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Gates K, Knowles T, Mach H, Higginbotham J, Holder T. Speech Amplification Device Usage for the Management of Hypophonia: A Survey of Speech-Language Pathologists. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1662-1697. [PMID: 38563721 DOI: 10.1044/2024_ajslp-23-00395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
PURPOSE The purpose of this study was to survey speech-language pathologists (SLPs) who assess and treat people with Parkinson's disease (PD) to gather insights into their decision making regarding their use or potential use of speech amplification technology for the management of hypophonia. METHOD A total of 111 SLPs who were currently practicing in the United States or Canada and had experience working with clients with PD for at least 2 years completed an anonymous Qualtrics survey. Questions were designed to probe the following areas: (a) degree of familiarity with amplification devices as a form of treatment for PD, (b) attitudes and perceptions of the implementation of these devices for PD, and (c) factors that influence the clinical decision to prescribe such devices. RESULTS Most participants (75; 71%) reported they had considered prescribing a device to at least one client with PD. When asked at which stages of speech or voice impairment they would consider the use of an amplification device for clients with PD, the most common response was for clients with moderate or severe hypophonia who were not stimulable for louder speech. However, 36 (32%) respondents indicated they would also consider an amplification device for clients who were stimulable for louder speech with severe hypophonia. When asked to rank the most important factors they would weigh when considering the prescription of an amplification device, they ranked the client's preference and comfort level as the most important consideration. CONCLUSION This study provides valuable clinical insights regarding how SLPs can approach utilizing speech amplification devices in the therapy environment.
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Affiliation(s)
- Kelly Gates
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Thea Knowles
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Helen Mach
- Department of Communication Sciences and Disorders, University of Delaware, Newark
| | - Jeff Higginbotham
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Thea Holder
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
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Gates K, Knowles T, Mach H, Higginbotham J. Clinical Insights Into the Use of Speech Amplification Devices for Managing Hypophonia: Interviews With Speech-Language Pathologists. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1639-1661. [PMID: 38512013 DOI: 10.1044/2024_ajslp-23-00396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
PURPOSE The purpose of this qualitative interview study was to identify themes regarding considerations in the usage of speech amplification device usage for people with Parkinson's disease (PD) and hypophonia from the perspective of speech-language pathologists (SLPs). METHOD Eligible participants included SLPs currently practicing in the United States or Canada with experience working with clients with PD for at least 2 years. Ten SLPs participated in 60-min interviews conducted via Zoom. A semistructured interview guide was created prior to the interviews. The interviews were transcribed following their completion, and an iterative coding process was used to identify themes using thematic analysis. RESULTS Three main themes were identified from the interviews. The first theme encapsulated how clinicians described amplification devices as a potential treatment tool, which highlighted the nuances that may impact selecting an amplification device as a treatment option such as increased hypophonia or dysarthria severity and cognitive decline. The second theme highlighted how device selection depends on the individual needs of the user. Individual client characteristics (such as disease symptoms and individual needs and preferences) may impact the choice of amplification device. The last theme outlined the importance of involving family members in all stages of device use and involving other health care team members on a case-by-case basis. CONCLUSIONS The insights provided by the SLP participants help to understand the clinical decisions that are made when determining device candidacy, selecting a device, and evaluating device success. These insights can be used to improve research studies of augmentative management of hypophonia and guide more personalized management decisions.
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Affiliation(s)
- Kelly Gates
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Thea Knowles
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Helen Mach
- Department of Communication Sciences and Disorders, University of Delaware, Newark
| | - Jeff Higginbotham
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
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Contreras-Ruston F, Castillo-Allendes A, Saavedra-Garrido J, Ochoa-Muñoz AF, Hunter EJ, Kotz SA, Navarra J. Voice self-assessment in individuals with Parkinson's Disease as compared to general voice disorders. Parkinsonism Relat Disord 2024; 123:106944. [PMID: 38552350 DOI: 10.1016/j.parkreldis.2024.106944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Individuals with Parkinson's Disease (IwPD) often fail to adjust their voice in different situations, without awareness of this limitation. Clinicians use self-report questionnaires that are typically designed for individuals with General Voice Disorders (GVD) in the vocal assessment of IwPD. However, these instruments may not consider that IwPD have a reduced self-perception of their vocal deficits. This study aimed to compare self-reported vocal symptoms and voice loudness between IwPD and GVD. METHODS 28 IwPD and 26 with GVD completed the Voice Symptom Scale (VoiSS) questionnaire to evaluate their voice self-perception. Vocal loudness (dB) was also assessed. Univariate and multivariate analyses were used to compare the outcomes from these measures between the two groups. Principal Component Analysis and Hierarchical Clustering Analysis were applied to explore data patterns related to voice symptoms. RESULTS IwPD reported significantly fewer vocal symptoms than those with GVD in all VoiSS questionnaire domains. Multivariate principal component analysis found no significant correlations between VoiSS scores and participant similarities in voice measures. Despite experiencing hypophonia, IwPD scored lower in all VoiSS domains but still fell in the healthy voice range. Hierarchical Clustering Analysis grouped participants into three distinct categories, primarily based on age, vocal loudness, and VoiSS domain scores, distinguishing between PD and GVD individuals. CONCLUSIONS IwPD reported fewer vocal symptoms than GVD. The voice self-assessment seems to be unreliable to assess vocal symptoms in IwPD, at least regarding loudness. New self-report instruments tailored to PD individuals are needed due to their particular voice characteristics.
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Affiliation(s)
- Francisco Contreras-Ruston
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain; Faculty of Psychology and Neuroscience, Department of Neuropsychology & Psychopharmacology, Maastricht University, 6229 ER, Maastricht, the Netherlands; Speech-Language Pathology and Audiology Department - Universidad de Valparaíso, San Felipe, Chile.
| | - Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, USA; Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA
| | - Jorge Saavedra-Garrido
- Institute of Statistics, University of Valparaíso, Faculty of Science, Valparaíso, Chile; Department of Meteorology, University of Valparaíso, Valparaíso, Chile
| | - Andrés Felipe Ochoa-Muñoz
- Institute of Statistics, University of Valparaíso, Faculty of Science, Valparaíso, Chile; School of Statistics, Universidad del Valle, Cali, Colombia
| | - Eric J Hunter
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA
| | - Sonja A Kotz
- Faculty of Psychology and Neuroscience, Department of Neuropsychology & Psychopharmacology, Maastricht University, 6229 ER, Maastricht, the Netherlands
| | - Jordi Navarra
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
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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.
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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
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Konnai R, Van Harn M, Silbergleit A. Conversational Vocal Intensity in Parkinson's Disease: Treatment and Environmental Comparisons. J Voice 2023; 37:707-715. [PMID: 34134903 DOI: 10.1016/j.jvoice.2021.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Vibrotactile Feedback (VF) using wearable devices is an emerging treatment option for hypophonia in Individuals with Parkinson's disease (IwPD). Studies evaluating the effectiveness of VF in improving conversational vocal intensity in real-life environment in IwPD are limited. OBJECTIVE To determine the effect of VF on conversational vocal intensity and compare vocal intensity between a) clinic and real-life environment b) VF and Lee Silverman Voice Treatment (LSVT LOUD®)vs. VF alone in IwPD using a portable voice monitor (VocaLog2). METHODS Eight individuals with hypophonia secondary to PD were randomly assigned to two treatment groups- VF and LSVT LOUD® (Group 1) and VF (Group 2). VF was provided using VocaLog2 device. Duration of treatment was 4 weeks for both groups. Vocal intensity was measured in the real-life environment at baseline, during treatment, and at one-month follow-up. Vocal intensity in clinic was obtained at baseline and one-month follow-up. Voice Handicap Index (VHI) questionnaire was administered at baseline and one-month follow-up. RESULTS There was no significant difference in conversational vocal intensity between a) clinic and real-life environment at any point of time b) baseline and follow up for both treatment groups c) the two treatment groups at baseline, during each of the 4 weeks of treatment and at follow up d) VHI baseline and one month follow up scores. CONCLUSION VF, including when combined with LSVT LOUD®, is limited in improving conversational vocal intensity in real-life in IwPD. The effects of frequency and duration of VF on conversational vocal intensity must be systematically investigated using large scale studies in IwPD.
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Affiliation(s)
- Ramya Konnai
- Department of Neurology, Henry Ford Health System, West Bloomfield, Michigan.
| | - Meredith Van Harn
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Alice Silbergleit
- Department of Neurology, Henry Ford Health System, West Bloomfield, Michigan
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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.
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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
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Crispiatico V, Baldanzi C, Bertuletti M, Grassi S, Tedeschi F, Groppo E, Rovaris M, Cattaneo D, Vitali C. Factors Associated With Treatment-Related Changes in Voice Volume in People With Multiple Sclerosis. Int J MS Care 2023; 25:1-7. [PMID: 36711218 PMCID: PMC9881420 DOI: 10.7224/1537-2073.2021-056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Vocal disorders are frequent in people with multiple sclerosis (MS). Cognitive impairment, fatigue, depression, and other clinical characteristics can be associated with treatment effectiveness in rehabilitation. Finding baseline characteristics that identify those who are responding to treatment can help the clinical decision-making process, which can then help improve the effectiveness of voice treatment. We developed a model to identify factors associated with treatment-related improvement on voice intensity in people with MS. METHODS Data are from a randomized controlled trial of the effects of voice therapy. Forty-four people with MS were enrolled and randomized to receive Lee Silverman Voice Treatment LOUD, specifically addressing voice intensity, or conventional speech-therapy group. Voice intensity (dB) was measured during monologue before and after treatment and was used to differentiate those who responded (posttreatment voice intensity > 60 dB) from those who did not. Possible associated factors were cognitive impairment, fatigue, depression, disability, and disease duration. Associations were assessed by univariate logistic regression and univariate and multivariate linear regressions. RESULTS Mean ± SD monologue voice intensity is improved in the whole sample (before rehabilitation: 51.8 ± 4.2 dB; and after rehabilitation 57.0 ± 6.5 dB; P < .001), and 11 people with MS (27.5%) responded to treatment. Specificity of treatment was associated with the return to normal voice intensity (OR, 14.28; 95% CI, 12.17-309.56) and we found a linear association between voice improvement and the specificity of treatment (6.65 [SE = 1.54] dB; P < .05). Moreover, the analysis revealed a nonlinear association between improvement and fatigue, suggesting increased benefits for people with MS with moderate fatigue. Other factors were not significantly associated with treatment effectiveness. CONCLUSIONS Moderate fatigue and the specificity of the intervention seem to be key factors associated with clinically relevant improvement in voice intensity even in people with MS with a high level of disability and long disease duration.
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Affiliation(s)
- Valeria Crispiatico
- From the ASTeR Lab Adult Speech-therapy Team Research and Department of Neurorehabilitation (VC, CB, MB, SG, FT, MR, DC, CV), IRCSS Fondazione Don Carlo Gnocchi, Milano, Italia
| | - Cinzia Baldanzi
- From the ASTeR Lab Adult Speech-therapy Team Research and Department of Neurorehabilitation (VC, CB, MB, SG, FT, MR, DC, CV), IRCSS Fondazione Don Carlo Gnocchi, Milano, Italia
| | - Martina Bertuletti
- From the ASTeR Lab Adult Speech-therapy Team Research and Department of Neurorehabilitation (VC, CB, MB, SG, FT, MR, DC, CV), IRCSS Fondazione Don Carlo Gnocchi, Milano, Italia
| | - Silvia Grassi
- From the ASTeR Lab Adult Speech-therapy Team Research and Department of Neurorehabilitation (VC, CB, MB, SG, FT, MR, DC, CV), IRCSS Fondazione Don Carlo Gnocchi, Milano, Italia
| | - Francesca Tedeschi
- From the ASTeR Lab Adult Speech-therapy Team Research and Department of Neurorehabilitation (VC, CB, MB, SG, FT, MR, DC, CV), IRCSS Fondazione Don Carlo Gnocchi, Milano, Italia
| | - Elisabetta Groppo
- From Ospedale San Paolo - ASST Santi Paolo e Carlo, Milano, Italia (EG)
| | - Marco Rovaris
- From the ASTeR Lab Adult Speech-therapy Team Research and Department of Neurorehabilitation (VC, CB, MB, SG, FT, MR, DC, CV), IRCSS Fondazione Don Carlo Gnocchi, Milano, Italia
| | - Davide Cattaneo
- From the ASTeR Lab Adult Speech-therapy Team Research and Department of Neurorehabilitation (VC, CB, MB, SG, FT, MR, DC, CV), IRCSS Fondazione Don Carlo Gnocchi, Milano, Italia
- From the Department of Physiopathology and Transplants, University of Milano, Italia (DC)
| | - Chiara Vitali
- From the ASTeR Lab Adult Speech-therapy Team Research and Department of Neurorehabilitation (VC, CB, MB, SG, FT, MR, DC, CV), IRCSS Fondazione Don Carlo Gnocchi, Milano, Italia
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Hallé MC, Delorme C, Coulombe É, Rekik O, Verduyckt I. Participants' perspective on a COVID-19 online vocal group stimulation for people with Parkinson's disease. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:951426. [PMID: 36189073 PMCID: PMC9397883 DOI: 10.3389/fresc.2022.951426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/12/2022] [Indexed: 11/15/2022]
Abstract
The COVID-19 related confinement and social distancing had negative consequences on the health of individuals living with Parkinson's Disease (PD). In collaboration with a non-profit organization, we developed and implemented a daily online vocal stimulation group named “Musculation de la Voix” (MdlV) in April 2020. To better understand the potential of MdlV to diversify existing services available to people with PD experiencing vocal symptoms, this study aimed to explore participants' experience and perception of MdlV in terms of participation, motivations, feelings, perceived changes, and appreciation. The 45 individuals who registered to the Summer 2020 Semester of MdlV were invited to complete an online ten-question survey. Responses to the four close-ended questions were analyzed using descriptive statistics while statements provided in response to the six open-ended questions were subjected to an inductive qualitative content analysis. Thirty seven participants completed the survey. Results revealed that the sample of respondents was mostly constituted of individuals who were engaged in this activity since its very beginning (62,2%), participated daily (59,5%), intended to keep participating in the activity (97,3%), and had never received speech-language therapy (SLT) services before (72,97%). The qualitative analysis yielded one theme relating to prior services: “Previous SLT services are variable and perceived as beneficial but with limitations,” and three themes pertaining to MdlV: “Seeking improvement and support as initial motivations to engage in MdlV,” “Unanticipated benefits and desired gains catalyzing motivation to participate in MdlV,” and “Perceived limitations of MdlV and persisting needs.” Our study participants' engagement and motivation toward MdlV as well as the benefits they perceived in relation to this activity suggest that an online vocal stimulation group may be a promising complement to currently limited SLT services. As limitations and persisting needs were also identified, future studies are required to elucidate what aspect of MdlV works, for whom and how.
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Affiliation(s)
- Marie-Christine Hallé
- Laboratoire IV, École d'orthophonie et d'audiologie, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR) du Montréal Métropolitain, Montréal, QC, Canada
| | - Charline Delorme
- Laboratoire IV, École d'orthophonie et d'audiologie, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR) du Montréal Métropolitain, Montréal, QC, Canada
| | - Édith Coulombe
- Laboratoire IV, École d'orthophonie et d'audiologie, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR) du Montréal Métropolitain, Montréal, QC, Canada
| | - Ouswa Rekik
- Laboratoire IV, École d'orthophonie et d'audiologie, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR) du Montréal Métropolitain, Montréal, QC, Canada
| | - Ingrid Verduyckt
- Laboratoire IV, École d'orthophonie et d'audiologie, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR) du Montréal Métropolitain, Montréal, QC, Canada
- *Correspondence: Ingrid Verduyckt
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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.
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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
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Ganzeboom M, Bakker M, Beijer L, Strik H, Rietveld T. A serious game for speech training in dysarthric speakers with Parkinson's disease: Exploring therapeutic efficacy and patient satisfaction. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:808-821. [PMID: 35338751 PMCID: PMC9543756 DOI: 10.1111/1460-6984.12722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The increasing need for speech therapy due to our ageing population raises the demand on therapeutical resources. To meet this demand, innovative delivery of speech training is required. eHealth applications may provide a solution, as intensified and prolonged training is only possible and affordable in patients' home environment. AIMS This study explores the effects on speech intelligibility of game-based speech training that provides automatic feedback on loudness, pitch and pronunciation. Additionally, we investigate how satisfied patients are with the game-based speech training and how they experience the automatic feedback. Furthermore, patients' preferences for game-based speech training compared with face-to-face training are explored. METHODS AND PROCEDURES Eight adult dysarthric speakers with Parkinson's disease (PD) completed a 4-week game-based speech training in their home environment. For each speaker, 24 speech utterances were audio recorded 4 weeks before (T1), immediately before (T2) and immediately after (T3) the training. All speech samples were rated on speech intelligibility by 10 untrained listeners, by comparing them with the corresponding utterances realized by a healthy speaker. Changes over time were analysed using a linear mixed-effects analysis. Patient satisfaction with the game and the automatic feedback was assessed using a questionnaire. The preferences of patients were collected using a paired comparisons procedure in which the patients were asked whether they would prefer game-based or face-to-face speech training in four hypothetical scenarios with different hypothesized levels of speech improvement. OUTCOMES AND RESULTS While there was no significant difference in speech intelligibility ratings between T1 and T2, we did find one between T2 and T3. At T3, speech intelligibility was rated higher than at T2, indicating positive effects of the game-based speech training. Patients generally seemed satisfied with the game as average ratings were above 7 on a 10-point rating scale. Generally, patients agreed with the automatic feedback and could use it to positively change the way they spoke. Patients prefer the training that provides the highest hypothetical improvement, and thus do not prefer face-to-face above game-based therapy. CONCLUSIONS AND IMPLICATIONS The results of this study suggest that dysarthric speakers due to PD see game-based speech therapy as a valid alternative for face-to-face therapy and that it leads to an average improvement in speech intelligibility. For an optimal effect and user satisfaction it should preferably not be used in isolation but in combination with face-to-face training. In this manner, the strengths of both therapeutic deliveries can be harnessed. WHAT THIS PAPER ADDS What is already known on this subject Dysarthric speech in patients with PD is known to benefit from intensified and long-term speech therapy. The increasing need for speech therapy due to our ageing population raises the demand on therapeutical resources making highly frequent and long-term therapy difficult. eHealth provides the opportunity to intensify and prolong speech training in patients' home environment. A drill-and-practice method was employed and investigated in a web-based speech application, indicating positive effects on speech intelligibility. However, participants indicated a lack of variation in exercises making the training less enjoyable. Other research showed that serious games can increase enjoyment during training. What this paper adds to existing knowledge The results of this study show that it is possible to develop a serious game that can be successfully used for speech training by patients with dysarthria due to PD. Comparing speech intelligibility ratings before and after training, we observed significant improvements in speech intelligibility ratings. Patients generally agree with the automatic feedback and can use it to positively change the way they speak. Average ratings were above 7 on a 10-point scale, indicating that patients are satisfied with the game. Patients prefer the type of training (game based or face to face) that provides the highest hypothetical improvement. What are the potential or actual clinical implications of this work? The results of this study suggest that game-based speech training can improve speech intelligibility in patients. This indicates that it can be considered a suitable approach in the treatment of patients with dysarthria due to PD. Patients do not prefer game-based training above face-to-face training in all scenarios. For that reason, for every patient one should carefully consider how to optimally combine game-based and face-to-face training.
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Affiliation(s)
- Mario Ganzeboom
- Centre for Language StudiesRadboud University NijmegenNijmegenthe Netherlands
- Centre for Language and Speech TechnologyRadboud University NijmegenNijmegenthe Netherlands
| | - Marjoke Bakker
- Centre for Language and Speech TechnologyRadboud University NijmegenNijmegenthe Netherlands
- iXperium/Centre of Expertise Learning and Teaching with ICTHAN University of Applied SciencesNijmegenthe Netherlands
| | - Lilian Beijer
- Research DepartmentSint MaartenskliniekNijmegenthe Netherlands
- Chair Key Factors in Physiotherapy and Allied HealthcareHAN University of Applied SciencesNijmegenthe Netherlands
| | - Helmer Strik
- Centre for Language StudiesRadboud University NijmegenNijmegenthe Netherlands
- Centre for Language and Speech TechnologyRadboud University NijmegenNijmegenthe Netherlands
- Donders Institute for Brain, Cognition and BehaviourRadboud University NijmegenNijmegenthe Netherlands
| | - Toni Rietveld
- Centre for Language StudiesRadboud University NijmegenNijmegenthe Netherlands
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Maas JJL, De Vries NM, Bloem BR, Kalf JG. Design of the PERSPECTIVE study: PERsonalized SPEeCh Therapy for actIVE conversation in Parkinson's disease (randomized controlled trial). Trials 2022; 23:274. [PMID: 35395953 PMCID: PMC8990485 DOI: 10.1186/s13063-022-06160-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the effectiveness of personalized and home-based speech therapy on quality of life, intelligibility, and social participation for people with Parkinson’s disease (PD) who have a reduced intelligibility of speech. Background Speech problems in PD have a profound negative impact on social interaction and quality of life. Evidence for speech therapy in PD is growing, but more work remains needed to explore its full potential. Efficacy exists for highly intensive standardized speech treatment programs, but not all patients can comply with this rather intense intervention, especially the more severely affected ones. Here, we aim to study the effectiveness of personalized and home-based (remote) speech therapy in PD on quality of life and speech. The intervention will be supported by a dedicated speech training app. We expect that this approach will improve speech intelligibility and quality of life in patients irrespective of disease stage. Methods We will perform a single blind, randomized controlled trial, comparing 8 weeks of speech therapy to no intervention using a waiting list design. A total of 215 PD patients with problems in intelligibility will be recruited by 12 highly experienced speech therapists. All patients will be measured at baseline and after 8 weeks (primary endpoint). Additionally, the experimental group will be re-assessed one more time, after a wash-out period of 24 weeks. The control group will receive deferred treatment after 8 weeks, but without additional follow-up assessments. Our primary outcome is quality of life (as measured with PDQ-39). Secondary outcomes include speech and voice quality, intelligibility, severity of voice and speech complaints, and caregiver burden. Results The inclusion of participants has started on March 1, 2019, and is expected to be finalized on April 1, 2021. We expect to have the first results in January 2022. Conclusions We will investigate the effectiveness of speech therapy in PD. Particular strengths of our study include a randomized and single-blinded design, the personalized treatment approach, the inclusion of PD patients irrespective of disease stage or severity of the speech complaint, the long-term follow-up, the adequate power, and the use of a patient-relevant primary endpoint. This will allow us to draw firm conclusions about the effectiveness of personalized and remote speech therapy for PD patients in all disease stages. Trial registration ClinicalTrials.govNCT03963388. Registered on May 24, 2019
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Affiliation(s)
- J J L Maas
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - N M De Vries
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J G Kalf
- Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
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12
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Finnimore A, Theodoros D, Rumbach A. The Impact of PD Check-In, a Model for Supported Self-Managed Maintenance of Speech on the Quality of Life of People with Parkinson's Disease: A Phase 1 Study. Brain Sci 2022; 12:433. [PMID: 35447964 PMCID: PMC9030296 DOI: 10.3390/brainsci12040433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023] Open
Abstract
Quality of life (QoL) for people with Parkinson’s Disease (PD) is diminished by speech and communication changes. The impact of PD Check-In, an intervention for supported self-managed maintenance of speech following LSVT LOUD®, on QoL of people with PD was investigated. Sixteen people with PD and dysarthria completed LSVT LOUD followed by PD Check-Ins up until 24 months post-treatment. Self-rated QoL and voice handicap scales were used to determine the psychosocial and perceived impact of PD Check-In on the speech and voice of people with PD. The perceived impact of PD Check-In on speech and voice was also sought from 15 communication partners (CPs). A significant treatment effect for time was identified for the Dysarthria Impact Profile (DIP), Voice Handicap Index (VHI), and Voice Handicap Index-Partner (VHI-P) (p < 0.05). There was no significant effect for time for the Parkinson’s Disease Questionnaire (PDQ-39). Planned comparisons of timepoints for DIP, VHI, and VHI-P showed no significant differences (p > 0.01). Comparison of perceived voice handicap by people with PD and CPs revealed no significant differences (p > 0.01). The impact of PD Check-In on QoL of people with PD and CPs for 24 months post-LSVT-LOUD is unclear. Self-reported outcome measures alone do not fully capture changes in QoL in PD.
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Affiliation(s)
- Ann Finnimore
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4067, Australia; (D.T.); (A.R.)
- Speech Pathology Department, The Prince Charles Hospital, Metro North Hospital & Health Service, Brisbane, QLD 4032, Australia
| | - Deborah Theodoros
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4067, Australia; (D.T.); (A.R.)
| | - Anna Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4067, Australia; (D.T.); (A.R.)
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Whelan BM, Theodoros D, Cahill L, Vaezipour A, Vogel AP, Finch E, Farrell A, Cardell E. Feasibility of a Telerehabilitation Adaptation of the Be Clear Speech Treatment Program for Non-Progressive Dysarthria. Brain Sci 2022; 12:brainsci12020197. [PMID: 35203960 PMCID: PMC8870717 DOI: 10.3390/brainsci12020197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 11/21/2022] Open
Abstract
This study evaluated the feasibility and outcomes of a telerehabilitation adaptation of the Be Clear speech treatment program for adults with non-progressive dysarthria to determine clinical delivery viability and future research directions. Treatment effects on speech clarity, intelligibility, communication effectiveness, and participation, as well as psychosocial outcomes in 15 participants with non-progressive dysarthria, were explored. Intervention involved daily 1-h online sessions (4 days per week for 4 weeks, totalling 16 sessions) and daily home practice. Outcome measures were obtained at baseline (PRE), post-treatment (POST), and 12 weeks following treatment (FUP). Feasibility measures targeting participant satisfaction, treatment adherence and fidelity, and technical viability were also employed. The programme was feasible concerning technical viability and implementation, treatment adherence and fidelity. High levels of participant satisfaction were reported. Increases in overall ratings of communication participation and effectiveness were identified at POST and FUP. Reductions in speech rate were identified at FUP. Improvements in aspects of lingual and laryngeal function were also noted after treatment. Over time, improvements relating to the negative impact of dysarthria were identified. Naïve listeners perceived negligible changes in speech clarity following treatment. Online delivery of the Be Clear speech treatment program was feasible, and some positive speech benefits were observed. Due to the small sample size included in this research, statistically significant findings related to speech outcomes must be interpreted with caution. An adequately powered randomised controlled trial of Be Clear online is warranted to evaluate treatment efficacy.
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Affiliation(s)
- Brooke-Mai Whelan
- Recover Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane 4072, Australia; (D.T.); (L.C.); (A.V.)
- Faculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia;
- Correspondence:
| | - Deborah Theodoros
- Recover Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane 4072, Australia; (D.T.); (L.C.); (A.V.)
- Faculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia;
| | - Louise Cahill
- Recover Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane 4072, Australia; (D.T.); (L.C.); (A.V.)
| | - Atiyeh Vaezipour
- Recover Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane 4072, Australia; (D.T.); (L.C.); (A.V.)
| | - Adam P. Vogel
- Centre for the Neuroscience of Speech, Department of Audiology and Speech Pathology, Melbourne School of Health Sciences, The University of Melbourne, Melbourne 3010, Australia;
- Redenlab Inc., Melbourne 3000, Australia
| | - Emma Finch
- Faculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia;
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Brisbane 4102, Australia
- The Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland Health, Brisbane 4102, Australia;
| | - Anna Farrell
- The Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland Health, Brisbane 4102, Australia;
- The Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Queensland Health, Brisbane 4029, Australia
| | - Elizabeth Cardell
- Menzies Health Institute Queensland, School of Medicine and Dentistry, Griffith University, Gold Coast 4215, Australia;
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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.
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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
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15
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Crispiatico V, Baldanzi C, Napoletano A, Tomasoni L, Tedeschi F, Groppo E, Rovaris M, Vitali C, Cattaneo D. Effects of voice rehabilitation in people with MS: A double-blinded long-term randomized controlled trial. Mult Scler 2021; 28:1081-1090. [PMID: 34652243 DOI: 10.1177/13524585211051059] [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: 11/16/2022]
Abstract
BACKGROUND Hypophonia is a prevailing problem in people with multiple sclerosis (PwMS). However, evidence supporting the effectiveness of voice rehabilitation is lacking. OBJECTIVE The aim of this study was to identify the most effective method to reduce hypophonia. METHODS In this randomized controlled trial, 44 PwMS were randomized to intensive and high-effort voice treatment groups, the LSVT-LOUD®, and conventional treatment group. Subjects received 16 treatments (4 sessions/week) lasting 45 minutes. The primary outcome was voice intensity (dB) in monologue, vocalization, and sentences while voice handicap index (VHI) measured voice self-perception. Outcomes were assessed by a blinded observer at baseline, post-treatment, and 15-month follow-up (FU). RESULTS Linear models revealed a significant post-intervention between-group mean difference in favor of LSVT-LOUD for monologue: +6.3 dB (95% CI: 2.5 to 10.1); vocalization: +7.4 dB (95% CI: 2.3 to 12.5); and sentences: +9.5 dB (95% CI: 4.7 to 14.3). However, 43.7% PwMS in the LSVT-LOUD and 10% in the conventional treatment group obtained a full recovery of voice intensity (>60 dB) post-treatment, Fisher's test = 13.3, p < 0.01. However, these improvements were not maintained at FU. Between-group differences at VHI were -10.8 (95% CI: -21.2 to -0.4) and -11.3 (95% CI: -24.3 to -1.7) in favor of LSVT-LOUD at post and FU. CONCLUSION LSVT-LOUD can be a valid treatment to increase voice intensity in PwMS. However, results suggest the need for FU interventions targeting maintenance.
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Affiliation(s)
| | | | | | | | | | - Elisabetta Groppo
- Ospedale San Paolo-Azienda Socio-Sanitaria Territoriale (ASST) Santi Paolo e Carlo, Milano, Italy
| | | | | | - Davide Cattaneo
- Department of of Pathophysiology and Transplantation, University of Milano, Milano, Italy
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Bryans LA, Palmer AD, Anderson S, Schindler J, Graville DJ. The impact of Lee Silverman Voice Treatment (LSVT LOUD®) on voice, communication, and participation: Findings from a prospective, longitudinal study. JOURNAL OF COMMUNICATION DISORDERS 2021; 89:106031. [PMID: 33259945 DOI: 10.1016/j.jcomdis.2020.106031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Lee Silverman Voice Treatment (LSVT LOUD®), an intensive 4-week program of voice therapy, is regarded as the most well-researched, efficacious treatment for hypokinetic dysarthria in individuals with Parkinson's disease (PD). Although numerous studies have published acoustic and perceptual findings, there is comparatively little information about the impact of LSVT LOUD® on functional communication outcomes. METHODS This prospective, longitudinal study investigated the impact of treatment on daily communication in 25 individuals with PD. Three validated communication measures (the Voice Handicap Index, the Communicative Effectiveness Scale, and the Communicative Participation Item Bank) were given before and after treatment and again 4-8 weeks and 3-6 months following treatment. Communication partners were also asked to rate communication effectiveness at all four timepoints. RESULTS Significant improvements were found for all three self-reported scales which remained above baseline across all post-treatment timepoints. In addition, self-reported communicative effectiveness was significantly correlated with the assessments of communication partners. Particular benefits were reported for more complex communicative activities such as asking questions, giving detailed information, communicating in noisy situations, and speaking in groups. CONCLUSIONS Overall, the findings suggested that LSVT LOUD® promotes an increased sense of personal control over the communication difficulties resulting from PD by decreasing voice handicap and improving communication effectiveness and communicative participation. For individuals with PD, LSVT LOUD® may reduce the risk of social isolation by improving communication and facilitating social participation. LEARNING OUTCOMES As a result of this activity, the participant will be able to (1) describe the impact of PD on voice and communication, (2) discuss how these characteristics may be associated with more global measures of functional communication and particularly communicative participation, (3) explain which aspects of functional communication were affected by LSVT LOUD® as assessed by study participants and their communication partners.
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Affiliation(s)
- Linda A Bryans
- NW Center for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Rd., Portland, OR, 97239, USA.
| | - Andrew D Palmer
- NW Center for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Rd., Portland, OR, 97239, USA.
| | - Shannon Anderson
- Dept. of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - Joshua Schindler
- NW Center for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Rd., Portland, OR, 97239, USA.
| | - Donna J Graville
- NW Center for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Rd., Portland, OR, 97239, USA.
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17
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Baldanzi C, Crispiatico V, Foresti S, Groppo E, Rovaris M, Cattaneo D, Vitali C. Effects of Intensive Voice Treatment (The Lee Silverman Voice Treatment [LSVT LOUD]) in Subjects With Multiple Sclerosis: A Pilot Study. J Voice 2020; 36:585.e1-585.e13. [PMID: 32819780 DOI: 10.1016/j.jvoice.2020.07.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 11/16/2022]
Abstract
AIM The rehabilitation of voice disorders is an unmet need in multiple sclerosis (MS). The Lee Silverman Voice Treatment (LSVT LOUD) is a well-documented and effective speech treatment, developed to treat voice disorders in Parkinson Disease. The purpose of the present study was to examine the viability of applying the LSVT LOUD to individuals with MS and verify short- and long-term improvements in acoustic and perceptual voice parameters. METHODS A single subject design was performed in a consecutive sample of 8 subjects with MS. The subjects' voice was recorded with PRAAT software for 5 days at baseline during the 16 treatment sessions, and at follow-up (FU) 6/12 months later. PRAAT provided data on sustained /a/ (SPL/a/) voice intensity and maximum phonation time (MPT/a/) of sustained /a/, and on functional sentences voice intensity. In addition, self-assessment questionnaire Voice Handicap Index, the perceptual GIRBAS scale and intensity of monologue were collected at first day of baseline, post-treatment and at FU. In the treatment phase each subject received treatment according to LSVT LOUD protocol. Visual analysis calculated for daily acoustic variables was used to determine baseline stability and analyse changes following treatment. The Wilcoxon test was used to assess statistically significant differences between baseline and post treatment. RESULTS All participants completed the LSVT LOUD programme; one participant dropped out at FU. Improvements in acoustic analysis were found: SPL/a/ improved on average (± standard deviation) 11.64 ± 4.19 dB with 7 subjects showing statistically significant improvement (P < 0.05); MPT/a/ improved on average 1.2 ± 1.53seconds, while intensity of functional sentences improved on average 8.11 ± 3.46 dB with 4 and 5 subjects showed statistically significant improvement, respectively. Intensity of monologue improved 14.90 ± 3.33 dB. Acoustic values are maintained or increased at FU respect to baseline. All subjects improved perceptual ratings at Voice Handicap Index and results were maintained at FU. These changes were associated with improvements on five parameters on the GIRBAS scale at post-treatment, however no further improvement were observed at FU. CONCLUSION Intensive LSVT LOUD treatment is a viable approach to treat hypophonia in MS. LSVT LOUD improved both quantitative-instrumental and perceptive-subjective assessments. Randomised controlled trials are needed to provide a firm support on the effectiveness of LSVT LOUD in MS.
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Affiliation(s)
| | | | | | - Elisabetta Groppo
- Ospedale San Paolo - Azienda Socio-Sanitaria Territoriale (ASST), Milano, Italy
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18
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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.
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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
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Monroe P, Halaki M, Kumfor F, Ballard KJ. The effects of choral singing on communication impairments in acquired brain injury: A systematic review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:303-319. [PMID: 32096327 DOI: 10.1111/1460-6984.12527] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/09/2020] [Accepted: 01/21/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Acquired brain injury (ABI), such as Parkinson's disease, dementia or stroke, can result in communication difficulties that lead to an impoverished ability to connect meaningfully with others. Choral singing is a complex task that uses multiple brain regions which are also responsible for language and communication skills. The potential therapeutic effects of group singing on communication-related outcomes across ABI aetiologies have not been systematically reviewed. AIMS To examine whether participation in group singing over multiple sessions improves speech, voice, language and/or communication skills in individuals with ABI-related communication disorders. METHODS & PROCEDURES A database search was undertaken according to the PRISMA guidelines. Search terms included: stroke OR Parkinson* OR dementia OR 'acquired brain injury' AND choir OR choral OR singing OR sing OR 'choral sing* ' OR group adj3 singing OR community adj3 singing AND speech OR language OR communication. MAIN CONTRIBUTION A total of 11 studies were included. Nine were quantitative, including one randomized and one non-randomized control trial, and two were mixed method. Nine studies were scored as level IV (uncontrolled) on the American Academy of Neurology (AAN) Classification of Evidence Matrix and two as level III (e.g., lack of blinded assessors). Eight examined speech and voice skills in Parkinson's disease, two functional communication skills in post-stroke aphasia and one communication between individuals with dementia and a significant other. One level III control trials provided evidence for a therapeutic effect of group singing on communication in individuals with Parkinson's disease. CONCLUSIONS & IMPLICATIONS Currently, there is only one study providing support for using group singing to improve speech and voice skills in people with Parkinson's disease, and no studies of adequate quality indicating positive effects on language and functional communication abilities in ABI. Further research using more rigorous experimental designs is required to determine whether group singing can influence communication skills in ABI. What this paper adds What is already known on the subject Music activates widespread, bilateral cortical and subcortical brain regions. Group singing is increasingly understood to have positive benefits on quality of life and health-related well-being in both healthy and clinical populations. Given the crossover in neural networks between singing, speech and language, singing activities are also thought to have positive effect of communication impairments secondary to ABI. However, to date, the research evidence supporting the application of group singing for communication impairments in ABI has not been summarized. What this paper adds to existing knowledge A total of 11 studies have looked at communication outcomes after group singing in ABI. For most of these, the quality of evidence was low (AAN level IV). It also highlights that there is a bias in the literature towards the studying individuals with Parkinson's disease (i.e., nine of the 11 studies). What are the potential or actual clinical implications of this work? This review concludes that, currently, there is emerging evidence to support positive effects of a group singing for speech and voice symptoms in individuals with Parkinson's disease, when provided using the Tamplin protocol. However, there is not yet any evidence for communication benefits for individuals with aphasia or dementia.
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Affiliation(s)
- Penelope Monroe
- Discipline of Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Mark Halaki
- Discipline of Exercise and Sport Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Fiona Kumfor
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Kirrie J Ballard
- Discipline of Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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Godoy J, Silverio K, Brasolotto A. Effectiveness of Vocal Therapy for the Elderly When Applying Conventional and Intensive Approaches: A Randomized Clinical Trial. J Voice 2019; 33:809.e19-809.e26. [DOI: 10.1016/j.jvoice.2018.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/26/2018] [Indexed: 11/16/2022]
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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.
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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
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Gaballah A, Parsa V, Andreetta M, Adams S. Objective and Subjective Speech Quality Assessment of Amplification Devices for Patients With Parkinson’s Disease. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1226-1235. [DOI: 10.1109/tnsre.2019.2915172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Aerodynamic findings and Voice Handicap Index in Parkinson’s disease. Eur Arch Otorhinolaryngol 2018; 275:1569-1577. [PMID: 29687184 DOI: 10.1007/s00405-018-4967-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
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Sackley CM, Smith CH, Rick CE, Brady MC, Ives N, Patel S, Woolley R, Dowling F, Patel R, Roberts H, Jowett S, Wheatley K, Kelly D, Sands G, Clarke CE. Lee Silverman Voice Treatment versus standard speech and language therapy versus control in Parkinson's disease: a pilot randomised controlled trial (PD COMM pilot). Pilot Feasibility Stud 2018; 4:30. [PMID: 29344405 PMCID: PMC5763537 DOI: 10.1186/s40814-017-0222-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 12/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Speech-related problems are common in Parkinson's disease (PD), but there is little evidence for the effectiveness of standard speech and language therapy (SLT) or Lee Silverman Voice Treatment (LSVT LOUD®). METHODS The PD COMM pilot was a three-arm, assessor-blinded, randomised controlled trial (RCT) of LSVT LOUD®, SLT and no intervention (1:1:1 ratio) to assess the feasibility and to inform the design of a full-scale RCT. Non-demented patients with idiopathic PD and speech problems and no SLT for speech problems in the past 2 years were eligible. LSVT LOUD® is a standardised regime (16 sessions over 4 weeks). SLT comprised individualised content per local practice (typically weekly sessions for 6-8 weeks). Outcomes included recruitment and retention, treatment adherence, and data completeness. Outcome data collected at baseline, 3, 6, and 12 months included patient-reported voice and quality of life measures, resource use, and assessor-rated speech recordings. RESULTS Eighty-nine patients were randomised with 90% in the therapy groups and 100% in the control group completing the trial. The response rate for Voice Handicap Index (VHI) in each arm was ≥ 90% at all time-points. VHI was highly correlated with the other speech-related outcome measures. There was a trend to improvement in VHI with LSVT LOUD® (difference at 3 months compared with control: - 12.5 points; 95% CI - 26.2, 1.2) and SLT (difference at 3 months compared with control: - 9.8 points; 95% CI - 23.2, 3.7) which needs to be confirmed in an adequately powered trial. CONCLUSION Randomisation to a three-arm trial of speech therapy including a no intervention control is feasible and acceptable. Compliance with both interventions was good. VHI and other patient-reported outcomes were relevant measures and provided data to inform the sample size for a substantive trial. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number Register: ISRCTN75223808. registered 22 March 2012.
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Affiliation(s)
| | - Christina H. Smith
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
| | - Caroline E. Rick
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Marian C. Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Smitaa Patel
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Francis Dowling
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Ramilla Patel
- Parkinson’s UK West Midlands Regional Branch, London, UK
| | - Helen Roberts
- Faculty of Medicine, University of Southampton, London, UK
| | - Sue Jowett
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Debbie Kelly
- School of Rehabilitation Sciences, University of East Anglia, Norwich, UK
| | - Gina Sands
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Carl E. Clarke
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Neurology, Clinical Neurology City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH UK
| | - on behalf of the PD COMM Pilot Collaborative Group
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
- Parkinson’s UK West Midlands Regional Branch, London, UK
- Faculty of Medicine, University of Southampton, London, UK
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
- School of Rehabilitation Sciences, University of East Anglia, Norwich, UK
- Department of Neurology, Clinical Neurology City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH UK
- School of Health Sciences, University of Nottingham, Nottingham, UK
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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
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Dias AE, Limongi JCP, Hsing WT, Barbosa ER. Telerehabilitation in Parkinson's disease: Influence of cognitive status. Dement Neuropsychol 2016; 10:327-332. [PMID: 29213477 PMCID: PMC5619273 DOI: 10.1590/s1980-5764-2016dn1004012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Background The need for efficacy in voice rehabilitation in patients with Parkinson's
disease is well established. Given difficulties traveling from home to
treatment centers, the use of telerehabilitation may represent an invaluable
tool for many patients. Objective To analyze the influence of cognitive performance on acceptance of
telerehabilitation. Methods Fifty patients at stages 2-4 on the Hoehn-Yahr scale, aged 45-87 years old,
with cognitive scores of19-30 on the Mini-Mental State Examination, and 4-17
years of education were enrolled. All patients were submitted to evaluation
of voice intensity pre and post in-person treatment with the Lee Silverman
Voice Treatment (LSVT) and were asked to fill out a questionnaire regarding
their preferences between two options of treatment and evaluating basic
technological competence. Results Comparisons between pre and post-treatment values showed a mean increase of
14dBSPL in vocal intensity. When asked about potential acceptance to
participate in future telerehabilitation, 38 subjects agreed to take part
and 12 did not. For these two groups, 26% and 17% self-reported
technological competence, respectively. Agreement to engage in remote
therapy was positively associated with years of education and cognitive
status. Conclusion Responses to the questionnaire submitted after completion of traditional
in-person LSVT showed that the majority of patients (76%) were willing to
participate in future telerehabilitation. Age, gender, disease stage and
self-reported basic technological skills appeared to have no influence on
the decision, whereas other factors such as cognitive status and higher
school education were positively associated with acceptance of the new
therapy approach.
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Affiliation(s)
- Alice Estevo Dias
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | | | - Wu Tu Hsing
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - Egberto Reis Barbosa
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
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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.
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Affiliation(s)
- Christopher R. Watts
- Davies School of Communication Sciences & Disorders, Texas Christian University, TCU Box 297450, Fort Worth, TX 76129 USA
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Iddon H, Read J, Miller N. Does voice amplification increase intelligibility in people with Parkinson's disease? INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.10.479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: Patients with speech intelligibility difficulties associated with a quiet voice are often prescribed a voice amplifier. This study examined whether artificial voice amplification improved intelligibility in people with Parkinson's disease and whether there was an optimum increase that brought about best improvement. Methods: Twelve people diagnosed with Parkinson's disease (mild=4, moderate intelligibility difficulties=8) and five age-matched controls read low predictability sentences in their habitual voice. Audio recordings were digitally manipulated to create samples at +2.3 dB, +5 dB and +10 dB amplification. Listeners transcribed the recorded sentences. The percentage of words correctly identified was compared across levels of amplification and groups. Results: Participants with moderate Parkinson's disease were significantly less intelligible than controls in all conditions. Moderately, but not mildly affected participants with Parkinson's disease showed higher intelligibility in the amplified conditions, though statistically significantly only at +2.3 dB. No other significant effects of intensity or interactions with groups were found. At an individual level, some participants showed clear advantages of amplification. Conclusion: Based on results from the current participants, potential benefits of amplification cannot be promised to all people with Parkinson's disease. Nevertheless, several provisos regarding methods employed suggest the question can gainfully be pursued using broader measures to assess effects of amplification with more varied groups of people with Parkinson's disease and with other aetiologies where voice production can be an issue.
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Affiliation(s)
- Hannah Iddon
- Speech and language therapist, East Coast Community Health Care, Great Yarmouth, UK
| | - Jennifer Read
- Senior lecturer in speech pathology and therapy, Health Professions Department, Manchester Metropolitan University, Manchester, UK
| | - Nick Miller
- Professor and speech language clinician, Speech and Language Sciences, Newcastle University, Newcastle-Upon-Tyne, UK
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Atkinson-Clement C, Sadat J, Pinto S. Behavioral treatments for speech in Parkinson's disease: meta-analyses and review of the literature. Neurodegener Dis Manag 2015; 5:233-48. [DOI: 10.2217/nmt.15.16] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
SUMMARY Parkinson's disease (PD) results from neurodegenerative processes leading to alteration of motor functions. Most motor symptoms respond well to pharmacological and neurosurgical treatments, except some axial symptoms such as speech impairment, so-called dysarthria. However, speech therapy is rarely proposed to PD patients. This review aims at evaluating previous research on the effects of speech behavioral therapies in patients with PD. We also performed two meta-analyses focusing on speech loudness and voice pitch. We showed that intensive therapies in PD are the most effective for hypophonia and can lead to some improvement of voice pitch. Although speech therapy is effective in handling PD dysarthria, behavioral speech rehabilitation in PD still needs further validation.
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Affiliation(s)
- Cyril Atkinson-Clement
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France
| | - Jasmin Sadat
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France
| | - Serge Pinto
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France
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Kim J, Sidransky E, Lopez G. Understanding and managing parkinsonism in patients with glucocerebrosidase mutations. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1034271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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