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

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BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

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