáciu pri Parkinsonovej chorobe – kvantitatívne výsledky a klinické implikácie

Stáhnout PDF English version

Autoři: M. Habalová ¹; Z. Fábry Lucká ¹; Z. Cséfalvay ²; I. Straka ³; A. Kušnírová ³; Z. Košutzká ³
Působiště autorů: Department of Therapeutic Education, Faculty of Education, Comenius University, Bratislava, Slovakia ¹; Department of Communication Disorders, Faculty of Education, Comenius University, Bratislava, Slovakia ²; 2nd Department of Neurology, Faculty of Medicine, Comenius University and University Hospital Bratislava, Slovakia ³
Vyšlo v časopise: Cesk Slov Neurol N 2026; 89(2): 123-129
Kategorie: Původní práce
doi: https://doi.org/10.48095/cccsnn2026123

Souhrn

Úvod: Parkinsonova choroba je neurodegeneratívne ochorenie, ktoré ovplyvňuje nielen motorické funkcie, ale aj oblasť reči a hlasu. Muzikoterapia predstavuje sľubný nefarmakologický prístup na podporu komunikácie u tejto populácie. Ciele: Cieľom intervenčnej štúdie bolo zhodnotiť prínos originálneho muzikoterapeutického intervenčného programu na zrozumiteľnosť reči, kvalitu hlasu a spontánnu rečovú produkciu u osôb s Parkinsonovou chorobou. Metódy: Participanti (n = 17) absolvovali osemtýždňový skupinový program zameraný na precvičovanie hlasu, dýchania, artikulácie a spevu. Pred a po intervencii boli realizované hodnotenia pomocou škály GRBAS, testu zrozumiteľnosti reči a testu spontánnej rečovej produkcie (Analysis of Spontaneous Speech; ASpoR) na vyhodnotenie spontánnej reči. Dáta boli analyzované prostredníctvom deskriptívnej a inferenčnej štatistiky vrátane výpočtu veľkosti efektu. Výsledky: U participantov sa preukázalo zlepšenie celkovej zrozumiteľnosti reči so signifikantným nárastom kombinovaného skóre (p = 0,0099, d = 0,71). Skóre GRBAS sa deskriptívne zlepšilo bez štatistickej signifikancie, s veľkými efektmi pri parametroch dyšnosť (r = 0,83) a napätie (r = 0,67). Plynulosť a počet chýb v spontánnej reči zostali stabilné, avšak intervencia významne zlepšila sebamonitorovanie, čo potvrdzuje vyšší podiel opravených chýb (p = 0,00097, r = 0,87) a nižší pomer neopravených chýb k opraveným chybám (p = 0,00049, r = 0,87). Záver: Program zlepšil viaceré aspekty komunikácie, čo poukazuje na terapeutický potenciál muzikoterapie pre túto populáciu.

Klíčová slova:

Parkinsonova choroba – kvalita hlasu – zrozumiteľnosť reči – muzikoterapia – komunikácia

...

Zdroje

1. de Lau LM, Breteler MM. Epidemiology of Parkinson’s disease. Lancet Neurol 2006; 5 (6): 525–535. doi: 10.1016/S1474-4422 (06) 70471-9.

2. Ramig L, Halpern A, Spielman J et al. Speech treatment in Parkinson’s disease: randomized controlled trial (RCT). Mov Disord 2018; 33 (11): 1777–1791. doi: 10.1002/mds.27460.

3. Brabenec L, Mekyska J, Galaz Z et al. Speech disorders in Parkinson’s disease: early diagnostics and effects of medication and brain stimulation. J Neural Transm 2017; 124 (3): 303–334. doi: 10.1007/s00702-017-1676-0.

4. Atalar MS, Oguz O, Genc G. Hypokinetic dysarthria in Parkinson’s disease: a narrative review. Sisli Etfal Hastan Tip Bul 2023; 57 (2): 163–170. doi: 10.14744/SEMB.2023.29560.

5. Duffy JR. Motor speech disorders: substrates, differential diagnosis, and management. St. Louis: Elsevier Mosby 2013.

6. Miller N, Allcock L, Jones D et al. Prevalence and pattern of perceived intelligibility changes in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2007; 78 (11): 1188–1190. doi: 10.1136/jnnp.2006.110171.

7. Darling-White M, Huber JE. The impact of expiratory muscle strength training on speech breathing in individuals with Parkinson’s disease: a preliminary study. Am J Speech Lang Pathol 2017; 26 (4): 1159–1166. doi: 10.1044/2017_AJSLP-16-0132.

8. Freed DB. Motor speech disorders: diagnosis and treatment. Cengage Learning 2020.

9. Altmann LJP, Troche MS. High-level language production in Parkinson’s disease: a review. Parkinsons Dis 2011; 2011 : 238956. doi: 10.4061/2011/238956.

10. Murray LL. Language and Parkinson’s disease. Annu Rev Appl Linguist 2008; 28 : 113–127. doi: 10.1017/S0 267190508080100.

11. Altmann LJP, Schumacher JG, Paul RL. Language and communication changes in Parkinson’s disease. In: Miller RG, Lang AG (eds). Cognition and communication in aging and neurodegenerative disease. Amsterdam: Elsevier 2016 : 145–166.

12. Miller N. Speech, voice and language in Parkinson’s disease: changes and interventions. Neurodegener Dis Manag 2012; 2 (3): 279–289. doi: 10.2217/nmt.12.15.

13. Mahler LA, Ramig LO, Fox CM. Evidence-based treatment of voice and speech disorders in Parkinson disease. Curr Opin Otolaryngol Head Neck Surg 2015; 23 (3): 209–215. doi: 10.1097/MOO.0000000000000151.

14. Wright H, Aharonson V. Vocal feature changes for monitoring Parkinson’s disease progression –⁠ a systematic review. Brain Sci 2025; 15 (3): 320. doi: 10.3390/brainsci15030320.

15. Haneishi E. Effects of a music therapy voice protocol on speech intelligibility, vocal acoustic measures, and mood of individuals with Parkinson’s disease. J Music Ther 2001; 38 (4): 273–290. doi: 10.1093/jmt/38.4.273.

16. Di Benedetto P, Cavazzon M, Mondolo F et al. Voice and choral singing treatment: a new approach for speech and voice disorders in Parkinson’s disease. Eur J Phys Rehabil Med 2009; 45 (1): 13–19.

17. Elefant C, Baker FA, Lotan M et al. The effect of group music therapy on mood, speech, and singing in individuals with Parkinson‘s disease: a feasibility study. J Music Ther 2012; 49 (3): 278–290. doi: 10.1093/jmt/49.3.278.

18. Yinger OS, Lapointe LL. The effects of participation in a group music therapy voice protocol (G-MTVP) on the speech of individuals with Parkinson’s disease. Music Ther Perspect 2012; 30 (1): 25–31. doi: 10.1093/mtp/30.1.25.

19. Shih LC, Wang J, Fu YH et al. Singing in groups for Parkinson‘s disease (SING-PD): a pilot study of group singing therapy for PD-related voice/speech disorders. Parkinsonism Relat Disord 2012; 18 (5): 548–552. doi: 10.1016/j.parkreldis.2012.02.009.

20. Stegemöller EL, Radig H, Hibbing P et al. Effects of singing on voice, respiratory control and quality of life in persons with Parkinson’s disease. Disabil Rehabil 2017; 39 (6): 594–600. doi: 10.3109/09638288.2016.1152610.

21. Azekawa M, Lagasse AB. Singing exercises for speech and vocal abilities in individuals with hypokinetic dysarthria: a feasibility study. Music Ther Perspect 2018; 36 (1): 40–49. doi: 10.1093/mtp/miw042.

22. Tamplin J, Morris ME, Marigliani C et al. ParkinSong: outcomes of a 12-month controlled trial of therapeutic singing groups in Parkinson’s disease. J Parkinsons Dis 2020; 10 (3): 1217–1230. doi: 10.3233/JPD-191838.

23. Butala A, Li K, Swaminathan A et al. Parkinsonics: a randomized, blinded, cross-over trial of group singing for motor and non-motor symptoms in idiopathic Parkinson disease. Parkinsons Dis 2022; 2022 : 4233203. doi: 10.1155/2022/4233203.

24. Mohseni Z, Mohamadi R, Habibi SAH et al. Voice improvement following conventional speech therapy combined with singing intervention in people with Parkinson’s disease: a three-arm randomized controlled trial. Int J Lang Commun Disord 2023; 58 (5): 1752–1767. doi: 10.1111/1460-6984.12900.

25. Lee SJ, Dvorak AL, Manternach JN. Therapeutic singing and semi-occluded vocal tract exercises for individuals with Parkinson’s disease: a randomized controlled trial of a single session intervention. J Music Ther 2024; 61 (2): 132–167. doi: 10.1093/jmt/thae004.

26. Postuma RB, Berg D, Stern M et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord 2015; 30 (12): 1591–1601. doi: 10.1002/mds.26424.

27. Ricci-Maccarini A, Schindler A, Mozzanica Fet al. Validity, reliability and reproducibility of the “Extended GRBAS Scale,” a comprehensive perceptual evaluation of dysphonia. J Voice 2025; 39 (2): 393–402. doi: 10.1016/j.jvoice.2022.09.008.

28. Mičianová Ľ, Kušnírová A, Straka I et al. Zrozumiteľnosť reči a klinické parametre u pacientov s Parkinsonovou chorobou. Cesk Slov Neurol N 2018; 81 (5): 586–592. doi: 10.14735/amcsnn2018586.

29. Marková J, Kevická V, Buntová D. Analýza spontánnej reči a jej využitie v logopedickej praxi. Bratislava: Univerzita Komenského 2021.

30. Plonsky L, Oswald FL. How big is “big”? Interpreting effect sizes in L2 research. Lang Learn 2014; 64 (4): 878–912. doi: 10.1111/lang.12079.

31. Mertel K. Oral motor and respiratory exercises. In: Thaut MH, Hoemberg V (eds). Handbook of neurologic music therapy. Oxford: Oxford University Press 2014 : 161–178.

32. García-Casares N, Martín-Colom JE, García-Arnés JA. Music therapy in Parkinson’s disease. J Am Med Dir Assoc 2018; 19 (12): 1054–1062. doi: 10.1016/j.jamda.2018.09.025.

33. Vydrová J. Hlasová terapie. Havlíčkův Brod: Tobiáš 2017.

34. Thaut MH. Vocal intonation therapy (VIT). In: Thaut MH, Hoemberg V (eds). Handbook of neurologic music therapy. Oxford: Oxford University Press 2014 : 179–184.

35. de Oliveira Lemos I, da Cunha Pereira G, DruckSant’Anna G et al. Effects of a voice therapy program forpatients with muscle tension dysphonia. Folia PhoniatrLogop 2018; 69 (5–6): 239–245. doi: 10.1159/000487942.

36. Mainka S, Mallien A. Rhythmic speech cueing. In: Thaut MH, Hoemberg V (eds). Handbook of neurologic music therapy. Oxford: Oxford University Press 2014 : 150–161.

37. Fujii S, Wan CY. The role of rhythm in speech and language rehabilitation: the SEP hypothesis. Front Hum Neurosci 2014; 8 : 777. doi: 10.3389/fnhum.2014.00777.

38. Thaut MH. Rhythm, music, and the brain: scientific foundations and clinical applications. New York: Routledge 2005.

39. Särkämö T. Musical leisure activities to support cognitive and emotional functioning in aging and dementia: a review of current evidence. 2020 [online]. Available from: https: //helda.helsinki.fi/server/api/core/bitstreams/7fc67b3d-589a-4d2b-869b-3dc03952ec1f/content.

40. Kusý P, Palčeková A. The potential of music-based interventions as a component of social rehabilitation. Rehabilitacia 2025; 62 (3): 162–181. doi: 10.61983/lcrh.v62i3.116.