The effects of neural modulation on phonatory function in laryngeal dystonia

神经调节对喉肌张力障碍发声功能的影响

• 批准号: 10578816
• 负责人: Teresa Jacobson Kimberley
• 金额: $ 19.49万
• 依托单位: MGH INSTITUTE OF HEALTH PROFESSIONS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-15 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10578816
• 关键词: Acceleration; Acoustics; Address; Affect; Age; Area; Auditory; Award; Body Regions; Brain; Characteristics; Clinical; Clinical Research; Clinical assessments; Communication; Communication impairment; Cross-Over Studies; Data; Development; Disease; Dose; Double-Blind Method; Dystonia; Environment; Failure; Focal Dystonias; Frequencies; Functional disorder; General Hospitals; Goals; Grant; Hand; Health Occupations; Healthcare; Hospitals; Impairment; Individual; Interruption; Intervention; Investigation; Knowledge; Laryngeal Diseases; Laryngeal muscle structure; Larynx; Left; Limb Dystonia; Limb structure; Link; Massachusetts; Measures; Mentors; Methodology; Methods; Motor; Motor Cortex; Motor Evoked Potentials; Movement Disorders; Muscle; National Institute on Deafness and Other Communication Disorders; Neural Inhibition; Neurologic; Participant; Patients; Pattern; Persons; Phonation; Positioning Attribute; Principal Investigator; Production; Protocols documentation; Quality of life; Randomized; Rehabilitation therapy; Research; Research Personnel; Research Training; Resources; Running; Severities; Spasm; Spastic Dysphonias; Speech; Symptoms; Testing; Thyroarytenoid Muscle; Time; Training; Transcranial magnetic stimulation; Translating; Translational Research; Translations; Voice; Voice Disorders; Work; adduct; care burden; clinical application; improved; innovation; interdisciplinary approach; intervention effect; neural; neuroimaging; neuromechanism; neurophysiology; neuroregulation; next generation; noninvasive brain stimulation; novel; patient oriented; post intervention; pre-clinical; randomized, clinical trials; repetitive transcranial magnetic stimulation; responders and non-responders; response; safety and feasibility; synergism; training opportunity; vocal cord

Project Summary This application will provide the Principal Investigator, Dr. Teresa Kimberley, with protected time and support to (1) accelerate a successful record of mentoring junior investigators; (2) provide research training to mentees engaged in patient-oriented communication disorder research; (3) enhance training in assessing voice production and; (4) advance the translation of Dr. Kimberley's ongoing research on laryngeal dystonia. Dystonia is a group of devastating neurological movement disorders that can affect any body region. There is no cure or disease-modifying treatment and the pathophysiology of the disorder remains largely unknown. The most common dystonia affecting the vocal fold muscles is adductor laryngeal dystonia (AdLD). People with AdLD suffer from a strangled voice and speech interruption due to involuntary spasms of the thyroarytenoid (TA) muscles. The long- term goal of this award is to elucidate the pathophysiology of laryngeal dystonia and to develop sensitive testing and novel interventions to treat the disease. The proposed project builds upon Dr. Kimberley's cutting-edge work of developing a novel and valid transcranial magnetic stimulation (TMS) methodology to assess the cortical excitability of the laryngeal motor cortical area. Recent findings have shown an atypical pattern of brain activation and decreased intracortical inhibition in people with AdLD. The hypothesis is that a 5-day inhibitory rTMS protocol targeted to the left laryngeal motor area associated with the TA muscles will increase intracortical inhibition and improve phonatory function in people with AdLD. Individuals with AdLD will participate in a randomized, double-blinded, sham-controlled, preliminary trial. The primary tests will include assessments of phonatory function (Aim 1) and TMS-measured neurophysiology (Aim 2). Factors associated with positive response to the intervention will also be explored (Aim 3). This project offers a unique opportunity for mentees to train in clinical and translational research that is at the intersection of corticobulbar neurophysiology, non- invasive neuromodulation, and clinical assessment of voice disorders. The rich resources at Massachusetts General Hospital, MGH Institute of Health Professions, and Spaulding Rehabilitation Hospital provide an outstanding scientific environment to train the next generation of researchers in an interdisciplinary approach to communication disorders research. This project has the potential to positively impact people with AdLD by expanding treatment options, improving quality of life and reducing healthcare burden for people with this disorder. The knowledge gained from the proposed study will extend to future research to optimize neuromodulatory interventions, explore rTMS as an adjunct therapy to current treatments, and to determine if rTMS can be translated to other voice disorders or types of focal dystonia.

项目概要 该应用程序将为首席研究员 Teresa Kimberley 博士提供受保护的时间和时间 支持 (1) 加速指导初级研究者的成功记录； (2) 提供研究 对从事以患者为中心的沟通障碍研究的学员进行培训； (3)增强 评估声音产生的培训； (4) 推进金伯利博士正在进行的翻译 喉肌张力障碍的研究。肌张力障碍是一组破坏性的神经运动障碍 可以影响身体的任何部位。没有治愈或改变疾病的治疗方法， 这种疾病的病理生理学在很大程度上仍然未知。最常见的肌张力障碍影响 声带肌肉是喉内收肌张力障碍（AdLD）。患有 AdLD 的人会被勒死 由于甲杓肌 (TA) 肌肉不自主痉挛而导致声音和言语中断。长- 该奖项的长期目标是阐明喉肌张力障碍的病理生理学并开发 敏感的测试和新颖的干预措施来治疗该疾病。拟议的项目建立在博士的基础上。 Kimberley 在开发新颖有效的经颅磁刺激 (TMS) 方面的前沿工作 评估喉运动皮质区皮质兴奋性的方法。最近的研究结果有 在患有以下疾病的人中显示出非典型的大脑激活模式和皮质内抑制减少 AdLD。假设针对左喉运动的 5 天抑制性 rTMS 方案 与 TA 肌肉相关的区域将增加皮质内抑制并改善发声 在 AdLD 患者中发挥作用。 AdLD 患者将参加一项随机、双盲、 假对照初步试验。主要测试将包括发声功能的评估 （目标 1）和 TMS 测量的神经生理学（目标 2）。与积极反应相关的因素 还将探讨干预措施（目标 3）。该项目为学员提供了独特的培训机会 在皮质延神经生理学交叉点的临床和转化研究中，非 侵入性神经调节和声音障碍的临床评估。丰富的资源位于 马萨诸塞州总医院、麻省总医院健康专业研究所和斯波尔丁康复中心 医院提供卓越的科学环境来培养下一代研究人员 沟通障碍研究的跨学科方法。该项目有潜力 通过扩大治疗选择、改善生活质量和 减轻患有这种疾病的人的医疗负担。从建议中获得的知识 研究将扩展到未来的研究，以优化神经调节干预措施，探索 rTMS 作为一种 当前治疗的辅助治疗，并确定 rTMS 是否可以转换为其他声音 局灶性肌张力障碍的疾病或类型。