구조화된 노래활동을 통한 파킨슨병 내담자의 음성의 질 향상과 우울 감소에 관한 사례

Abstract

본 연구의 목적은 파킨슨병 내담자에게 구조화된 노래활동이 음성의 질 향상뿐만 아니라 우울 감소에 어떻게 영향을 미치며, 구조화된 노래활동에 참여한 내담자들의 자가 평가와 태도의 변화에 대해 알아보는 것이다. 본 연구는 수도권 내 대학병원 신경과 외래로 내원하고 파킨슨병으로 진단 받은 53세 - 76세의 내담자 세 명을 대상으로 한 사례연구이다. 연구결과를 살펴보면, 첫째, 음향학적 음성의 질 측면에서 내담자 모두 최대발성시간(MPT)이 최소 0.78초에서 최대 11.38초까지 증가되어 음성의 질이 향상되었다. 둘째, 음성장애지수(VHI)에서는 내담자 A와 C는 기능, 신체, 감정 측면에서 음성장애지수가 감소되어 음성의 질이 향상된 결과를 보였다. 셋째, 음성과 관련된 삶의 질(V-RQOL)결과, 내담자 A와 C는 음성과 관련된 삶의 질이 향상되었다. 넷째, 노인우울척도(GDS) 결과, 내담자 A, B, C 모두 감소하였는데 특히 내담자 A는 중증 우울 상태에서 세션 후 경미한 우울 상태로 호전되었다. 다섯째, 내담자들은 세션 기간 동안 음성의 변화와 긍정적 정서를 경험하고, 호흡 패턴 유지, 발성 시간 증가, 음정과 다이내믹 변화 등 음성의 질 향상으로 인해 구조화된 노래활동에 더욱 주체적으로 참여하고 감정과 언어의 표현의 기회도 증가되었다. 본 연구의 구조화된 노래활동은 단순 선율과 모음을 이용한 발성과 목소리 즉흥 연주와 선호곡 중심의 노래창작활동으로 구성되었다. 호흡의 자연스런 흐름 강화, 후두 근육 움직임 강화, 성대 이완, 공명 증가 등의 발성과 목소리 즉흥, 가사 회상 및 창작, ‘생활노래’ 창작, ‘노래를 통한 추억 메들리’ 창작 등 다양한 노래활동으로 진행되었다. 본 연구를 통해 구조화된 노래활동이 파킨슨병 내담자의 음성의 질 향상과 더불어 우울 감소에도 영향을 미치는 치료적 중재임을 확인한 것에 연구 의의가 있다.; The purpose of this case study is to examine the use of the structured singing activities to improve the vocal quality and alleviate the depression symptoms for the clients with Idiopathic Parkinson's disease (IPD). Moreover, the purpose of this case study is to describe the client's self-report for using one's own voice and feeling every session and the physical, musical, verbal, and emotional responses in the structured singing activities. Three clients who had undergone IPD between 53 and 76 years old and recommended by a neurologist participated in a total of 6 sessions for 2 weeks. Each client received 40 minutes of the structured singing activities, including vocalizing with the simple melody and the vowels, the vocal improvisation, and the music making with the favorite songs. In the pre- and post-test, the Maximum Phonation Time(MPT) via the Praat test, the Voice Handicap Index(VHI), the Voice-Related Quality of Life(V-RQOL), and the Geriatric Depression Scale(GDS) were measured. Especially, the client's self-report with the 5 Likert scale and MPT were measured before and after the sessions. As a result, the vocal quality of the clients, including the acoustic and subjective vocal evaluations, was improved and the depression symptoms of the clients were also alleviated through the structured singing activities. In detail, the results demonstrated that the clients showed the acoustic vocal improvements in the MPT data. Secondly, the data of the VHI for the clients A and C were decreased and the V-RQOL for the clients A and C were increased. These data showed that clients tend to improve their acoustic and subjective vocal quality. Thirdly, the GDS's scores of all the clients were remarkably lowered. Fourthly, according to the self-report for using one's own voice and feeling every session, all the clients were kept with their positive emotions without the vocal conditions through the structured singing activities. Lastly, all the clients also showed not only the changed singing attitudes with the sustained breathing patterns, increased the phonation time, the flexibility of the intonations and the dynamics with their own voices, but also positive and active participated in the vocal improvisations and the music making with their favorite songs. Therefore, the expressions of the verbal and the emotional with regard to all the clients were increased in the sessions incrementally. This case study, as one of the initial attempts at applying the structured singing activities to the clients who have IPD, has confirmed that the potential effectiveness of the integration of the vocalizing with the simple melodies and the vowels, the vocal improvisations, and the music making of the favorite songs not only improves the vocal quality but also reduces the depression. Moreover, the structured singing activities program was demonstrated to effectively facilitate and relax the muscles of the larynx, the vocal cord as well as the abdominal muscles for the IPD patients so that these improved the phonation functions with their own voices, which tended to help the participation in the vocal improvisations and the music making positively. Further studies are warranted to develop the protocol required to determine and adjust the intensity and the level of the tasks in these structured singing activities in consideration of the differing vocal functions and the depression states of the individual clients with the IPD.