1
|
Moya-Galé G, Hernández JD, Goudarzi A, Walsh SJ. ¿Notas La Diferencia? [Do You Hear the Difference?]: Perceptual Consequences of Intensive Voice Treatment in Spanish Speakers With Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:2872-2892. [PMID: 38513128 DOI: 10.1044/2023_jslhr-23-00379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE The primary objective of this study was to explore the effects of intensive voice-focused treatment on speech parameters in Spanish speakers with dysarthria associated with Parkinson's disease (PD) as perceived by naïve listeners. METHOD Fifteen Spanish speakers with dysarthria associated with PD received the Lee Silverman Voice Treatment (LSVT LOUD) for a month. Voice and speech recordings were conducted pretreatment, posttreatment, and at a 1-month follow-up. Thirty naïve adult listeners rated the perceptual dimensions of ease of understanding (EoU), resonance, articulatory precision, prosody, and voice quality from sentences extracted from an emotional monologue on a visual analogue scale. RESULTS EoU, resonance, articulatory precision, and voice quality significantly improved pre- to posttreatment, but gains were not maintained at follow-up. Speech severity was a significant source of variance in mean listener response for all perceptual dimensions, although the interaction between speech severity and time was only significant for resonance and voice quality. CONCLUSIONS LSVT LOUD may be beneficial to improve perceptual speech domains affected by PD in Spanish speakers with dysarthria. Its impact on the different speech subsystems may reflect a universal distribution of effects when directly targeting the glottal source. Language-specific contributions of each perceptual domain to speech intelligibility should be explored in further research to determine linguistically sensitive treatment targets.
Collapse
|
2
|
Levy ES, Moya-Galé G. Revisiting Dysarthria Treatment Across Languages: The Hybrid Approach. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:2893-2902. [PMID: 38056466 DOI: 10.1044/2023_jslhr-23-00629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
PURPOSE Ten years after Miller and Lowit's (2014) groundbreaking book providing a cross-linguistic perspective on motor speech disorders, we ask where we are regarding dysarthria treatment across languages in two specific populations: adults with Parkinson's disease (PD) and children with cerebral palsy (CP). METHOD In this commentary, we consider preliminary evidence for both language-independent and language-specific approaches to treatment and propose a hybrid approach to speech treatment across languages, centered on the individual with dysarthria who speaks any given language. CONCLUSIONS Treatment research on individuals with dysarthria secondary to PD and CP is advancing, but several areas remain to be explored. Next steps are suggested for addressing the paucity and complexity of cross-linguistic speech treatment research.
Collapse
|
3
|
Sackley CM, Rick C, Brady MC, Woolley R, Burton C, Patel S, Masterson-Algar P, Nicoll A, Smith CH, Jowett S, Ives N, Beaton G, Dickson S, Ottridge R, Sharp L, Nankervis H, Clarke CE. Lee Silverman voice treatment versus NHS speech and language therapy versus control for dysarthria in people with Parkinson's disease (PD COMM): pragmatic, UK based, multicentre, three arm, parallel group, unblinded, randomised controlled trial. BMJ 2024; 386:e078341. [PMID: 38986549 PMCID: PMC11232530 DOI: 10.1136/bmj-2023-078341] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES To assess the clinical effectiveness of two speech and language therapy approaches versus no speech and language therapy for dysarthria in people with Parkinson's disease. DESIGN Pragmatic, UK based, multicentre, three arm, parallel group, unblinded, randomised controlled trial. SETTING The speech and language therapy interventions were delivered in outpatient or home settings between 26 September 2016 and 16 March 2020. PARTICIPANTS 388 people with Parkinson's disease and dysarthria. INTERVENTIONS Participants were randomly assigned to one of three groups (1:1:1): 130 to Lee Silverman voice treatment (LSVT LOUD), 129 to NHS speech and language therapy, and 129 to no speech and language therapy. LSVT LOUD consisted of four, face-to-face or remote, 50 min sessions each week delivered over four weeks. Home based practice activities were set for up to 5-10 mins daily on treatment days and 15 mins twice daily on non-treatment days. Dosage for the NHS speech and language therapy was determined by the local therapist in response to the participants' needs (estimated from prior research that NHS speech and language therapy participants would receive an average of one session per week over six to eight weeks). Local practices for NHS speech and language therapy were accepted, except for those within the LSVT LOUD protocol. Analyses were based on the intention to treat principle. MAIN OUTCOME MEASURES The primary outcome was total score at three months of self-reported voice handicap index. RESULTS People who received LSVT LOUD reported lower voice handicap index scores at three months after randomisation than those who did not receive speech and language therapy (-8.0 points (99% confidence interval -13.3 to -2.6); P<0.001). No evidence suggests a difference in voice handicap index scores between NHS speech and language therapy and no speech and language therapy (1.7 points (-3.8 to 7.1); P=0.43). Patients in the LSVT LOUD group also reported lower voice handicap index scores than did those randomised to NHS speech and language therapy (-9.6 points (-14.9 to -4.4); P<0.001). 93 adverse events (predominately vocal strain) were reported in the LSVT LOUD group, 46 in the NHS speech and language therapy group, and none in the no speech and language therapy group. No serious adverse events were recorded. CONCLUSIONS LSVT LOUD was more effective at reducing the participant reported impact of voice problems than was no speech and language therapy and NHS speech and language therapy. NHS speech and language therapy showed no evidence of benefit compared with no speech and language therapy. TRIAL REGISTRATION ISRCTN registry ISRCTN12421382.
Collapse
Affiliation(s)
- Catherine M Sackley
- School of Health Science, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre
- Population Health Sciences, Addison House, King's College London, Guy's Campus, London, UK
| | - Caroline Rick
- Nottingham Clinical Trials Unit, University of Nottingham, Applied Health Research Building, University Park, Nottingham, UK
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Christopher Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Smitaa Patel
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Avril Nicoll
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Christina H Smith
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
- NHS Lothian
| | - Sue Jowett
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Gillian Beaton
- Queen Elizabeth Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sylvia Dickson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Ryan Ottridge
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Helen Nankervis
- School of Health Science, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- Population Health Sciences, Addison House, King's College London, Guy's Campus, London, UK
| | - Carl E Clarke
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| |
Collapse
|
4
|
Gustafsson JK, Södersten M, Ternström S, Schalling E. Treatment of Hypophonia in Parkinson's Disease Through Biofeedback in Daily Life Administered with A Portable Voice Accumulator. J Voice 2024; 38:800.e27-800.e38. [PMID: 34893384 DOI: 10.1016/j.jvoice.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the outcome following continuous tactile biofeedback of voice sound level administered, with a portable voice accumulator to individuals with Parkinson's disease (PD). METHOD Nine out of 16 participants with PD completed a 4-week intervention program where biofeedback of voice sound level was administered with the portable voice accumulator VoxLog during speech in daily life. The feedback, a tactile vibration signal from the device, was activated when the wearer used a voice sound level below an individually predetermined threshold level, reminding the wearer to increase voice sound level during speech. Voice use was registered in daily life with the VoxLog during the intervention period as well as during one baseline week, one follow-up week post intervention and 1 week 3 months post intervention. Self-to-other ratio (SOR), which is the difference between voice sound level and environmental noise, was studied in multiple noise ranges. RESULTS A significant increase in SOR across all noise ranges of 2.28 dB (SD: 0.55) was seen for participants with scores above the cut-off for normal function (>26 points) on the cognitive screening test Montreal Cognitive Assessment (MoCA) (n = 5). No significant increase was seen for the group of participants with MoCA scores below 26 (n = 4). Forty-four percent ended their participation early, all which scored below 26 on MoCA (n = 7). CONCLUSIONS Biofeedback administered in daily life regarding voice level may help individuals with PD to increase their voice sound level in relation to environmental noise in daily life, but only for a limited subset. Only participants with normal cognitive function as screened by MoCA improved their voice sound level in relation to environmental noise.
Collapse
Affiliation(s)
- Joakim Körner Gustafsson
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden; Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden.
| | - Maria Södersten
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden; Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Sten Ternström
- School of Electrical Engineering and Computer Science, Division of Speech, Music and Hearing, Royal Institute of Technology (KTH), Stockholm, Sweden
| | - Ellika Schalling
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden; Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience/Speech and Language Pathology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
5
|
Perry SE, Troche M, Huber JE, Curtis J, Kiefer B, Sevitz J, Dennard Q, Borders J, Browy JR, Dakin A, Gonzalez V, Chapman J, Wu T, Katz L, Britton D. Behavioral Management of Respiratory/Phonatory Dysfunction for Dysarthria Associated With Neurodegenerative Disease: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1069-1097. [PMID: 38232176 DOI: 10.1044/2023_ajslp-23-00274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
PURPOSE This systematic review represents an update to previous reviews of the literature addressing behavioral management of respiratory/phonatory dysfunction in individuals with dysarthria due to neurodegenerative disease. METHOD Multiple electronic database searches and hand searches of prominent speech-language pathology journals were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. RESULTS The search yielded 1,525 articles, from which 88 met inclusion criteria and were reviewed by two blinded co-investigators. A large range of therapeutic approaches have been added to the evidence base since the last review, including expiratory muscle strength training, singing, and computer- and device-driven programs, as well as a variety of treatment modalities, including teletherapy. Evidence for treatment in several different population groups-including cerebellar ataxia, myotonic dystrophy, autosomal recessive spastic ataxia of Charlevoix-Saguenay, Huntington's disease, multiple system atrophy, and Lewy body dementia-were added to the current review. Synthesis of evidence quality provided strong evidence in support of only one behavioral intervention: Lee Silverman Voice Treatment Program (LSVT LOUD) in people with Parkinson's disease. No other treatment approach or population included in this review demonstrated more than limited evidence, reflecting that these approaches/populations require urgent further examination. CONCLUSION Suggestions about where future research efforts could be significantly strengthened and how clinicians can apply research findings to their practice are provided. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24964473.
Collapse
Affiliation(s)
- Sarah E Perry
- University of Canterbury/Otago, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch
| | - Michelle Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Jessica E Huber
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - James Curtis
- Department of Otolaryngology - Head & Neck Surgery, Weill Cornell Medical College, New York, NY
| | - Brianna Kiefer
- Department of Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento
| | - Jordanna Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Qiana Dennard
- Department of Speech & Hearing Sciences, Portland State University, OR
| | - James Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | | | - Avery Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | | | | | - Tiffany Wu
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Lily Katz
- Department of Otolaryngology, University of Wisconsin Health University Hospital, Madison
| | - Deanna Britton
- Department of Speech & Hearing Sciences, Portland State University, OR
- Northwest Clinic for Voice and Swallowing, Oregon Health & Science University, Portland
- Department of Rehabilitation Medicine, University of Washington, Seattle
| |
Collapse
|
6
|
Hawley JL, Hancock AB. Incorporating Mobile App Technology in Voice Modification Protocol for Transgender Women. J Voice 2024; 38:337-345. [PMID: 34706847 DOI: 10.1016/j.jvoice.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Motivated by practice and feedback principles of motor learning, a hybrid clinic-home protocol for voice feminization was developed to minimize the role of SLPs to 1 of supervision and professional guidance and to maximize learning during independent practice apart from intervention sessions. The purpose was to explore the effectiveness and acceptability of the innovative service delivery. METHOD This single-subject changing criterion design included four transgender women who completed a 10-week hybrid clinic-home voice intervention program delivered via 30 -minute weekly in-clinic sessions and a technology-supported home program. The program was client-centered and capitalized on principles of motor learning in that it incorporated frequent practice with intermittent, knowledge-of-result feedback. Participants' desired outcomes were measured using acoustics, self and listener ratings of audio samples, and a program evaluation questionnaire. RESULTS Average speaking fundamental frequency of phrases and picture descriptions gradually increased into the 170-220 Hz range for all except one participant. All four transgender women were perceived to sound more feminine following treatment compared to baseline. Participants found the in-clinic sessions useful, the app easy to use, and noted limited fatigue or discomfort. CONCLUSION Four transwomen met their goals using this hybrid clinic-home service delivery format. Further investigations may elucidate key factors of the success achieved in the current study by designing comparison delivery models and including people from other populations.
Collapse
Affiliation(s)
- Janet L Hawley
- Speech, Language, and Hearing Sciences Department, University of Arizona, Tucson, Arizona.
| | - Adrienne B Hancock
- Dept of Speech, Language, and Hearing Sciences, George Washington University, Washington, District of Columbia
| |
Collapse
|
7
|
Daşdöğen Ü, Awan SN, Bottalico P, Iglesias A, Getchell N, Abbott KV. The Influence of Multisensory Input On Voice Perception and Production Using Immersive Virtual Reality. J Voice 2023:S0892-1997(23)00235-7. [PMID: 37739864 DOI: 10.1016/j.jvoice.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES The purpose was to examine the influence of auditory vs visual vs combined audiovisual input on perception and production of one's own voice, using immersive virtual reality technology. METHODS Thirty-one vocally healthy men and women were investigated under 18 sensory input conditions, using immersive virtual reality technology. Conditions included two auditory rooms with varying reverberation times, two visual rooms with varying volumes, and the combination of audiovisual conditions. All conditions were repeated with and without background noise. Speech tasks included counting, sustained vowel phonation, an all-voiced sentence from the Consensus Auditory-Perceptual Evaluation of Voice, and the first sentence from the Rainbow Passage, randomly ordered. Perception outcome measures were participants' self-reported perceptions of their vocal loudness, vocal effort, and vocal comfort in speech. Production outcome measures were sound pressure level (SPL) and spectral moments (spectral mean and standard deviation in Hz, skewness, and kurtosis). Statistical analyses used self-reported vocal effort, vocal loudness, and vocal comfort in percent (0 = "not at all," 100 = extremely), SPL in dB, and spectral moments in Hz. The reference level was a baseline audiovisual deprivation condition. RESULTS Results suggested (i) increased self-perceived vocal loudness and effort, and decreased comfort, with increasing room volume, speaker-to-listener distance, audiovisual input, and background noise, and (ii) increased SPL and fluctuations in spectral moments across conditions. CONCLUSIONS Not only auditory, but also visual and audiovisual input influenced voice perception and production in ways that have not been previously documented. Findings contribute to the basic science understanding the role of visual, audiovisual and auditory input in voice perception and production, and also to models of voice training and therapy. The findings also set the foundation for the use of virtual reality in voice and speech training, as a potentially power solution to the generalization problem.
Collapse
Affiliation(s)
- Ümit Daşdöğen
- Mount Sinai Health System, Department of Otolaryngology, New York, NY.
| | - Shaheen N Awan
- University of Central Florida, Communication Sciences and Disorders, Orlando, FL
| | - Pasquale Bottalico
- University of Illinois Urbana-Champaign, Department of Speech and Hearing Science, Champaign, IL
| | - Aquiles Iglesias
- University of Delaware, Communication Sciences and Disorders, Newark, DE
| | - Nancy Getchell
- University of Delaware, Kinesiology & Applied Physiology, Newark, DE
| | - Katherine Verdolini Abbott
- Mount Sinai Health System, Department of Otolaryngology, New York, NY; University of Illinois Urbana-Champaign, Department of Speech and Hearing Science, Champaign, IL
| |
Collapse
|
8
|
Mohseni Z, Mohamadi R, Habibi SAH, Saffarian A, Abolghasemi J. Voice improvement following conventional speech therapy combined with singing intervention in people with Parkinson's disease: A three-arm randomised controlled trial. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:1752-1767. [PMID: 37282797 DOI: 10.1111/1460-6984.12900] [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: 11/08/2022] [Accepted: 04/26/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Although speech and voice disorders are common in Parkinson's disease (PD), there is insufficient evidence to support the effectiveness of behavioural speech therapies in these patients. AIMS This study aimed to examine the effects of a new tele-rehabilitation program, a combining of conventional speech therapy and singing intervention, on voice deficits in patients with PD. METHODS & PROCEDURES This study was a three-armed, assessor-masked, randomised controlled trial. Thirty-three people with PD were randomly assigned to the combination therapy, conventional speech therapy, or singing intervention group. This study followed the Consolidated Standards of Reporting Trials guidelines for non-pharmacological treatment. Each patient participated in 12 tele-rehabilitation sessions over 4 weeks. The combination therapy group received speech and singing interventions simultaneously (respiratory, speech, voice, and singing exercises). Voice intensity as a primary outcome and the voice handicap index (VHI), maximum frequency range, jitter and shimmer as secondary outcomes were evaluated 1 week before the first intervention session, 1 week after the last intervention session and 3 months after the last evaluation. OUTCOMES & RESULTS The results of repeated measures analysis of variance showed a significant main effect of time on all outcomes in all three groups after treatment (p < 0.001). There was a significant group effect for voice intensity (p < 0.001), VHI (p < 0.001), maximum frequency range (p = 0.014) and shimmer (p = 0.001). The combination therapy group demonstrated a significant outperformance in the VHI and shimmer than the speech therapy (p = 0.038) and singing intervention (p < 0.001) groups. The results of this study also indicated that combination therapy group compared to singing intervention group had a larger effect on voice intensity (p < 0.001), shimmer (p < 0.001) and maximum frequency range (p = 0.048). CONCLUSIONS & IMPLICATION The results demonstrated that combining speech therapy with a singing intervention delivered through tele-rehabilitation might be more effective in improving voice problems in patients with PD. WHAT THIS PAPER ADDS What is already known on the subject Parkinson's disease (PD) is a neurological disorder that frequently causes disturbances in speech and voice, which negatively affect patients' quality of life. Although speech difficulties occur in 90% of patients with PD, evidence-based treatment options for speech and language problems in these patients are limited. Therefore, further studies are required to develop and assess evidence-based treatment programs. What this study adds The findings of this study showed that a combination therapy program including conventional speech therapy approaches and individual singing intervention provided through tele-rehabilitation may have a greater effect on the improvement of voice problems in people with PD compared to speech therapy and singing intervention alone. What are the clinical implications of this work? Tele-rehabilitation combination therapy is an inexpensive and enjoyable behavioural treatment. The advantages of this method are that it is easy to access, appropriate for many stages of voice problems in PD, requires no prior singing training, encourages voice health and self-management and maximises treatment resources available to people with PD. We believe that the results of this study can provide a new clinical basis for treatment of voice disorders in people with PD.
Collapse
Affiliation(s)
- Zeinab Mohseni
- Rehabilitation Research Center, Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Reyhane Mohamadi
- Rehabilitation Research Center, Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Amir Hasan Habibi
- Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Arezoo Saffarian
- Rehabilitation Research Center, Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Jamile Abolghasemi
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
9
|
McAllister T, Nightingale C, Moya-Galé G, Kawamura A, Ramig LO. Crowdsourced Perceptual Ratings of Voice Quality in People With Parkinson's Disease Before and After Intensive Voice and Articulation Therapies: Secondary Outcome of a Randomized Controlled Trial. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1541-1562. [PMID: 37059078 PMCID: PMC10457080 DOI: 10.1044/2023_jslhr-22-00694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Limited research has examined the suitability of crowdsourced ratings to measure treatment effects in speakers with Parkinson's disease (PD), particularly for constructs such as voice quality. This study obtained measures of reliability and validity for crowdsourced listeners' ratings of voice quality in speech samples from a published study. We also investigated whether aggregated listener ratings would replicate the original study's findings of treatment effects based on the Acoustic Voice Quality Index (AVQI) measure. METHOD This study reports a secondary outcome measure of a randomized controlled trial with speakers with dysarthria associated with PD, including two active comparators (Lee Silverman Voice Treatment [LSVT LOUD] and LSVT ARTIC), an inactive comparator (untreated PD), and a healthy control group. Speech samples from three time points (pretreatment, posttreatment, and 6-month follow-up) were presented in random order for rating as "typical" or "atypical" with respect to voice quality. Untrained listeners were recruited through the Amazon Mechanical Turk crowdsourcing platform until each sample had at least 25 ratings. RESULTS Intrarater reliability for tokens presented repeatedly was substantial (Cohen's κ = .65-.70), and interrater agreement significantly exceeded chance level. There was a significant correlation of moderate magnitude between the AVQI and the proportion of listeners classifying a given sample as "typical." Consistent with the original study, we found a significant interaction between group and time point, with the LSVT LOUD group alone showing significantly higher perceptually rated voice quality at posttreatment and follow-up relative to the pretreatment time point. CONCLUSIONS These results suggest that crowdsourcing can be a valid means to evaluate clinical speech samples, even for less familiar constructs such as voice quality. The findings also replicate the results of the study by Moya-Galé et al. (2022) and support their functional relevance by demonstrating that the effects of treatment measured acoustically in that study are perceptually apparent to everyday listeners.
Collapse
Affiliation(s)
| | | | | | | | - Lorraine Olson Ramig
- University of Colorado Boulder
- National Center for Voice and Speech, Denver, CO
- Columbia University, New York, NY
- LSVT Global, Inc., Tucson, AZ
| |
Collapse
|
10
|
De Taeye R, Van Lierde K, Alighieri C. Telepractice in the diagnosis and treatment of pediatric speech-language disorders: The opinions and experiences of speech-language pathologists. Int J Pediatr Otorhinolaryngol 2023; 169:111560. [PMID: 37116275 DOI: 10.1016/j.ijporl.2023.111560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE This prospective cross-sectional study aimed to investigate the opinions and experiences with telepractice (TP) of Dutch-speaking speech-language pathologists (SLPs) living in the Dutch-speaking part of Belgium (Flanders). This study will help to optimize care for children with speech-language disorders as we will gain more insight into the experienced barriers and facilitators while using TP for assessing and treating these disorders. METHOD Twenty-nine Dutch-speaking speech-language pathologists living in Flanders (age category 20-30 years: n = 16/29, 55.2%, 31-40 years: n = 10/29, 34.2%, 41-50 years: n = 2/29, 6.9%, 51-60 years: n = 1/29, 3.4%) were recruited through the social media. An online questionnaire was developed based on the available literature and administered to the SLPs. To compare the opinions and experiences of SLPs with TP, χ2 tests or Fisher's exact tests were used. RESULTS The study showed a statistically significant association between years of clinical experience of SLPs and their opinion that TP does not provide more options in a clinical setting compared to face-to-face contact. SLPs who had expertise in multiple domains experienced significantly more added value of TP during the corona pandemic than SLPs who had expertise in only one specific domain. Additionally, SLPs who worked in a private practice indicated significantly more difficulties in developing a therapeutic relationship due to a lack of personal contact than SLPs who worked in other settings. 51.7% (15/29) of the SLPs experienced technical barriers using TP. CONCLUSION Expertise in multiple domains of pediatric speech-language therapy resulted in experiencing more added value of TP during the corona pandemic, possibly because of the experience of multiple different and simultaneous advantages of TP in several domains. Additionally, SLPs in a private practice experienced more difficulties in developing a therapeutic relationship due to a lack of personal contact with their clients. This is in contrast to hospitals where children are often seen for a shorter period. Hence, there may be less chance of a negative perception of relationships with clients. Another conclusion is that treatment drop-out was not larger using TP compared to face-to-face therapy. However, SLPs experienced that the use of TP was not promoted/encouraged by their employer possibly because of technical barriers. It is hoped that the findings of this study will help SLPs and policymakers overthrow existing barriers and make telepractice a substantial, effective, and efficient service delivery model.
Collapse
Affiliation(s)
- Robin De Taeye
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Gent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Gent, Belgium
| | - Cassandra Alighieri
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Gent, Belgium.
| |
Collapse
|
11
|
Li Q, Millard K, Tetnowski J, Narayana S, Cannito M. Acoustic Analysis of Intonation in Persons With Parkinson's Disease Receiving Transcranial Magnetic Stimulation and Intensive Voice Treatment. J Voice 2023; 37:203-214. [PMID: 33461880 DOI: 10.1016/j.jvoice.2020.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022]
Abstract
Intonation is one of the prosodic features manifested acoustically in the fundamental frequency (f0). Intonation abnormality is common and prominent in the speech of persons with Parkinson's disease (PD). The current research investigated acoustically five intonational features including f0 declination, f0 resetting, sentence stress, terminal fall, and syntactic prejunctural fall in 20 PD participants, receiving Lee Silverman Voice Treatment (LSVT)-LOUD alone, or combined with transcranial magnetic stimulation delivered to the left or right primary laryngeal motor cortex. The results revealed that f0 declination, sentence stress, and terminal fall changed significantly from pre- to post-treatment, and the changes of declination and terminal fall were maintained at the follow-up evaluations. The observed changes in intonation were attributed to LSVT alone, which caused large changes of f0 magnitude. f0 resetting and syntactic prejunctural fall did not change significantly following treatment, probably because these intonational features need very precise fine motor control of the intrinsic laryngeal muscles to make small-range, rapid f0 adjustments, which were not improved by LSVT in the present PD participants. Difficulties with syntactic processing previously reported in PD may have also contributed to the lack of improvement in resetting and prejunctural fall, since these f0 features are used to mark syntactic boundaries within utterances.
Collapse
Affiliation(s)
- Qiang Li
- Department of Communication Sciences and Disorders, Fort Hays State University, Hays, Kansas.
| | - Kelly Millard
- Department of Communicative Disorders, University of Louisiana at Lafayette, Lafayette, Louisiana
| | - John Tetnowski
- Department of Communicative Disorders, University of Louisiana at Lafayette, Lafayette, Louisiana
| | - Shalini Narayana
- Department of Pediatrics, Department of Anatomy and Neurology, University of Tennessee Health Science Center, Memphis, Tennesse
| | - Michael Cannito
- Department of Communicative Disorders, University of Louisiana at Lafayette, Lafayette, Louisiana
| |
Collapse
|
12
|
Finnimore A, Theodoros D, Rumbach AF. Clinical outcomes of PD Check-In, a model for supported self-managed maintenance of speech in Parkinson's disease: A Phase 1 study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:241-255. [PMID: 36036751 DOI: 10.1111/1460-6984.12772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
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.
Collapse
Affiliation(s)
- Ann Finnimore
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
- The Prince Charles Hospital, Metro North Hospital & Health Service, Brisbane, QLD, Australia
| | - Deborah Theodoros
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
| | - Anna F Rumbach
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
| |
Collapse
|
13
|
Halpern A, Fox C, Ramig L, Tripoliti E. Evidenzbasierte Sprachtherapie bei Morbus Parkinson: LSVT LOUD. SPRACHE · STIMME · GEHÖR 2022. [DOI: 10.1055/a-1941-3605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
|
14
|
Johnson AM, Pukin F, Krishna V, Phansikar M, Mullen SP. Feasibility and Preliminary Efficacy of Two Technology-assisted Vocal Interventions for Older Adults Living in a Residential Facility. J Voice 2022:S0892-1997(22)00221-1. [PMID: 35985896 DOI: 10.1016/j.jvoice.2022.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES/HYPOTHESIS An increasing number of older adults are seeking behavioral voice therapy to manage their voice problems. Poor adherence to voice therapy is a known problem across all treatment-seeking populations. Given age-related physical and cognitive impairments and multiple chronic conditions, older adults are more susceptible to low adherence to behavioral therapies. The purpose of this study was to test the feasibility of an at-home, vocal training intervention for older adults without a known voice disorder living in a senior living community, as well as compare the effects of two modes of mobile health (mHealth) technology-assisted vocal training targeting vocal function and adherence in older adults. STUDY DESIGN Cohort Study (Prospective Observational Study). METHODS Twenty-three individuals were recruited from a single residential retirement community and randomly allocated into two experimental groups. Both groups were asked to practice the Vocal Function Exercises with increasing frequency over an 8-week period. Tablets with instructions for performing the exercises were provided to all participants. The feedback group's tablets also contained an application providing real-time feedback on pitch, loudness, and duration. Acoustic and aerodynamic measures of vocal function and cognitive measures were obtained before and after the intervention. Self-reported measures of practice frequency, perceived vocal progress and changes, and motivation were obtained weekly. RESULTS The feedback control group adhered to the requested practice sessions more in the latter half of the intervention (weeks 5 and 8). Vocal function measures remained stable. Overall, a pattern reflecting self-reported vocal progress and a general improvement in working memory and global cognitive functioning was observed in the feedback group. CONCLUSIONS This study demonstrated that an 8-week mHealth intervention is viable to facilitate vocal practice in older adults. Although vocal ability did not improve with training, results indicated that vocal performance remained stable and age-related vocal changes did not progress. Future research on implementation of mHealth applications in conjunction with behavioral voice therapy is warranted to assess adherence and improvements in vocal function in individuals with age-related voice problems.
Collapse
Affiliation(s)
- Aaron M Johnson
- Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine. New York, New York, United States.
| | - Farrah Pukin
- Department of Communicative Disorders, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, United States
| | - Vaishnavi Krishna
- Department of Speech and Hearing Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Madhura Phansikar
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Sean P Mullen
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois; Center for Social & Behavioral Science, University of Illinois at Urbana-Champaign, Urbana, Illinois; Illinois Informatics Institute, University of Illinois at Urbana-Champaign, Champaign, Illinois
| |
Collapse
|
15
|
Marchese MR, Proietti I, Longobardi Y, Mari G, Ausili Cefaro C, D’Alatri L. Multidimensional voice assessment after Lee Silverman Voice Therapy (LSVT ®) in Parkinson's disease. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:348-354. [PMID: 36254651 PMCID: PMC9577687 DOI: 10.14639/0392-100x-n1962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/21/2022] [Indexed: 11/06/2022]
Abstract
Objective To investigate the effectiveness of Lee Silvermann Voice Treatment (LSVT®) in improving prosody in patients with Parkinson’s disease over medium-term follow-up. Methods 15 patients with Parkinson’s disease were assessed before LSVT®, within one week, and 3 and 6 months after treatment. Subjective and objective evaluation included: Voice Handicap Index - 10 (VHI-10), perceptual assessment by GRBAS scale and item 18 of the Unified Parkinson’s Disease Rating Scale III (UPDRS III), maximum phonation time (MPT /s/) and acoustic analysis by means the Voice Range Profile (VRP) and the “Intonation Stimulability Protocol” of the Motor Speech Profile (MSP). Results A significant increase of the mean values of Imax and rF0 was observed until 6 months post-therapy (p < 0.001), whereas Running Speech Standard Deviation (rSTD) (p = 0.004), Amplitude Variability (rVAm) (p = 0.02) and Frequency Variability (rvF0) (p = 0-01) improved significantly after 3 months, but returned to pre-therapy levels after 6 months. The score of item 18 of the UPDRS III increased significantly early post-therapy (p = 0.03), but did not maintain the improvement at 3 and 6 months. Median values of Grade (G), Asthenia (A) and mean values VHI-10 score significantly decreased at each post-therapy control (p < 0.05). Conclusions In addition to the subjective and perceptual beneficial effect of LSVT®, we found a long-lasting increase of loudness and fundamental frequency. There was also improvement of acoustic parameters related to prosody, although it was temporary.
Collapse
Affiliation(s)
- Maria Raffaella Marchese
- Otorhinolaryngology Head & Neck Surgery Unit, Fondazione Policlinico Universitario “A. Gemelli” - IRCCS - Rome, Italy
| | - Ilaria Proietti
- Otorhinolaryngology Head & Neck Surgery Unit, Fondazione Policlinico Universitario “A. Gemelli” - IRCCS - Rome, Italy
| | - Ylenia Longobardi
- Otorhinolaryngology Head & Neck Surgery Unit, Fondazione Policlinico Universitario “A. Gemelli” - IRCCS - Rome, Italy
| | - Giorgia Mari
- Otorhinolaryngology Head & Neck Surgery Unit, Fondazione Policlinico Universitario “A. Gemelli” - IRCCS - Rome, Italy,Correspondence Giorgia Mari Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, largo “A. Gemelli” 8, 00168 Rome, Italy Tel. +39 06 30155193. Fax +39 06 3051194 E-mail:
| | - Carolina Ausili Cefaro
- Otorhinolaryngology Head & Neck Surgery Unit, Fondazione Policlinico Universitario “A. Gemelli” - IRCCS - Rome, Italy
| | - Lucia D’Alatri
- Otorhinolaryngology Head & Neck Surgery Unit, Fondazione Policlinico Universitario “A. Gemelli” - IRCCS - Rome, Italy, Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
16
|
Moya-Galé G, Spielman J, Ramig LA, Campanelli L, Maryn Y. The Acoustic Voice Quality Index (AVQI) in People with Parkinson's Disease Before and After Intensive Voice and Articulation Therapies: Secondary Outcome of a Randomized Controlled Trial. J Voice 2022:S0892-1997(22)00080-7. [PMID: 35450735 PMCID: PMC9576821 DOI: 10.1016/j.jvoice.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The majority of individuals with Parkinson's disease (PD) experience voice and speech problems during the course of the disease. Despite the importance of voice quality in communication and the documented disordered voice quality in PD, few studies have explored the effects of speech treatment on this variable. STUDY DESIGN/METHODS A parallel arm, unblinded randomized controlled trial (RCT) was conducted with two active comparators, LSVT LOUD (n = 23) and LSVT ARTIC (n = 20), and an inactive comparator group of untreated individuals with PD (n = 22). A group of 20 healthy adults was also included for pre-treatment analysis. Voice recordings were obtained pre-treatment, immediately post-treatment and at 6-month follow-up. The acoustic voice quality index (AVQI) is reported here as a secondary outcome measure of the RCT. Linear mixed-effects regression analysis was performed with AVQI and sound pressure level (SPL) as dependent variables. Pearson correlation coefficient analysis was also conducted to explore the relationship between voice quality and SPL. RESULTS Statistically significant improvements in AVQI and SPL from pre-treatment to post-treatment and follow-up were only observed in the LSVT LOUD group. Voice quality significantly improved only from pre-treatment to follow-up in the LSVT ARTIC group, whilst significant improvements in SPL were observed during maximum phonation only immediately post-treatment. No significant changes were observed in the untreated group. DISCUSSION This study investigated the effects of intensive speech treatment targeting voice or targeting articulation on voice quality, as measured by the AVQI, in individuals with PD. Findings indicate that voice-focused treatment leads to greater improvements in voice quality in this population.
Collapse
Affiliation(s)
- Gemma Moya-Galé
- Department of Communication Sciences and Disorders, Long Island University, Brooklyn, New York.
| | | | - Lorraine A Ramig
- National Center for Voice and Speech-Denver, University of Colorado, Boulder, Colorado; Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York; LSVT Global, Inc, Tucson, Arizona
| | - Luca Campanelli
- Department of Communicative Disorders, The University of Alabama, Tuscaloosa, Alabama
| | - Youri Maryn
- Department of Otorhinolaryngology and Head and Neck Surgery, European Institute for ORL-HNS, Wilrijk, Belgium; Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium; Department of Speech-Language Therapy and Audiology, University College Ghent, Ghent, Belgium; School of Logopedics, Faculty of Psychology and Educational Sciences, Université Catolique de Louvain, Louvain-La-Neuve, Belgium; Phonanium, Lokeren, Belgium
| |
Collapse
|
17
|
Finnimore A, Theodoros D, Rumbach AF. PD Check-In: The development and trial of a supported self-management program for people with Parkinson's disease following intensive speech intervention. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:138-151. [PMID: 34767290 DOI: 10.1111/1460-6984.12682] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
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.
Collapse
Affiliation(s)
- Ann Finnimore
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- The Prince Charles Hospital, Metro North Hospital & Health Service, Brisbane, QLD, Australia
| | - Deborah Theodoros
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Anna F Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
18
|
Wood E, Bhalloo I, McCaig B, Feraru C, Molnar M. Towards development of guidelines for virtual administration of paediatric standardized language and literacy assessments: Considerations for clinicians and researchers. SAGE Open Med 2021; 9:20503121211050510. [PMID: 34646565 PMCID: PMC8504279 DOI: 10.1177/20503121211050510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/09/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Previous virtual care literature within the field of speech-language pathology has primarily focused on validating the virtual use of intervention programmes. There are fewer articles addressing the validity of conducting virtual assessments, particularly standardized assessment of oral language and literacy abilities in children. In addition, there is a lack of practical, useful recommendations available to support clinicians and researchers on how to conduct these assessment measures virtually. Given the recent rapid rise in virtual care and research as a result of the Coronavirus-19 pandemic, clinicians and researchers require guidance on best practices for virtual administration of these tools imminently. This article seeks to fill this gap in the literature by providing such recommendations. METHODS We (a) completed a narrative review of the extant literature, and (b) conducted semi-structured interviews with a group of 12 clinicians, students and researchers who had administered standardized language and literacy assessments with a variety of monolingual and multilingual school-aged children, with and without speech and language difficulties, in clinical and research settings. Six themes: candidacy for virtual assessment, communication and collaboration with caregivers, technology and equipment, virtual administration, ethics, consent and confidentiality, and considerations for bilingual populations were identified as a result of these two processes and were used to develop a set of recommendations to guide the use of standardized assessments in a virtual setting. In line with the Guidelines International Network, these recommendations were rated by group members, and reviewed by external stakeholders. A quasi-Delphi consensus procedure was used to reach agreement on ratings for recommendations. RESULTS We have developed and outlined several recommendations for clinicians and researchers to guide their use of standardized language and literacy assessments in virtual care, across six key themes. CONCLUSIONS This article is one of the first to share practical recommendations for virtual assessment in the domain of oral language and literacy assessment for clinicians and researchers. We hope the current recommendations will facilitate future clinical research in this area, and as the body of research in this field grows, this article will act as a basis for the development of formal Clinical Practice Guidelines.
Collapse
Affiliation(s)
- Emily Wood
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Insiya Bhalloo
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brittany McCaig
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cristina Feraru
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Monika Molnar
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
19
|
Mendoza Ramos V, Vasquez‐Correa JC, Cremers R, Van Den Steen L, Nöth E, De Bodt M, Van Nuffelen G. Automatic boost articulation therapy in adults with dysarthria: Acceptability, usability and user interaction. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:892-906. [PMID: 34227721 PMCID: PMC9546165 DOI: 10.1111/1460-6984.12647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/22/2021] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Imprecise articulation has a negative impact on speech intelligibility. Therefore, treatment of articulation is clinically relevant in patients with dysarthria. In order to be effective and according to the principles of motor learning, articulation therapy needs to be intensive, well organized, with adequate feedback and requires frequent practice. AIMS The aims of this pilot study are (1) to evaluate the feasibility of a virtual articulation therapy (VAT) to guide patients with dysarthria through a boost articulation therapy (BArT) program; (2) to evaluate the acoustic models' performance used for automatic phonological error detection; and (3) to validate the system by end-users from their perspective. METHODS & PROCEDURES The VAT provides an extensive and well-structured package of exercises with visual and auditory modelling and adequate feedback on the utterances. The tool incorporates automated methods to detect phonological errors, which are specifically designed to analyse Dutch speech production. A total of 14 subjects with dysarthria evaluated the acceptability, usability and user interaction with the VAT based on two completed therapy sessions using a self-designed questionnaire. OUTCOMES & RESULTS In general, participants were positive about the new computer-based therapy approach. The algorithm performance for phonological error detection shows it to be accurate, which contributes to adequate feedback of utterance production. The results of the study indicate that the VAT has a user-friendly interface that can be used independently by patients with dysarthria who have sufficient cognitive, linguistic, motoric and sensory skills to benefit from speech therapy. Recommendations were given by the end-users to further optimize the program and to ensure user engagement. CONCLUSIONS & IMPLICATIONS The initial implementation of an automatic BArT shows it to be feasible and well accepted by end-users. The tool is an appropriate solution to increase the frequency and intensity of articulation training that supports traditional methods. WHAT THIS PAPER ADDS What is already known on the subject Behavioural interventions to improve articulation in patients with dysarthria demand intensive treatments, repetitive practice and feedback. However, the current treatments are mainly limited in time to the interactive sessions in the presence of speech-language pathology. Automatic systems addressing the needs of individuals with dysarthria are scarce. This study evaluates the feasibility of a VAT program and investigates its acceptability, usability and user interaction. What this paper adds to existing knowledge The computer-based speech therapy approach developed and applied in this study intends to support intensive articulation training of patients with dysarthria. The virtual speech therapy offers the possibility of an individualized and customized therapy programme, with an extensive database of exercises, visual and auditory models of the target utterances, and providing adequate feedback based on automatic acoustic analysis of speech. What are the potential or actual clinical implications of this work? The automatic BArT overcomes the limitation in time of face-to-face traditional speech therapy. It offers patients the opportunity to have access to speech therapy more intensively and frequently in their home environment.
Collapse
Affiliation(s)
- Viviana Mendoza Ramos
- Department of OtorhinolaryngologyHead and Neck Surgery and Communication Disorders, University Hospital of AntwerpEdegemBelgium
- Faculty of Medicine and Health SciencesUniversity of AntwerpWilrijkAntwerpBelgium
| | | | - Rani Cremers
- Faculty of Medicine and Social Health SciencesUniversity of GhentGhentBelgium
| | - Leen Van Den Steen
- Department of OtorhinolaryngologyHead and Neck Surgery and Communication Disorders, University Hospital of AntwerpEdegemBelgium
| | - Elmar Nöth
- Pattern Recognition LabFriedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Marc De Bodt
- Department of OtorhinolaryngologyHead and Neck Surgery and Communication Disorders, University Hospital of AntwerpEdegemBelgium
- Faculty of Medicine and Health SciencesUniversity of AntwerpWilrijkAntwerpBelgium
- Faculty of Medicine and Social Health SciencesUniversity of GhentGhentBelgium
| | - Gwen Van Nuffelen
- Department of OtorhinolaryngologyHead and Neck Surgery and Communication Disorders, University Hospital of AntwerpEdegemBelgium
- Faculty of Medicine and Health SciencesUniversity of AntwerpWilrijkAntwerpBelgium
- Faculty of Medicine and Social Health SciencesUniversity of GhentGhentBelgium
| |
Collapse
|
20
|
Xu H, Bao Z, Liang D, Li M, Wei M, Ge X, Liu J, Li J. Speech and Language Therapy for Voice Problems in Parkinson's Disease: A Meta-Analysis. J Neuropsychiatry Clin Neurosci 2021; 32:344-351. [PMID: 32374650 DOI: 10.1176/appi.neuropsych.19020044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with Parkinson's disease (PD) commonly have speech and voice problems that affect their functional communication and that are not sensitive to pharmacological or neurosurgical treatments. The authors aimed to evaluate the effects of speech and language therapies (SLTs) on dysphonia in patients with PD by analyzing data from published randomized controlled trials (RCTs). Studies in English and Chinese that were related to speech and language treatment for patients with PD were retrieved from PubMed, Embase, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, Chinese Biomedical Literature Database, and Wanfang Database. On the basis of exclusion criteria, 391 records identified through the search were reduced to 10 studies that included 230 patients in the treatment groups and 205 patients in the control groups. A meta-analysis of data from the 10 studies was performed to examine the effects of SLTs on dysphonia in patients with PD. SLTs increased sound pressure level during sustained phonation, reading of the Rainbow Passage, and monologue 6 months after treatment, enhanced semitone standard deviation during reading of the Rainbow Passage more than 12 months after treatment, and reduced Voice Handicap Index scores among patients with PD with dysphonia problems at least 3 months after treatment. These findings demonstrate the efficacy of SLTs, especially Lee Silverman Voice Treatment, in increasing vocal loudness and functional communication among patients with PD. Further RCTs with large samples and multicenter participation are needed to validate the long-term effects and the efficacy of SLTs among patients with severe PD.
Collapse
Affiliation(s)
- Hongyan Xu
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Zhuohua Bao
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Daye Liang
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Mengxia Li
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Minguang Wei
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Xueqing Ge
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Jingli Liu
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Jinpin Li
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| |
Collapse
|
21
|
Ertan E, Gürvit HI, Hanağası HH, Bilgiç B, Tunçer MA, Yılmaz C. Intensive voice treatment (the Lee Silverman Voice Treatment [LSVT ®LOUD]) for individuals with Wilson's disease and adult cerebral palsy: two case reports. LOGOP PHONIATR VOCO 2021; 47:262-270. [PMID: 34287100 DOI: 10.1080/14015439.2021.1951348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: In this case report, we aimed to examine the effects of an intensive voice treatment (the Lee Silverman Voice Treatment [LSVT®LOUD]) for Wilson's disease (WD), and adult cerebral palsy (CP), and dysarthria.Method: The participants received LSVT®LOUD four times a week for 4 weeks. Acoustic, perceptual (GRBAS) analyses were performed and data from the Voice Handicap Index (VHI) were obtained before and after treatment.Results: Besides the Harmonics-to Noise Ratio (HNR) value (dB) of the participant with WD, for both participants' fundamental frequencies (Hz), jitter (%), and shimmer (%) values showed significant differences (p < .05) after therapy. Both participants showed significant improvements (p < .05) in the duration (s) and the sound pressure level (dB, SPL) of sustained vowel phonation (/a/), in SPL (dB) of pitch range (high and low /a/) and reading and conversation (p < .01). There was a positive improvement in the high-frequency values (Hz) of both participants but not in the low-frequency values (Hz) in the participant with WD. Perceptual analysis with GRBAS judgements of sustained vowel (/a/) and paragraph reading of two participants also showed improvement. After therapy, perceived loudness of the participants' voice increased.Conclusions: The findings provide some preliminary observations that the individuals with WD and the adult individuals with CP can respond positively to intensive speech treatment such as LSVT®LOUD. Further studies are needed to investigate speech treatments specific to WD and adult CP.
Collapse
Affiliation(s)
- Esra Ertan
- Institut für Deutsche Sprache und Linguistik, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hakan I Gürvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Haşmet H Hanağası
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Başar Bilgiç
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Müge A Tunçer
- Department of Speech and Language Therapy, Faculty of Health Science, Sıtkı Koçman University, Muğla, Turkey
| | - Cemil Yılmaz
- Department of Speech and Language Therapy, Faculty of Health Science, Anadolu University, Eskişehir, Turkey
| |
Collapse
|
22
|
Theodoros D. Telerehabilitation for Communication and Swallowing Disorders in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:S65-S70. [PMID: 33896848 PMCID: PMC8385517 DOI: 10.3233/jpd-202414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Communication and swallowing disorders are highly prevalent in people with Parkinson's disease (PD). The negative impact of these disorders on the quality of life of the person with PD and their families cannot be underestimated. Despite a demand for speech-language pathology services to support people with PD, many barriers to services exist. Telerehabilitation provides an alternate and complementary approach to in-person therapy that is patient-centered, enables timely assessment and intervention, and facilitates continuity of care throughout the course of the disease. This review explores the telerehabilitation applications designed for the management of the communication and swallowing disorders in PD, addresses the benefits and challenges of telerehabilitation, identifies future research directions, and highlights the potential of new technologies to enhance the management of communication and swallowing disorders and quality of life for people with PD.
Collapse
Affiliation(s)
- Deborah Theodoros
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
23
|
Schalling E, Winkler H, Franzén E. HiCommunication as a novel speech and communication treatment for Parkinson's disease: A feasibility study. Brain Behav 2021; 11:e02150. [PMID: 33943030 PMCID: PMC8213924 DOI: 10.1002/brb3.2150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/05/2021] [Accepted: 03/14/2021] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Speech and communication problems are common in Parkinson's disease (PD) and can result in social withdrawal and reduced quality of life. Intervention may improve symptoms but transfer and maintenance remain challenging for many. Access to treatment may also be limited. Group intervention incorporating principles for experience-dependent plasticity may address these challenges. The aim of this study was to develop and study feasibility aspects of a new intervention program for group training of speech and communication in people with PD. MATERIALS & METHODS Development and content of the program called HiCommunication is described. Core target areas are voice, articulation, word-finding and memory. Five participants with mild-moderate PD completed this feasibility trial. Attendance rate and possible adverse events as well as the participants' experiences were documented. A speech recording and dysarthria testing were completed to study feasibility of the assessment procedure and evaluate possible changes in voice sound level and intelligibility. RESULTS Attendance rate was 89%. No adverse events occurred. Participants reported a positive experience and limited fatigue. Assessment was completed in approximately 30 min and was well tolerated. Four of five participants had an increased voice sound level during text-reading postintervention and mean intelligibility improved. CONCLUSIONS Results indicate that HiCommunication is feasible for people with mild-moderate PD. The program was appreciated and well tolerated. Positive outcomes regarding voice sound level and intelligibility were observed; however, the number of participants was very limited. The results motivate that effects of HiCommunication are further studied in a randomized controlled trial, which is ongoing.
Collapse
Affiliation(s)
- Ellika Schalling
- Division of Speech and Language Pathology, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Winkler
- Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Erika Franzén
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
24
|
Swales M, Theodoros D, Hill AJ, Russell T. Communication and swallowing changes, everyday impacts and access to speech-language pathology services for people with Parkinson's disease: An Australian survey. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:70-82. [PMID: 32245329 DOI: 10.1080/17549507.2020.1739332] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To investigate people with Parkinson's disease (PwPD): 1) self-reported communication and swallowing difficulties due to Parkinson's disease (PD), 2) participation and psychosocial impacts of these difficulties and 3) experience with and access to speech-language pathology (SLP) services. METHOD A cross-sectional mix-methods survey was conducted using nonprobability, purposive sampling for recruitment. An inclusion criterion was that participants needed to have self-reported communication and/or swallowing changes due to PD. Descriptive statistics and thematic analysis were utilised. RESULT All of the 78 PwPD who participated reported changes to their communication (97%) and/or swallowing (93%). A diverse range of participation restrictions was found in social, recreational, vocational and everyday living activities. Adverse emotional impacts including frustration, loss of self-confidence, depression and isolation were reported due to these changes. Only 59% of our sample had accessed SLP services. The most common reason for PwPD not accessing services was that neither their general practitioner nor neurologist had referred them to SLP. The majority of PwPD wanted to access SLP at some point in the future. Wide variability in the SLP services provided was evident. Most of the PwPD who had received SLP support wanted further ongoing management. CONCLUSION This study provided insight into the everyday impacts of communication and swallowing changes experienced by PwPD, and the gap between service supply and demand.
Collapse
Affiliation(s)
- Megan Swales
- Centre for Research in Telerehabilitation, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Deborah Theodoros
- Centre for Research in Telerehabilitation, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Anne J Hill
- Centre for Research in Telerehabilitation, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Trevor Russell
- Centre for Research in Telerehabilitation, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| |
Collapse
|
25
|
van Leer E, Lewis B, Porcaro N. Effect of an iOS App on Voice Therapy Adherence and Motivation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:210-227. [PMID: 33476177 PMCID: PMC8740599 DOI: 10.1044/2020_ajslp-19-00213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 12/17/2019] [Accepted: 09/28/2020] [Indexed: 05/22/2023]
Abstract
Purpose Patients commonly report difficulties adhering to voice therapy. An iOS app was developed in our lab that assists practice via reminder notifications, instructional recordings, and cepstral peak prominence analysis results. The purpose of this study was to assess the effect of such homework support modality on adherence behavior and associated motivation in a comparison of app support and written homework instructions and to assess the usability and utility of the app. Method Thirty-four individuals exhibiting adducted hyperfunction were randomized to receive either written homework instructions or the app when practicing resonant voice exercises for 3 weeks. All patients digitally audio-recorded all home practice, provided self-reported estimates of generalization, and completed weekly motivation scales. Results App support significantly increased practice frequency but did not affect self-reported generalization or motivation. Practice was significantly predicted by System Usability Scale scores. Utility of reminders and instructions were good, but cepstral peak prominence feedback was considered useful to only a subset of participants. Conclusion Interactive mobile therapy support can significantly increase practice of resonant voice homework without influencing motivation.
Collapse
Affiliation(s)
- Eva van Leer
- Department of Communication Sciences and Disorders, Georgia State University, Atlanta
| | - Brittney Lewis
- Autonomous Reanimation and Evacuation Program, The Geneva Foundation, San Antonio, TX
| | | |
Collapse
|
26
|
Whillans C, Lawrie M, Cardell EA, Kelly C, Wenke R. A systematic review of group intervention for acquired dysarthria in adults. Disabil Rehabil 2020; 44:3002-3018. [PMID: 33356634 DOI: 10.1080/09638288.2020.1859629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This review aimed to evaluate the evidence for group therapy in improving speech production in adults with acquired dysarthria. Secondary outcomes included communication effectiveness and/or wellbeing. MATERIALS AND METHODS A review protocol was prospectively published on PROSPERO. Fourteen electronic databases were searched to identify experimental studies investigating adults with acquired dysarthria participating in group intervention with outcomes related to communication and/or wellbeing. The quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT) or the McMaster University's Critical Review Form, and the TIDieR template for intervention description and replication. RESULTS 21 studies were identified involving 330 individuals with dysarthria, from mostly Parkinson's disease (PD) (97%; n = 321). Treatment approaches included singing therapy (n = 10), loudness therapy (n = 5) and multi-components therapy (including a combination of impairment and/or compensatory approaches) (n = 4). Studies varied in intensity and outcome measures used. Statistically significant improvements to speech production and/or wellbeing were reported following most approaches. CONCLUSION There is some preliminary moderate-quality evidence to suggest that group therapy may improve speech production and in some cases communication effectiveness or wellbeing in people with dysarthria following PD, with more consistent improvements being found for loudness approaches. Singing approaches were frequently studied in PD with some improvements to intelligibility evident. Further well-designed controlled studies including individuals with non-progressive aetiologies is warranted to establish the effectiveness of group treatment.IMPLICATIONS FOR REHABILITATIONGroup therapy may be an effective means of improving speech production and/or wellbeing in individuals with dysarthria following Parkinson's disease.Studies' employing loudness-based group therapy for PD demonstrated more consistent improvements to intensity measures.Some controlled studies utilising singing group therapy resulted in improved intelligibility in PD.PROSPERO registration number: CRD42015029374.
Collapse
Affiliation(s)
- Chelsea Whillans
- Speech Pathology & Audiology Services, Gold Coast Health, Southport, Australia
| | - Melissa Lawrie
- Speech Pathology & Audiology Services, Gold Coast Health, Southport, Australia.,School of Allied Health Sciences, Griffith University, Southport, Australia
| | - Elizabeth A Cardell
- School of Allied Health Sciences, Griffith University, Southport, Australia.,Menzies Institute Queensland, Southport, Australia
| | - Crystal Kelly
- School of Allied Health Sciences, Griffith University, Southport, Australia
| | - Rachel Wenke
- Speech Pathology & Audiology Services, Gold Coast Health, Southport, Australia.,School of Allied Health Sciences, Griffith University, Southport, Australia
| |
Collapse
|
27
|
Yuan F, Guo X, Wei X, Xie F, Zheng J, Huang Y, Huang Z, Chang Z, Li H, Guo Y, Chen J, Guo J, Tang B, Deng B, Wang Q. Lee Silverman Voice Treatment for dysarthria in patients with Parkinson's disease: a systematic review and meta-analysis. Eur J Neurol 2020; 27:1957-1970. [PMID: 32539227 DOI: 10.1111/ene.14399] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/04/2020] [Indexed: 02/06/2023]
Abstract
Approximately 89% of patients with Parkinson's disease (PD) suffer from dysarthria. Lee Silverman Voice Treatment (LSVT), a behavioral therapy, aims to improve speech and voice functions. The objective was to assess the effectiveness of LSVT compared with other/no speech interventions for dysarthria in patients with PD. Electronic databases, including PubMed, Embase and the Cochrane Library, were searched. The publication date of all included studies was before 6 March 2020. Only randomized controlled trials (RCTs) that evaluated the LSVT intervention compared with other/no speech intervention were considered. The data obtained from the included studies were described and the mean differences were calculated. Eight RCTs were included in this meta-analysis comparing LSVT with other/no speech interventions. In the comparison of LSVT versus no intervention, vocal intensity for sustained 'Ah' phonation, reading the 'Rainbow passage', monologue and describing a picture increased by 8.87, 4.34, 3.25 and 3.31 dB, respectively, after 1 month of therapy. Compared with the respiratory therapy group, the LSVT group also showed significant improvement in vocal intensity for sustained 'Ah' phonation, reading the 'Rainbow passage' and monologue immediately after treatment (13.39, 6.66 and 3.19 dB). Positive improvement still existed after 24 months. There was no difference in the therapeutic effect between face-to-face and online LSVT. The effectiveness of LSVT for dysarthria in patients with PD was verified in these trials. However, future RCTs with sufficient participants are essential to evaluate the effectiveness of LSVT for dysarthria.
Collapse
Affiliation(s)
- F Yuan
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - X Guo
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - X Wei
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - F Xie
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - J Zheng
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Y Huang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Z Huang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Z Chang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - H Li
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Y Guo
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - J Chen
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - J Guo
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, China
| | - B Tang
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, China
| | - B Deng
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Q Wang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
28
|
Ferreira GZ, Bressmann T, de Cássia Rillo Dutka J, Whitaker ME, de Boer G, de Castro Marino VC, Pegoraro-Krook MI. Analysis of oral-nasal balance after intensive speech therapy combined with speech bulb in speakers with cleft palate and hypernasality. JOURNAL OF COMMUNICATION DISORDERS 2020; 85:105945. [PMID: 31607437 DOI: 10.1016/j.jcomdis.2019.105945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 09/06/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the efficacy of the combination of a speech bulb with an intensive speech therapy program in hypernasal participants with cleft palate. METHODS Twenty hypernasal speakers with cleft palate (12 females and 8 males, median age 28.45 years), who were wearing speech bulbs underwent an intensive speech therapy program of 45 sessions over 3 weeks. Three experienced speech-language pathologists rated the participants' speech recordings before and after intensive speech therapy, with and without the speech bulb. Nasometric recordings and long-term averaged spectra were also analyzed using repeated-measures ANOVAs. RESULTS The ANOVA of the hypernasality ratings showed significant effects of therapy [F (1,19) = 15.97; p < .001], speech bulb [F(1,190 = 28.54, p < .001] and a therapy -speech bulb interaction effect [F(1.19) = 22.30, p < 0.001]. The most favorable listener ratings of hypernasality were obtained post-therapy when participants were wearing their speech bulbs. Without the speech bulb, intensive speech therapy by itself did not result in a significant improvement. With speech bulb, nasalance scores for high [F (1,19) = 14.07, p < .001] and low pressure [F (1,19) = 14.84, p < .001] sentences were significantly lower post-therapy, providing preliminary evidence that an intensive speech therapy program may enhance the effect of a speech bulb. Before and after comparisons of individual nasalance profiles demonstrated variable improvement in 15 participants, no progress in 2 participants and more severe hypernasality after therapy in 3 participants. Long-term averaged spectra corroborated the findings of the perceptual analysis. Based on a frequency bin from 201 to 300 Hz, there was a significant within-subject effect for with and without speech bulb [F(1, 18) = 4.54, p = .047] as well as for before vs. after session [F (1,18) = 7.14, p = .015]. CONCLUSION The speech bulb in combination with intensive speech therapy resulted in improved oral-nasal balance for the majority of participants. More research is needed to investigate long-term outcomes as well as individual factors contributing to therapy success.
Collapse
Affiliation(s)
- Gabriela Zuin Ferreira
- Speech-Language and Audiology Department, Faculdade de Odontologia de Bauru and Graduate Programs at the Universidade de São Paulo (USP), 9-75 Alameda Octávio Pinheiro Brisolla, Bauru, SP, CEP 17012-901, Brazil.
| | - Tim Bressmann
- Department of Speech-Language Pathology, University of Toronto (UofT), University Ave, 500, Toronto, ON, M5G 1V7, Canada.
| | - Jennifer de Cássia Rillo Dutka
- Speech-Language and Audiology Department, Faculdade de Odontologia de Bauru and Graduate Programs at the Universidade de São Paulo (USP), 9-75 Alameda Octávio Pinheiro Brisolla, Bauru, SP, CEP 17012-901, Brazil; Palatal Prosthesis Services, Hospital for the Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Rua Sílvio Marchione, 3-20, Vila Universitária, Bauru, SP, CEP 17012-900, Brazil.
| | - Melina Evangelista Whitaker
- Palatal Prosthesis Services, Hospital for the Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Rua Sílvio Marchione, 3-20, Vila Universitária, Bauru, SP, CEP 17012-900, Brazil.
| | - Gillian de Boer
- Department of Speech-Language Pathology, University of Toronto (UofT), University Ave, 500, Toronto, ON, M5G 1V7, Canada.
| | - Viviane Cristina de Castro Marino
- Department of Speech-Language Pathology and Audiology, São Paulo State University (UNESP), Faculdade de Filosofia e Ciências, Campus de Marília, Av. Higino Muzzi Filho, 737, Marília, SP, CEP 17525-900, Brazil.
| | - Maria Inês Pegoraro-Krook
- Speech-Language and Audiology Department, Faculdade de Odontologia de Bauru and Graduate Programs at the Universidade de São Paulo (USP), 9-75 Alameda Octávio Pinheiro Brisolla, Bauru, SP, CEP 17012-901, Brazil; Palatal Prosthesis Services, Hospital for the Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Rua Sílvio Marchione, 3-20, Vila Universitária, Bauru, SP, CEP 17012-900, Brazil.
| |
Collapse
|
29
|
Update on the Management of Parkinson's Disease for General Neurologists. PARKINSONS DISEASE 2020; 2020:9131474. [PMID: 32300476 PMCID: PMC7136815 DOI: 10.1155/2020/9131474] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
Management of Parkinson's disease (PD) is complicated due to its progressive nature, the individual patient heterogeneity, and the wide range of signs, symptoms, and daily activities that are increasingly affected over its course. The last 10–15 years have seen great progress in the identification, evaluation, and management of PD, particularly in the advanced stages. Highly specialized information can be found in the scientific literature, but updates do not always reach general neurologists in a practical and useful way, potentially creating gaps in knowledge of PD between them and neurologists subspecialized in movement disorders, resulting in several unmet patient needs. However, general neurologists remain instrumental in diagnosis and routine management of PD. This review provides updated practical information to identify problems and resolve common issues, particularly when the advanced stage is suspected. Some tips are provided for efficient communication with the members of a healthcare team specialized in movement disorders, in order to find support at any stage of the disease in a given patient, and especially for a well-timed decision on referral.
Collapse
|
30
|
Amadori K, Steiner T. [Parkinson's syndromes in geriatric patients : Epidemiological, clinical and therapeutic characteristics]. DER NERVENARZT 2019; 90:1279-1291. [PMID: 31776592 DOI: 10.1007/s00115-019-00825-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Due to their high prevalence, Parkinson's syndromes are exemplary geriatric syndromes. In addition to idiopathic Parkinson's disease, drug-induced and vascular Parkinson's syndromes are especially relevant in older age. A comprehensive anamnesis, thorough clinical neurological examination and rational additional diagnostics ensure the correct differential diagnostic classification. The multidimensional geriatric assessment is used to quantify the syndrome-specific ability impairments. The primary therapeutic objective in old age is the preservation of everyday competences. Drug treatment is centered around L‑dopa because of its favorable effect-side effect ratio. In cases of motor fluctuations, entacapone, opicapone or safinamide can be added, whereas dopamine agonists are generally unsuitable. Rivastigmine is indicated in mild to moderate Parkinson's dementia and furthermore can possibly improve gait stability. Speech therapy, as well as physical and occupational therapy, including the Parkinson's disease-specific Lee Silverman voice treatment are indispensable components of the multiprofessional treatment concept.
Collapse
Affiliation(s)
- K Amadori
- Klinik für Altersmedizin, Klinikum Frankfurt Höchst, Gotenstraße 6-8, 65929, Frankfurt am Main, Deutschland. .,Klinik für Neurologie, Klinikum Frankfurt Höchst, Frankfurt am Main, Deutschland.
| | - T Steiner
- Klinik für Neurologie, Klinikum Frankfurt Höchst, Frankfurt am Main, Deutschland.,Klinik für Neurologie, Universitätsklinik Heidelberg, Heidelberg, Deutschland
| |
Collapse
|
31
|
Chan MY, Chu SY, Ahmad K, Ibrahim NM. Voice therapy for Parkinson's disease via smartphone videoconference in Malaysia: A preliminary study. J Telemed Telecare 2019; 27:174-182. [PMID: 31431134 DOI: 10.1177/1357633x19870913] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Intensive voice therapy is one of the best evidence-based treatments to improve speech and voice difficulties to individuals with Parkinson's disease (PD). However, accessibility to intensive voice therapy is highly challenging in Malaysia due to the lack of voice specialised speech-language therapists. This study examined the feasibility of using smartphone videoconference to deliver intensive voice therapy to individuals with PD in Malaysia. METHODS Intensive voice therapy was delivered to 11 adults with PD using a smartphone videoconference method via WhatsApp Messenger freeware. The therapy consisted of 12 sessions over four weeks and focused on increasing vocal loudness. Outcomes were assessed using objective, perceptual and quality-of-life measures pre and post treatment. Participant satisfaction with the telerehabilitation method was obtained via the Smartphone-Based Therapy Satisfaction Questionnaire. RESULTS Significant gains were reported for sound pressure level in sustained vowels and monologue. Perceptual ratings showed significant improvements in overall mean severity and loudness after treatment. Mean scores of speech intelligibility and Voice Handicap Index-10 were significantly better post treatment. Overall, participants were highly satisfied with the smartphone videoconference method. DISCUSSION Present results suggest that the smartphone videoconference method is feasible to deliver intensive voice therapy to individuals with PD to gain better speech and voice functions. Future studies need to address the standardisation of the system protocol to optimise this novel service delivery method in Malaysia.
Collapse
Affiliation(s)
- Min Yen Chan
- Speech Sciences Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Malaysia
| | - Shin Ying Chu
- Faculty of Health Sciences, Centre for Healthy Aging and Wellness (H-CARE), Universiti Kebangsaan Malaysia, Malaysia
| | - Kartini Ahmad
- Speech Sciences Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Malaysia
| | | |
Collapse
|
32
|
Quinn R, Park S, Theodoros D, Hill AJ. Delivering group speech maintenance therapy via telerehabilitation to people with Parkinson's disease: A pilot study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:385-394. [PMID: 29879854 DOI: 10.1080/17549507.2018.1476918] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 12/01/2017] [Accepted: 05/11/2018] [Indexed: 06/08/2023]
Abstract
Purpose: This study aimed to determine the feasibility of delivering a group speech maintenance programme (eLoud and Proud) to people with Parkinson's disease via telerehabilitation. Method: Treatment was delivered to eight participants who had previously received LSVT LOUD®. The programme focussed on using a "loud" voice within conversational and cognitively loaded tasks, and was delivered in two 90-minute sessions per week for four weeks. Data pertaining to sound pressure level (SPL) (for sustained phonation, reading and monologue tasks), maximum frequency range, maximum phonation duration and impact of dysarthria on quality of life were collected at three time points: (1) pre-treatment (PRE); (2) immediately post-treatment (POST); and (3) three months post-treatment (FU). Participant satisfaction with telerehabilitation was also obtained at POST. Result: Significant improvements were identified for all SPL measures PRE-POST and maintained for sustained phonation and reading tasks at FU. No significant differences were identified for the remaining outcome measures. Participants were overall highly satisfied with telerehabilitation and considered it to be an acceptable alternative to traditional service delivery. Conclusion: This study demonstrated the feasibility of delivering group speech maintenance therapy via telerehabilitation, and the potential for eLoud and Proud to improve and maintain vocal loudness in people with PD.
Collapse
Affiliation(s)
- Rachel Quinn
- School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Stacie Park
- School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Deborah Theodoros
- School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Anne J Hill
- School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| |
Collapse
|
33
|
Alharbi GG, Cannito MP, Buder EH, Awan SN. Spectral/Cepstral Analyses of Phonation in Parkinson's Disease before and after Voice Treatment: A Preliminary Study. Folia Phoniatr Logop 2019; 71:275-285. [PMID: 31117110 DOI: 10.1159/000495837] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/27/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE This article examines cepstral/spectral analyses of sustained /α/ vowels produced by speakers with hypokinetic dysarthria secondary to idiopathic Parkinson's disease (PD) before and after Lee Silverman Voice Treatment (LSVT®LOUD) and the relationship of these measures with overall voice intensity. METHODOLOGY Nine speakers with PD were examined in a pre-/post-treatment design, with multiple daily audio recordings before and after treatment. Sustained vowels were analyzed for cepstral peak prominence (CPP), CPP standard deviation (CPP SD), low/high spectral ratio (L/H SR), and Cepstral/Spectral Index of Dysphonia (CSID) using the KAYPENTAX computer software. RESULTS CPP and CPP SD increased significantly and CSID decreased significantly from pre- to post-treatment recordings, with strong effect sizes. Increased CPP indicates increased dominance of harmonics in the spectrum following LSVT. After restricting the frequency cutoff to the region just above the first formant and second formant and below the third formant, L/H SR was observed to decrease significantly following treatment. Correlation analyses demonstrated that CPP was more strongly associated with CSID before treatment than after. CONCLUSION In addition to increased vocal intensity following LSVT, speakers with PD exhibited both improved harmonic structure and voice quality as reflected by cepstral/spectral analysis, indicating that there was improved harmonic structure and reduced dysphonia following treatment.
Collapse
Affiliation(s)
- Ghadah G Alharbi
- Department of Special Education, College of Education, University of Jeddah, Jeddah, Saudi Arabia,
| | - Michael P Cannito
- Department of Communicative Disorders, University of Louisiana, Lafayette, Louisiana, USA
| | - Eugene H Buder
- School of Communication Sciences and Disorders, University of Memphis, Memphis, Tennessee, USA
| | - Shaheen N Awan
- Department of Communication Sciences and Disorders, Bloomsburg University of Pennsylvania, Bloomsburg, Pennsylvania, USA
| |
Collapse
|
34
|
Horin AP, McNeely ME, Harrison EC, Myers PS, Sutter EN, Rawson KS, Earhart GM. Usability of a daily mHealth application designed to address mobility, speech and dexterity in Parkinson's disease. Neurodegener Dis Manag 2019; 9:97-105. [PMID: 30998100 DOI: 10.2217/nmt-2018-0036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study investigated the usability of a mobile health (mHealth) smartphone application to treat gait, speech and dexterity in people with Parkinson's disease. Methods: Participants either used an mHealth application (intervention) or maintained their normal routine (control) for 12 weeks and were evaluated at baseline and post-test time points for primary outcome measures of adherence, gait, speech and dexterity. mHealth application adherence was compared with percent change scores on gait, speech and dexterity measures. Results: Adherence was moderate and there were no significant group, time or interaction effects for any outcome measures. Correlations between adherence and outcomes were weak and negative. Conclusion: These data suggest that usability of this mHealth application was limited as indicated by low adherence. The application alone in its present form was not adequate to treat symptoms of gait, speech or dexterity in people with Parkinson's disease.
Collapse
Affiliation(s)
- Adam P Horin
- Program in Physical Therapy, Washington University School of Medicine, St Louis, MO, USA
| | - Marie E McNeely
- Program in Physical Therapy, Washington University School of Medicine, St Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St Louis, MO, USA.,Change in affiliation: Unfold Productions, LLC, St. Louis, MO, USA
| | - Elinor C Harrison
- Program in Physical Therapy, Washington University School of Medicine, St Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - Peter S Myers
- Program in Physical Therapy, Washington University School of Medicine, St Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - Ellen N Sutter
- Program in Physical Therapy, Washington University School of Medicine, St Louis, MO, USA.,Change in affiliation: Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Kerri S Rawson
- Program in Physical Therapy, Washington University School of Medicine, St Louis, MO, USA
| | - Gammon M Earhart
- Program in Physical Therapy, Washington University School of Medicine, St Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St Louis, MO, USA.,Department of Neuroscience, Washington University School of Medicine, St Louis, MO, USA
| |
Collapse
|
35
|
Look C, McCabe P, Heard R, Madill CJ. Show and Tell: Video Modeling and Instruction Without Feedback Improves Performance but Is Not Sufficient for Retention of a Complex Voice Motor Skill. J Voice 2019; 33:239-249. [DOI: 10.1016/j.jvoice.2017.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
|
36
|
Theodoros D, Aldridge D, Hill AJ, Russell T. Technology-enabled management of communication and swallowing disorders in Parkinson's disease: a systematic scoping review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:170-188. [PMID: 29923267 DOI: 10.1111/1460-6984.12400] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/07/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Communication and swallowing disorders are highly prevalent in people with Parkinson's disease (PD). Maintenance of functional communication and swallowing over time is challenging for the person with PD and their families and may lead to social isolation and reduced quality of life if not addressed. Speech and language therapists (SLTs) face the conundrum of providing sustainable and flexible services to meet the changing needs of people with PD. Motor, cognitive and psychological issues associated with PD, medication regimens and dependency on others often impede attendance at a centre-based service. The access difficulties experienced by people with PD require a disruptive service approach to meet their needs. Technology-enabled management using information and telecommunications technologies to provide services at a distance has the potential to improve access, and enhance the quality of SLT services to people with PD. AIMS To report the status and scope of the evidence for the use of technology in the management of the communication and swallowing disorders associated with PD. METHODS & PROCEDURES Studies were retrieved from four major databases (PubMed, CINAHL, EMBASE and Medline via Web of Science). Data relating to the types of studies, level of evidence, context, nature of the management undertaken, participant perspectives and the types of technologies involved were extracted for the review. MAIN CONTRIBUTION A total of 17 studies were included in the review, 15 of which related to the management of communication and swallowing disorders in PD with two studies devoted to participant perspectives. The majority of the studies reported on the treatment of the speech disorder in PD using Lee Silverman Voice Treatment (LSVT LOUD® ). Synchronous and asynchronous technologies were used in the studies with a predominance of the former. There was a paucity of research in the management of cognitive-communication and swallowing disorders. CONCLUSIONS & IMPLICATIONS Research evidence supporting technology-enabled management of the communication and swallowing disorders in PD is limited and predominantly low in quality. The treatment of the speech disorder online is the most developed aspect of the technology-enabled management pathway. Future research needs to address technology-enabled management of cognitive-communication and swallowing disorders and the use of a more diverse range of technologies and management approaches to optimize SLT service delivery to people with PD.
Collapse
Affiliation(s)
- Deborah Theodoros
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Danielle Aldridge
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Anne J Hill
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
37
|
Palmer AD, Carder PC, White DL, Saunders G, Woo H, Graville DJ, Newsom JT. The Impact of Communication Impairments on the Social Relationships of Older Adults: Pathways to Psychological Well-Being. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:1-21. [PMID: 30950760 DOI: 10.1044/2018_jslhr-s-17-0495] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose Social contact is known to be vital for older adults' mental and physical health but, because communication impairments often co-occur with other types of disability, it is difficult to generalize about the relative impact of a communication impairment on the social relationships of older adults. Specific aims of the study were to examine whether the severity of a communication impairment was associated with a range of social measures and to examine the association between these characteristics and psychological well-being. Method Community-dwelling older adults ranging in age from 65 to 94 were recruited for the study of Communication, Health, Aging, Relationship Types and Support. The sample included 240 participants with communication disorders arising from a variety of etiologies including hearing impairment, voice disorders, head and neck cancer, and neurologic disease, as well as older adults without a communication disorder. Results Communication impairment was a significant independent predictor for key characteristics of social relationships, including the number of friends in the social network, two types of social support, the frequency of social participation, and social self-efficacy. Communication impairment was also a significant predictor for higher levels of loneliness and depression. In addition, two distinct pathways between communication impairment and psychological well-being were identified, with social self-efficacy and reassurance of worth as mediators. Conclusions Even after controlling for age, gender, health, and disability, communication impairment is a significant independent predictor for key aspects of the social function of older adults and demonstrates two distinct pathways to loneliness and depression. Supplemental Material https://doi.org/10.23641/asha.7250282.
Collapse
Affiliation(s)
- Andrew D Palmer
- NW Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Paula C Carder
- Institute on Aging, College of Urban and Public Affairs, Portland State University, OR
| | - Diana L White
- Institute on Aging, College of Urban and Public Affairs, Portland State University, OR
| | - Gabrielle Saunders
- National Center for Rehabilitative Auditory Research, Portland VA Medical Center, OR
| | - Hyeyoung Woo
- Department of Sociology, Portland State University, OR
| | - Donna J Graville
- NW Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | | |
Collapse
|
38
|
Körner Gustafsson J, Södersten M, Ternström S, Schalling E. Long-term effects of Lee Silverman Voice Treatment on daily voice use in Parkinson's disease as measured with a portable voice accumulator. LOGOP PHONIATR VOCO 2018; 44:124-133. [PMID: 29447488 DOI: 10.1080/14015439.2018.1435718] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examines the effects of an intensive voice treatment focusing on increasing voice intensity, LSVT LOUD® Lee Silverman Voice Treatment, on voice use in daily life in a participant with Parkinson's disease, using a portable voice accumulator, the VoxLog. A secondary aim was to compare voice use between the participant and a matched healthy control. Participants were an individual with Parkinson's disease and his healthy monozygotic twin. Voice use was registered with the VoxLog during 9 weeks for the individual with Parkinson's disease and 2 weeks for the control. This included baseline registrations for both participants, 4 weeks during LSVT LOUD for the individual with Parkinson's disease and 1 week after treatment for both participants. For the participant with Parkinson's disease, follow-up registrations at 3, 6, and 12 months post-treatment were made. The individual with Parkinson's disease increased voice intensity during registrations in daily life with 4.1 dB post-treatment and 1.4 dB at 1-year follow-up compared to before treatment. When monitored during laboratory recordings an increase of 5.6 dB was seen post-treatment and 3.8 dB at 1-year follow-up. Changes in voice intensity were interpreted as a treatment effect as no significant correlations between changes in voice intensity and background noise were found for the individual with Parkinson's disease. The increase in voice intensity in a laboratory setting was comparable to findings previously reported following LSVT LOUD. The increase registered using ambulatory monitoring in daily life was lower but still reflecting a clinically relevant change.
Collapse
Affiliation(s)
- Joakim Körner Gustafsson
- a Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology , Karolinska Institutet , Stockholm , Sweden.,b Functional Area Speech and Language Pathology , Karolinska University Hospital , Stockholm , Sweden
| | - Maria Södersten
- a Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology , Karolinska Institutet , Stockholm , Sweden.,b Functional Area Speech and Language Pathology , Karolinska University Hospital , Stockholm , Sweden
| | - Sten Ternström
- c Department of Speech, Music and Hearing, School of Computer Science and Communication , Royal Institute of Technology (KTH) , Stockholm , Sweden
| | - Ellika Schalling
- a Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology , Karolinska Institutet , Stockholm , Sweden.,b Functional Area Speech and Language Pathology , Karolinska University Hospital , Stockholm , Sweden
| |
Collapse
|
39
|
Edwards A, Theodoros D, Davidson B. Group therapy for maintenance of speech in parkinson’s disease following LSVT LOUD: a pilot study. SPEECH LANGUAGE AND HEARING 2017. [DOI: 10.1080/2050571x.2017.1334849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ann Edwards
- School of Allied Health, Australian Catholic University, Brisbane, QLD, Australia
- QEII Jubilee Hospital, Metro South Health, Brisbane, QLD, Australia
| | - Deborah Theodoros
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Bronwyn Davidson
- Audiology and Speech Pathology, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
40
|
Desjardins M, Halstead L, Cooke M, Bonilha HS. A Systematic Review of Voice Therapy: What “Effectiveness” Really Implies. J Voice 2017; 31:392.e13-392.e32. [DOI: 10.1016/j.jvoice.2016.10.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/29/2016] [Accepted: 10/04/2016] [Indexed: 12/31/2022]
|
41
|
Griffin M, Bentley J, Shanks J, Wood C. The effectiveness of Lee Silverman Voice Treatment therapy issued interactively through an iPad device: A non-inferiority study. J Telemed Telecare 2017; 24:209-215. [DOI: 10.1177/1357633x17691865] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction This study compared the differences in recorded speech variables between people treated with conventional ‘in person’ Lee Silverman Voice Treatment (LSVT) and those treated remotely via iPad-based ‘Facetime’. Method Eight participants were selected for the iPad LSVT, and 21 similarly matched subjects were selected from existing data to form the ‘in person’ group. Participants in both groups had diagnosed idiopathic Parkinson’s disease and moderate hypokinetic dysarthria. Eighteen sessions of prescribed LSVT comprising a pre-treatment assessment, 16 treatment sessions, and a six months’ post-treatment assessment were administered for each person. In both groups, pre- and post-treatment assessments were conducted face-to-face. Performance measures were recorded during assessment and treatment. Average measures were determined for all tasks at all time points and a summary outcome variable was composed from across-task performance. Results Non-inferiority testing confirmed that iPad LSVT was non-inferior in treating all LSVT task 3 variables except generating words, with the 90% upper confidence intervals (CI) lying between the non-inferiority margin of ± 2.25 and zero. The iPad was superior in treating the task 3 rainbow reading passage and describing motor task variables with upper and lower 90% CI values being negative. The improvement in the summary outcome variable score was also superior in the iPad group. Discussion Non-inferiority testing implies that the iPad LSVT is non-inferior in treating task three variables when compared to traditional LSVT. The study supports further development of remote delivery solutions involving the Apple iPad and ‘Facetime’ system as a means of improving access to services and the participant’s experience.
Collapse
Affiliation(s)
| | - John Bentley
- Department of Adult Speech and Language Therapy, Provide C.I.C., Colchester, UK
| | - Joseph Shanks
- School of Biological Sciences, University of Essex, UK
| | - Carly Wood
- Department of Life Sciences, University of Westminster, UK
| |
Collapse
|
42
|
Dias AE, Limongi JCP, Barbosa ER, Hsing WT. Voice telerehabilitation in Parkinson's disease. Codas 2016; 28:176-81. [PMID: 27191882 DOI: 10.1590/2317-1782/20162015161] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 07/07/2015] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED Parkinson's disease (PD) is a neurodegenerative condition associated with motor, neuropsychological, sensorial, and vocal symptoms. It has been suggested that eventual obstacles faced by many patients to reach speech therapy rehabilitation centers could be overcome with the use of synchronous telerehabilitation (real time) approach employing communication technologies. PURPOSE To investigate the efficacy of vocal telerehabilitation in PD patients. METHODS Twenty patients diagnosed with PD and with vocal complaints participated in this study. Patients were evaluated by videoconference (Adobe Connect 8) before and after treatment. Evaluation method consisted of perceptual analysis of vocal quality measured by the GRBASI scale. Treatment was conducted following the extended version of Lee Silverman method (LSVT-X). At the end of treatment all patients were requested to fill a questionnaire to assess their experience with telerehabilitation. RESULTS Analysis revealed decrease in magnitude of voice quality changes after the intervention, indicating improvement of vocal pattern. All patients reported satisfaction and preference for telerehabilitation compared to face-to-face rehabilitation, as well as positive perception of audio and video. Some technological adversities have been identified but did not prevent the approaches to assessment and treatment. CONCLUSION Present results suggest that telerehabilitation methods can be considered as an effective treatment for speech symptoms associated with PD and can be indicated to patients presenting limited access to speech therapy centers and technological readiness.
Collapse
Affiliation(s)
- Alice Estevo Dias
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | | | - Wu Tu Hsing
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
43
|
Lancioni G, Singh N, O'Reilly M, Sigafoos J, D'Amico F, Sasanelli G, Denitto F, Lang R. Technology-aided leisure and communication: Opportunities for persons with advanced Parkinson's disease. Dev Neurorehabil 2016; 19:398-404. [PMID: 25826719 DOI: 10.3109/17518423.2014.1002637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE This study investigated whether simple technology-aided programs could be used to promote leisure and communication engagement in three persons with advanced Parkinson's disease. METHOD The programs included music and video options, which were combined with (a) text messaging and telephone calls for the first participant, (b) verbal statements/requests, text messaging, and reading for the second participant, and (c) verbal statements/requests and prayers for the third participant. The participants could activate those options via hand movement or vocal emission and specific microswitches. RESULTS All three participants were successful in activating the options available. The mean cumulative frequencies of option activations were about five per 15-min session for the first two participants and about four per 10-min session for the third participant. CONCLUSION The results were considered encouraging and relevant given the limited amount of evidence available on helping persons with advanced Parkinson's disease with leisure and communication.
Collapse
Affiliation(s)
- Giulio Lancioni
- a Department of Neuroscience and Sense Organs , University of Bari , Bari , Italy
| | - Nirbhay Singh
- b Medical College of Georgia, Georgia Regents University , Augusta , GA , USA
| | - Mark O'Reilly
- c Department of Special Education , University of Texas at Austin , Austin , TX , USA
| | - Jeff Sigafoos
- d Department of Educational Psychology , Victoria University of Wellington , Wellington , New Zealand
| | - Fiora D'Amico
- e S. Raffaele Medical Care Center , Alberobello , Italy
| | | | | | - Russell Lang
- g Department of Curriculum Instruction , Texas State University , San Marcos , TX , USA
| |
Collapse
|
44
|
Carding P, Bos-Clark M, Fu S, Gillivan-Murphy P, Jones S, Walton C. Evaluating the efficacy of voice therapy for functional, organic and neurological voice disorders. Clin Otolaryngol 2016; 42:201-217. [DOI: 10.1111/coa.12765] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 11/28/2022]
Affiliation(s)
- P. Carding
- Speech Pathology; Australian National Catholic University; Brisbane Qld Australia
| | - M. Bos-Clark
- Royal Devon and Exeter NHS Trust and University of ST Mark and St John; Plymouth UK
| | - S. Fu
- Department of Audiology and Speech Pathology; MacKay Medical College; New Taipei City Taiwan
| | | | - S.M. Jones
- University Hospital of South Manchester; Manchester UK
| | - C. Walton
- Speech Pathology; Australian National Catholic University; Brisbane Qld Australia
| |
Collapse
|
45
|
de Campos Moreira T, Gadenz CD, Capobianco DM, Figueiró LR, Ferigolo M, Vissoci JRN, Barros HMT, Cassol M, Pietrobon R. Factors Associated With Attrition in Randomized Controlled Trials of Vocal Rehabilitation: Systematic Review and Meta-Analysis. J Voice 2016; 31:259.e29-259.e40. [PMID: 27545074 DOI: 10.1016/j.jvoice.2016.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/13/2016] [Accepted: 05/18/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to determine the dropout rates and the reasons for dropout in randomized clinical trials of vocal rehabilitation. STUDY DESIGN This study used systematic review and meta-analysis (CRD42013003807). METHODS We included randomized controlled trials for voice disorders. In June 2015, we searched the following databases: MEDLINE, EMBASE, Cochrane, Clinical Trials, and AJSLP. The titles and abstracts or full texts of articles were independently analyzed by two reviewers. Study quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) scale. Our initial research base included more than 8491 articles. RESULTS A total of 51 articles were obtained using our eligibility criteria. The low-quality studies evaluated had higher dropout rates (odds ratio: 3.3, 95% confidence interval: 1.04-12.9). Studies with healthy patients (45%) or vocal training versus no training (25%) also had higher dropout rates. Methodological issues seemed to have a greater influence on the dropout rates of the studies included in the co-occurrence matrix. CONCLUSIONS Dropout rates of approximately 15% occur in randomized clinical trials of speech therapy when assessed by the Grading of Recommendations Assessment, Development and Evaluation. Studies with lower methodological quality had higher patient loss rates. Methodological and clinical reasons accounted for the highest dropout rates in the studies included in this meta-analysis.
Collapse
|
46
|
Lam J, Tjaden K. Clear Speech Variants: An Acoustic Study in Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:631-46. [PMID: 27355431 PMCID: PMC5280060 DOI: 10.1044/2015_jslhr-s-15-0216] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/17/2015] [Indexed: 05/10/2023]
Abstract
PURPOSE The authors investigated how different variants of clear speech affect segmental and suprasegmental acoustic measures of speech in speakers with Parkinson's disease and a healthy control group. METHOD A total of 14 participants with Parkinson's disease and 14 control participants served as speakers. Each speaker produced 18 different sentences selected from the Sentence Intelligibility Test (Yorkston & Beukelman, 1996). All speakers produced stimuli in 4 speaking conditions (habitual, clear, overenunciate, and hearing impaired). Segmental acoustic measures included vowel space area and first moment (M1) coefficient difference measures for consonant pairs. Second formant slope of diphthongs and measures of vowel and fricative durations were also obtained. Suprasegmental measures included fundamental frequency, sound pressure level, and articulation rate. RESULTS For the majority of adjustments, all variants of clear speech instruction differed from the habitual condition. The overenunciate condition elicited the greatest magnitude of change for segmental measures (vowel space area, vowel durations) and the slowest articulation rates. The hearing impaired condition elicited the greatest fricative durations and suprasegmental adjustments (fundamental frequency, sound pressure level). CONCLUSIONS Findings have implications for a model of speech production for healthy speakers as well as for speakers with dysarthria. Findings also suggest that particular clear speech instructions may target distinct speech subsystems.
Collapse
|
47
|
Lansford KL, Borrie SA, Bystricky L. Use of Crowdsourcing to Assess the Ecological Validity of Perceptual-Training Paradigms in Dysarthria. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 25:233-9. [PMID: 27145295 DOI: 10.1044/2015_ajslp-15-0059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 11/30/2015] [Indexed: 05/13/2023]
Abstract
PURPOSE It has been documented in laboratory settings that familiarizing listeners with dysarthric speech improves intelligibility of that speech. If these findings can be replicated in real-world settings, the ability to improve communicative function by focusing on communication partners has major implications for extending clinical practice in dysarthria rehabilitation. An important step toward development of a listener-targeted treatment approach requires establishment of its ecological validity. To this end, the present study leveraged the mechanism of crowdsourcing to determine whether perceptual-training benefits achieved by listeners in the laboratory could be elicited in an at-home computer-based scenario. METHOD Perceptual-training data (i.e., intelligibility scores from a posttraining transcription task) were collected from listeners in 2 settings-the laboratory and the crowdsourcing website Amazon Mechanical Turk. RESULTS Consistent with previous findings, results revealed a main effect of training condition (training vs. control) on intelligibility scores. There was, however, no effect of training setting (Mechanical Turk vs. laboratory). Thus, the perceptual benefit achieved via Mechanical Turk was comparable to that achieved in the laboratory. CONCLUSION This study provides evidence regarding the ecological validity of perceptual-training paradigms designed to improve intelligibility of dysarthric speech, thereby supporting their continued advancement as a listener-targeted treatment option.
Collapse
|
48
|
Theodoros DG, Hill AJ, Russell TG. Clinical and Quality of Life Outcomes of Speech Treatment for Parkinson's Disease Delivered to the Home Via Telerehabilitation: A Noninferiority Randomized Controlled Trial. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 25:214-232. [PMID: 27145396 DOI: 10.1044/2015_ajslp-15-0005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 11/30/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE This study investigated the noninferiority and validity of an intensive speech treatment for people with Parkinson's disease (PD) delivered via telerehabilitation to the home. The effect of location on online delivery was also investigated. METHOD In this single-blinded, randomized controlled noninferiority trial, 31 participants with dysarthria associated with PD from a metropolitan area were randomly assigned to either face-to-face or online Lee Silverman Voice Treatment (LSVT LOUD). A cohort of 21 participants from nonmetropolitan areas was also recruited and treated online. Outcomes were assessed using acoustic, perceptual, and quality of life measures. RESULTS Noninferiority of online treatment was confirmed through comparable clinical and quality of life outcomes for the metropolitan online and face-to-face treatment groups. Significant improvements posttreatment were achieved for several acoustic, perceptual, and quality of life measures across the groups. No significant effect of online treatment location was identified. CONCLUSIONS Clinical and quality of life outcomes supported the noninferiority and validity of online delivery of intensive speech treatment to people with PD in the home. Future research should address the implementation of online treatment in a clinical service, cost analyses, and potentially technology-enabled clinical pathways for people with PD in order to maintain optimal communication and quality of life.
Collapse
|
49
|
Douglas NF. Organizational context associated with time spent evaluating language and cognitive-communicative impairments in skilled nursing facilities: Survey results within an implementation science framework. JOURNAL OF COMMUNICATION DISORDERS 2016; 60:1-13. [PMID: 26851747 DOI: 10.1016/j.jcomdis.2015.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 11/13/2015] [Accepted: 11/17/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND The Consolidated Framework for Implementation Research (CFIR) was developed to merge research and practice in healthcare by accounting for the many elements that influence evidence-based treatment implementation. These include characteristics of the individuals involved, features of the treatment itself, and aspects of the organizational culture where the treatment is being provided. AIMS The purpose of this study was to apply the CFIR to a measurement of current practice patterns of speech-language pathologists (SLPs) working in the skilled nursing facility (SNF) environment. In an effort to inform future evidence-based practice implementation interventions, research questions addressed current practice patterns, clinician treatment use and preferences, and perceptions of the organizational context including leadership, resources, and other staff. METHODS AND PROCEDURES Surveys were mailed to each SLP working in a SNF in the state of Michigan. Participants (N=77, 19% response rate) completed a survey mapping on to CFIR components impacting evidence-based practice implementation. Quantitative descriptive and nonparametric correlational analyses were completed. OUTCOMES AND RESULTS Use of evidence-based treatments by SLPs in SNFs was highly variable. Negative correlations between treating speech and voice disorders and treating swallowing disorders (rs=-.35, p<.01), evaluating language and cognitive-communicative disorders and treating swallowing disorders (rs=-.30, p<.01), treating language and cognitive-communicative disorders and treating swallowing disorders (rs=-.67, p<.01), and evaluating swallowing disorders and treating language and cognitive-communicative disorders (rs=-.37, p<.01) were noted. A positive correlation between the SLPs' perception of organizational context and time spent evaluating language and other cognitive-communicative disorders (rs=.27, p<.05) was also present. CONCLUSIONS Associative data suggest that the more an SLP in the SNF evaluates and treats swallowing disorders, the less he or she will evaluate speech, voice, language or other cognitive-communicative disorders. Further, SLPs in this sample spent more time evaluating language and cognitive-communicative impairments if they perceived their organizational context in a more positive way. The CFIR may guide treatment and implementation research to increase the uptake of evidence-based practices for SLPs working in the SNF setting.
Collapse
Affiliation(s)
- Natalie F Douglas
- Central Michigan University, Department of Communication Disorders, 1170 Health Professions Building, Mt. Pleasant, MI 48859, United States.
| |
Collapse
|
50
|
Watts CR. A retrospective study of long-term treatment outcomes for reduced vocal intensity in hypokinetic dysarthria. BMC EAR, NOSE, AND THROAT DISORDERS 2016; 16:2. [PMID: 26839511 PMCID: PMC4736551 DOI: 10.1186/s12901-016-0022-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/26/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Reduced vocal intensity is a core impairment of hypokinetic dysarthria in Parkinson's disease (PD). Speech treatments have been developed to rehabilitate the vocal subsystems underlying this impairment. Intensive treatment programs requiring high-intensity voice and speech exercises with clinician-guided prompting and feedback have been established as effective for improving vocal function. Less is known, however, regarding long-term outcomes of clinical benefit in speakers with PD who receive these treatments. METHODS A retrospective cohort design was utilized. Data from 78 patient files across a three year period were analyzed. All patients received a structured, intensive program of voice therapy focusing on speaking intent and loudness. The dependent variable for all analyses was vocal intensity in decibels (dBSPL). Vocal intensity during sustained vowel production, reading, and novel conversational speech was compared at pre-treatment, post-treatment, six month follow-up, and twelve month follow-up periods. RESULTS Statistically significant increases in vocal intensity were found at post-treatment, 6 months, and 12 month follow-up periods with intensity gains ranging from 5 to 17 dB depending on speaking condition and measurement period. Significant treatment effects were found in all three speaking conditions. Effect sizes for all outcome measures were large, suggesting a strong degree of practical significance. CONCLUSIONS Significant increases in vocal intensity measured at 6 and 12 moth follow-up periods suggested that the sample of patients maintained treatment benefit for up to a year. These findings are supported by outcome studies reporting treatment outcomes within a few months post-treatment, in addition to prior studies that have reported long-term outcome results. The positive treatment outcomes experienced by the PD cohort in this study are consistent with treatment responses subsequent to other treatment approaches which focus on high-intensity, clinician guided motor learning for voice and speech production in PD. Theories regarding the underlying neurophysiological response to treatment will be discussed.
Collapse
Affiliation(s)
- Christopher R. Watts
- Davies School of Communication Sciences & Disorders, Texas Christian University, TCU Box 297450, Fort Worth, TX 76129 USA
| |
Collapse
|