“YiJinJing, Wohu Pushi” Posture‐Voice Therapy for Dysarthria in Parkinson's Disease Patients Following Subthalamic Nucleus Deep Brain Stimulation: A Randomized Controlled Trial

TL;DR

A new posture-voice therapy called YJJ-WPVT improved speech and swallowing in Parkinson's patients after brain stimulation, outperforming another therapy.

Contribution

YJJ-WPVT is introduced as a novel posture-voice therapy showing efficacy for dysarthria in Parkinson's patients post-STN-DBS.

Findings

YJJ-WPVT significantly reduced Voice Handicap Index-30 scores compared to no training.

YJJ-WPVT improved swallowing and motor function more than LSVT.

Benefits of YJJ-WPVT were sustained at 6 months.

Abstract

Dysarthria in Parkinson's disease (PD) is difficult to treat, especially post–subthalamic nucleus deep brain stimulation (STN‐DBS), as therapies like LSVT show variable efficacy and limited accessibility. “Yi Jin Jing, Wohu Pushi” posture‐voice therapy (YJJ‐WPVT), emphasizing postural coordination, offers a promising yet underexplored alternative. The objective of this study is to evaluate the effectiveness of YJJ‐WPVT versus Lee Silverman Voice Treatment (LSVT) and no training for dysarthria in PD patients post‐STN‐DBS.

This is a prospective, parallel‐assignment, unblinded, randomized controlled trial with follow‐up at 6 months. The trial was conducted at the Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Patients ≥ 18 years with idiopathic PD treated with STN‐DBS, native Chinese speakers, and Voice Handicap Index‐10 (VHI‐10) > 10. Participants were randomized 1:1:1 to YJJ‐WPVT (n = 11), LSVT (n = 11), or no training (n = 12). Both intervention groups received 16 sessions over 4 weeks. LSVT included sustained phonation, pitch glides, and structured speech tasks with daily home practice. YJJ‐WPVT followed a similar 4‐week protocol and emphasized posture correction through lunges, clawing posture, and tiger roar vocalization. Primary outcomes were changes in Voice Handicap Index‐30 (VHI‐30) and sound pressure level (SPL) at 1 month.

Of 68 patients screened, 34 were enrolled (mean age: YJJ‐WPVT 62 [8] years; LSVT 65 [5]; untreated 60 [6]). At 1 month, YJJ‐WPVT showed significantly lower VHI‐30 total scores by five points (95% CI −8.7 to −1.3; p = 0.04) versus no training, with a nonsignificant SPL increase (1.8 points; 95% CI −1.3 to 4.9; p > 0.05). YJJ‐WPVT improved MPT, jitter, shimmer, and HNR at 1 and 6 months, along with VHI functional subscores. Motor symptoms, swallowing function, and quality of life also improved, with YJJ‐WPVT outperforming LSVT in swallowing and showing slight motor function benefits. Adverse effects (fatigue, hoarseness) were mild and transient.

YJJ‐WPVT is a safe, effective alternative for dysarthria in PD post‐STN‐DBS, with added swallowing and motor benefits. Larger multicenter trials are warranted.

We assessed the effectiveness of “YiJinJing, Wohu Pushi” posture‐voice therapy (YJJ‐WPVT) versus Lee Silverman voice treatment (LSVT) versus no training for dysarthria in patients with Parkinson's disease (PD) after subthalamic nucleus deep brain stimulation (STN‐DBS). The randomized controlled trial showed a significant improvement in the VHI‐30 score after 1 month of YJJ‐WPVT, with no change in SPL. Comparisons with LSVT favored YJJ‐WPVT for swallowing function and showed a slight advantage for motor function.

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