Bases Of Normal & Disordered Laryngeal & Speech Systems

正常的基础

• 批准号: 7143892
• 负责人: Christy Leslie Ludlow
• 金额: --
• 依托单位: NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7143892
• 关键词: clinical research; developmental disease /disorder; dysphagia; dystonia; electrostimulus; family genetics; gastrointestinal stimulator; genetic disorder; genetic screening; human subject; language development; language disorders; larynx disorder; larynx muscle; motor neurons; muscle function; nervous system disorder; nervous system prosthesis; neuromuscular function; prognosis; sensory feedback; speech disorders; speech therapy; stretch receptors; swallowing

Our goal is to improve the treatment and prevention of voice, speech and swallowing disorders. For this purpose, the Section conducts research both on the neural control of the larynx for voice, speech and swallowing as well as the pathogenesis and pathophysiology of neurogenic idiopathic voice and speech disorders. In addition, new treatment methods are being developed for persons with chronic pharyngeal dysphagia. Significant advances have been made during the last year in several areas. Our Section is particularly interested in the role of sensation in idiopathic voice disorders such as spasmodic dysphonia. First, however, we must determine what types of sensory feedback play a role in laryngeal motor control in humans. Speakers may use laryngeal sensory feedback to adjust vocal fold tension and length prior to initiating voice when auditory feedback becomes available. One of the questions we have is what sensors are used to provide feedback for vocal fold movement prior to voice initiation. Others have proposed that the thyroarytenoid muscles within the vocal folds contain muscle spindles that provide proprioceptive feedback. The possible role of stretch receptors in the larynx is controversial given the absence of muscle spindles in the laryngeal muscles in other mammals and conflicting findings regarding their existence in humans. We evaluated whether rapid changes in vocal fold length modulate laryngeal muscle contraction in humans during voicing. Mechanical perturbation was applied with a servomotor to first stretch the cricothyroid muscle by indenting the thyroid cartilage followed by a rapid release, stretching the thyroarytenoid muscle. Although servomotor displacements produced consistent changes in the subjects' voices, demonstrating changes in vocal fold length and tension, no simultaneous electromyographic reponses to stretch occurred in the thyroarytenoid or cricothyroid muscles inside the larynx. Instead, short-latency responses occurred in the sternothyroid muscle, an overlying strap muscle known to contain spindle afferents, The absence of intrinsic laryngeal muscle responses to stretch is consistent with a lack of spindles in these muscles and suggests that other sensory receptors, such as mucosal mechanoreceptors, are more likely to provide proprioceptive feedback for voice control in humans. Developmental speech disorders often occur in isolation and are idiopathic. The rate of spontaneous recovery from such developmental disorders is high, however, because no predictors of recovery are available, all children receive speech therapy. We are completing a series of studies of adults who have not recovered from developmental speech disorders to identify which factors are associated with poor recovery from developmental speech disorders. All of the adults studied had a persistent familial developmental speech disorder without language impairment. They were compared with unaffected adults on tasks requiring the discrimination of fine acoustic cues for word identification and on measures of verbal and nonverbal short-term memory. Significant group differences were found in the slopes of the discrimination curves for formant transitions for word identification and on tests of nonverbal rhythm and tonal memory, and verbal short-term memory. No group differences occurred in the use of stop gap durations for word identification, however, demonstrating that only selective deficits were present in auditory processing and memory. We are now examining whether specific auditory processing and short term memory disorders occur in those children who fail to recover from developmental multiple articulation disorders. Dysphagia is a significant health problem affecting many aging adults who suffer from neurological disorders and diseases. These swallowing disorders usually stem from central nervous system injury, leaving the peripheral control of muscles intact but without appropriate central control. We are studying the feasibility of using intramuscular electrical stimulation to augment airway protection by hyolaryngeal elevation during swallowing to reduce the risk of aspiration in those with chronic dysphagia. One of the difficulties is to trigger the onset of electrical stimulation so that it is coordinated with attempts to swallow. Patients must synchronize functional electrical stimulation (FES) with their reflexive swallowing and not adapt to FES by reducing the amplitude or duration of their own muscle activity. We first studied this in healthy adults by assessing whether they could learn to manually synchronize FES with hyolaryngeal muscle activity during swallowing, and whether they modified their patterns of muscle activity in response to FES of the same muscles during discrete swallows. Hooked-wire electrodes were used to record from the mylohyoid and thyrohyoid muscles on one side of the neck while delivering FES to the same muscles on the other side during swallowing. After performing baseline swallows, volunteers were instructed to trigger FES with a thumb switch in synchrony with their swallows for a series of trials. On the last trial, FES was disabled creating a foil. From the outset, volunteers synchronized FES with the onset of swallow-related thyrohyoid activity (about 225 ms after mylohyoid activity onset), preserving the normal sequence of muscle activation. When the baseline and foil trials were compared, no significant adaptive changes occurred in the amplitude, duration, or relative timing of activity in either muscle, indicating that the central pattern generator for hyolaryngeal elevation is immutable with short term stimulation that augments laryngeal elevation during the reflexive, pharyngeal phase of swallowing. In the last year, we have started using the same techniques in persons with chronic dysphagia aimed at determining if they can learn to coordinate FES with their own attempts to swallow. Our long term goal is to determine if FES can be used to reduce the risk of aspiration in chronic pharyngeal dysphagia.

我们的目标是改善语音，言语和吞咽障碍的治疗和预防。为此，本节对喉部的神经控制进行了研究，以进行语音，言语和吞咽，以及神经发生特发性语音和语音障碍的发病机理和病理生理学。此外，为患有慢性咽吞咽困难的人开发了新的治疗方法。去年在多个领域取得了重大进展。 我们的部分对感觉在特发性语音疾病中的作用（例如痉挛性吞咽困难）特别感兴趣。但是，首先，我们必须确定哪种类型的感觉反馈在人类的喉运动控制中起作用。当听觉反馈可用时，扬声器可以使用喉部感觉反馈来调整声带张力和长度。我们遇到的问题之一是在语音启动之前使用哪些传感器为声带移动提供反馈。其他人则提出，声带中的甲状腺素肌肉包含肌肉纺锤体，可提供本体感受反馈。鉴于其他哺乳动物的喉肌中缺乏肌肉纺锤体，并且有关其在人类中存在的发现相互矛盾的发现，拉伸受体在喉部中的可能作用是有争议的。我们评估了声带长度的快速变化是否会调节发声过程中人类的喉肌收缩。用伺服电机施加机械扰动，首先通过缩进甲状腺软骨，然后快速释放，从而伸展甲状腺素肌肌肌肌肉，从而首先拉伸甲状腺功能肌肌肉。尽管伺服电机位移在受试者的声音中产生了一致的变化，表明声带长度和张力的变化，但在larynx内部的甲状腺素甲肌膜或甲状腺素肌肉中没有同时进行肌电图。取而代之的是，短期反应发生在雌性肌肉肌肉中，这是一种已知包含纺锤体传入的上覆的皮带肌肉，缺乏固有的喉部肌肉对拉伸的反应与这些肌肉中缺乏纺锤体一致，并且在这些肌肉中缺乏纺锤体，并且表明其他感觉受体（例如，更有可能提供了粘液型机制的感觉）。 发育性语音障碍通常是孤立发生的，并且是特发性的。但是，从这种发育障碍中自发恢复的速度很高，但是由于没有恢复的预测指标，所有儿童都接受了言语治疗。我们正在完成一系列研究成年人的研究，这些研究尚未从发育语音疾病中恢复过来，以确定哪些因素与从发育型言语疾病中恢复不良有关的因素。所有被研究的成年人都有持续的家庭发展语音障碍，而没有语言障碍。将他们与未受影响的成年人进行了比较，需要歧视良好的声明提示，以识别单词识别以及言语和非语言短期记忆的度量。在歧视曲线的斜坡上发现了显着的群体差异，用于词法识别和非语言节奏和音调记忆的测试以及言语短期记忆。在使用停止差距持续时间进行单词识别时，没有群体差异发生，但是表明在听觉处理和内存中仅存在选择性缺陷。我们现在正在研究那些未能从发育性多重关节疾病中恢复过来的儿童中是否会发生特定的听觉处理和短期记忆障碍。 吞咽困难是影响许多患有神经系统疾病和疾病的成年人的重大健康问题。这些吞咽疾病通常源于中枢神经系统损伤，使肌肉的周围控制完好无损，但没有适当的中央控制。我们正在研究使用肌内电刺激在吞咽过程中通过hyolaryngeal升高增强气道保护的可行性，以降低患有慢性吞咽困难的人的吸入风险。困难之一是触发电刺激的发作，以便与吞咽的尝试协调。患者必须将功能性电刺激（FES）与反射性吞咽同步，而不是通过减少自己肌肉活动的幅度或持续时间来适应FES。我们首先通过评估他们是否可以学会在吞咽过程中与hyolaryngeal肌肉活动手动同步FES，并在离散吞咽过程中对相同肌肉的FES进行修饰。钩线电极用于记录颈部一侧的肌羟基和甲状腺素肌肉，同时在吞咽过程中向另一侧的同一肌肉传递FES。执行基线燕子后，指示志愿者与他们的燕子同步触发FES进行一系列试验。在最后一次试验中，FES被禁用了箔纸。从一开始，志愿者将FES与燕子相关的甲状腺素活性（肌羟基活性发作后约225毫秒）同步，从而保留了正常的肌肉激活序列。当比较基线和箔试验时，任何一种肌肉的振幅，持续时间或相对时机在活性的振幅，持续时间或相对时机中没有发生显着的自适应变化，这表明Hyolaryngeal升高的中心模式发生器是短期刺激的不可变化的，可以增强喉部吞咽吞咽相的喉部heperation。 在去年，我们已经开始在患有慢性吞咽困难的人中使用相同的技术，旨在确定他们是否可以学会与自己的吞咽尝试协调FES。我们的长期目标是确定是否可以使用FES来降低慢性咽吞咽困难的攻击风险。