Dissertação
Estimulação transcraniana na disartria decorrente da doença de Parkinson: estudo de casos
Fecha
2022-02-25Autor
Rosa, Rafaela Rossini
Institución
Resumen
Parkinson's disease (PD) is the second most common neurodegenerative disease in
adults aged 60 years . PD diagnosis is clinical and based on the symptoms: resting
tremor, stiffness, bradykinesia, and impaired postural balance. Motor speech
subsystems disorders are also common in PD, named dysarthria. Transcranial direct
current stimulation (tDCS) is a non-invasive and cost-effective option compared to
deep brain stimulation in therapeutic resources for PD Studies show that tDCS
promotes improvements in Parkinson's global motors. However, there are no studies
that research this technique in dysarthria cases. Thus, this present study aimed to
compare the results of different treatment designs for dysarthria in subjects with PD,
involving conventional speech therapy and tDCS and a control. It is an analytical,
observational, transversal, descriptive, interventional, and quantitative research. Four
male subjects with PD (aged between 68 and 79), were evaluated and re-evaluated
with the Dysarthria Assessment Protocol, Speech Intelligibility Assessment Protocol,
the Consensus auditory-perceptual evaluation of voice, and by glottal source
acoustic analysis. Each subject was assigned a different study design: a control
subject (S1); one submitted to 10 sessions of 20 minutes of tDCS (S2); one
submitted to 10 sessions of 20-minute sessions of tDCS and conventional speech
therapy for concomitant dysarthria (S3); and one to 25 sessions of 50-minutes of
conventional speech therapy (S4). Effects immediately after the last session and
after 30 days were analyzed. All speech subsystems improved in subjects who
received some intervention. S2 had more improvements in the phonation time task,
velar movement, and dysarthria evaluation, followed by S3. In the acoustic vocal
analysis of glottic source, the standard deviation of the fundamental frequency,
maximum fundamental frequency, Jitter, Shimmer, and noise
measurementsimproved with some intervention, especially at S3 in the immediate
post-intervention assessment and 30 days after, followed by S2, in the immediately
post-intervention evaluation. However, only conventional therapy made it possible to
change the dysarthria severity. Conventional speech therapy combined with the
tDCS, and therapy with tDCS alone had more impact on speech and voice than
conventional therapy alone.