collagen injections for patients with PD
Posted 16 January 2009 - 03:16 PM
Posted 17 January 2009 - 04:33 PM
• Bowed vocal folds (Baker et al., 1998; Hansen et al., ; Smith et al., 1995)
• Low amplitude desynchronized muscle activity as measured by EMG (Baker et al., 1998; Luschei et al., 1999)
• Decreased respiratory support for speech (Stathopolous & Sapienza, 1993)
• Small mouth opening (Ho, Iansek, & Bradshaw, 1999)
Most people with PD can be stimulated to increase loudness by being cued to "shout". The usual response is for the person to take a deeper breath and adduct the vocal folds more forcefully and overexaggerate articulation without conciously being aware of their actions. Therefore, treatment could capitalize on this existing ability rather than relying on injections to achieve a similar goal. This is different from other people with voice disorders who are candidates for collagen injections.
Collagen injections are temporary and only address the motor component of reduced vocal fold adduction or vocal fold bowing that is common in PD. The perception that their speech is of normal loudness when it is in reality significantly softer than healthy aged-matched controls (Fox & Ramig, 1997) is critical to address in people with PD for carryover of improved communication in functional situations.
My recommendation is to try intensive voice and speech treatment first to determine if additional interventions are needed.
Leslie Mahler, PhD, CCC-SLP
University of Rhode Island
Posted 12 February 2009 - 04:54 PM
Berke, G. S., Gerratt, B., Kreiman, J., & Jackson, K. (1999). Treatment of Parkinson hypophonia with percutaneous collagen augmentation. Laryngoscope, 109(8), 1295-1299.
This study included 25 patients with PD who were injected with bovine collagen. Seventy-five percent of these patients reported improvement. However, collagen injections are temporary – as the substance is reabsorbed over time and you must have repeated injections. In this study, the average length of improvement was 12 weeks (range 4 – 52 weeks). More severely impaired patients experienced less improvement.
Another study by Kim (2002) reported similar results. Sixty-one percent of the 18 patients reported improvement for at least 2 months. The average length of benefit was 3.2 months (range 2 – 6 months). Again, patients without improvement were in the advanced stage of disease. They were non-ambulatory and/or required a G-tube.
I agree with Leslie, in that collagen injections are temporary and one should try intensive voice and speech treatment first. However, I have treated a few patients who were in early or middle stages of PD, actively employed, and were not able to complete the intensive treatment protocol of Lee Silverman Voice Treatment. They did benefit from the collagen injections but required a few follow-up voice therapy sessions to learn how to readjust their voice.
Another consideration is the cost of collagen injections (perhaps needed every 3 or 4 months) and if it is covered by your insurance.
I hope this provides more information about the benefits and drawbacks to this treatment approach!
Celia J. Bassich, Ph.D., CCC-SLP
Speech Pathology Faculty Member
Allied Team Training for Parkinson Disease, NPF
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