Revisión del concepto de eficacia en el tratamiento vocal de las enfermedades neurodegenerativas

Treating voice problems in neurodegenerative diseases is a controversial topic due to the lack of expectations of achieving complete functional recovery or long-lasting improvement. Therefore, when planning voice therapy in these disorders, the concept of efficacy needs to be redefined, since permanent improvements cannot be achieved in these patients. However, studies have been published that show more permanent functional benefits and improvements in quality of life of these persons. The present study was designed to review the state of the art on the vocal therapy of neurodegenerative diseases and to analyze the factors that enhance treatment efficacy and favor greater and longer-lasting reduction of functional limitations. Among the proposed factors to increase treatment efficacy are starting the intervention in the initial phases of the disorder, systematically planning the hierarchy of therapeutic targets, and implementing a multidimensional approach to different types of treatment resources. Additionally, a series of therapeutic protocols were selected to address the three main phonation deficits in neurodegenerative diseases, i.e. respiratory insufficiency, phonation incoordination and laryngeal dysfunction. All of the therapeutic strategies proposed in this study have been documented as being target efficient by either scientific evidence or expert opinion.