Examining the relationship between speech intensity and self-rated communicative effectiveness in individuals with Parkinson's disease and hypophonia

Speech Amplification Device Usage for the Management of Hypophonia: A Survey of Speech-Language Pathologists

PURPOSE

The purpose of this study was to survey speech-language pathologists (SLPs) who assess and treat people with Parkinson's disease (PD) to gather insights into their decision making regarding their use or potential use of speech amplification technology for the management of hypophonia.

METHOD

A total of 111 SLPs who were currently practicing in the United States or Canada and had experience working with clients with PD for at least 2 years completed an anonymous Qualtrics survey. Questions were designed to probe the following areas: (a) degree of familiarity with amplification devices as a form of treatment for PD, (b) attitudes and perceptions of the implementation of these devices for PD, and (c) factors that influence the clinical decision to prescribe such devices.

RESULTS

Most participants (75; 71%) reported they had considered prescribing a device to at least one client with PD. When asked at which stages of speech or voice impairment they would consider the use of an amplification device for clients with PD, the most common response was for clients with moderate or severe hypophonia who were not stimulable for louder speech. However, 36 (32%) respondents indicated they would also consider an amplification device for clients who were stimulable for louder speech with severe hypophonia. When asked to rank the most important factors they would weigh when considering the prescription of an amplification device, they ranked the client's preference and comfort level as the most important consideration.

CONCLUSION

This study provides valuable clinical insights regarding how SLPs can approach utilizing speech amplification devices in the therapy environment.

Clinical Insights Into the Use of Speech Amplification Devices for Managing Hypophonia: Interviews With Speech-Language Pathologists

PURPOSE

The purpose of this qualitative interview study was to identify themes regarding considerations in the usage of speech amplification device usage for people with Parkinson's disease (PD) and hypophonia from the perspective of speech-language pathologists (SLPs).

METHOD

Eligible participants included SLPs currently practicing in the United States or Canada with experience working with clients with PD for at least 2 years. Ten SLPs participated in 60-min interviews conducted via Zoom. A semistructured interview guide was created prior to the interviews. The interviews were transcribed following their completion, and an iterative coding process was used to identify themes using thematic analysis.

RESULTS

Three main themes were identified from the interviews. The first theme encapsulated how clinicians described amplification devices as a potential treatment tool, which highlighted the nuances that may impact selecting an amplification device as a treatment option such as increased hypophonia or dysarthria severity and cognitive decline. The second theme highlighted how device selection depends on the individual needs of the user. Individual client characteristics (such as disease symptoms and individual needs and preferences) may impact the choice of amplification device. The last theme outlined the importance of involving family members in all stages of device use and involving other health care team members on a case-by-case basis.

CONCLUSIONS

The insights provided by the SLP participants help to understand the clinical decisions that are made when determining device candidacy, selecting a device, and evaluating device success. These insights can be used to improve research studies of augmentative management of hypophonia and guide more personalized management decisions.

Daily Phonatory Activity of Individuals With Parkinson's Disease

PURPOSE

This study evaluated the amount of phonatory activity of Persons with Parkinson disease (PwPD) compared to adults without Parkinson's disease measured over 3 days. The relationship between the amount of phonatory activity and Voice Handicap Index (VHI) total score was assessed as were differences in voicing activity across 3 days of data collection.

METHODS

Fifteen PwPD receiving dopaminergic medication and fifteen age and sex matched adults without Parkinson's disease completed the VHI and then wore a VocaLog vocal monitor (VM) for 3 consecutive days. From the VM data, the number of 1-second windows with dB sound pressure level > 0 were summed as a measure of phonatory activity (PA) and reported relative to the time the VM was worn (%PA).

RESULTS

The percentage of time the VM was worn did not differ between groups or across days. The PwPD had statistically significantly fewer minutes of PA per day than controls (F = 21.782, P < 0.001) by 54 minutes on average. The %PA also differed significantly (F = 31.825, P < 0.001) with a mean of 11.1% for PwPD and 18.6% for controls. Neither PA nor %PA differed across the 3 days of vocal monitoring. VHI total score was significantly correlated with PA (r = -0.436, P = 0.016) and %PA (r = -0.534, P = 0.002) for all participants.

CONCLUSIONS

The results indicate that PwPD engaged in less verbal communication in their daily environment compared to adults without Parkinson's disease. The findings support reports in the literature indicating that PwPD often have reduced communication participation. Measures such as %PA could serve as a quantifiable metric in future studies assessing communication changes in PwPD as a function of disease progression or therapeutic interventions.

Effects of speech rate modifications on phonatory acoustic outcomes in Parkinson's disease

Speech rate reduction is a global speech therapy approach for speech deficits in Parkinson's disease (PD) that has the potential to result in changes across multiple speech subsystems. While the overall goal of rate reduction is usually improvements in speech intelligibility, not all people with PD benefit from this approach. Speech rate is often targeted as a means of improving articulatory precision, though less is known about rate-induced changes in other speech subsystems that could help or hinder communication. The purpose of this study was to quantify phonatory changes associated with speech rate modification across a broad range of speech rates from very slow to very fast in talkers with and without PD. Four speaker groups participated: younger and older healthy controls, and people with PD with and without deep brain stimulation of the subthalamic nucleus (STN-DBS). Talkers read aloud standardized sentences at 7 speech rates elicited using magnitude production: habitual, three slower rates, and three faster rates. Acoustic measures of speech intensity, cepstral peak prominence, and fundamental frequency were measured as a function of speech rate and group. Overall, slower rates of speech were associated with differential effects on phonation across the four groups. While all talkers spoke at a lower pitch in slow speech, younger talkers showed increases in speech intensity and cepstral peak prominence, while talkers with PD and STN-DBS showed the reverse pattern. Talkers with PD without STN-DBS and older healthy controls behaved in between these two extremes. At faster rates, all groups uniformly demonstrated increases in cepstral peak prominence. While speech rate reductions are intended to promote positive changes in articulation to compensate for speech deficits in dysarthria, the present results highlight that undesirable changes may be invoked across other subsystems, such as at the laryngeal level. In particular, talkers with STN-DBS, who often demonstrate speech deterioration following DBS surgery, demonstrated more phonatory detriments at slowed speech rates. Findings have implications for speech rate candidacy considerations and speech motor control processes in PD.

Self-perceived affective, behavioral, and cognitive reactions associated with voice use in people with Parkinson's disease: a pilot study

PURPOSE

This study aimed to compare the affective, behavioral, and cognitive reactions related to vocal function in people with Parkinson's disease (PWPD) and healthy controls using the Behavior Assessment Battery - Voice (BAB-Voice). The test's internal consistency was also described.

METHODS

31 PWPD and 19 healthy controls were recruited from September 2020 to March 2021. Participants completed four BAB-Voice subtests: Speech Situation Checklist - Emotional Reaction (SSC-ER), the Speech Situation Checklist - Speech Disruption (SSC-SD), Behavior Checklist (BCL), and Communication Attitude Test for Adults (BigCAT), describing the experienced negative emotional reaction, voice disruptions, coping behaviors, and negative attitude regarding communication respectively. Subtest scores were calculated and analyzed.

RESULTS

The scores of the PWPD were significantly different from those of the controls (Pillai's Trace = 0.344, F[4] = 5.508, p = .001, ηp2 = .344): PWPD showed more negative emotions and voice problems, more coping behaviors, and more negative speech-related attitude compared to healthy controls. All subtests showed excellent internal consistency.

CONCLUSIONS

The BAB-Voice proved a tool with a good internal consistency that measured different psychosocial reactions in PWPD versus controls. PWPD exhibited significantly more negative emotions and voice problems in specific speech situations, more coping behaviors, and a more negative speech-related attitude. The specificity of information obtained from the BAB-Voice may aid in improving the treatment planning of voice disorders in PWPD.

Thyroarytenoid Oxidative Metabolism and Synaptic Signaling Dysregulation in the Female Pink1-/- Rat

OBJECTIVES AND HYPOTHESIS

Vocal dysfunction, including hypophonia, in Parkinson disease (PD) manifests in the prodromal period and significantly impacts an individual's quality of life. Data from human studies suggest that pathology leading to vocal deficits may be structurally related to the larynx and its function. The Pink1-/- rat is a translational model used to study pathogenesis in the context of early-stage mitochondrial dysfunction. The primary objective of this work was to identify differentially expressed genes in the thyroarytenoid muscle and examine the dysregulated biological pathways in the female rat.

METHODS

RNA sequencing was used to determine thyroarytenoid (TA) muscle gene expression in adult female Pink1-/- rats compared with controls. A bioinformatic approach and the ENRICHR gene analysis tool were used to compare the sequencing dataset with biological pathways and processes, disease relationships, and drug-repurposing compounds. Weighted Gene Co-expression Network Analysis was used to construct biological network modules. The data were compared with a previously published dataset in male rats.

RESULTS

Significant upregulated pathways in female Pink1-/- rats included fatty acid oxidation and muscle contraction, synaptic transmission, and neuromuscular processes. Downregulated pathways included anterograde transsynaptic signaling, chemical synaptic transmission, and ion release. Several drug treatment options including cetuximab, fluoxetine, and resveratrol are hypothesized to reverse observed genetic dysregulation.

CONCLUSIONS

Data presented here are useful for identifying biological pathways that may underlie the mechanisms of peripheral dysfunction including neuromuscular synaptic transmission to the TA muscle. These experimental biomarkers have the potential to be targeted as sites for improving the treatment for hypophonia in early-stage PD.

LEVEL OF EVIDENCE

NA Laryngoscope, 133:3412-3421, 2023.

A Comparison of Voice Amplifiers and Personal Communication Systems for Hypophonia: An Exploration of Communicative Participation

PURPOSE

The primary purpose of this study was to evaluate how individuals with hypophonia (HP; also referred to as HP participants) and their primary communication partners (PCPs; also referred to as PCP participants) rate communicative participation before and after experience with a speech amplification device. A secondary purpose was to evaluate pre- and post-device effects on self-rated communicative participation for each of the three speech amplification devices trialed outside of the laboratory.

METHOD

Seventeen individuals with HP and their PCPs participated in a crossover design study that compared three different amplification devices: a wired belt-pack amplifier, a wireless stationary amplifier, and a personal frequency modulation (FM) system. Both the individuals with HP and their PCPs self-rated communicative participation at baseline and after trialing each device following 1-week device trial periods at home. Patient-reported outcome measures included the Communicative Effectiveness Survey (CES) and the Voice Activity and Participation Profile (VAPP). Following study completion, participants indicated whether they would like to select a specific device to continue using.

RESULTS

Overall, HP participants rated communicative participation following device use higher than that in the pre-device condition, with the FM system resulting in the overall highest VAPP ratings and second highest CES ratings. Furthermore, HP and PCP participants rated these measures similarly. Finally, HP participants who selected a device to continue using self-reported lower total communicative effectiveness scores and greater voice activity limitations and participation restrictions at baseline in comparison to the nonselectors.

CONCLUSIONS

This study contributes to an increased understanding of how communicative participation is experienced within this clinical population resulting from speech amplification. It is suggested that the inclusion of participation-based outcome measurement is essential to ensure a multidimensional and comprehensive approach to device prescription for individuals with HP.

Clinical outcomes of PD Check-In, a model for supported self-managed maintenance of speech in Parkinson's disease: A Phase 1 study

BACKGROUND

For many people with Parkinson's disease (PWPD), the long-term maintenance of speech following intensive treatment remains elusive. PD Check-In, a model for supported self-managed maintenance of speech following LSVT LOUD^® , was developed and evaluated.

AIMS

To evaluate the impact of PD Check-In on vocal intensity and level of satisfaction of PWPD and their communication partners (CPs) over 24 months following LSVT LOUD.

METHODS & PROCEDURES

A repeated-measures study design examined the impact of PD Check-In on the speech of 16 PWPD. Participants received LSVT LOUD followed by PD Check-In at 6 and 12 weeks, and 6, 12 and 24 months after treatment. Outcome measures included acoustic measures of vocal intensity (sound pressure level-SPL) during sustained phonation, functional phrases, reading, and monologue, and satisfaction questionnaires for PWPD and their CPs.

OUTCOMES & RESULTS

A significant treatment effect for time (p < 0.01) was identified for all SPL variables. Planned comparisons showed significant improvements for each variable pre- to post-LSVT LOUD. There was a significant maintenance effect for SPL maximum sustained phonation only, post-LSVT LOUD to 24 months. SPL remained significantly above baseline for functional phrases and maximum sustained phonation at 24 months. Participants' satisfaction with PD Check-In was high, at 93.75% for PWPD and 79.99% for CPs, at 24 months post-treatment. Long intervals between appointments led PWPD to feel less motivated about speech practice but more confident in self-management.

CONCLUSIONS & IMPLICATIONS

For PWPD and CPs, maintenance of speech following LSVT LOUD encompasses more than acoustic outcomes.

WHAT THIS PAPER ADDS

What is already known on this subject? Maintenance of speech following LSVT LOUD has been shown to be variable in individual and group models. For PWPD and their CPs, a model for speech maintenance supports their expectation of sustained treatment effect over time and meets their changing needs for speech and language therapy services. Supported self-management is a model under investigation for long-term maintenance of speech. What this paper adds to existing knowledge? This study presents the impact of five individual PD Check-In interventions on the maintenance of vocal intensity (SPL) of 16 PWPD over 24 months following LSVT LOUD. PWPD and CPs reported a high level of satisfaction with PD Check-In independent of acoustic outcomes. What are the potential or actual clinical implications of this work? Participant satisfaction with PD Check-In is derived from multiple factors and not limited to acoustic outcomes post-LSVT LOUD. Further investigation of the efficacy of PD Check-In to support the perceived maintenance of speech of PWPD and CPs is warranted.

The Impact of PD Check-In, a Model for Supported Self-Managed Maintenance of Speech on the Quality of Life of People with Parkinson's Disease: A Phase 1 Study

Quality of life (QoL) for people with Parkinson’s Disease (PD) is diminished by speech and communication changes. The impact of PD Check-In, an intervention for supported self-managed maintenance of speech following LSVT LOUD®, on QoL of people with PD was investigated. Sixteen people with PD and dysarthria completed LSVT LOUD followed by PD Check-Ins up until 24 months post-treatment. Self-rated QoL and voice handicap scales were used to determine the psychosocial and perceived impact of PD Check-In on the speech and voice of people with PD. The perceived impact of PD Check-In on speech and voice was also sought from 15 communication partners (CPs). A significant treatment effect for time was identified for the Dysarthria Impact Profile (DIP), Voice Handicap Index (VHI), and Voice Handicap Index-Partner (VHI-P) (p < 0.05). There was no significant effect for time for the Parkinson’s Disease Questionnaire (PDQ-39). Planned comparisons of timepoints for DIP, VHI, and VHI-P showed no significant differences (p > 0.01). Comparison of perceived voice handicap by people with PD and CPs revealed no significant differences (p > 0.01). The impact of PD Check-In on QoL of people with PD and CPs for 24 months post-LSVT-LOUD is unclear. Self-reported outcome measures alone do not fully capture changes in QoL in PD.

Communicative Participation in Dysarthria: Perspectives for Management

Communicative participation is restricted in many conditions associated with dysarthria. This position paper defines and describes the construct of communicative participation. In it, the emergence of this construct is reviewed, along with the predictors of and variables associated with communicative participation in the dysarthrias. In doing so, the features that make communicative participation unique and distinct from other measures of dysarthria are highlighted, through emphasizing how communicative participation cannot be predicted solely from other components of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF), including levels of impairment or activity limitations. Next, the empirical literature related to the measurement of communicative participation and how this research relates to dysarthria management is presented. Finally, the development of robust clinical measures of communicative participation and approaches to management is described from the point of view of the clinician. We argue that communicative participation should be a primary focus of treatment planning and intervention to provide patient-centered, holistic, and value-based clinical interventions which are responsive to the needs of individuals living with dysarthria.

From Speech Acoustics to Communicative Participation in Dysarthria: Toward a Causal Framework

PURPOSE

We proposed and tested a causal instantiation of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework, linking acoustics, intelligibility, and communicative participation in the context of dysarthria.

METHOD

Speech samples and communicative participation scores were collected from individuals with dysarthria (n = 32). Speech was analyzed for two acoustic metrics (i.e., articulatory precision and speech rate), and an objective measure of intelligibility was generated from listener transcripts. Mediation analysis was used to evaluate pathways of effect between acoustics, intelligibility, and communicative participation.

RESULTS

We observed a strong relationship between articulatory precision and intelligibility and a moderate relationship between intelligibility and communicative participation. Collectively, data supported a significant relationship between articulatory precision and communicative participation, which was almost entirely mediated through intelligibility. These relationships were not significant when speech rate was specified as the acoustic variable of interest.

CONCLUSION

The statistical corroboration of our causal instantiation of the ICF framework with articulatory acoustics affords important support toward the development of a comprehensive causal framework to understand and, ultimately, address restricted communicative participation in dysarthria.

Feasibility of a Telerehabilitation Adaptation of the Be Clear Speech Treatment Program for Non-Progressive Dysarthria

This study evaluated the feasibility and outcomes of a telerehabilitation adaptation of the Be Clear speech treatment program for adults with non-progressive dysarthria to determine clinical delivery viability and future research directions. Treatment effects on speech clarity, intelligibility, communication effectiveness, and participation, as well as psychosocial outcomes in 15 participants with non-progressive dysarthria, were explored. Intervention involved daily 1-h online sessions (4 days per week for 4 weeks, totalling 16 sessions) and daily home practice. Outcome measures were obtained at baseline (PRE), post-treatment (POST), and 12 weeks following treatment (FUP). Feasibility measures targeting participant satisfaction, treatment adherence and fidelity, and technical viability were also employed. The programme was feasible concerning technical viability and implementation, treatment adherence and fidelity. High levels of participant satisfaction were reported. Increases in overall ratings of communication participation and effectiveness were identified at POST and FUP. Reductions in speech rate were identified at FUP. Improvements in aspects of lingual and laryngeal function were also noted after treatment. Over time, improvements relating to the negative impact of dysarthria were identified. Naïve listeners perceived negligible changes in speech clarity following treatment. Online delivery of the Be Clear speech treatment program was feasible, and some positive speech benefits were observed. Due to the small sample size included in this research, statistically significant findings related to speech outcomes must be interpreted with caution. An adequately powered randomised controlled trial of Be Clear online is warranted to evaluate treatment efficacy.

Partner perception of affective, behavioral, and cognitive reactions to voice use in people with Parkinson’s disease

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Behavior Assessment Battery – Voice in people with Parkinson’s disease and proxies.

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Proxies and people with Parkinson’s Disease rate psychosocial impact similarly.

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Proxies can be part of vocal assessment and treatment in Parkinson’s Disease.

Introduction

People with Parkinson’s disease (PWPD) experience negative feelings, thoughts, and coping behaviors due to the experienced communication challenges. This study aimed to compare the perceptions of PWPD with those of proxies for the affective, behavioral, and cognitive reactions specific to voice production during communicative interactions.

Methods

The Behavior Assessment Battery – Voice (BAB-Voice) was administered to 31 PWPD and their close communication partner/proxy. The BAB-Voice contained four subtests: Speech Situation Checklist – Emotional Reaction (SSC-ER), Speech Situation Checklist – Speech Disruption (SSC-SD), Behavior Checklist (BCL), and Communication Attitude Test for Adults (BigCAT). The scores for each of these subtests were calculated and statistically analyzed.

Results

A repeated measures MANOVA did not find statistically significant differences between the subscores of PWPD and proxies (Pillai’s trace = 0.25, F[4] = 2.22, p =.094, η_p² = 0.25). Fair to excellent agreement between the PWPD and proxies was found. The highest agreement was found on the BigCAT (ICC = 0.80). The SSC-SD (ICC = 0.77) and SSC-ER (ICC = 0.71) still showed excellent agreement, while only fair agreement was found for the BCL (ICC = 0.57).

Conclusion

Proxies were able to identify the affective, behavioral, and cognitive reactions to voice use in PWPD. Communication partners close to the PWPD could, therefore, provide valuable information regarding the assessment and treatment of hypophonia in PD.

PD Check-In: The development and trial of a supported self-management program for people with Parkinson's disease following intensive speech intervention

BACKGROUND

Debilitating speech and communication changes in Parkinson's disease (PD) lead to diminished quality of life for people with PD and their communication partners. Maintenance of the long-term effects of treatment such as LSVT LOUD^® remains equivocal. Development of supported long-term maintenance programs is warranted.

AIMS

This article describes the development and preliminary outcome data for PD Check-In, a supported self-management intervention for the maintenance of speech and social communication for people with PD following LSVT LOUD.

METHODS & PROCEDURES

A narrative literature review of the principles of self-management and social cognitive theory of self-regulation was conducted to develop the core elements of PD Check-In. PD Check-In was conducted in person by a speech and language therapist (SLT) for three participants at 6 and 12 weeks, and at 6, 12 and 24 months following LSVT LOUD. Outcome measures included vocal intensity (SPL) during monologue and the dysarthria impact profile (DIP). PD Check-In utilized semi-structured discussion to develop, evaluate, and support the self-efficacy and skill of the person with PD in maintaining speech and social communication.

OUTCOMES & RESULTS

Six conceptual elements of PD Check-In were identified in the development phase: partnerships, self-reflection, maintenance issues, revision, goal-setting and maintenance strategies. Preliminary intervention data revealed monologue vocal intensity at 24 months post-LSVT LOUD was maintained above pre-treatment level, but below levels achieved post-treatment. The psychosocial impact of speech changes from pre-LSVT LOUD to 24 months post-treatment as measured by the DIP was variable. Qualitative statements reflected participant experiences underlying the clinical data.

CONCLUSIONS & IMPLICATIONS

The theoretical and practical underpinnings of PD Check-In were defined. The impact of PD Check-In on three persons with PD was variable but positive. Further evaluation of the model is warranted.

WHAT THIS PAPER ADDS

What is already known on the subject LSVT LOUD provides efficacious treatment for the speech disorder associated with PD. Long-term maintenance of speech post-treatment varies following self-managed and group therapy interventions. People with PD have an unmet expectation of long-term maintenance of speech and improved quality of life following intensive treatment. What this paper adds to existing knowledge This study describes the development of a novel clinic-based approach to long-term maintenance of speech in PD based on the principles of self-management and self-efficacy. It provides preliminary data to demonstrate the method and its effects on three participants with varying speech difficulty, self-management skill development and psychosocial impact. What are the potential or actual clinical implications of this work? The positive impact of PD Check-In on the maintenance of monologue vocal intensity above baseline 24 months post-intensive treatment was independent of the variable impact on the quality of life of the participants. Further exploration of PD Check-In is warranted to determine the efficacy of this approach.

The effects of a simulated fMRI environment on voice intensity in individuals with Parkinson's disease hypophonia and older healthy adults

PURPOSE

Functional magnetic resonance imaging (fMRI) has promise for understanding neural mechanisms of neurogenic speech and voice disorders. However, performing vocal tasks within the fMRI environment may not always be analogous to performance outside of the scanner. Using a mock MRI scanner, this study examines the effects of a simulated scanning environment on vowel intensity in individuals with Parkinson's disease (PD) and hypophonia and older healthy control (OHC) participants.

METHOD

Thirty participants (15 PD, 15 OHC) performed a sustained /ɑ/ vowel production task in three conditions: 1) Upright, 2) Mock Scanner + No Noise, and 3) Mock Scanner + MRI noise. We used a linear mixed-effects (multi-level) model to evaluate the contributions of group and recording environment to vowel intensity. A second linear mixed-effects model was also used to evaluate the contributions of PD medication state (On vs. Off) to voice intensity.

RESULTS

Vowel intensity was significantly lower for PD compared to the OHC group. The intensity of vowels produced in the Upright condition was significantly lower compared to the Mock Scanner + No Noise condition, while vowel intensity in the Mock Scanner + MRI Noise condition was significantly higher compared to the Mock Scanner + No Noise condition. A group by condition interaction also indicated that the addition of scanner noise had a greater impact on the PD group. A second analysis conducted within the PD group showed no effects of medication state on vowel intensity.

CONCLUSION

Our findings demonstrate that performance on voice production tasks is altered for PD and OHC groups when translated into the fMRI environment, even in the absence of acoustic scanner noise. For fMRI studies of voice in PD hypophonia, careful thought should be given to how the presence of acoustic noise may differentially affect PD and OHC, for both group and task comparisons.

Single Word Intelligibility of Individuals with Parkinson's Disease in Noise: Pre-Specified Secondary Outcome Variables from a Randomized Control Trial (RCT) Comparing Two Intensive Speech Treatments (LSVT LOUD vs. LSVT ARTIC)

The majority of people with Parkinson's disease (PD) experience both prosodic changes (reduced vocal volume, reduced pitch range) and articulatory changes (imprecise articulation) that often limit speech intelligibility and may contribute to significant declines in quality of life. We conducted a randomized control trial comparing two intensive treatments, voice (LSVT LOUD) or articulation (LSVT ARTIC) to assess single word intelligibility in the presence of background noise (babble and mall). Participants (64 PD and 20 Healthy) read words from the diagnostic rhyme test (DRT), an ANSI Standard for measuring intelligibility of speech, before and after one month (treatment or no treatment). Teams of trained listeners blindly rated the data. Speech intelligibility of words in the presence of both noise conditions improved in PD participants who had LSVT LOUD compared to the groups that had LSVT ARTIC or no treatment. Intensive speech treatment targeting prominent prosodic variables in LSVT LOUD had a positive effect on speech intelligibility at the single word level in PD.

The impact of Lee Silverman Voice Treatment (LSVT LOUD®) on voice, communication, and participation: Findings from a prospective, longitudinal study

BACKGROUND

Lee Silverman Voice Treatment (LSVT LOUD®), an intensive 4-week program of voice therapy, is regarded as the most well-researched, efficacious treatment for hypokinetic dysarthria in individuals with Parkinson's disease (PD). Although numerous studies have published acoustic and perceptual findings, there is comparatively little information about the impact of LSVT LOUD® on functional communication outcomes.

METHODS

This prospective, longitudinal study investigated the impact of treatment on daily communication in 25 individuals with PD. Three validated communication measures (the Voice Handicap Index, the Communicative Effectiveness Scale, and the Communicative Participation Item Bank) were given before and after treatment and again 4-8 weeks and 3-6 months following treatment. Communication partners were also asked to rate communication effectiveness at all four timepoints.

RESULTS

Significant improvements were found for all three self-reported scales which remained above baseline across all post-treatment timepoints. In addition, self-reported communicative effectiveness was significantly correlated with the assessments of communication partners. Particular benefits were reported for more complex communicative activities such as asking questions, giving detailed information, communicating in noisy situations, and speaking in groups.

CONCLUSIONS

Overall, the findings suggested that LSVT LOUD® promotes an increased sense of personal control over the communication difficulties resulting from PD by decreasing voice handicap and improving communication effectiveness and communicative participation. For individuals with PD, LSVT LOUD® may reduce the risk of social isolation by improving communication and facilitating social participation.

LEARNING OUTCOMES

As a result of this activity, the participant will be able to (1) describe the impact of PD on voice and communication, (2) discuss how these characteristics may be associated with more global measures of functional communication and particularly communicative participation, (3) explain which aspects of functional communication were affected by LSVT LOUD® as assessed by study participants and their communication partners.

Social Symptoms of Parkinson's Disease

Parkinson's disease (PD) is typically well recognized by its characteristic motor symptoms (e.g., bradykinesia, rigidity, and tremor). The cognitive symptoms of PD are increasingly being acknowledged by clinicians and researchers alike. However, PD also involves a host of emotional and communicative changes which can cause major disruptions to social functioning. These incude problems producing emotional facial expressions (i.e., facial masking) and emotional speech (i.e., dysarthria), as well as difficulties recognizing the verbal and nonverbal emotional cues of others. These social symptoms of PD can result in severe negative social consequences, including stigma, dehumanization, and loneliness, which might affect quality of life to an even greater extent than more well-recognized motor or cognitive symptoms. It is, therefore, imperative that researchers and clinicans become aware of these potential social symptoms and their negative effects, in order to properly investigate and manage the socioemotional aspects of PD. This narrative review provides an examination of the current research surrounding some of the most common social symptoms of PD and their related social consequences and argues that proactively and adequately addressing these issues might improve disease outcomes.

A Comparison of Speech Amplification and Personal Communication Devices for Hypophonia

Purpose This study compared the performance of three amplification devices hypothesized to improve speech communication in individuals with hypophonia (HP), as well as to identify individuals' device preferences. Method Twenty-two individuals with HP and their primary communication partners participated in a cross-over design study comparing three different speech amplification devices: a wired portable amplifier (Device A), a wireless stationary amplifier (Device B), and a one-way personal communication system (Device C). Participants attended one laboratory visit followed by 1-week trial periods with each device. At the first visit, HP participants completed speech tasks with and without the devices, in quiet and in noise. Following the in-laboratory test period, participants trialed each device at home for approximately 1 week per device. Following completion of the study, participants indicated whether or not they would like to continue using a device. Results Overall, in the presence of noise, all three devices demonstrated significant improvements in speech-to-noise levels and speech intelligibility compared to no device. A clear device hierarchy emerged such that the personal communication device (Device C) was associated with significantly better speech outcomes compared to the other two devices. The majority of participants elected to continue using a device at the completion of the study. Device preferences, however, did not clearly reflect the objective device hierarchy that was found for the objective speech measures. Each of the three devices was selected as a preferred device by at least three participants at the completion of the study. Conclusion Results from this study demonstrated clear differences in device performance in three distinct forms of amplification devices for individuals with HP. Findings suggest that amplification device use may be beneficial for this clinical population and underscore the potential to improve device availability and device selection criteria in future research. Supplemental Material https://doi.org/10.23641/asha.12735875.

ParkinSong: A Controlled Trial of Singing-Based Therapy for Parkinson’s Disease

Background. Communication impairment is one of the most common symptoms of Parkinson’s disease (PD), significantly affecting quality of life. Singing shares many of the neural networks and structural mechanisms used during speech and, thus, has potential for therapeutic application to address speech disorders. Objective. To explore the effects of an interdisciplinary singing-based therapeutic intervention (ParkinSong) on voice and communication in people with PD. Methods. A controlled trial compared the effects of the ParkinSong intervention with an active control condition at 2 dosage levels (weekly vs monthly) over 3 months, on voice, speech, respiratory strength, and voice-related quality-of-life outcomes for 75 people living with PD. The interdisciplinary ParkinSong model comprised high-effort vocal and respiratory tasks, speech exercises, group singing, and social communication opportunities. Results. ParkinSong intervention participants demonstrated significant improvements in vocal intensity ( P = .018), maximum expiratory pressure ( P = .032), and voice-related quality of life ( P = .043) in comparison to controls. Weekly ParkinSong participants increased vocal intensity more than monthly participants ( P = .011). Vocal intensity declined in nontreatment control groups. No statistical differences between groups on maximum phonation length or maximum inspiratory pressure were observed at 3 months. Conclusions. ParkinSong is an engaging intervention with the potential to increase loudness and respiratory function in people with mild to moderately severe PD.

Deep Brain Stimulation of the Subthalamic Nucleus Parameter Optimization for Vowel Acoustics and Speech Intelligibility in Parkinson's Disease

PURPOSE

The settings of 3 electrical stimulation parameters were adjusted in 12 speakers with Parkinson's disease (PD) with deep brain stimulation of the subthalamic nucleus (STN-DBS) to examine their effects on vowel acoustics and speech intelligibility.

METHOD

Participants were tested under permutations of low, mid, and high STN-DBS frequency, voltage, and pulse width settings. At each session, participants recited a sentence. Acoustic characteristics of vowel production were extracted, and naive listeners provided estimates of speech intelligibility.

RESULTS

Overall, lower-frequency STN-DBS stimulation (60 Hz) was found to lead to improvements in intelligibility and acoustic vowel expansion. An interaction between speaker sex and STN-DBS stimulation was found for vowel measures. The combination of low frequency, mid to high voltage, and low to mid pulse width led to optimal speech outcomes; however, these settings did not demonstrate significant speech outcome differences compared with the standard clinical STN-DBS settings, likely due to substantial individual variability.

CONCLUSIONS

Although lower-frequency STN-DBS stimulation was found to yield consistent improvements in speech outcomes, it was not found to necessarily lead to the best speech outcomes for all participants. Nevertheless, frequency may serve as a starting point to explore settings that will optimize an individual's speech outcomes following STN-DBS surgery.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.5899228.

Variables associated with communicative participation in Parkinson's disease and its relationship to measures of health-related quality-of-life

PURPOSE

Communication disorders associated with Parkinson's disease (PD) often lead to restricted participation in life roles, yet there is a limited understanding of influencing factors and few quantitative measurement tools available. This study aimed to identify variables associated with communicative participation in PD and to examine the relationship between the Communicative Participation Item Bank (CPIB) and existing health-related quality-of-life (HRQoL) measures.

METHOD

Self-report data from 378 participants with PD from the US and New Zealand were analysed. Data included responses to the CPIB, PD Questionnaire-8, sub-scales of the Global Health instrument from the Patient Reported Outcomes Measurement Information System (PROMIS) and additional self-report instruments.

RESULT

Greater perceived speech disorder, lower levels of speech usage, fatigue, cognitive and emotional problems and swallowing difficulties were associated with lower levels of communicative participation. Participants' age significantly influenced findings, interacting with country of residence, sex and speech usage. Scores on the CPIB were moderately correlated with HRQoL measures.

CONCLUSION

Communicative participation in PD is complex and influenced by both demographic and disease-based variables, necessitating a broader view of the communicative experiences of those with PD. Measurement of communicative participation as a separate construct to existing HRQoL measures is recommended.

Speech Versus Speaking: The Experiences of People With Parkinson's Disease and Implications for Intervention

PURPOSE

In this project, we explore the experiences of people who report speech changes associated with Parkinson's disease as they describe taking part in everyday communication situations and report impressions related to speech treatment.

METHOD

Twenty-four community-dwelling adults with Parkinson's disease took part in face-to-face, semistructured interviews. Qualitative research methods were used to code and develop themes related to the interviews.

RESULTS

Two major themes emerged. The first, called "speaking," included several subthemes: thinking about speaking, weighing value versus effort, feelings associated with speaking, the environmental context of speaking, and the impact of Parkinson's disease on speaking. The second theme involved "treatment experiences" and included subthemes: choosing not to have treatment, the clinician, drills and exercise, and suggestions for change.

CONCLUSIONS

From the perspective of participants with Parkinson's disease, speaking is an activity requiring both physical and cognitive effort that takes place in a social context. Although many report positive experiences with speech treatment, some reported dissatisfaction with speech drills and exercises and a lack of focus on the social aspects of communication. Suggestions for improvement include increased focus on the cognitive demands of speaking and on the psychosocial aspects of communication.

Self-Rated Communication-Related Quality of Life of Individuals With Oromandibular Dystonia Receiving Botulinum Toxin Injections

PURPOSE

In this preliminary study, we examined self-rated communication-related quality of life (CR-QoL) of 10 control participants and 10 individuals with oromandibular dystonia (OMD) and dysarthria receiving therapeutic botulinum toxin (BoNT-A) injections.

METHOD

Participants with OMD and associated dysarthria self-rated CR-QoL pre- and post- BoNT-A injection using the American Speech-Language-Hearing Association's Quality of Communication Life Scale (ASHA QCL; Paul et al., 2004). Control participants self-rated CR-QoL during a single experimental visit.

RESULTS

Significant differences were found between control participants and participants with OMD on ratings of CR-QoL across all 5 domains and subdomains of the ASHA QCL. No significant differences in CR-QoL were found over the course of the BoNT-A treatment cycle.

CONCLUSIONS

CR-QoL was rated lower by participants with OMD as compared with control participants across all ASHA QCL domains/subdomains with "socialization/activities" and "confidence/self-concept" having the largest effect sizes. No differences in CR-QoL were found over the course of the treatment cycle. We advocate for outcome measures that include patient report. The use of patient-reported outcome measures in conjunction with objective or impairment-based outcome measures can help inform meaningful clinical indicators of treatment success. This study adds novel information that may aid our understanding of the experience of living with OMD in this underserviced clinical population.