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We want to demonstrate that modifications of the ventilation parameters are liable to improve the different characteristics of phonation (duration, intensity, prosody..) in neuromuscular patients who are dependent on non invasive ventilation.
Speech and communication quality depend on respiration efficiency. The respiratory involvement observed in neuromuscular disorders can impair speech quality in patients, while the underlying disease may also contribute to alter phonation.
Nowadays, the first line treatment of neuromuscular chronic neuromuscular respiratory failure is noninvasive ventilation (NIV). With disease progression, it is used with increasingly duration during daytime. In that situation, mouthpiece ventilation is preferred as it allows efficient ventilation while being more comfortable for patients who can chose when they want to be ventilated. However, in that situation, patients do not receive ventilatory support while they are speaking which puts them in a less favorable situation for speech. We think that pre-phonation inspiratory volume is an essential part of speech quality. Without mechanical ventilation, this volume is reduced as a consequence of respiratory failure but it is liable to increase significantly if the patient used the volume delivered by the ventilator .
We believe that phonation is improved by NIV by applying specific ventilation parameters in patients dependant on mechanical ventilation. The modification could be used by neuromuscular patients to improve speech quality; the patients would then be able to use their usual ventilatory support to improve phonation and modulation of their speech.
In this crossover open labelled, randomised study, done in a single center (home ventilation unit of the referral center of Hospital Raymond Poincaré HUPIFO (University Hospital of Western Paris and Ile de France) (Garches, France)), phonation characteristics will be studied in 3 situations (during spontaneous breathing without ventilatory support, with the usual NIV parameters, with speech-specific NIV parameters) during which speech trials will be performed.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Spontaneous breathing | No Intervention | Spontaneous breathing without mechanical ventilation | |
| Conventional mechanical ventilation | Experimental | Conventional mechanical ventilation, with patient ventilator usual parameters |
|
| Speech specific mechanical ventilation | Experimental | Mechanical ventilation with specific parameters to improve speech |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| speech trial | Other | speech trial during different ventilation conditions |
|
| Measure | Description | Time Frame |
|---|---|---|
| Phonation duration | evaluation by the measurement of the longest duration of a sustained A sound. The subject is asked to sustain a vowel as long as possible during a respiratory cycle while being recorded. Phonation duration is measured (in seconds) on the recording | 1 hour |
| Measure | Description | Time Frame |
|---|---|---|
| Speech Intelligibility | assessment of intelligibility during reading of preselected words by listeners blinded to ventilation condition with a validated scale | 1 hour |
| Quality of prosodia | evaluation of prosodia by listeners blinded to ventilation condition with a score based on the number of correct identification |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Hélène Prigent, MD PhD | Contact | 0033147107911 | helene.prigent@aphp.fr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Raymond Poincaré hospital | Recruiting | Garches | 92380 | France |
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monocentric, open, randomize, crossover study
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| 1 hour |
| Phonation flow | Measurement of the number of syllables/min during the reading of a predetermined text | 1 hour |
| Reading duration | Measurement of the duration for the reading of a predetermined text | 1 hour |
| Phonation quality | evaluation of the phonation quality by the patient with a horizontal visual analogical scale ranked from 0 to 10 (0= very poor quality and 10= very good quality). The scale is 10 cm long ; the patient indicate his perceived sensation on the scale and the according measure (between 0 and 10) is recorded | 1 hour |
| Breathing quality | evaluation of the breating quality during speech in each condition by the patient with a horizontal visual analogical scale ranked from 0 to 10 (0= very uncomfortable and 10= very comfortable). The scale is 10 cm long ; the patient indicate his perceived sensation and the according measure (between 0 and 10) is recorded | 1 hour |
| ID | Term |
|---|---|
| D009468 | Neuromuscular Diseases |
| ID | Term |
|---|---|
| D009422 | Nervous System Diseases |
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