Carl L. Fairburn III ’10, PT, DPT, assistant professor of physical therapy, and Derek Isetti ’08, PhD, CCC-SLP, assistant professor of speech-language pathology, have teamed up for a research project to explore if respiratory muscle strength training (RMST), commonly used in physical therapy, can benefit patients who are having difficulty with speaking. For this study Dr. Fairburn and Dr. Isetti are focusing on individuals with Parkinson’s disease, as often these individuals experience diminished lung capacity and decreased speaking volume.
Ultimately, the goal of this study is to improve the quality of life for individuals with Parkinson’s disease by improving their pulmonary function, which in turn could make it easier for them to speak. Vocal loudness is intricately related to the amount of air pressure an individual can generate within the lungs. It is Dr. Fairburn and Dr. Isetti’s theory that as pulmonary function and strength improves with respiratory strength training this could have a translational effect on vocal loudness when speaking.
In this study, participants are trained on how to use small, portable respiratory trainers. “These are small hand-held devices that are typically spring-loaded,” said Dr. Fairburn. “They apply a resistance to the user when they are either breathing in or breathing out. The trainers are calibrated to each individual with resistance adjusted based on the user response.” Calibration is important as these devices employ the progressive overload principle. Dr. Fairburn explains, “Placing strain on the muscle causes adaptive hypertrophy and growths in strength. The diaphragm and muscles in the rib cage can be strengthened to improve the individual aspects of pulmonary function.”
Dr. Fairburn is the lead investigator of the study. “My responsibilities are recruiting and selecting candidates, study design and selecting outcome assessments that relate to pulmonary function and quality of life in Parkinsonism,” Dr. Fairburn said. “We also measure thoracic expansion, or how much movement they get in their rib cage.” In addition, he trains the study’s participants on how to use the respiratory devices and teaches them the exercise protocol. Dr. Fairburn also assesses “how much their respiratory function affects their quality of life.”
Co-investigator Dr. Isetti lends his expertise as a speech-language pathologist. “I’m essentially obtaining baseline measurement data on the participants,” Dr. Isetti said. Once he has established a baseline of the participant’s vocals he then follows up at two week intervals with a vocal assessment. “Some of the things we are looking at are maximum phonation time, or the length of time someone can sustain a sound, and vocal loudness, how loudly someone can project their voice.” In addition, he measures pitch range. He also assesses their perceived vocal handicap before and after the respiratory strength training, as well as the amount of self-perceived effort that a participant feels is necessary in order to produce speech.
Dr. Isetti emphasizes the importance of seeking out the expertise of a speech-language pathologist. “RMST is not designed to be a replacement for speech therapy,” stresses Dr. Isetti. “However, if use of respiratory trainers is shown to improve vocal outcomes they could be a valuable ancillary treatment, complementing the patient’s speech therapy.”
Several doctor of physical therapy students are involved in this research study: Alycia Clark ’17, Andy Westhafer ’17 and Amanda Whalen ’17. “Their responsibilities include assistance with data collection and helping perform some of the outcome assessments,” Dr. Fairburn said. This study is just one way that students have the opportunity to work alongside Pacific faculty. Dr. Fairburn shares, “A large number of our students are involved in research projects or state and national-level presentations. Opportunities outside of the classroom are available to all of our students should they express their desire to pursue research activities.”
Pacific is committed to creating an environment where interdisciplinary collaboration thrives. Speaking from personal experience, Dr. Fairburn has found that when physical therapists work with speech-language pathologists they can become a “cohesive, collaborative rehabilitation team.” Dr. Isetti adds that when students are exposed to rehabilitation research that is being developed outside of their own discipline they are better prepared to meet the needs of their patients in strategic and innovative ways.
By Anne Marie H. Bergthold