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Stipancic KL, van Brenk F, Kain A, Wilding G, Tjaden K. Clear Speech Variants: An Investigation of Intelligibility and Speaker Effort in Speakers With Parkinson's Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2789-2805. [PMID: 36327495 PMCID: PMC9911091 DOI: 10.1044/2022_ajslp-22-00189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 05/03/2023]
Abstract
PURPOSE This study investigated the effects of three clear speech variants on sentence intelligibility and speaking effort for speakers with Parkinson's disease (PD) and age- and sex-matched neurologically healthy controls. METHOD Fourteen speakers with PD and 14 neurologically healthy speakers participated. Each speaker was recorded reading 18 sentences from the Speech Intelligibility Test in their habitual speaking style and for three clear speech variants: clear (SC; given instructions to speak clearly), hearing impaired (HI; given instructions to speak with someone with a hearing impairment), and overenunciate (OE; given instructions to overenunciate each word). Speakers rated the amount of physical and mental effort exerted during each speaking condition using visual analog scales (averaged to yield a metric of overall speaking effort). Sentence productions were orthographically transcribed by 50 naive listeners. Linear mixed-effects models were used to compare intelligibility and speaking effort across the clear speech variants. RESULTS Intelligibility was reduced for the PD group in comparison to the control group only in the habitual condition. All clear speech variants significantly improved intelligibility above habitual levels for the PD group, with OE maximizing intelligibility, followed by the SC and HI conditions. Both groups rated speaking effort to be significantly higher for both the OE and HI conditions versus the SC and habitual conditions. DISCUSSION For speakers with PD, all clear speech variants increased intelligibility to a level comparable to that of healthy controls. All clear speech variants were also associated with higher levels of speaking effort than habitual speech for the speakers with PD. Clinically, findings suggest that clear speech training programs consider using the instruction "overenunciate" for maximizing intelligibility. Future research is needed to identify if high levels of speaking effort elicited by the clear speech variants affect long-term sustainability of the intelligibility benefit.
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Affiliation(s)
- Kaila L. Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Frits van Brenk
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
- Utrecht Institute of Linguistics OTS, Utrecht University, the Netherlands
| | - Alexander Kain
- Department of Pediatrics, Oregon Health & Science University, Portland
| | | | - Kris Tjaden
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
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Thilakaratne R, Loftus AM, Cocks N. Assessing and treating conversations with partners in Parkinson's disease: A scoping review of the evidence. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:427-436. [PMID: 34565250 DOI: 10.1080/17549507.2021.1978545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: This is a scoping review of the methods used in published research to assess conversations and the interventions used to treat conversations between people with Parkinson's disease and their partners. Communication partners were defined as significant others or next-of-kin. The aims were to describe the assessment methods and interventions used, and to identify gaps in the literature.Method: Four online databases were used to identify peer reviewed journal articles in English, which assess and/or treat conversations in this population. The titles and abstracts of the obtained articles were screened and irrelevant articles were excluded. The full texts of the remaining articles were read to determine which studies met the inclusion/exclusion criteria of this review. The methods used, conversational aspects assessed, the treatments conducted and outcome measures used, and the speech and language domains targeted were charted in order to examine the extent of the evidence to inform future research directions.Result: Eight studies met inclusion criteria. "Conversation analysis" was the most widely used method to assess conversations. These studies assessed conversational aspects relating to the domains of pragmatics, fluency, prosody and semantics. They highlighted the role of communication partners to support conversational interactions by using repair strategies during a communication breakdown. Only one study treated conversations by implementing communication partner training.Conclusion: The findings of this review emphasise gaps in the literature. It highlights the need for future research implementing communication partner training. There is also a need to assess conversation skills of partners in order to determine which strategies would be most effective to support their interaction. It highlights the importance of incorporating a participation-based approach to assessment and intervention involving all communication partners. This may lead to enhanced support for people with Parkinson's disease and their families, thus improving their quality of life.
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Affiliation(s)
| | - Andrea M Loftus
- School of Public Health, Curtin University, Bentley, Australia
| | - Naomi Cocks
- Curtin School of Allied Health, Curtin University, Bentley, Australia
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Campbell P, Rooney S, Nicoll A, Brady MC, Smith CH, Deane KHO, Herd CP, Tomlinson CL, Clarke CE, Sackley CM. Speech and language therapy interventions for speech problems in Parkinson's disease. Hippokratia 2022. [DOI: 10.1002/14651858.cd015009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; Glasgow UK
| | - Scott Rooney
- Nursing, Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; Glasgow UK
| | - Avril Nicoll
- Health Services Research Unit; University of Aberdeen; Aberdeen UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; Glasgow UK
| | - Christina H Smith
- Division of Psychology and Language Sciences; University College London; London UK
| | | | - Clare P Herd
- Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - Claire L Tomlinson
- Birmingham Clinical Trials Unit; University of Birmingham; Birmingham UK
| | - Carl E Clarke
- Department of Neurology; City Hospital, Sandwell and West Birmingham Hospitals NHS Trust; Birmingham UK
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Maas JJL, De Vries NM, Bloem BR, Kalf JG. Design of the PERSPECTIVE study: PERsonalized SPEeCh Therapy for actIVE conversation in Parkinson's disease (randomized controlled trial). Trials 2022; 23:274. [PMID: 35395953 PMCID: PMC8990485 DOI: 10.1186/s13063-022-06160-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the effectiveness of personalized and home-based speech therapy on quality of life, intelligibility, and social participation for people with Parkinson’s disease (PD) who have a reduced intelligibility of speech. Background Speech problems in PD have a profound negative impact on social interaction and quality of life. Evidence for speech therapy in PD is growing, but more work remains needed to explore its full potential. Efficacy exists for highly intensive standardized speech treatment programs, but not all patients can comply with this rather intense intervention, especially the more severely affected ones. Here, we aim to study the effectiveness of personalized and home-based (remote) speech therapy in PD on quality of life and speech. The intervention will be supported by a dedicated speech training app. We expect that this approach will improve speech intelligibility and quality of life in patients irrespective of disease stage. Methods We will perform a single blind, randomized controlled trial, comparing 8 weeks of speech therapy to no intervention using a waiting list design. A total of 215 PD patients with problems in intelligibility will be recruited by 12 highly experienced speech therapists. All patients will be measured at baseline and after 8 weeks (primary endpoint). Additionally, the experimental group will be re-assessed one more time, after a wash-out period of 24 weeks. The control group will receive deferred treatment after 8 weeks, but without additional follow-up assessments. Our primary outcome is quality of life (as measured with PDQ-39). Secondary outcomes include speech and voice quality, intelligibility, severity of voice and speech complaints, and caregiver burden. Results The inclusion of participants has started on March 1, 2019, and is expected to be finalized on April 1, 2021. We expect to have the first results in January 2022. Conclusions We will investigate the effectiveness of speech therapy in PD. Particular strengths of our study include a randomized and single-blinded design, the personalized treatment approach, the inclusion of PD patients irrespective of disease stage or severity of the speech complaint, the long-term follow-up, the adequate power, and the use of a patient-relevant primary endpoint. This will allow us to draw firm conclusions about the effectiveness of personalized and remote speech therapy for PD patients in all disease stages. Trial registration ClinicalTrials.govNCT03963388. Registered on May 24, 2019
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Affiliation(s)
- J J L Maas
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - N M De Vries
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J G Kalf
- Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
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Perin C, Mazzucchelli M, Piscitelli D, Braghetto G, Meroni R, Cornaggia CM, Cerri CG. Feasibility of a standardized protocol for respiratory training with intermitted positive pressure breathing ventilator application in dysphonia and dysarthria. Eur J Phys Rehabil Med 2022; 58:218-224. [PMID: 34652084 PMCID: PMC9980488 DOI: 10.23736/s1973-9087.21.06946-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Brain damage can affect several functions related to speech production leading to dysphonia and dysarthria. Most rehabilitation treatments focus on articulation training rather than on pneumophonic coordination and respiratory muscle strength. Respiratory training using an intermitted positive pressure breathing (IPPB) ventilator can be used for this last purpose; no agreement on a standard protocol has been reached to date. AIM To evaluate the feasibility and the effectiveness of a standardized incremental protocol of respiratory training using IPPB to treat dysphonia and dysarthria. DESIGN Case series study. SETTING Neuropsychological Rehabilitation Unit in an Italian Neurorehabilitation Division. POPULATION Thirty-two subjects with dysphonia and dysarthria resulting from neurological lesion. METHODS Participants were assessed using clinical evaluation scales (GIRBAS scale of dysphonia, Robertson dysarthria profile), respiratory function test, and arterial blood gas analysis in air. The evaluations were performed at baseline and after 20 sessions of respiratory training with IPPB. The protocol provided a default increment of ventilator parameters. All subjects also underwent a standard speech and language therapy treatment. A satisfaction survey to assess acceptability and the Goal Attainment Scale were applied. RESULTS All participants fulfilled the protocol. No complications or discomfort were reported. Subjects' satisfaction at survey was 97.7%. After respiratory training, all respiratory function parameters increased, but only maximal voluntary ventilation (MVV), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were statistically significant (P<0.05). Clinical evaluation scales significantly improved (P<0.05). Correlation between respiratory function parameters and clinical evaluation scales showed a moderate correlation between MVV, MEP, MIP, and Robertson dysarthria profile (P<0.01). A weak correlation was found between MIP, MVV, and GIRBAS scale (P<0.05). CONCLUSIONS Our protocol showed to be practical and well-tolerated. After respiratory training, MVV, MIP and MEP improved in significantly. Clinical scale scores improved in all participants. CLINICAL REHABILITATION IMPACT Respiratory training using IPPB ventilator can be useful in implementing speech and language treatments in subjects with dysphonia and dysarthria linked to brain injury.
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Affiliation(s)
- Cecilia Perin
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy.,Istituti Clinici Zucchi, Carate Brianza, Monza e Brianza, Italy
| | - Miryam Mazzucchelli
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy - .,Istituti Clinici Zucchi, Carate Brianza, Monza e Brianza, Italy
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy.,School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Giacomo Braghetto
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy
| | - Roberto Meroni
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy.,Istituti Clinici Zucchi, Carate Brianza, Monza e Brianza, Italy.,Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
| | - Cesare M Cornaggia
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy.,Istituti Clinici Zucchi, Carate Brianza, Monza e Brianza, Italy
| | - Cesare G Cerri
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy.,Istituti Clinici Zucchi, Carate Brianza, Monza e Brianza, Italy
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Rösch AD, Taub E, Gschwandtner U, Fuhr P. Evaluating a Speech-Specific and a Computerized Step-Training-Specific Rhythmic Intervention in Parkinson's Disease: A Cross-Over, Multi-Arms Parallel Study. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:783259. [PMID: 36188780 PMCID: PMC9397933 DOI: 10.3389/fresc.2021.783259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022]
Abstract
Background: Recent studies suggest movements of speech and gait in patients with Parkinson's Disease (PD) are impaired by a common underlying rhythmic dysfunction. If this being the case, motor deficits in speech and gait should equally benefit from rhythmic interventions regardless of whether it is a speech-specific or step-training-specific approach. Objective: In this intervention trial, we studied the effects of two rhythmic interventions on speech and gait. These rhythmic intervention programs are similar in terms of intensity and frequency (i.e., 3x per week, 45 min-long sessions for 4 weeks in total), but differ regarding therapeutic approach (rhythmic speech vs. rhythmic balance-mobility training). Methods: This study is a cross-over, parallel multi-arms, single blind intervention trial, in which PD patients treated with rhythmic speech-language therapy (rSLT; N = 16), rhythmic balance-mobility training (rBMT; N = 10), or no therapy (NT; N = 18) were compared to healthy controls (HC; N = 17; matched by age, sex, and education: p > 0.82). Velocity and cadence in speech and gait were evaluated at baseline (BL), 4 weeks (4W-T1), and 6 months (6M-T2) and correlated. Results: Parameters in speech and gait (i.e., speaking and walking velocity, as well as speech rhythm with gait cadence) were positively correlated across groups (p < 0.01). Statistical analyses involved repeated measures ANOVA across groups and time, as well as independent and one-samples t-tests for within groups analyses. Statistical analyses were amplified using Reliable Change (RC) and Reliable Change Indexes (RCI) to calculate true clinically significant changes due to the treatment on a patient individual level. Rhythmic intervention groups improved across variables and time (total Mean Difference: 3.07 [SD 1.8]; 95% CI 0.2–11.36]) compared to the NT group, whose performance declined significantly at 6 months (p < 0.01). HC outperformed rBMT and NT groups across variables and time (p < 0.001); the rSLT performed similarly to HC at 4 weeks and 6 months in speech rhythm and respiration. Conclusions: Speech and gait deficits in PD may share a common mechanism in the underlying cortical circuits. Further, rSLT was more beneficial to dysrhythmic PD patients than rBMT, likely because of the nature of the rhythmic cue.
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Affiliation(s)
- Anne Dorothée Rösch
- Department of Clinical Neurophysiology/Neurology, Hospital of the University of Basel, Basel, Switzerland
| | - Ethan Taub
- Department of Neurosurgery, Hospital of the University of Basel, Basel, Switzerland
| | - Ute Gschwandtner
- Department of Clinical Neurophysiology/Neurology, Hospital of the University of Basel, Basel, Switzerland
- *Correspondence: Ute Gschwandtner
| | - Peter Fuhr
- Department of Clinical Neurophysiology/Neurology, Hospital of the University of Basel, Basel, Switzerland
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Stipancic KL, Kuo YL, Miller A, Ventresca HM, Sternad D, Kimberley TJ, Green JR. The effects of continuous oromotor activity on speech motor learning: speech biomechanics and neurophysiologic correlates. Exp Brain Res 2021; 239:3487-3505. [PMID: 34524491 PMCID: PMC8599312 DOI: 10.1007/s00221-021-06206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Abstract
Sustained limb motor activity has been used as a therapeutic tool for improving rehabilitation outcomes and is thought to be mediated by neuroplastic changes associated with activity-induced cortical excitability. Although prior research has reported enhancing effects of continuous chewing and swallowing activity on learning, the potential beneficial effects of sustained oromotor activity on speech improvements is not well-documented. This exploratory study was designed to examine the effects of continuous oromotor activity on subsequent speech learning. Twenty neurologically healthy young adults engaged in periods of continuous chewing and speech after which they completed a novel speech motor learning task. The motor learning task was designed to elicit improvements in accuracy and efficiency of speech performance across repetitions of eight-syllable nonwords. In addition, transcranial magnetic stimulation was used to measure the cortical silent period (cSP) of the lip motor cortex before and after the periods of continuous oromotor behaviors. All repetitions of the nonword task were recorded acoustically and kinematically using a three-dimensional motion capture system. Productions were analyzed for accuracy and duration, as well as lip movement distance and speed. A control condition estimated baseline improvement rates in speech performance. Results revealed improved speech performance following 10 min of chewing. In contrast, speech performance following 10 min of continuous speech was degraded. There was no change in the cSP as a result of either oromotor activity. The clinical implications of these findings are discussed in the context of speech rehabilitation and neuromodulation.
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Affiliation(s)
- Kaila L Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, USA
| | - Yi-Ling Kuo
- Department of Physical Therapy, Upstate Medical University, Syracuse, NY, USA
| | - Amanda Miller
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, USA
| | - Hayden M Ventresca
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Building 79/96, 2nd Floor 13th Street, Boston, MA, 02129, USA
| | - Dagmar Sternad
- Department of Biology, Northeastern University, Boston, MA, USA
| | - Teresa J Kimberley
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Building 79/96, 2nd Floor 13th Street, Boston, MA, 02129, USA
| | - Jordan R Green
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Building 79/96, 2nd Floor 13th Street, Boston, MA, 02129, USA.
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Borrie SA, Lansford KL. A Perceptual Learning Approach for Dysarthria Remediation: An Updated Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:3060-3073. [PMID: 34289312 PMCID: PMC8740677 DOI: 10.1044/2021_jslhr-21-00012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/15/2021] [Accepted: 03/29/2021] [Indexed: 05/19/2023]
Abstract
Purpose Early studies of perceptual learning of dysarthric speech, those summarized in Borrie, McAuliffe, and Liss (2012), yielded preliminary evidence that listeners could learn to better understand the speech of a person with dysarthria, revealing a potentially promising avenue for future intelligibility interventions. Since then, a programmatic body of research grounded in models of perceptual processing has unfolded. The current review provides an updated account of the state of the evidence in this area and offers direction for moving this work toward clinical implementation. Method The studies that have investigated perceptual learning of dysarthric speech (N = 24) are summarized and synthesized first according to the proposed learning source and then by highlighting the parameters that appear to mediate learning, culminating with additional learning outcomes. Results The recent literature has established strong empirical evidence of intelligibility improvements following familiarization with dysarthric speech and a theoretical account of the mechanisms that facilitate improved processing of the neurologically degraded acoustic signal. Conclusions There are no existing intelligibility interventions for individuals with dysarthria who cannot behaviorally modify their speech. However, there is now robust support for the development of an approach that shifts the weight of behavioral change from speaker to listener, exploiting perceptual learning to ease the intelligibility burden of dysarthria. To move this work from bench to bedside, recommendations for translational studies that establish best practices and candidacy for listener-targeted dysarthria remediation, perceptual training, are provided.
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Affiliation(s)
- Stephanie A. Borrie
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
| | - Kaitlin L. Lansford
- Department of Communication Science and Disorders, Florida State University, Tallahassee
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Scobie S, Jowett S, Lambe T, Patel S, Woolley R, Ives N, Rick C, Smith C, Brady MC, Clarke C, Sackley C. Lee Silverman Voice Treatment versus standard speech and language therapy versus control in Parkinson's disease: preliminary cost-consequence analysis of the PD COMM pilot randomised controlled trial. Pilot Feasibility Stud 2021; 7:154. [PMID: 34372913 PMCID: PMC8351093 DOI: 10.1186/s40814-021-00888-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 07/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The PD COMM pilot randomised controlled trial compared Lee Silverman Voice Treatment (LSVT® LOUD) with standard NHS speech and language therapy (SLT) and a control arm in people with Parkinson's disease (PwPD) with self-reported problems with voice or speech. This analysis compares costs and quality of life outcomes between the trial arms, and considers the validity of the alternative outcome measures for economic evaluations. METHODS A comparison of costs and outcomes was undertaken alongside the PD COMM pilot trial involving three arms: LSVT® LOUD treatment (n = 30); standard NHS SLT (n = 30); and a control arm (n = 29) excluded from receiving therapy for at least 6 months after randomisation unless deemed medically necessary. For all trial arms, resource use and NHS, social care and patient costs and quality of life were collected prospectively at baseline, 3, 6, and 12 months. Total economic costs and outcomes (EQ-5D-3L, ICECAP-O) were considered over the 12-month follow-up period from an NHS payer perspective. Quality of life measures for economic evaluation of SLT for people with Parkinson's disease were compared. RESULTS Whilst there was no difference between arms in voice or quality of life outcomes at 12 months, there were indications of differences at 3 months in favour of SLT, which need to be confirmed in the main trial. The estimated mean cost of NHS care was £3288 per patient per year for the LSVT® LOUD arm, £2033 for NHS SLT, and £1788 for the control arm. EQ-5D-3L was more strongly correlated to voice impairment than ICECAP-O, and was sensitive to differences in voice impairment between arms. CONCLUSIONS The pilot did not identify an effect of SLT on disease-specific or economic outcomes for PwPD at 12 months; however, there appeared to be improvements at 3 months. In addition to the sample size not powered to detect difference in cost-consequence analysis, many patients in the control arm started SLT during the 12-month period used for economic analysis, in line with the study protocol. The LSVT® LOUD intervention was more intense and therefore more costly. Early indications suggest that the preferred economic outcome measure for the full trial is EQ-5D-3L; however, the ICECAP-O should still be included to capture a broader measure of wellbeing. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number Register: ISRCTN75223808. Registered 22 March 2012.
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Affiliation(s)
- Sarah Scobie
- Nuffield, Trust, London, UK
- Health Economics Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Health Economics Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Tosin Lambe
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Smitaa Patel
- Birmingham Clinical Trials Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Caroline Rick
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Christina Smith
- Psychology and Language Science, University College London, London, UK
| | - Marion C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Carl Clarke
- Health Economics Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Cath Sackley
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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10
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Sackley CM, Rick C, Au P, Brady MC, Beaton G, Burton C, Caulfield M, Dickson S, Dowling F, Hughes M, Ives N, Jowett S, Masterson-Algar P, Nicoll A, Patel S, Smith CH, Woolley R, Clarke CE. A multicentre, randomised controlled trial to compare the clinical and cost-effectiveness of Lee Silverman Voice Treatment versus standard NHS Speech and Language Therapy versus control in Parkinson's disease: a study protocol for a randomised controlled trial. Trials 2020; 21:436. [PMID: 32460885 PMCID: PMC7251680 DOI: 10.1186/s13063-020-04354-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/27/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) affects approximately 145,519 people in the UK. Speech impairments are common with a reported prevalence of 68%, which increase physical and mental demands during conversation, reliance on family and/or carers, and the likelihood of social withdrawal reducing quality of life. In the UK, two approaches to Speech and Language Therapy (SLT) intervention are commonly available: National Health Service (NHS) SLT or Lee Silverman Voice Treatment (LSVT LOUD®). NHS SLT is tailored to the individuals' needs per local practice typically consisting of six to eight weekly sessions; LSVT LOUD® comprises 16 sessions of individual treatment with home-based practice over 4 weeks. The evidence-base for their effectiveness is inconclusive. METHODS/DESIGN PD COMM is a phase III, multicentre, three-arm, unblinded, randomised controlled trial. Five hundred and forty-six people with idiopathic PD, reporting speech or voice problems will be enrolled. We will exclude those with a diagnosis of dementia, laryngeal pathology or those who have received SLT for speech problems in the previous 2 years. Following informed consent and completion of baseline assessments, participants will be randomised in a 1:1:1 ratio to no-intervention control, NHS SLT or LSVT LOUD® via a central computer-generated programme, using a minimisation procedure with a random element, to ensure allocation concealment. Participants randomised to the intervention groups will start treatment within 4 (NHS SLT) or 7 (LSVT LOUD®) weeks of randomisation. PRIMARY OUTCOME Voice Handicap Index (VHI) total score at 3 months. Secondary outcomes include: VHI subscales, Parkinson's Disease Questionnaire-39; Questionnaire on Acquired Speech Disorders; EuroQol-5D-5 L; ICECAP-O; resource utilisation; adverse events and carer quality of life. Mixed-methods process and health economic evaluations will take place alongside the trial. Assessments will be completed before randomisation and at 3, 6 and 12 months after randomisation. The trial started in December 2015 and will run for 77 months. Recruitment will take place in approximately 42 sites around the UK. DISCUSSION The trial will test the hypothesis that SLT is effective for the treatment of speech or voice problems in people with PD compared to no SLT. It will further test whether NHS SLT or LSVT LOUD® provide greater benefit and determine the cost-effectiveness of both interventions. TRIAL REGISTRATION International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ID: 12421382. Registered on 18 April 2016.
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Affiliation(s)
- C. M. Sackley
- Population Health Sciences, Addison House, King’s College London, Guy’s Campus, London, SE1 1UL UK
- School of Health Science, University of Nottingham, QMC, Nottingham, NG7 2HA UK
| | - C. Rick
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - P. Au
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - M. C. Brady
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0BA UK
| | - G. Beaton
- Queen Elizabeth Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - C. Burton
- School of Allied and Public Health Professions, Canterbury Christ church University, Canterbury, CT1 1QU UK
| | - M. Caulfield
- Bangor Institute for Health and Medical Research, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - S. Dickson
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0BA UK
| | - F. Dowling
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ UK
| | - M. Hughes
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - N. Ives
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - S. Jowett
- Health Economics, University of Birmingham, Birmingham,, B15 2TT UK
| | - P. Masterson-Algar
- Bangor Institute for Health and Medical Research, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - A. Nicoll
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0BA UK
| | - S. Patel
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - C. H. Smith
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
| | - R. Woolley
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - C. E. Clarke
- Institute for Applied Health Research, University of Birmingham, Birmingham, B15 2TT UK
- Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham,, B18 7QH UK
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11
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Marumoto K, Yokoyama K, Inoue T, Yamamoto H, Kawami Y, Nakatani A, Fukazawa Y, Hosoe Y, Yamasaki A, Domen K. Inpatient Enhanced Multidisciplinary Care Effects on the Quality of Life for Parkinson Disease: A Quasi-Randomized Controlled Trial. J Geriatr Psychiatry Neurol 2019; 32:186-194. [PMID: 30966869 PMCID: PMC6552116 DOI: 10.1177/0891988719841721] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare the effects of inpatient enhanced multidisciplinary care (EMC) and multidisciplinary rehabilitation (MR) on the symptoms and quality of life (QOL) of patients with Parkinson disease (PD) and to clarify the relation between reduction in symptoms and the improved QOL. METHODS This study was a quasi-randomized controlled (alternate allocation), assessor-blinded, single-center study. We recruited 80 patients with idiopathic Parkinson disease, Hoehn and Yahr stage 2 to 4, on stable medication. Patients were included in an EMC or MR group. Both rehabilitation programs were performed for 8 weeks (17 h/wk). Main outcome measures were Parkinson's Disease Questionnaire-39 and Unified Parkinson's Disease Rating Scale. RESULTS The EMC induced significant improvements in QOL compared to MR. We found that body axis symptoms (rising from a chair, posture, postural stability, falling, and walking) as well as nonmotor symptoms (depression) in patients with PD were relieved by the inpatient EMC. CONCLUSIONS Enhanced multidisciplinary care for patients with PD appears to be effective in improving the QOL. The improvement in motor and nonmotor symptoms, including depression, may contribute to the improved QOL.
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Affiliation(s)
- Kohei Marumoto
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Kouto, Shingu-cho, Tatsuno, Hyogo, Japan,Hyogo College of Medicine, Mukogawa-cho, Nishinomiya, Hyogo, Japan,Kohei Marumoto, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1, Kouto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan.
| | - Kazumasa Yokoyama
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Kouto, Shingu-cho, Tatsuno, Hyogo, Japan
| | - Tomomi Inoue
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Kouto, Shingu-cho, Tatsuno, Hyogo, Japan
| | - Hiroshi Yamamoto
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Kouto, Shingu-cho, Tatsuno, Hyogo, Japan
| | - Yuki Kawami
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Kouto, Shingu-cho, Tatsuno, Hyogo, Japan
| | - Ayumi Nakatani
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Kouto, Shingu-cho, Tatsuno, Hyogo, Japan
| | - Yoshihiro Fukazawa
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Kouto, Shingu-cho, Tatsuno, Hyogo, Japan
| | - Yayoi Hosoe
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Kouto, Shingu-cho, Tatsuno, Hyogo, Japan
| | - Aki Yamasaki
- Hyogo College of Medicine, Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Kazuhisa Domen
- Hyogo College of Medicine, Mukogawa-cho, Nishinomiya, Hyogo, Japan
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12
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Saffarian A, Amiri Shavaki Y, Shahidi GA, Hadavi S, Jafari Z. Lee Silverman voice treatment (LSVT) mitigates voice difficulties in mild Parkinson's disease. Med J Islam Repub Iran 2019; 33:5. [PMID: 31086784 PMCID: PMC6504915 DOI: 10.34171/mjiri.33.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Parkinson's disease (PD) is a progressive neurological disorder and many PD patients experience some type of voice and speech disorders during the course of illness. In this study, the aim was to investigate the effect of Lee Silverman voice treatment (LSVT) on improving voice difficulties in patients with mild PD using voice handicap index (VHI). Methods: This interventional study was conducted on 23 PD patients who were randomly divided into 2 groups: a treatment group (PD-T) (n=13) and a no-treatment group (PD-NT) (n=10). Neurologically healthy control (NNC) group consisted of 13 healthy participants who did not suffer from voice and speech problems and were matched with PD group by age (50-65 years), sex, and education. VHI questionnaire was completed a day before the start of LSVT and a day after the treatment fulfillment for the PD-T group; the same time spots were applied for the PD-NT and NNC groups. Statistical analyses were performed using SPSS Statistics 22.0 and significance level was set at 0.05. The multivariate analysis of variance and repeated measure analysis of variance were used for data analysis. Results: PD groups showed a significant weakness in VHI scores before treatment compared to NNC group (p≤ 0.001). The mean of VHI scores for PD-T, PD-NT, and NNC groups before treatment was 44.31±11.23, 43.54±6.10, and 8.15±4.27, respectively. LSVT was successful in improving VHI scores in PD-T group (17.23±5.35, p≤ 0.001). However, no improvement was observed in PD-NT group (44.00±5.88). Conclusion: Improvement in VHI score could be the result of ameliorated self-monitoring and self-regulation created by LSVT.
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Affiliation(s)
- Arezoo Saffarian
- 1 Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Yunes Amiri Shavaki
- 1 Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Gholam Ali Shahidi
- 2 Movement Disorders Clinic, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahram Hadavi
- 1 Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Jafari
- 3 Department of Basic Sciences in Rehabilitation, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
,Corresponding author: Dr Zahra Jafari,
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13
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Sackley CM, Smith CH, Rick CE, Brady MC, Ives N, Patel S, Woolley R, Dowling F, Patel R, Roberts H, Jowett S, Wheatley K, Kelly D, Sands G, Clarke CE. Lee Silverman Voice Treatment versus standard speech and language therapy versus control in Parkinson's disease: a pilot randomised controlled trial (PD COMM pilot). Pilot Feasibility Stud 2018; 4:30. [PMID: 29344405 PMCID: PMC5763537 DOI: 10.1186/s40814-017-0222-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 12/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Speech-related problems are common in Parkinson's disease (PD), but there is little evidence for the effectiveness of standard speech and language therapy (SLT) or Lee Silverman Voice Treatment (LSVT LOUD®). METHODS The PD COMM pilot was a three-arm, assessor-blinded, randomised controlled trial (RCT) of LSVT LOUD®, SLT and no intervention (1:1:1 ratio) to assess the feasibility and to inform the design of a full-scale RCT. Non-demented patients with idiopathic PD and speech problems and no SLT for speech problems in the past 2 years were eligible. LSVT LOUD® is a standardised regime (16 sessions over 4 weeks). SLT comprised individualised content per local practice (typically weekly sessions for 6-8 weeks). Outcomes included recruitment and retention, treatment adherence, and data completeness. Outcome data collected at baseline, 3, 6, and 12 months included patient-reported voice and quality of life measures, resource use, and assessor-rated speech recordings. RESULTS Eighty-nine patients were randomised with 90% in the therapy groups and 100% in the control group completing the trial. The response rate for Voice Handicap Index (VHI) in each arm was ≥ 90% at all time-points. VHI was highly correlated with the other speech-related outcome measures. There was a trend to improvement in VHI with LSVT LOUD® (difference at 3 months compared with control: - 12.5 points; 95% CI - 26.2, 1.2) and SLT (difference at 3 months compared with control: - 9.8 points; 95% CI - 23.2, 3.7) which needs to be confirmed in an adequately powered trial. CONCLUSION Randomisation to a three-arm trial of speech therapy including a no intervention control is feasible and acceptable. Compliance with both interventions was good. VHI and other patient-reported outcomes were relevant measures and provided data to inform the sample size for a substantive trial. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number Register: ISRCTN75223808. registered 22 March 2012.
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Affiliation(s)
| | - Christina H. Smith
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
| | - Caroline E. Rick
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Marian C. Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Smitaa Patel
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Francis Dowling
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Ramilla Patel
- Parkinson’s UK West Midlands Regional Branch, London, UK
| | - Helen Roberts
- Faculty of Medicine, University of Southampton, London, UK
| | - Sue Jowett
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Debbie Kelly
- School of Rehabilitation Sciences, University of East Anglia, Norwich, UK
| | - Gina Sands
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Carl E. Clarke
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Neurology, Clinical Neurology City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH UK
| | - on behalf of the PD COMM Pilot Collaborative Group
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
- Parkinson’s UK West Midlands Regional Branch, London, UK
- Faculty of Medicine, University of Southampton, London, UK
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
- School of Rehabilitation Sciences, University of East Anglia, Norwich, UK
- Department of Neurology, Clinical Neurology City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH UK
- School of Health Sciences, University of Nottingham, Nottingham, UK
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14
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Witt K, Kalbe E, Erasmi R, Ebersbach G. [Nonpharmacological treatment procedures for Parkinson's disease]. DER NERVENARZT 2017; 88:383-390. [PMID: 28251243 DOI: 10.1007/s00115-017-0298-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Nonpharmacological treatment strategies in Parkinson' disease include heterogeneous treatment modalities, such as physiotherapy, occupational therapy, speech therapy, cognitive training and deep brain stimulation as well as noninvasive brain stimulation strategies. Even in the early stages of Parkinson's disease nonpharmacological interventions, such as active exercise therapy and speech therapy can be indicated taking the individual symptoms of a patient into account. Mild cognitive deficits are frequently detected in the course of the disease and progression of these disorders to dementia in the advanced stages of the disease is not uncommon. The starting point for a cognitive training, training strategy and training frequency is unknown and currently under investigation. Deep brain stimulation is an established treatment modality, which should be considered when motor fluctuations cannot be adequately controlled by pharmacological treatment. This therapeutic option depends on patient-specific needs and has to be managed by a multiprofessional team. Non-invasive neurostimulation techniques, such as transcranial magnetic stimulation and transcranial direct current stimulation are experimental tools and cannot currently be recommended for general use.
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Affiliation(s)
- K Witt
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian Albrechts Universität Kiel, Rosalind Franklin Straße 10, 24105, Kiel, Deutschland.
| | - E Kalbe
- Medizinische Psychologie | Neuropsychologie und Gender Studies & Center für Neuropsychologische Diagnostik und Intervention (CeNDI), Zentrum für Neurologie und Psychiatrie, Uniklinik Köln, Köln, Deutschland
| | - R Erasmi
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian Albrechts Universität Kiel, Rosalind Franklin Straße 10, 24105, Kiel, Deutschland
| | - G Ebersbach
- Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson, Beelitz-Heilstätten, Deutschland
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15
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Masterson-Algar P, Burton CR, Brady MC, Nicoll A, Clarke CE, Rick C, Hughes M, Au P, Smith CH, Sackley CM. The PD COMM trial: a protocol for the process evaluation of a randomised trial assessing the effectiveness of two types of SLT for people with Parkinson's disease. Trials 2017; 18:397. [PMID: 28851443 PMCID: PMC5576370 DOI: 10.1186/s13063-017-2130-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/01/2017] [Indexed: 11/10/2022] Open
Abstract
Background The PD COMM trial is a phase III multi-centre randomised controlled trial whose aim is to evaluate the effectiveness and cost-effectiveness of two approaches to speech and language therapy (SLT) compared with no SLT intervention (control) for people with Parkinson’s disease who have self-reported or carer-reported problems with their speech or voice. Our protocol describes the process evaluation embedded within the outcome evaluation whose aim is to evaluate what happened at the time of the PD COMM intervention implementation and to provide findings that will assist in the interpretation of the PD COMM trial results. Furthermore, the aim of the PD COMM process evaluation is to investigate intervention complexity within a theoretical model of how the trialled interventions might work best and why. Methods/design Drawing from the Normalization Process Theory and frameworks for implementation fidelity, a mixed method design will be used to address process evaluation research questions. Therapists’ and participants’ perceptions and experiences will be investigated via in-depth interviews. Critical incident reports, baseline survey data from therapists, treatment record forms and home practice diaries also will be collected at relevant time points throughout the running of the PD COMM trial. Process evaluation data will be analysed independently of the outcome evaluation before the two sets of data are then combined. Discussion To date, there are a limited number of published process evaluation protocols, and few are linked to trials investigating rehabilitation therapies. Providing a strong theoretical framework underpinning design choices and being tailored to meet the complex characteristics of the trialled interventions, our process evaluation has the potential to provide valuable insight into which components of the interventions being delivered in PD COMM worked best (and what did not), how they worked well and why. Trial registration ISRCTN Registry, ISRCTN12421382. Registered on 18 April 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2130-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patricia Masterson-Algar
- Bangor Institute for Health & Medical Research, School of Healthcare Sciences, Bangor University, Ffriddoedd Road, Bangor, UK.
| | - Christopher R Burton
- Bangor Institute for Health & Medical Research, School of Healthcare Sciences, Bangor University, Ffriddoedd Road, Bangor, UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Avril Nicoll
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Carl E Clarke
- Institute for Applied Health Research, University of Birmingham, Vincent Drive, Birmingham, UK.,Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Caroline Rick
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Max Hughes
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Edgbaston, Birmingham, UK
| | - Pui Au
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Edgbaston, Birmingham, UK
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16
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Donovan NJ. People with Parkinson’s disease and dysarthria benefit equally from Lee Silverman Voice Treatment (LSVT LOUD) delivered via tele-rehabilitation compared with conventional face-to-face version of the treatment1. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/17489539.2017.1339764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Neila J. Donovan
- Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, LA, USA
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17
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Enderby P. Speech pathology as the MasterChef: Getting the right ingredients and stirring the pot. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:232-236. [PMID: 28425759 DOI: 10.1080/17549507.2017.1287219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/04/2017] [Indexed: 06/07/2023]
Abstract
The purpose of this paper is to consider the many influences that have an impact on appropriate speech-language pathology service delivery. The competitive cooking and entertainment television program, MasterChef, is used as an analogy to consider the ingredients, blend and approach required to improve speech-language pathology services. Speech-language pathologists (SLPs) enter the profession with the aim of assisting those with communication and swallowing disorders to have a better quality of life. Thus, we should be restless to continue to improve our services in order to achieve the best influence and outcomes by changing our recipes and ingredients. However, having good technical skills as a SLP is not sufficient in ensuring that the services are the best they can be. We have to consider available resources, customers and service users, who it is that judges our services, whether we are as good as we could or should be, what can help us improve our services, what the appetite is for our services, and how we incorporate evidence-based practice. This paper considers the value of understanding and using information on incidence and prevalence, evidence-based practice and outcome measurement. Blending technical, clinical and academic abilities with personal skills will result in an award-winning menu.
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Affiliation(s)
- Pam Enderby
- a School of Health and Related Research , University of Sheffield , Sheffield , UK
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18
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Khan F, Amatya B, Galea MP, Gonzenbach R, Kesselring J. Neurorehabilitation: applied neuroplasticity. J Neurol 2016; 264:603-615. [PMID: 27778158 DOI: 10.1007/s00415-016-8307-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/06/2016] [Accepted: 10/07/2016] [Indexed: 12/28/2022]
Abstract
The prevalence of disability due to neurological conditions is escalating worldwide. Neurological disorders have significant disability-burden with long-term functional and psychosocial issues, requiring specialized rehabilitation services for comprehensive management, especially treatments tapping into brain recovery 'neuroplastic' processes. Neurorehabilitation is interdisciplinary and cross-sectorial, requiring coordinated effort of diverse sectors, professions, patients and community to manage complex condition-related disability. This review provides evidence for a range of neurorehabilitation interventions for four common neurological conditions: multiple sclerosis (MS), stroke, traumatic brain injury and Parkinson's disease using the Grade of Recommendation, Assessment, Development and Evaluation tool for quality of evidence. Although, existing best-evidence for many interventions is still sparse, the overall findings suggest 'strong' evidence for physical therapy and psychological intervention for improved patient outcomes; and. 'moderate' evidence for multidisciplinary rehabilitation for longer term gains at the levels of activity (disability) and participation in MS and stroke population. The effect of other rehabilitation interventions is inconclusive, due to a paucity of methodologically robust studies. More research is needed to improve evidence-base for many promising rehabilitation interventions.
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Affiliation(s)
- Fary Khan
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road, Parkville, Victoria, 3052, Australia.
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Grattan Street, Parkville, Victoria, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Bhasker Amatya
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road, Parkville, Victoria, 3052, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Grattan Street, Parkville, Victoria, Australia
| | - Mary P Galea
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road, Parkville, Victoria, 3052, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Grattan Street, Parkville, Victoria, Australia
| | - Roman Gonzenbach
- Department of Neurology and Neurorehabilitation, Rehabilitation Center, Valens, Switzerland
| | - Jürg Kesselring
- Department of Neurology and Neurorehabilitation, Rehabilitation Center, Valens, Switzerland
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19
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Spurgeon L, Clarke CE, Sackley C. Subjective Experiences of Speech and Language Therapy in Patients with Parkinson's Disease: A Pilot Study. Rehabil Res Pract 2015; 2015:839895. [PMID: 26236508 PMCID: PMC4510263 DOI: 10.1155/2015/839895] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/10/2015] [Accepted: 06/24/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. Parkinson's disease can produce a range of speech-language pathologies, which may require intervention. While evaluations of speech-language therapy have been undertaken, no work has been undertaken to capture patients' experiences of therapy. This was the aim of the present study. Methods. Semistructured interviews, using themes derived from the literature, were conducted with nine Parkinson's disease patients, all of whom had undergone speech-language therapy. Participants' responses were analysed in accordance with Thematic Network Analysis. Results. Four themes emerged: emotional reactions (frustration, embarrassment, lack of confidence, disappointment, and anxiety); physical impact (fatigue, breathing and swallowing, and word production); practical aspects (cost of treatment, waiting times, and the actual clinical experience); and expectations about treatment (met versus unmet). Conclusions. While many benefits of speech-language therapy were reported, several negative issues emerged which could impact adversely on rehabilitation. Parkinson's disease is associated with a range of psychological and physical sequelae, such as fatigue and depression; recognising any individual experiences which could exacerbate the existing condition and incorporating these into treatment planning may improve rehabilitation outcomes.
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Affiliation(s)
- Laura Spurgeon
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Carl E. Clarke
- School of Clinical and Experimental Medicine, College of Medicine and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Cath Sackley
- Division of Health and Social Care, Faculty of Life Sciences and Medicine, King's College, 7th Floor Capital House, 42 Weston Street, London SE1 3QD, UK
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20
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Deane KHO, Flaherty H, Daley DJ, Pascoe R, Penhale B, Clarke CE, Sackley C, Storey S. Priority setting partnership to identify the top 10 research priorities for the management of Parkinson's disease. BMJ Open 2014; 4:e006434. [PMID: 25500772 PMCID: PMC4281559 DOI: 10.1136/bmjopen-2014-006434] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/14/2014] [Accepted: 11/18/2014] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES This priority setting partnership was commissioned by Parkinson's UK to encourage people with direct and personal experience of the condition to work together to identify and prioritise the top 10 evidential uncertainties that impact on everyday clinical practice for the management of Parkinson's disease (PD). SETTING The UK. PARTICIPANTS Anyone with experience of PD including: people with Parkinson's (PwP), carers, family and friends, healthcare and social care professionals. Non-clinical researchers and employees of pharmaceutical or medical devices companies were excluded. 1000 participants (60% PwP) provided ideas on research uncertainties, 475 (72% PwP) initially prioritised them and 27 (37% PwP) stakeholders agreed a final top 10. METHODS Using a modified nominal group technique, participants were surveyed to identify what issues for the management of PD needed research. Unique research questions unanswered by current evidence were identified and participants were asked to identify their top 10 research priorities from this list. The top 26 uncertainties were presented to a consensus meeting with key stakeholders to agree the top 10 research priorities. RESULTS 1000 participants provided 4100 responses, which contained 94 unique unanswered research questions that were initially prioritised by 475 participants. A consensus meeting with 27 stakeholders agreed the top 10 research priorities. The overarching research aspiration was an effective cure for PD. The top 10 research priorities for PD management included the need to address motor symptoms (balance and falls, and fine motor control), non-motor symptoms (sleep and urinary dysfunction), mental health issues (stress and anxiety, dementia and mild cognitive impairments), side effects of medications (dyskinesia) and the need to develop interventions specific to the phenotypes of PD and better monitoring methods. CONCLUSIONS These research priorities identify crucial gaps in the existing evidence to address everyday practicalities in the management of the complexities of PD.
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Affiliation(s)
| | - Helen Flaherty
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - David J Daley
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Roland Pascoe
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Bridget Penhale
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Carl E Clarke
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham, UK
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21
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Sackley CM, Smith CH, Rick C, Brady MC, Ives N, Patel R, Roberts H, Dowling F, Jowett S, Wheatley K, Patel S, Kelly D, Sands G, Clarke C. Lee Silverman voice treatment versus standard NHS speech and language therapy versus control in Parkinson's disease (PD COMM pilot): study protocol for a randomized controlled trial. Trials 2014; 15:213. [PMID: 24908096 PMCID: PMC4059086 DOI: 10.1186/1745-6215-15-213] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/20/2014] [Indexed: 11/14/2022] Open
Abstract
Background Parkinson’s disease is a common movement disorder affecting approximately 127,000 people in the UK, with an estimated two thirds having speech-related problems. Currently there is no preferred approach to speech and language therapy within the NHS and there is little evidence for the effectiveness of standard NHS therapy or Lee Silverman voice treatment. This trial aims to investigate the feasibility and acceptability of randomizing people with Parkinson’s disease-related speech or voice problems to Lee Silverman voice treatment or standard speech and language therapy compared to a no-intervention control. Methods/Design The PD COMM pilot is a three arm, assessor-blinded, randomized controlled trial. Randomization will be computer-generated with participants randomized at a ratio of 1:1:1. Participants randomized to intervention arms will be immediately referred to the appropriate speech and language therapist. The target population are patients with a confirmed diagnosis of idiopathic Parkinson’s disease who have problems with their speech or voice. The Lee Silverman voice treatment intervention group will receive the standard regime of 16 sessions between 50 and 60 minutes in length over four weeks, with extra home practice. The standard speech and language therapy intervention group will receive a dose determined by patients’ individual needs, but not exceeding eight weeks of treatment. The control group will receive standard care with no speech and language therapy input for at least six months post-randomization. Outcomes will be assessed at baseline (pre-randomization) and post- randomization at three, six, and 12 months. The outcome measures include patient-reported voice measures, quality of life, resource use, and assessor-rated speech recordings. The recruitment aim is at least 60 participants over 21 months from 11 sites, equating to at least 20 participants in each arm of the trial. This trial is ongoing and recruitment commenced in May 2012. Discussion This study will provide information on the feasibility and acceptability of randomizing participants to different speech and language therapies or control/deferred treatment. The findings relating to recruitment, treatment compliance, outcome measures, and effect size will inform a future phase III randomized controlled trial. Trial registration International Standard Randomised Controlled Trial Number Register: ISRCTN75223808 registered 22 March 2012.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Gina Sands
- School of Rehabilitation Sciences, University of East Anglia, Earlham Road, Norwich NR4 7TJ, UK.
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Ciucci MR, Grant LM, Rajamanickam ESP, Hilby BL, Blue KV, Jones CA, Kelm-Nelson CA. Early identification and treatment of communication and swallowing deficits in Parkinson disease. Semin Speech Lang 2013; 34:185-202. [PMID: 24166192 DOI: 10.1055/s-0033-1358367] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Parkinson disease (PD) is a complex, progressive, neurodegenerative disorder that leads to a wide range of deficits including fine and gross sensorimotor impairment, autonomic dysfunction, mood disorders, and cognitive decline. Traditionally, the focus for diagnosis and treatment has been on sensorimotor impairment related to dopamine depletion. It is now widely recognized, however, that PD-related pathology affects multiple central nervous system neurotransmitters and pathways. Communication and swallowing functions can be impaired even in the early stages, significantly affecting health and quality of life. The purpose of this article is to review the literature on early intervention for communication and swallowing impairment in PD. Overarching themes were that (1) studies and interpretation of data from studies in early PD are limited; (2) best therapy practices have not been established, in part due to the heterogeneous nature of PD; and (3) as communication and swallowing problems are pervasive in PD, further treatment research is essential.
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Affiliation(s)
- Michelle R Ciucci
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin
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