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.

项目摘要 该申请将为主要研究人员Teresa Kimberley博士提供受保护的时间和 支持（1）成功指导初级调查员的记录； （2）提供研究 对从事以患者为导向的沟通障碍研究的受训者进行培训； （3）增强 评估语音生产的培训； （4）推进金伯利博士正在进行的翻译 喉肌肌张力障碍研究。肌张力障碍是一群毁灭性的神经运动障碍 这可能会影响任何身体区域。没有治愈或修改疾病的治疗 该疾病的病理生理学基本上未知。最常见的肌张力障碍影响 声带肌肉是内收肌肌张力障碍（ADLD）。 ADLD的人遭受勒死 由于甲状腺类动物（TA）肌肉的非自愿痉挛而引起的语音和言语中断。长期 该奖项的一项目标是阐明喉肌张力障碍的病理生理学并发展 敏感的测试和治疗疾病的新干预措施。拟议的项目基于博士。 金伯利（Kimberley）开发新颖且有效的经颅磁刺激（TMS）的尖端工作 评估喉运动皮质区域皮质兴奋性的方法。最近的发现有 显示出非典型的大脑激活模式，并降低了患有 ADLD。假设是针对左喉运动的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提高语音 在患有ADLD的人中的功能。患有ADLD的人将参加一个随机的双盲， 假对照，初步试验。主要测试将包括评估语音功能 （AIM 1）和TMS测量神经生理学（AIM 2）。与对 干预也将探讨（AIM 3）。该项目为受训者提供了独特的机会训练 在临床和转化研究中，是在皮质骨神经生理学的交集中 侵入性神经调节和语音疾病的临床评估。丰富的资源 马萨诸塞州综合医院，MGH卫生专业研究所和Spaulding Rehabilitation 医院提供了一个杰出的科学环境，以培训下一代研究人员 跨学科的沟通障碍研究方法。这个项目有可能 通过扩大治疗方案，改善生活质量和 减轻这种疾病患者的医疗保健负担。从拟议中获得的知识 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 当前治疗的辅助疗法，并确定RTM是否可以翻译成其他声音 疾病或类型的局灶性肌张力障碍。