Short-term effects of “Yijinjing Wohu Pushi” posture-voice therapy on speech in Parkinson’s disease after STN-DBS

Hypokinetic dysarthria in Parkinson’s Disease (HD-PD) deteriorates patients’ quality of life by impeding communication and social engagement. Existing treatments like levodopa drugs and deep brain stimulation (DBS) can improve motor symptoms but fall short in addressing speech-related impairments; effective speech therapies tend not to mandate the posture, which potentially hinders vocal performance. Here we first proposed a therapeutic protocol that specified a lunging-and-clawing posture (Wohu Pushi method from Yijinjing) during vocalization training. The protocol aimed to ensure that PD patients could accomplish the training even with moderate motor impairments. A total of 20 HD-PD patients with implanted stimulators in subthalamic nuclei (STN-DBS) participated in one session of training, either following our posture-voice therapy (PVT) or the conventional voice therapy (CVT). Results indicated that the maximum phonation time was significantly elongated in PVT(3.85±2.81s) but not in CVT(0.46 ± 2.24s), and the formant-distance was significantly increased in PVT(95.80 ± 112.71Hz) compare to CVT(-47.10 ± 84.28Hz). Our results indicated that by demanding appropriate amount of postural maintenance during vocalization, it might facilitate the recovery of speech-related functions. This study warranted larger-scale clinical trials to understand the impact, limitation, and optimization of posture-voice therapy for HD-PD. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT04528147 ### Funding Statement "Shanghai General Hospital Integrated Traditional Chinese and Western Medicine Special Project" grant number: ZHYY-ZXYJHZX-202103. "Shanghai STC International Science and Technology Cooperation Project" grant number:22490711000. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Committee of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University (no. 224 of 2022) gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes * CVT : conventional voice therapy DBS : deep brain stimulation DDK : diadochokinetic DSI : dysphonia severity index HD : hypokinetic dysarthria HY : Hoehn-Yahr scale LSVT : Lee Silverman Voice Therapy MMSE : mini-mental state examination MPT : maximum phonation time MS : maximum sustained movements PD : Parkinson’s disease PVT : posture-voice therapy RMST : Respiratory Muscle Strength Training RM-ANOVA : repeated-measures analysis of variance SPL : sound pressure level STN : subthalamic nucleus TD : tone-down TU : tone-up UPDRS : Unified Parkinson’s Disease Rating Scale VHI : Voice Handicap Index