Motnje govora in požiranja pri osebah s Parkinsonovo boleznijo - Rajh, Daša (2019)
Parkinsonova bolezen (PB) s svojim potekom oškoduje nemalo človekovih funkcij in z leti privede do številnih negativnih posledic, ki pomembno ovirajo vsakdanje dejavnosti ter močno zmanjšajo kvaliteto življenja. Bolniki s PB se poleg težav z gibanjem pogosto soočajo tudi z motnjami komunikacije in hranjenja, ki so poleg značilnosti PB natančneje predstavljene v teoretičnih izhodiščih magistrske naloge. Opisan je ustrezen potek in vse sodelujoče strukture v procesu požiranja ter govora. Natančno so predstavljena odstopanja omenjenih funkcij pri osebah s PB, opozorilni znaki, morebitni vzroki in prevalenca. V drugem delu teoretičnih izhodišč so orisani diagnostični postopki motenj govora in požiranja ter različne možnosti rehabilitacije omenjenih težav. Z empiričnim delom smo želeli v prvi vrsti ugotoviti prevalenco ter vrsto motenj govora in požiranja med osebami s PB, najti povezavo med njimi ter različnimi dejavniki tveganja (vrsta PB, starost, trajanje bolezni), ki bi lahko vplivali na pojav in resnost preiskovanih motenj. V raziskavi je sodelovalo 62 bolnikov s PB: 56 oseb s PB, ki so v obdobju 4 zaporednih mesecev obiskale ambulanto za motnje gibanja, ter 6 oseb s PB, ki so bile zaradi motenj požiranja pregledane v foniatrični ambulanti. Na vzorcu 56 bolnikov s PB smo pridobili podatke o njihovem subjektivnem opažanju in doživljanju motenj požiranja ter govora, ki smo jih zbrali s pomočjo Vprašalnika o motnjah govora in požiranja pri osebah s Parkinsonovo boleznijo. Ta sestoji iz dveh prirejenih in dopolnjenih že obstoječih vprašalnikov (Voice Handicap Index 10 - VHI-10 in Eating Assessment Tool - EAT-10) ter posebej oblikovanih dodatnih vprašanjih o patologiji govora in požiranja. Bolniki so podali tudi odgovore o značilnostih bolezni in splošnih podatkih, potrebnih za raziskavo. Med spontanim pogovorom smo pri 53 bolnikih, ki so pristali na klinično oceno govora, ocenili kakovost glasu z GRBAS lestvico, ustreznost hitrosti in glasnosti govora, artikulacijska odstopanja ter resonanco. Izmerjen je bil maksimalni fonacijski čas vokala /a/ in opravljen test diadohokineze artikulacijskih organov. Preverili smo tudi motorične sposobnosti orofacialnega predela ter izvedli hitri vodni test požiranja. Pri izbranih 17 posameznikih smo opravili tudi analizo požiranja s fiberoptičnim nazolaringoskopom in po vnaprej pripravljenem protokolu ocenili akt požiranja. Na vzorcu 6 oseb s PB, ki so zaradi subjektivno opaženih težav pri požiranju sami poiskali pomoč neposredno pri foniatru, pa smo z analizo in oceno akta požiranja s fiberoptičnim nazolaringoskopom pridobili podatke o specifičnih motnjah požiranja bolnikov s PB. Izsledki raziskave so pokazali relativno visoko prevalenco motenj govora in požiranja med bolniki s PB. Odstopanja v govornem izražanju smo namreč odkrili pri 57,1 % bolnikov, patologijo v procesu požiranja pa smo prepoznali pri 37,5 % bolnikov s PB. Sočasna prisotnost motenega govora in požiranja se je pojavila pri 30,4 % bolnikov, a pomembna povezava med motnjami govora in požiranja ni bila dokazana. S primerjavo klinične ocene govora, analize požiranja ter rezultatov vprašalnika smo spoznali, da se kar precej (26,7 % bolnikov z govornimi motnjami) bolnikov ne zaveda odstopanj v lastnem govoru, medtem ko je odstotek bolnikov, ki ne opažajo svojih težav pri požiranju, občutno manjši (11,1 % bolnikov z motnjami požiranja). Z odkrivanjem povezav med posameznimi dejavniki tveganja in motnjami govora ter požiranja smo ugotovili, da obstaja statistično pomembna povezava med prisotnostjo govornih motenj in obliko PB. Z govornimi motnjami se je soočal občutno večji delež bolnikov z akinetično-rigidno obliko kot bolnikov s tremorozno obliko PB. V primeru motenj požiranja se je kot statistično pomembna izkazala povezava s spolom, patološko požiranje je bilo namreč pogosteje odkrito pri bolnicah kot bolnikih. Med preostalimi dejavniki tveganja in motnjami govora ter požiranja nismo odkrili statistično pomembnih povezav. Pridobljeni rezultati in spoznanja magistrskega dela opozarjajo na pogostost nekakovostnega požiranja in komunikacije bolnikov s PB, poudarjajo pomen ozaveščanja o tovrstni patologiji, vplivu na življenje ter prepoznavi smisla in potrebe po pravočasni logopedski pomoči. Parkinson's disease (PD) with its progression affects a considerable number of body functions. Over the years it leads to numerous negative consequences which significantly hinder everyday activities and reduce the quality of life to a great extent. Patients with PD confront not only movement disorders, but also communication and feeding disorders, which are, beside the PD characteristics, thoroughly presented in the theoretical basis of the thesis. This part describes adequate progression and every cooperative structure in the process of swallowing and speech, it thoroughly presents deviations of these functions with persons that suffer from PD, warning signs, possible causes and prevalence. The second part of the theoretical basis outlines diagnostic procedures of speech and swallowing disorders and different opportunities of rehabilitation. The main purpose of the empirical part was to establish prevalence and the type of speech and swallowing disorders among persons with PD, to find the connection between them and different risk factors (type of PD, age, duration of disease) that might affect the occurrence and importance of the disorders. 62 patients with PD participated in the research: 56 persons with PD who had visited the movement disorder clinic within 4 consecutive months, and 6 persons with PD who had been examined in the phoniatric clinic due to swallowing disorders. A sample of 56 patients with PD made it possible for us to acquire data on their subjective observation and experience in swallowing and speech disorders. The data were gathered by the Questionnaire of speech and swallowing disorders with persons who suffer from Parkinson’s disease, which consists of two rearranged and modified already existing questionnaires (Voice Handicap Index 10 - VHI-10 in Eating Assessment Tool - EAT-10) and of specially formed extra questions on speech and swallowing pathology. The patients also provided the answers about the characteristics of the disease and general data that were necessary for the research. During a spontaneous conversation with 53 patients, who agreed to a clinical speech evaluation, we evaluated the quality of their voice with the GRBAS scale, the adequacy of speech volume and speed, articulation deviations, and resonance. We measured the maximum phonation time (MPT) of the vowel /a/ and carried out the test of articulatory diadochokinesis. We also tested orofacial motor skills and carried out the water swallowing test (WST). With 17 individuals we made a swallowing analysis with a fiberoptic nasolaryngoscope and evaluated the act of swallowing according to the protocol prepared in advance. A sample of 6 persons with PD, who had visited a phoniatrician on their own due to the swallowing problems they had noticed themselves, made it possible for us to acquire data on specific swallowing disorders by analysing and evaluating the act of swallowing with a fiberoptic nasolaryngoscope. The results of the research indicated relatively high prevalence of speech and swallowing disorders with patients that suffer from PD. Speaking disorders were discovered within 57.1 % of patients, whereas pathology in the swallowing process was recognized within 37.5 % of patients with PD. With 30.4 % of patients, speech and swallowing disorders occurred simultaneously, however, an important connection between the disorders was not proved. By comparing the clinical speech evaluation, swallowing analysis, and questionnaire results we discovered that quite many patients (26.7 % of patients with speech disorders) were not aware of their own speech deviations. However, the percentage of patients who are not aware of their swallowing disorders is considerably lower (11.1 % patients with swallowing disorders). When we were discovering connections between individual risk factors and speech and swallowing disorders, we established there is a statistically important connection between speech disorders and a type of PD. A considerably higher percentage of patients with non-tremor dominant than with tremor dominant Parkinson’s disease faced speech disorders. In the case of swallowing disorders, a connection with sex proved to be statistically important, since pathological swallowing was more frequently discovered with female than male patients. We did not discover any statistically important connections between other risk factors and speech and swallowing disorders. The results and findings of the thesis warn of the frequency of poor-quality swallowing and communication with patients who suffer from PD. They emphasize the awareness of this sort of pathology, influence on living, and recognition of purpose and need to search for speech and language therapy in time.