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Scott AM, Clark J, Cardona M, Atkins T, Peiris R, Greenwood H, Wenke R, Cardell E, Glasziou P. Telehealth versus face-to-face delivery of speech language pathology services: A systematic review and meta-analysis. J Telemed Telecare 2024:1357633X241272976. [PMID: 39387166 DOI: 10.1177/1357633x241272976] [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: 10/12/2024]
Abstract
BACKGROUND There is an increasing demand for the provision of speech language pathology (SLP) services via telehealth. Therefore, we systematically reviewed randomized controlled trials comparing telehealth to face-to-face provision of SLP services. METHODS We searched Medline, Embase and Cochrane, clinical trial registries, and conducted a citation analysis to identify trials. We included randomized trials comparing similar care delivered live via telehealth (phone or video), to face-to-face. Primary outcomes included: % syllables stuttered (%SS) (for individuals who stutter); change in sound pressure levels monologue (for individuals with Parkinson's disease); and key function scores (for other areas). Where data were sufficient, mean differences were calculated. RESULTS Nine randomized controlled trials were included; eight evaluated video and one evaluated phone telehealth. Risk of bias was generally low or unclear, excepting blinding. There were no significant differences at any time-point up to 18 months for %SS (mean difference, MD 0.1, 95% CI -0.4 to 0.6, p = 0.70). For people with Parkinson's disease, there was no difference between groups in change in sound pressure levels (monologue) (MD 0.6, 95% CI -1.2 to 2.5, p = 0.49). Four trials investigated interventions for speech sound disorder, voice disorder and post-stroke dysphagia and aphasia; they found no differences between telehealth service delivery and face-to-face delivery. CONCLUSIONS Evidence suggests that the telehealth provision of SLP services may be a viable alternative to their provision face-to-face, particularly to people who stutter and people with Parkinson's disease. The key limitation is the small number of randomized controlled trials, as well as evidence on the quality of life, well-being and satisfaction and economic outcomes.
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Affiliation(s)
- Anna M Scott
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Magnolia Cardona
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Tiffany Atkins
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Ruwani Peiris
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Hannah Greenwood
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Rachel Wenke
- Gold Coast Health, Southport, Queensland, Australia
| | - Elizabeth Cardell
- School of Allied Health Services, Griffith University, Ipswich, Queensland, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
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Moya-Galé G, Hernández JD, Goudarzi A, Walsh SJ. ¿Notas La Diferencia? [Do You Hear the Difference?]: Perceptual Consequences of Intensive Voice Treatment in Spanish Speakers With Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:2872-2892. [PMID: 38513128 DOI: 10.1044/2023_jslhr-23-00379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE The primary objective of this study was to explore the effects of intensive voice-focused treatment on speech parameters in Spanish speakers with dysarthria associated with Parkinson's disease (PD) as perceived by naïve listeners. METHOD Fifteen Spanish speakers with dysarthria associated with PD received the Lee Silverman Voice Treatment (LSVT LOUD) for a month. Voice and speech recordings were conducted pretreatment, posttreatment, and at a 1-month follow-up. Thirty naïve adult listeners rated the perceptual dimensions of ease of understanding (EoU), resonance, articulatory precision, prosody, and voice quality from sentences extracted from an emotional monologue on a visual analogue scale. RESULTS EoU, resonance, articulatory precision, and voice quality significantly improved pre- to posttreatment, but gains were not maintained at follow-up. Speech severity was a significant source of variance in mean listener response for all perceptual dimensions, although the interaction between speech severity and time was only significant for resonance and voice quality. CONCLUSIONS LSVT LOUD may be beneficial to improve perceptual speech domains affected by PD in Spanish speakers with dysarthria. Its impact on the different speech subsystems may reflect a universal distribution of effects when directly targeting the glottal source. Language-specific contributions of each perceptual domain to speech intelligibility should be explored in further research to determine linguistically sensitive treatment targets.
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Levy ES, Moya-Galé G. Revisiting Dysarthria Treatment Across Languages: The Hybrid Approach. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:2893-2902. [PMID: 38056466 DOI: 10.1044/2023_jslhr-23-00629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
PURPOSE Ten years after Miller and Lowit's (2014) groundbreaking book providing a cross-linguistic perspective on motor speech disorders, we ask where we are regarding dysarthria treatment across languages in two specific populations: adults with Parkinson's disease (PD) and children with cerebral palsy (CP). METHOD In this commentary, we consider preliminary evidence for both language-independent and language-specific approaches to treatment and propose a hybrid approach to speech treatment across languages, centered on the individual with dysarthria who speaks any given language. CONCLUSIONS Treatment research on individuals with dysarthria secondary to PD and CP is advancing, but several areas remain to be explored. Next steps are suggested for addressing the paucity and complexity of cross-linguistic speech treatment research.
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Hoffmeister JD, Broadfoot CK, Schaen-Heacock NE, Lechner SA, Krasko MN, Nisbet AF, Russell J, Szot J, Glass TJ, Connor NP, Kelm-Nelson CA, Ciucci MR. Vocal and tongue exercise in early to mid-stage Parkinson disease using the Pink1-/- rat. Brain Res 2024; 1837:148958. [PMID: 38685371 PMCID: PMC11166513 DOI: 10.1016/j.brainres.2024.148958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/27/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
Vocal and swallowing deficits are common in Parkinson disease (PD). Because these impairments are resistant to dopamine replacement therapies, vocal and lingual exercise are the primary treatment, but not all individuals respond to exercise and neural mechanisms of treatment response are unclear. To explore putative mechanisms, we used the progressive Pink1-/- rat model of early to mid-stage PD and employed vocal and lingual exercises at 6- and 10-months of age in male Pink1-/- and wild type (WT) rats. We hypothesized that vocal and lingual exercise would improve vocal and tongue use dynamics and increase serotonin (5HT) immunoreactivity in related brainstem nuclei. Rats were tested at baseline and after 8 weeks of exercise or sham exercise. At early-stage PD (6 months), vocal exercise resulted in increased call complexity, but did not change intensity, while at mid-stage (10 months), vocal exercise no longer influenced vocalization complexity. Lingual exercise increased tongue force generation and reduced relative optical density of 5HT in the hypoglossal nucleus at both time points. The effects of vocal and lingual exercise at these time points are less robust than in prodromal stages observed in previous work, suggesting that early exercise interventions may yield greater benefit. Future work targeting optimization of exercise at later time points may facilitate clinical translation.
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Affiliation(s)
- J D Hoffmeister
- University of Minnesota, Dept. of Otolaryngology, 420 Delaware Street SE, Minneapolis, MN 55422, USA; University of Wisconsin-Madison, Dept. of Communication Sciences and Disorders, 1975 Willow Drive, Madison, WI 53706, USA.
| | - C K Broadfoot
- University of South Alabama, Dept. of Speech Pathology and Audiology, 5721 USA Drive N, HAHN 1119, Mobile, AL 36688, USA; University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - N E Schaen-Heacock
- University of Wisconsin-Madison, Dept. of Communication Sciences and Disorders, 1975 Willow Drive, Madison, WI 53706, USA; University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - S A Lechner
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - M N Krasko
- University of Wisconsin-Madison, Dept. of Communication Sciences and Disorders, 1975 Willow Drive, Madison, WI 53706, USA; University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - A F Nisbet
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - J Russell
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - J Szot
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - T J Glass
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - N P Connor
- University of Wisconsin-Madison, Dept. of Communication Sciences and Disorders, 1975 Willow Drive, Madison, WI 53706, USA; University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - C A Kelm-Nelson
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - M R Ciucci
- University of Wisconsin-Madison, Dept. of Communication Sciences and Disorders, 1975 Willow Drive, Madison, WI 53706, USA; University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA; University of Wisconsin-Madison, Neuroscience Training Program, 9531 WIMR II, 1111 Highland Ave., Madison, WI 53705, USA.
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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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Rong P, Benson J. Intergenerational choral singing to improve communication outcomes in Parkinson's disease: Development of a theoretical framework and an integrated measurement tool. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:722-745. [PMID: 36106430 DOI: 10.1080/17549507.2022.2110281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose: This study presented an initial step towards developing the evidence base for intergenerational choral singing as a communication-focussed rehabilitative approach for Parkinson's disease (PD).Method: A theoretical framework was established to conceptualise the rehabilitative effect of intergenerational choral singing on four domains of communication impairments - motor drive, timing mechanism, sensorimotor integration, higher-level cognitive and affective functions - as well as activity/participation, and quality of life. A computer-assisted multidimensional acoustic analysis was developed to objectively assess the targeted domains of communication impairments. Voice Handicap Index and the World Health Organization's Quality of Life assessment-abbreviated version were used to obtain patient-reported outcomes at the activity/participation and quality of life levels. As a proof of concept, a single subject with PD was recruited to participate in 9 weekly 1-h intergenerational choir rehearsals. The subject was assessed before, 1 week post, and 8 weeks post-choir.Result: Notable trends of improvement were observed in multiple domains of communication impairments at 1 week post-choir. Some improvements were maintained at 8 weeks post-choir. Patient-reported outcomes exhibited limited pre-post changes.Conclusion: This study provided the theoretical groundwork and an empirical measurement tool for future validation of intergenerational choral singing as a novel rehabilitation for PD.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, University of Kansas, Lawrence, KS, USA and
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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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Mohseni Z, Mohamadi R, Habibi SAH, Saffarian A, Abolghasemi J. Voice improvement following conventional speech therapy combined with singing intervention in people with Parkinson's disease: A three-arm randomised controlled trial. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:1752-1767. [PMID: 37282797 DOI: 10.1111/1460-6984.12900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/26/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Although speech and voice disorders are common in Parkinson's disease (PD), there is insufficient evidence to support the effectiveness of behavioural speech therapies in these patients. AIMS This study aimed to examine the effects of a new tele-rehabilitation program, a combining of conventional speech therapy and singing intervention, on voice deficits in patients with PD. METHODS & PROCEDURES This study was a three-armed, assessor-masked, randomised controlled trial. Thirty-three people with PD were randomly assigned to the combination therapy, conventional speech therapy, or singing intervention group. This study followed the Consolidated Standards of Reporting Trials guidelines for non-pharmacological treatment. Each patient participated in 12 tele-rehabilitation sessions over 4 weeks. The combination therapy group received speech and singing interventions simultaneously (respiratory, speech, voice, and singing exercises). Voice intensity as a primary outcome and the voice handicap index (VHI), maximum frequency range, jitter and shimmer as secondary outcomes were evaluated 1 week before the first intervention session, 1 week after the last intervention session and 3 months after the last evaluation. OUTCOMES & RESULTS The results of repeated measures analysis of variance showed a significant main effect of time on all outcomes in all three groups after treatment (p < 0.001). There was a significant group effect for voice intensity (p < 0.001), VHI (p < 0.001), maximum frequency range (p = 0.014) and shimmer (p = 0.001). The combination therapy group demonstrated a significant outperformance in the VHI and shimmer than the speech therapy (p = 0.038) and singing intervention (p < 0.001) groups. The results of this study also indicated that combination therapy group compared to singing intervention group had a larger effect on voice intensity (p < 0.001), shimmer (p < 0.001) and maximum frequency range (p = 0.048). CONCLUSIONS & IMPLICATION The results demonstrated that combining speech therapy with a singing intervention delivered through tele-rehabilitation might be more effective in improving voice problems in patients with PD. WHAT THIS PAPER ADDS What is already known on the subject Parkinson's disease (PD) is a neurological disorder that frequently causes disturbances in speech and voice, which negatively affect patients' quality of life. Although speech difficulties occur in 90% of patients with PD, evidence-based treatment options for speech and language problems in these patients are limited. Therefore, further studies are required to develop and assess evidence-based treatment programs. What this study adds The findings of this study showed that a combination therapy program including conventional speech therapy approaches and individual singing intervention provided through tele-rehabilitation may have a greater effect on the improvement of voice problems in people with PD compared to speech therapy and singing intervention alone. What are the clinical implications of this work? Tele-rehabilitation combination therapy is an inexpensive and enjoyable behavioural treatment. The advantages of this method are that it is easy to access, appropriate for many stages of voice problems in PD, requires no prior singing training, encourages voice health and self-management and maximises treatment resources available to people with PD. We believe that the results of this study can provide a new clinical basis for treatment of voice disorders in people with PD.
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Affiliation(s)
- Zeinab Mohseni
- Rehabilitation Research Center, Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Reyhane Mohamadi
- Rehabilitation Research Center, Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Amir Hasan Habibi
- Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Arezoo Saffarian
- Rehabilitation Research Center, Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Jamile Abolghasemi
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Zhu X, Dai G, Wang M, Tan M, Li Y, Xu Z, Lei D, Chen L, Chen X, Liu H. Continuous theta burst stimulation over right cerebellum for speech impairment in Parkinson's disease: study protocol for a randomized, sham-controlled, clinical trial. Front Aging Neurosci 2023; 15:1215330. [PMID: 37655339 PMCID: PMC10465698 DOI: 10.3389/fnagi.2023.1215330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/03/2023] [Indexed: 09/02/2023] Open
Abstract
Background Speech impairment is a common symptom of Parkinson's disease (PD) that worsens with disease progression and affects communication and quality of life. Current pharmacological and surgical treatments for PD have inconsistent effects on speech impairment. The cerebellum is an essential part of sensorimotor network that regulates speech production and becomes dysfunctional in PD. Continuous theta-burst stimulation (cTBS) is a non-invasive brain stimulation technique that can modulate the cerebellum and its connections with other brain regions. Objective To investigate whether cTBS over the right cerebellum coupled with speech-language therapy (SLT) can improve speech impairment in PD. Methods In this randomized controlled trial (RCT), 40 patients with PD will be recruited and assigned to either an experimental group (EG) or a control group (CG). Both groups will receive 10 sessions of standard SLT. The EG will receive real cTBS over the right cerebellum, while the CG will receive sham stimulation. Blinded assessors will evaluate the treatment outcome at three time points: pre-intervention, post-intervention, and at a 12-week follow-up. The primary outcome measures are voice/speech quality and neurobehavioral parameters of auditory-vocal integration. The secondary outcome measures are cognitive function, quality of life, and functional connectivity determined by resting-state functional magnetic resonance imaging (fMRI). Significance This trial will provide evidence for the efficacy and safety of cerebellar cTBS for the treatment of speech impairment in PD and shed light on the neural mechanism of this intervention. It will also have implications for other speech impairment attributed to cerebellar dysfunctions. Clinical trial registration www.chictr.org.cn, identifier ChiCTR2100050543.
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Affiliation(s)
- Xiaoxia Zhu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guangyan Dai
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meng Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingdan Tan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yongxue Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiqin Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Di Lei
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ling Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xi Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hanjun Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
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McAllister T, Nightingale C, Moya-Galé G, Kawamura A, Ramig LO. Crowdsourced Perceptual Ratings of Voice Quality in People With Parkinson's Disease Before and After Intensive Voice and Articulation Therapies: Secondary Outcome of a Randomized Controlled Trial. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1541-1562. [PMID: 37059078 PMCID: PMC10457080 DOI: 10.1044/2023_jslhr-22-00694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Limited research has examined the suitability of crowdsourced ratings to measure treatment effects in speakers with Parkinson's disease (PD), particularly for constructs such as voice quality. This study obtained measures of reliability and validity for crowdsourced listeners' ratings of voice quality in speech samples from a published study. We also investigated whether aggregated listener ratings would replicate the original study's findings of treatment effects based on the Acoustic Voice Quality Index (AVQI) measure. METHOD This study reports a secondary outcome measure of a randomized controlled trial with speakers with dysarthria associated with PD, including two active comparators (Lee Silverman Voice Treatment [LSVT LOUD] and LSVT ARTIC), an inactive comparator (untreated PD), and a healthy control group. Speech samples from three time points (pretreatment, posttreatment, and 6-month follow-up) were presented in random order for rating as "typical" or "atypical" with respect to voice quality. Untrained listeners were recruited through the Amazon Mechanical Turk crowdsourcing platform until each sample had at least 25 ratings. RESULTS Intrarater reliability for tokens presented repeatedly was substantial (Cohen's κ = .65-.70), and interrater agreement significantly exceeded chance level. There was a significant correlation of moderate magnitude between the AVQI and the proportion of listeners classifying a given sample as "typical." Consistent with the original study, we found a significant interaction between group and time point, with the LSVT LOUD group alone showing significantly higher perceptually rated voice quality at posttreatment and follow-up relative to the pretreatment time point. CONCLUSIONS These results suggest that crowdsourcing can be a valid means to evaluate clinical speech samples, even for less familiar constructs such as voice quality. The findings also replicate the results of the study by Moya-Galé et al. (2022) and support their functional relevance by demonstrating that the effects of treatment measured acoustically in that study are perceptually apparent to everyday listeners.
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Affiliation(s)
| | | | | | | | - Lorraine Olson Ramig
- University of Colorado Boulder
- National Center for Voice and Speech, Denver, CO
- Columbia University, New York, NY
- LSVT Global, Inc., Tucson, AZ
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Ribeiro VV, Nascimento W, da Silva RC, Gonçalves FM, Santos RS, Behlau M, de Araujo CM, Taveira KVM. Evidence on Vocal Interventions in Adults: A Scoping Review. J Voice 2023:S0892-1997(23)00101-7. [PMID: 37149394 DOI: 10.1016/j.jvoice.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To map the evidence on vocal intervention in people over 18 years old. METHODS A literature search was conducted using the following electronic databases: Cochrane Library, EMBASE, Latin American and Caribbean Literature on Health Sciences (LILACS), LIVIVO, Pubmed/Medline, Scopus, SpeechBITE, and Web of Science. Gray literature was also used as an information source through searches on Google Scholar, Open Grey, ProQuest Dissertation and Thesis, and the Brazilian digital library of theses and dissertations. Systematic reviews (SR) with a population of individuals over 18 years old were included. The included reviews addressed speech-language pathology interventions in the vocal area with reports of their respective outcome. The methodological quality of the included systematic reviews was analyzed using the AMSTAR II tool. Quantitative analysis was performed by frequency distribution, and qualitative research was analyzed through narrative synthesis. RESULTS A total of 2,443 references were retrieved, among which 20 studies met the inclusion criteria. The included studies had critically low quality, lacking the use of population, intervention, comparison, and outcome (PICO) components. Among the included SRs, 40% were made in Brazil, 45% were published in the Journal of Voice, and 75% analyzed dysphonic patients. The most frequent intervention was voice therapy (direct therapy associated with indirect therapy approaches). Positive results were observed in most of the outcomes for all studies. CONCLUSION Voice therapy was described as inducing positive effects for voice rehabilitation. However, due to the critically low quality of studies, the literature did not enable us to understand the best results for each intervention. Well-designed studies are necessary to clarify the relationship between the intervention goal and how the intervention was evaluated.
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Affiliation(s)
- Vanessa Veis Ribeiro
- Speech-language Pathology Course, Universidade de Brasília, Brasília, Distrito Federal, Brazil; Associated Postgraduate Program in Speech-Language Pathology, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil.
| | - Weslania Nascimento
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain
| | - Rebeca Cardoso da Silva
- Speech-language Pathology Departament, Universidade Federal de Sergipe, Lagarto, Sergipe, Brazil
| | - Flavio Magno Gonçalves
- Postgraduate Program in Communication Disorders, Universidade Tuiuti do Paraná, Curitiba, Paraná, Brazil
| | - Rosane Sampaio Santos
- Postgraduate Program in Communication Disorders, Universidade Tuiuti do Paraná, Curitiba, Paraná, Brazil
| | - Mara Behlau
- Postgraduate Program in Communication Disorders, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Karinna Veríssimo Meira Taveira
- Department of Morphology- Center of Biosciences, Associated Postgraduate Program in Speech-Language Pathology, Universidade Federal do Rio Grande do Note, Natal, Rio Grande do Norte, Brazil
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12
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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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13
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Behlau M, Almeida AA, Amorim G, Balata P, Bastos S, Cassol M, Constantini AC, Eckley C, Englert M, Gama ACC, Gielow I, Guimarães B, Lima LR, Lopes L, Madazio G, Moreti F, Mouffron V, Nemr K, Oliveira P, Padovani M, Ribeiro VV, Silverio K, Vaiano T, Yamasaki R. Reducing the gap between science and clinic: lessons from academia and professional practice - part B: traditional vocal therapy techniques and modern electrostimulation and photobiomodulation techniques applied to vocal rehabilitation. Codas 2022; 34:e20210241. [PMID: 36000681 PMCID: PMC9886189 DOI: 10.1590/2317-1782/20212021241pt] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023] Open
Abstract
This text is the continuation of the XVIII SBFa Congress publication. In part "A" we presented the analyses on clinical vocal evaluation. Part "B" focuses on vocal rehabilitation: 4. Traditional techniques of vocal therapy; 5. Modern techniques of electrostimulation and photobiomodulation applied to vocal rehabilitation. The numerous studies on the various programs, methods, and techniques of traditional rehabilitation techniques, and many with high quality of evidence, allow us to consider such procedures relatively well described, safe, and with known effects, accounting for the treatment of various vocal disorders. The scientific evidence with traditional techniques is recognized worldwide. New fronts of evolution, with electrostimulation or photobiomodulation used to handle voice problems, seem to be promising as coadjutant approaches. There are more studies on electrostimulation in vocal rehabilitation than with photobiomodulation; however, scientific evidence for these two modern techniques is still limited. Knowledge and caution are required for the application of either technique.
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Affiliation(s)
- Mara Behlau
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
- Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP - São Paulo (SP), Brasil.
| | - Anna Alice Almeida
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
- Universidade Federal da Paraíba – UFPB - João Pessoa (PB), Brasil.
| | - Geová Amorim
- Universidade Federal de Alagoas – UFAL - Maceió (AL), Brasil.
| | - Patrícia Balata
- Apta Comunicação, Recife (PE), Brasil.
- Universidade Federal de Pernambuco – UFPE - Recife (PE), Brasil.
| | - Sávio Bastos
- Centro de Fotobiomodulação e Saúde – CFOTOBIOS - Belém (PA), Brasil.
| | - Mauriceia Cassol
- Universidade Federal de Ciências da Saúde de Porto Alegre – UFCSPA - Porto Alegre (RS), Brasil.
| | | | - Claudia Eckley
- Faculdade de Ciências Médicas da Santa Casa de São Paulo – FCMSCSP - São Paulo (SP), Brasil.
| | - Marina Englert
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
| | | | - Ingrid Gielow
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
| | - Bruno Guimarães
- Clínica Bruno Guimarães Serviços de Fonoaudiologia e Fisioterapia, Fortaleza (CE), Brasil.
| | | | - Leonardo Lopes
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
- Universidade Federal da Paraíba – UFPB - João Pessoa (PB), Brasil.
| | | | - Felipe Moreti
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
- Centro Universitário da Faculdade de Medicina do ABC – FMABC - Santo André (SP), Brasil.
- Complexo Hospitalar Municipal de São Bernardo do Campo – CHMSBC - São Bernardo do Campo (SP), Brasil.
| | - Vanessa Mouffron
- Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
| | - Katia Nemr
- Universidade de São Paulo – USP - São Paulo (SP), Brasil.
| | | | - Marina Padovani
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
- Faculdade de Ciências Médicas da Santa Casa de São Paulo – FCMSCSP - São Paulo (SP), Brasil.
| | - Vanessa Veis Ribeiro
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
- Universidade Federal da Paraíba – UFPB - João Pessoa (PB), Brasil.
| | - Kelly Silverio
- Faculdade de Odontologia de Bauru, Universidade de São Paulo – USP - Bauru (SP), Brasil.
| | - Thays Vaiano
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
| | - Rosiane Yamasaki
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
- Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP - São Paulo (SP), Brasil.
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Moya-Galé G, Spielman J, Ramig LA, Campanelli L, Maryn Y. The Acoustic Voice Quality Index (AVQI) in People with Parkinson's Disease Before and After Intensive Voice and Articulation Therapies: Secondary Outcome of a Randomized Controlled Trial. J Voice 2022:S0892-1997(22)00080-7. [PMID: 35450735 PMCID: PMC9576821 DOI: 10.1016/j.jvoice.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The majority of individuals with Parkinson's disease (PD) experience voice and speech problems during the course of the disease. Despite the importance of voice quality in communication and the documented disordered voice quality in PD, few studies have explored the effects of speech treatment on this variable. STUDY DESIGN/METHODS A parallel arm, unblinded randomized controlled trial (RCT) was conducted with two active comparators, LSVT LOUD (n = 23) and LSVT ARTIC (n = 20), and an inactive comparator group of untreated individuals with PD (n = 22). A group of 20 healthy adults was also included for pre-treatment analysis. Voice recordings were obtained pre-treatment, immediately post-treatment and at 6-month follow-up. The acoustic voice quality index (AVQI) is reported here as a secondary outcome measure of the RCT. Linear mixed-effects regression analysis was performed with AVQI and sound pressure level (SPL) as dependent variables. Pearson correlation coefficient analysis was also conducted to explore the relationship between voice quality and SPL. RESULTS Statistically significant improvements in AVQI and SPL from pre-treatment to post-treatment and follow-up were only observed in the LSVT LOUD group. Voice quality significantly improved only from pre-treatment to follow-up in the LSVT ARTIC group, whilst significant improvements in SPL were observed during maximum phonation only immediately post-treatment. No significant changes were observed in the untreated group. DISCUSSION This study investigated the effects of intensive speech treatment targeting voice or targeting articulation on voice quality, as measured by the AVQI, in individuals with PD. Findings indicate that voice-focused treatment leads to greater improvements in voice quality in this population.
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Affiliation(s)
- Gemma Moya-Galé
- Department of Communication Sciences and Disorders, Long Island University, Brooklyn, New York.
| | | | - Lorraine A Ramig
- National Center for Voice and Speech-Denver, University of Colorado, Boulder, Colorado; Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York; LSVT Global, Inc, Tucson, Arizona
| | - Luca Campanelli
- Department of Communicative Disorders, The University of Alabama, Tuscaloosa, Alabama
| | - Youri Maryn
- Department of Otorhinolaryngology and Head and Neck Surgery, European Institute for ORL-HNS, Wilrijk, Belgium; Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium; Department of Speech-Language Therapy and Audiology, University College Ghent, Ghent, Belgium; School of Logopedics, Faculty of Psychology and Educational Sciences, Université Catolique de Louvain, Louvain-La-Neuve, Belgium; Phonanium, Lokeren, Belgium
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15
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Narayana S, Franklin C, Peterson E, Hunter EJ, Robin DA, Halpern A, Spielman J, Fox PT, Ramig LO. Immediate and long-term effects of speech treatment targets and intensive dosage on Parkinson's disease dysphonia and the speech motor network: Randomized controlled trial. Hum Brain Mapp 2022; 43:2328-2347. [PMID: 35141971 PMCID: PMC8996348 DOI: 10.1002/hbm.25790] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/16/2021] [Accepted: 01/07/2022] [Indexed: 11/07/2022] Open
Abstract
This study compared acoustic and neural changes accompanying two treatments matched for intensive dosage but having two different treatment targets (voice or articulation) to dissociate the effects of treatment target and intensive dosage in speech therapies. Nineteen participants with Parkinsonian dysphonia (11 F) were randomized to three groups: intensive treatment targeting voice (voice group, n = 6), targeting articulation (articulation group, n = 7), or an untreated group (no treatment, n = 6). The severity of dysphonia was assessed by the smoothed cepstral peak prominence (CPPS) and neuronal changes were evaluated by cerebral blood flow (CBF) recorded at baseline, posttreatment, and 7-month follow-up. Only the voice treatment resulted in significant posttreatment improvement in CPPS, which was maintained at 7 months. Following voice treatment, increased activity in left premotor and bilateral auditory cortices was observed at posttreatment, and in the left motor and auditory cortices at 7-month follow-up. Articulation treatment resulted in increased activity in bilateral premotor and left insular cortices that were sustained at a 7-month follow-up. Activation in the auditory cortices and a significant correlation between the CPPS and CBF in motor and auditory cortices was observed only in the voice group. The intensive dosage resulted in long-lasting behavioral and neural effects as the no-treatment group showed a progressive decrease in activity in areas of the speech motor network out to a 7-month follow-up. These results indicate that dysphonia and the speech motor network can be differentially modified by treatment targets, while intensive dosage contributes to long-lasting effects of speech treatments.
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Affiliation(s)
- Shalini Narayana
- Department of Pediatrics, Division of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Crystal Franklin
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA
| | | | - Eric J Hunter
- Department of Communicative Sciences and Disorders, Michigan State University, Lansing, Michigan, USA
| | - Donald A Robin
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, New Hampshire, USA
| | - Angela Halpern
- LSVT Global Inc, Tucson, Arizona, USA.,National Center for Voice and Speech and Department of Speech-Language and Hearing Sciences, University of Colorado-Boulder, Boulder, Colorado, USA
| | - Jennifer Spielman
- National Center for Voice and Speech and Department of Speech-Language and Hearing Sciences, University of Colorado-Boulder, Boulder, Colorado, USA.,Front Range Voice Care, Denver, Colorado, USA
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA.,Audie L. Murphy South Texas Veterans Administration Medical Center, San Antonio, Texas, USA
| | - Lorraine O Ramig
- LSVT Global Inc, Tucson, Arizona, USA.,National Center for Voice and Speech and Department of Speech-Language and Hearing Sciences, University of Colorado-Boulder, Boulder, Colorado, USA.,Columbia University, New York, New York, USA
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16
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Behlau M, Almeida AA, Amorim G, Balata P, Bastos S, Cassol M, Constantini AC, Eckley C, Englert M, Gama ACC, Gielow I, Guimarães B, Lima LR, Lopes L, Madazio G, Moreti F, Mouffron V, Nemr K, Oliveira P, Padovani M, Ribeiro VV, Silverio K, Vaiano T, Yamasaki R. Reducing the gap between science and clinic: lessons from academia and professional practice - part B: traditional vocal therapy techniques and modern electrostimulation and photobiomodulation techniques applied to vocal rehabilitation. Codas 2022. [DOI: 10.1590/2317-1782/20212021241en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT This text is the continuation of the XVIII SBFa Congress publication. In part “A” we presented the analyses on clinical vocal evaluation. Part “B” focuses on vocal rehabilitation: 4. Traditional techniques of vocal therapy; 5. Modern techniques of electrostimulation and photobiomodulation applied to vocal rehabilitation. The numerous studies on the various programs, methods, and techniques of traditional rehabilitation techniques, and many with high quality of evidence, allow us to consider such procedures relatively well described, safe, and with known effects, accounting for the treatment of various vocal disorders. The scientific evidence with traditional techniques is recognized worldwide. New fronts of evolution, with electrostimulation or photobiomodulation used to handle voice problems, seem to be promising as coadjutant approaches. There are more studies on electrostimulation in vocal rehabilitation than with photobiomodulation; however, scientific evidence for these two modern techniques is still limited. Knowledge and caution are required for the application of either technique.
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Affiliation(s)
- Mara Behlau
- Centro de Estudos da Voz, Brasil; Universidade Federal de São Paulo, Brasil
| | - Anna Alice Almeida
- Centro de Estudos da Voz, Brasil; Universidade Federal da Paraíba, Brasil
| | | | - Patrícia Balata
- Apta Comunicação, Brasil; Universidade Federal de Pernambuco, Brasil
| | | | - Mauriceia Cassol
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil
| | | | - Claudia Eckley
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brasil
| | | | | | | | - Bruno Guimarães
- Clínica Bruno Guimarães Serviços de Fonoaudiologia e Fisioterapia, Brasil
| | | | - Leonardo Lopes
- Centro de Estudos da Voz, Brasil; Universidade Federal da Paraíba, Brasil
| | | | - Felipe Moreti
- Centro de Estudos da Voz, Brasil; Centro Universitário da Faculdade de Medicina do ABC, Brasil; Complexo Hospitalar Municipal de São Bernardo do Campo, Brasil
| | | | | | | | - Marina Padovani
- Centro de Estudos da Voz, Brasil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brasil
| | | | | | | | - Rosiane Yamasaki
- Centro de Estudos da Voz, Brasil; Universidade Federal de São Paulo, Brasil
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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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Pu T, Huang M, Kong X, Wang M, Chen X, Feng X, Wei C, Weng X, Xu F. Lee Silverman Voice Treatment to Improve Speech in Parkinson's Disease: A Systemic Review and Meta-Analysis. PARKINSON'S DISEASE 2021; 2021:3366870. [PMID: 35070257 PMCID: PMC8782619 DOI: 10.1155/2021/3366870] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Speech changes occur in the early stages of Parkinson's disease (PD) and cause communication difficulties, leading to social isolation. Lee Silverman voice treatment (LSVT) is a speech therapy approach designed to improve patients' language and voice capabilities. OBJECTIVE The effectiveness of the LSVT was compared with that of other speech interventions or no treatment to evaluate PD patients with dysarthria. DESIGN Systematic review with meta-analysis of randomized trials. Data Sources: PubMed, Embase, Cochrane Library, CNKI, and SinoMed library were searched from inception to December 2021 related to PD and LSVT. METHOD Abstracts were screened and reviewed against the eligibility criteria (intervention group participants were PD assessed based on LSVT (LSVT Loud) and randomized control). RESULT Ten randomized controlled trials were identified on speech symptoms in patients with PD. Compared with the respiratory therapy (RET) exercise, or no training group, a significant improvement was detected in the sound press level (SPL) after immediate treatment during the reading of vowel and rainbow passages and an increase in semitone standard deviation (STSD). Furthermore, the LSVT training significantly increased the participants' scores on unified Parkinson's disease rating scale (UPDRS-III) and speech intelligibility. CONCLUSION This meta-analysis demonstrated the efficacy of LSVT in increasing vocal loudness and functional communication among individuals with PD. However, most studies included participants with mild-moderate PD. Thus, additional randomized controlled trials (RCTs) with large sample sizes are needed to validate the efficacy of LSVT in patients with different progressions of PD, including severe PD.
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Affiliation(s)
- Tingting Pu
- School of Pharmacy, Dali University, Yunnan 671000, Dali, China
- Department of Public Health, Chengdu Medical College, Sichuan 610500, Chengdu, China
| | - Min Huang
- Department of Physiology, Chengdu Medical College, Sichuan 610500, Chengdu, China
| | - Xiangyu Kong
- Department of Public Health, Chengdu Medical College, Sichuan 610500, Chengdu, China
| | - Meng Wang
- Department of Public Health, Chengdu Medical College, Sichuan 610500, Chengdu, China
| | - Xiangling Chen
- Department of Public Health, Chengdu Medical College, Sichuan 610500, Chengdu, China
| | - Xixi Feng
- Department of Public Health, Chengdu Medical College, Sichuan 610500, Chengdu, China
| | - Changyou Wei
- Department of Public Health, Chengdu Medical College, Sichuan 610500, Chengdu, China
| | - Xiechuan Weng
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Fan Xu
- Department of Public Health, Chengdu Medical College, Sichuan 610500, Chengdu, China
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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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20
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Van Stan JH, Whyte J, Duffy JR, Barkmeier-Kraemer J, Doyle P, Gherson S, Kelchner L, Muise J, Petty B, Roy N, Stemple J, Thibeault S, Tolejano CJ. Voice Therapy According to the Rehabilitation Treatment Specification System: Expert Consensus Ingredients and Targets. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2169-2201. [PMID: 34464550 PMCID: PMC8702840 DOI: 10.1044/2021_ajslp-21-00076] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/27/2021] [Accepted: 05/19/2021] [Indexed: 05/09/2023]
Abstract
Purpose Clinical trials have demonstrated that standardized voice treatment programs are effective for some patients, but identifying the unique individual treatment ingredients specifically responsible for observed improvements remains elusive. To address this problem, the authors used a taxonomy of voice therapy, the Rehabilitation Treatment Specification System (RTSS), and a Delphi process to develop the RTSS-Voice (expert consensus categories of measurable and unique voice treatment ingredients and targets). Method Initial targets and ingredients were derived from a taxonomy of voice therapy. Through six Delphi Rounds, 10 vocal rehabilitation experts rated the measurability and uniqueness of individual treatment targets and ingredients. After each round, revisions (guided by the experts' feedback) were finalized among a primary reader (a voice therapy expert) and two external readers (rehabilitation experts outside the field of voice). Consensus was established when the label and definition of an ingredient or target reached a supramajority threshold (≥ 8 of 10 expert agreement). Results Thirty-five target and 19 ingredient categories were agreed to be measurable, unique, and accurate reflections of the rules and terminology of the RTSS. Operational definitions for each category included differences in the way ingredients are delivered and the way individual targets are modified by those ingredients. Conclusions The consensus labels and operationalized ingredients and targets making up the RTSS-Voice have potential to improve voice therapy research, practice, and education/training. The methods used to develop these lists may be useful for other speech, language, and hearing treatment specifications. Supplemental Material https://doi.org/10.23641/asha.15243357.
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Affiliation(s)
- Jarrad H. Van Stan
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston
- MGH Institute of Health Professions, Boston, MA
| | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA
| | | | | | | | | | | | - Jason Muise
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
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21
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Vellata C, Belli S, Balsamo F, Giordano A, Colombo R, Maggioni G. Effectiveness of Telerehabilitation on Motor Impairments, Non-motor Symptoms and Compliance in Patients With Parkinson's Disease: A Systematic Review. Front Neurol 2021; 12:627999. [PMID: 34512495 PMCID: PMC8427282 DOI: 10.3389/fneur.2021.627999] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 07/19/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction: Parkinson's disease (PD) is a chronic neurodegenerative disease involving a progressive alteration of the motor and non-motor function. PD influences the patient's daily living and reduces participation and quality of life in all phases of the disease. Early physical exercise can mitigate the effects of symptoms but access to specialist care is difficult. With current technological progress, telemedicine, and telerehabilitation is now a viable option for managing patients, although few studies have investigated the use of telerehabilitation in PD. In this systematic review, was investigated whether telerehabilitation leads to improvements in global or specific motor tasks (gait and balance, hand function) and non-motor dysfunction (motor speech disorder, dysphagia). The impact of TR on quality of life and patient satisfaction, were also assessed. The usage of telerehabilitation technologies in the management of cognitive impairment was not addressed. Method: An electronic database search was performed using the following databases: PubMed/MEDLINE, COCHRANE Library, PEDro, and SCOPUS for data published between January 2005 and December 2019 on the effects of telerehabilitation systems in managing motor and non-motor symptoms. This systematic review was conducted in accordance with the PRISMA guideline and was registered in the PROSPERO database (CRD42020141300). Results: A total of 15 articles involving 421 patients affected by PD were analyzed. The articles were divided into two categories based on their topic of interest or outcome. The first category consisted of the effects of telerehabilitation on gait and balance (3), dexterity of the upper limbs (3), and bradykinesia (0); the second category regarded non-motor symptoms such as speech disorders (8) and dysphagia (0). Quality of life (7) and patient satisfaction (8) following telerehabilitation programs were also analyzed, as well as feasibility and costs. Conclusion: Telerehabilitation is feasible in people affected by PD. Our analysis of the available data highlighted that telerehabilitation systems are effective in maintaining and/or improving some clinical and non-clinical aspects of PD (balance and gait, speech and voice, quality of life, patient satisfaction). Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier: CRD42020141300.
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Affiliation(s)
- Chiara Vellata
- Istituti Clinici Scientifici Maugeri Spa - Società Benefit, Neurologic Rehabilitation Unit of Veruno Institute, Veruno, Italy
| | - Stefano Belli
- Istituti Clinici Scientifici Maugeri Spa - Società Benefit, Neurologic Rehabilitation Unit of Veruno Institute, Veruno, Italy
| | - Francesca Balsamo
- Istituti Clinici Scientifici Maugeri Spa - Società Benefit, Neurologic Rehabilitation Unit of Veruno Institute, Veruno, Italy
| | - Andrea Giordano
- Istituti Clinici Scientifici Maugeri Spa - Società Benefit, Bioengineering Service, Veruno, Italy
| | - Roberto Colombo
- Istituti Clinici Scientifici Maugeri Spa - Società Benefit, Bioengineering Service, Veruno, Italy
| | - Giorgio Maggioni
- Istituti Clinici Scientifici Maugeri Spa - Società Benefit, Neurologic Rehabilitation Unit of Veruno Institute, Veruno, Italy
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22
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Xu H, Bao Z, Liang D, Li M, Wei M, Ge X, Liu J, Li J. Speech and Language Therapy for Voice Problems in Parkinson's Disease: A Meta-Analysis. J Neuropsychiatry Clin Neurosci 2021; 32:344-351. [PMID: 32374650 DOI: 10.1176/appi.neuropsych.19020044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with Parkinson's disease (PD) commonly have speech and voice problems that affect their functional communication and that are not sensitive to pharmacological or neurosurgical treatments. The authors aimed to evaluate the effects of speech and language therapies (SLTs) on dysphonia in patients with PD by analyzing data from published randomized controlled trials (RCTs). Studies in English and Chinese that were related to speech and language treatment for patients with PD were retrieved from PubMed, Embase, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, Chinese Biomedical Literature Database, and Wanfang Database. On the basis of exclusion criteria, 391 records identified through the search were reduced to 10 studies that included 230 patients in the treatment groups and 205 patients in the control groups. A meta-analysis of data from the 10 studies was performed to examine the effects of SLTs on dysphonia in patients with PD. SLTs increased sound pressure level during sustained phonation, reading of the Rainbow Passage, and monologue 6 months after treatment, enhanced semitone standard deviation during reading of the Rainbow Passage more than 12 months after treatment, and reduced Voice Handicap Index scores among patients with PD with dysphonia problems at least 3 months after treatment. These findings demonstrate the efficacy of SLTs, especially Lee Silverman Voice Treatment, in increasing vocal loudness and functional communication among patients with PD. Further RCTs with large samples and multicenter participation are needed to validate the long-term effects and the efficacy of SLTs among patients with severe PD.
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Affiliation(s)
- Hongyan Xu
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Zhuohua Bao
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Daye Liang
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Mengxia Li
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Minguang Wei
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Xueqing Ge
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Jingli Liu
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Jinpin Li
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
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23
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Ertan E, Gürvit HI, Hanağası HH, Bilgiç B, Tunçer MA, Yılmaz C. Intensive voice treatment (the Lee Silverman Voice Treatment [LSVT ®LOUD]) for individuals with Wilson's disease and adult cerebral palsy: two case reports. LOGOP PHONIATR VOCO 2021; 47:262-270. [PMID: 34287100 DOI: 10.1080/14015439.2021.1951348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: In this case report, we aimed to examine the effects of an intensive voice treatment (the Lee Silverman Voice Treatment [LSVT®LOUD]) for Wilson's disease (WD), and adult cerebral palsy (CP), and dysarthria.Method: The participants received LSVT®LOUD four times a week for 4 weeks. Acoustic, perceptual (GRBAS) analyses were performed and data from the Voice Handicap Index (VHI) were obtained before and after treatment.Results: Besides the Harmonics-to Noise Ratio (HNR) value (dB) of the participant with WD, for both participants' fundamental frequencies (Hz), jitter (%), and shimmer (%) values showed significant differences (p < .05) after therapy. Both participants showed significant improvements (p < .05) in the duration (s) and the sound pressure level (dB, SPL) of sustained vowel phonation (/a/), in SPL (dB) of pitch range (high and low /a/) and reading and conversation (p < .01). There was a positive improvement in the high-frequency values (Hz) of both participants but not in the low-frequency values (Hz) in the participant with WD. Perceptual analysis with GRBAS judgements of sustained vowel (/a/) and paragraph reading of two participants also showed improvement. After therapy, perceived loudness of the participants' voice increased.Conclusions: The findings provide some preliminary observations that the individuals with WD and the adult individuals with CP can respond positively to intensive speech treatment such as LSVT®LOUD. Further studies are needed to investigate speech treatments specific to WD and adult CP.
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Affiliation(s)
- Esra Ertan
- Institut für Deutsche Sprache und Linguistik, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hakan I Gürvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Haşmet H Hanağası
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Başar Bilgiç
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Müge A Tunçer
- Department of Speech and Language Therapy, Faculty of Health Science, Sıtkı Koçman University, Muğla, Turkey
| | - Cemil Yılmaz
- Department of Speech and Language Therapy, Faculty of Health Science, Anadolu University, Eskişehir, Turkey
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24
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Single Word Intelligibility of Individuals with Parkinson's Disease in Noise: Pre-Specified Secondary Outcome Variables from a Randomized Control Trial (RCT) Comparing Two Intensive Speech Treatments (LSVT LOUD vs. LSVT ARTIC). Brain Sci 2021; 11:brainsci11070857. [PMID: 34199093 PMCID: PMC8301858 DOI: 10.3390/brainsci11070857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022] Open
Abstract
The majority of people with Parkinson's disease (PD) experience both prosodic changes (reduced vocal volume, reduced pitch range) and articulatory changes (imprecise articulation) that often limit speech intelligibility and may contribute to significant declines in quality of life. We conducted a randomized control trial comparing two intensive treatments, voice (LSVT LOUD) or articulation (LSVT ARTIC) to assess single word intelligibility in the presence of background noise (babble and mall). Participants (64 PD and 20 Healthy) read words from the diagnostic rhyme test (DRT), an ANSI Standard for measuring intelligibility of speech, before and after one month (treatment or no treatment). Teams of trained listeners blindly rated the data. Speech intelligibility of words in the presence of both noise conditions improved in PD participants who had LSVT LOUD compared to the groups that had LSVT ARTIC or no treatment. Intensive speech treatment targeting prominent prosodic variables in LSVT LOUD had a positive effect on speech intelligibility at the single word level in PD.
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25
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Senthinathan A, Adams S, Page AD, Jog M. Speech Intensity Response to Altered Intensity Feedback in Individuals With Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2261-2275. [PMID: 33830820 DOI: 10.1044/2021_jslhr-20-00278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Hypophonia (low speech intensity) is the most common speech symptom experienced by individuals with Parkinson's disease (IWPD). Previous research suggests that, in IWPD, there may be abnormal integration of sensory information for motor production of speech intensity. In the current study, intensity of auditory feedback was systematically manipulated (altered in both positive and negative directions) during sensorimotor conditions that are known to modulate speech intensity in everyday contexts in order to better understand the role of auditory feedback for speech intensity regulation. Method Twenty-six IWPD and 24 neurologically healthy controls were asked to complete the following tasks: converse with the experimenter, start vowel production, and read sentences at a comfortable loudness, while hearing their own speech intensity randomly altered. Altered intensity feedback conditions included 5-, 10-, and 15-dB reductions and increases in the feedback intensity. Speech tasks were completed in no noise and in background noise. Results IWPD displayed a reduced response to the altered intensity feedback compared to control participants. This reduced response was most apparent when participants were speaking in background noise. Specific task-based differences in responses were observed such that the reduced response by IWPD was most pronounced during the conversation task. Conclusions The current study suggests that IWPD have abnormal processing of auditory information for speech intensity regulation, and this disruption particularly impacts their ability to regulate speech intensity in the context of speech tasks with clear communicative goals (i.e., conversational speech) and speaking in background noise.
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Affiliation(s)
| | - Scott Adams
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Allyson D Page
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
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26
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Nozaki S, Fujiu-Kurachi M, Tanimura T, Ishizuka K, Miyata E, Sugishita S, Imai T, Nishiguchi M, Furuta M, Yorifuji S. Effects of Lee Silverman Voice Treatment (LSVT LOUD) on Swallowing in Patients with Progressive Supranuclear Palsy: A Pilot Study. Prog Rehabil Med 2021; 6:20210012. [PMID: 33644483 PMCID: PMC7897538 DOI: 10.2490/prm.20210012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/02/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives Progressive supranuclear palsy (PSP) is an uncommon progressive neurodegenerative disease with no effective cure at present. The initial symptoms resemble those of Parkinson's disease; however, the prevalence of PSP is about one-tenth that of Parkinson's disease. In many cases, dysphagia is severe, and the development of dysphagia is an early predictor of life expectancy. The aim of the current study was to define the effects of Lee Silverman Voice Treatment (LSVT LOUD) on swallowing and voice/speech in seven patients with PSP. Methods : Each patient underwent swallowing and voice/speech evaluations before and after 4 weeks of LSVT. Swallowing motility disorders were defined, temporal measures of swallowing were determined by videofluoroscopic evaluation, and voice measures of maximum phonation and speech intelligibility in reading and monologue were examined. Results After LSVT, the median duration of opening of the upper esophageal sphincter (from the beginning of the posterior movement of the bolus to upper esophageal sphincter opening) on videofluoroscopy was significantly shortened from 0.42 to 0.38 s (Wilcoxon signed-rank test P=0.016). The oral transit duration was decreased in five patients, but the decrease was not significant. Voice changes after LSVT included increases in voice intensity and in sustained duration were not significant. Conclusion In this small study, it was found that LSVT may improve swallowing functions in patients with PSP.
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Affiliation(s)
- Sonoko Nozaki
- Wakakusa Tatsuma Rehabilitation Hospital, Daito, Japan.,Kansai Rosai Hospital, Amagasaki, Japan
| | | | | | | | - Eri Miyata
- Kansai Medical University Hospital, Hirakata, Japan
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27
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Li Y, Tan M, Fan H, Wang EQ, Chen L, Li J, Chen X, Liu H. Neurobehavioral Effects of LSVT ® LOUD on Auditory-Vocal Integration in Parkinson's Disease: A Preliminary Study. Front Neurosci 2021; 15:624801. [PMID: 33716652 PMCID: PMC7952622 DOI: 10.3389/fnins.2021.624801] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
Individuals with Parkinson's disease (PD) are impaired in auditory-vocal integration, characterized by abnormal compensatory responses to auditory feedback errors during self-monitoring of vocal production. The present study examined whether auditory feedback control of vocal pitch production in PD can benefit from Lee Silverman voice treatment (LSVT® LOUD), a high effort, intensive speech treatment for hypokinetic dysarthria in PD. Before and immediately after LSVT LOUD, 12 individuals with PD were instructed to produce sustained vowel sounds while hearing their voice unexpectedly pitch-shifted by -200 cents. Their vocal responses and event-related potentials (ERPs) to pitch perturbations were measured to assess the treatment outcomes. A group of 12 healthy controls were one-to-one pair matched by age, sex, and language. Individuals with PD exhibited abnormally enhanced vocal and ERP P2 responses to pitch perturbations relative to healthy controls. Successful treatment with LSVT LOUD, however, led to significantly smaller and faster vocal compensations that were accompanied by significantly larger P2 responses. Moreover, improved vocal loudness during passage reading was significantly correlated with reduced vocal compensations for pitch perturbations. These preliminary findings provide the first neurobehavioral evidence for beneficial effects of LSVT LOUD on impaired auditory-vocal integration associated with PD, which may be related to improved laryngeal motor functions and a top-down modulation of the speech motor network by LSVT LOUD.
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Affiliation(s)
- Yongxue Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingdan Tan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Fan
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Emily Q. Wang
- Department of Communication Disorders and Sciences, RUSH University Medical Center, Chicago, IL, United States
| | - Ling Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingting Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xi Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hanjun Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
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28
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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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29
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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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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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The Impact of Respiratory Exercises on Voice Outcomes: A Systematic Review of the Literature. J Voice 2020; 34:648.e1-648.e39. [DOI: 10.1016/j.jvoice.2019.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 12/14/2022]
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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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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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Hsu SC, McAuliffe MJ, Lin P, Wu RM, Levy ES. Acoustic and Perceptual Consequences of Speech Cues for Mandarin Speakers With Parkinson's Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:521-535. [PMID: 31136238 DOI: 10.1044/2018_ajslp-18-0020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose This study investigated the effects of cueing for increased loudness and reduced speech rate on scaled intelligibility and acoustics of speech produced by Mandarin speakers with hypokinetic dysarthria due to Parkinson's disease (PD). Method Eleven speakers with PD read passages in habitual, loud, and slow speaking conditions. Fifteen listeners rated ease of understanding (EOU) of the speech samples on a visual analog scale. Effects of the cues on EOU, vocal loudness, pitch range, pause duration and frequency, articulation rate, and vowel space, as well as relationships between EOU gains and acoustic features, were analyzed. Results EOU increased significantly in the loud condition only. The loud cue resulted in increased intensity, and the slow cue resulted both in reduced articulation rate and increased pause frequency. In the loud condition, EOU increased significantly as intensity increased and vowel centralization decreased. In the slow condition, EOU tended to increase as intensity increased and vowel centralization decreased but did not reach statistical significance. Conclusion Cueing for loud speech may yield greater EOU gains than cueing for slow speech in Mandarin speakers with PD. Theoretical and clinical implications are discussed, although further investigations with more participants and a larger range of dysarthria severity are warranted.
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Affiliation(s)
- Sih-Chiao Hsu
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Megan J McAuliffe
- Department of Communication Disorders and New Zealand Institute of Language, Brain and Behaviour, University of Canterbury, Christchurch
| | - Peiyi Lin
- Institute for Learning Technologies, Teachers College, Columbia University, New York, NY
| | - Ruey-Meei Wu
- Centre of Parkinson and Movement Disorders, Department of Neurology, National Taiwan University Hospital, Taipei
- College of Medicine, National Taiwan University, Taipei
| | - Erika S Levy
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Abstract
The primary movement disorders affecting the voice are laryngeal dystonia (including spasmodic dysphonia), essential voice tremor, and Parkinson disease. Diagnosis of these conditions is clinical and based on a detailed history, voice evaluation, and physical and laryngoscopic examination. Laryngeal dystonia and essential voice tremor are hyperfunctional disorders and are treated most commonly with botulinum toxin injections. Parkinson disease is a hypofunctional disorder that may affect the voice and most commonly is treated with Lee Silverman Voice Treatment.
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Theodoros D, Aldridge D, Hill AJ, Russell T. Technology-enabled management of communication and swallowing disorders in Parkinson's disease: a systematic scoping review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:170-188. [PMID: 29923267 DOI: 10.1111/1460-6984.12400] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/07/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Communication and swallowing disorders are highly prevalent in people with Parkinson's disease (PD). Maintenance of functional communication and swallowing over time is challenging for the person with PD and their families and may lead to social isolation and reduced quality of life if not addressed. Speech and language therapists (SLTs) face the conundrum of providing sustainable and flexible services to meet the changing needs of people with PD. Motor, cognitive and psychological issues associated with PD, medication regimens and dependency on others often impede attendance at a centre-based service. The access difficulties experienced by people with PD require a disruptive service approach to meet their needs. Technology-enabled management using information and telecommunications technologies to provide services at a distance has the potential to improve access, and enhance the quality of SLT services to people with PD. AIMS To report the status and scope of the evidence for the use of technology in the management of the communication and swallowing disorders associated with PD. METHODS & PROCEDURES Studies were retrieved from four major databases (PubMed, CINAHL, EMBASE and Medline via Web of Science). Data relating to the types of studies, level of evidence, context, nature of the management undertaken, participant perspectives and the types of technologies involved were extracted for the review. MAIN CONTRIBUTION A total of 17 studies were included in the review, 15 of which related to the management of communication and swallowing disorders in PD with two studies devoted to participant perspectives. The majority of the studies reported on the treatment of the speech disorder in PD using Lee Silverman Voice Treatment (LSVT LOUD® ). Synchronous and asynchronous technologies were used in the studies with a predominance of the former. There was a paucity of research in the management of cognitive-communication and swallowing disorders. CONCLUSIONS & IMPLICATIONS Research evidence supporting technology-enabled management of the communication and swallowing disorders in PD is limited and predominantly low in quality. The treatment of the speech disorder online is the most developed aspect of the technology-enabled management pathway. Future research needs to address technology-enabled management of cognitive-communication and swallowing disorders and the use of a more diverse range of technologies and management approaches to optimize SLT service delivery to people with PD.
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Affiliation(s)
- Deborah Theodoros
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Danielle Aldridge
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Anne J Hill
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
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Bane M, Angadi V, Dressler E, Andreatta R, Stemple J. Vocal function exercises for normal voice: The effects of varying dosage. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:37-45. [PMID: 28925286 PMCID: PMC6207485 DOI: 10.1080/17549507.2017.1373858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE This study examined the effect of varying dosage of vocal function exercise (VFE) home practice on attainment of pre-established maximum phonation time (MPT) goals in individuals with normal voice. High dosage VFE practice was expected to result in greatest MPT. The overarching goal of this study was to contribute to a VFE dosage-response curve, potentially including a point of observable toxicity. METHOD Twenty-eight females ages 18-25 with normal voice participated in this pre-post longitudinal group study. Participants were randomly assigned to one of three experimental groups and completed a six-week VFE protocol with practice twice daily. The low dosage group performed each exercise once, the traditional group twice, and the high dosage group four times. The primary outcome measure was MPT as performed on the fourth VFE using the prescribed semi-occluded vocal tract posture. RESULT No toxic effects were observed. MPT increased for all participants, with significant improvement for traditional and high dosage groups. CONCLUSION High dosage VFEs may yield more rapid improvement in MPT, however benefits must be weighed against the risk of increased attrition. Low dosage VFEs insufficiently improved MPT. Further research on dosage is warranted, and should include individuals with disordered voice.
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Affiliation(s)
- Maria Bane
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
| | - Vrushali Angadi
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
| | - Emily Dressler
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
| | - Richard Andreatta
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
| | - Joseph Stemple
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
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Baumann A, Nebel A, Granert O, Giehl K, Wolff S, Schmidt W, Baasch C, Schmidt G, Witt K, Deuschl G, Hartwigsen G, Zeuner KE, van Eimeren T. Neural Correlates of Hypokinetic Dysarthria and Mechanisms of Effective Voice Treatment in Parkinson Disease. Neurorehabil Neural Repair 2018; 32:1055-1066. [DOI: 10.1177/1545968318812726] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Hypokinetic dysarthria is highly prevalent in idiopathic Parkinson disease (PD), and effectiveness of high-intensity voice treatment is well established. However, the neural correlates remain largely unknown. Objective. We aimed to specify cerebral pathophysiology of hypokinetic dysarthria and treatment-induced changes using functional magnetic resonance imaging (fMRI). Methods. We used fMRI to investigate healthy controls (HCs) and patients with idiopathic PD–associated dysarthria before and after treatment according to the Lee Silverman Voice Treatment LOUD (LSVT). During fMRI, participants covertly read sentences with normal (eg, conversation in a quiet room) or high (eg, shouting on a windy beach) intensity. In addition, we tested LSVT effects on intelligibility and different speech features (intensity, pitch, articulation). Results. LSVT effectively improved intelligibility, articulation, and pitch in patients. Covert high-intensity speech compared with covert normal-intensity speech led to increased activation of mainly secondary motor areas and bilateral superior and medial temporal regions. Prior to LSVT, patients showed less activity in several speech-associated areas compared with HCs. As a neural correlate of effective LSVT, increased right-sided superior temporal activity correlated with improved intelligibility. Conclusion. This is the first brain imaging study using a covert speech paradigm in PD, which revealed cortical hypoactivation as correlate of hypokinetic dysarthria. Furthermore, cortical correlates of effective LSVT treatment colocalized with the neuronal network, showing increased activation during high- versus normal-intensity speech generation.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Karsten Witt
- Carl von Ossietzky University Oldenburg, Germany
| | | | - Gesa Hartwigsen
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | | | - Thilo van Eimeren
- University Hospital of Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
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Ramig L, Halpern A, Spielman J, Fox C, Freeman K. Speech treatment in Parkinson's disease: Randomized controlled trial (RCT). Mov Disord 2018; 33:1777-1791. [PMID: 30264896 PMCID: PMC6261685 DOI: 10.1002/mds.27460] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/07/2018] [Accepted: 05/22/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND As many as 89% of people with Parkinson's disease (PD) develop speech disorders. OBJECTIVES This randomized controlled trial evaluated two speech treatments for PD matched in intensive dosage and high-effort mode of delivery, differing in subsystem target: voice (respiratory-laryngeal) versus articulation (orofacial-articulatory). METHODS PD participants were randomized to 1-month LSVT LOUD (voice), LSVT ARTIC (articulation), or UNTXPD (untreated) groups. Speech clinicians specializing in PD delivered treatment. Primary outcome was sound pressure level (SPL) in reading and spontaneous speech, and secondary outcome was participant-reported Modified Communication Effectiveness Index (CETI-M), evaluated at baseline, 1, and 7 months. Healthy controls were matched by age and sex. RESULTS At baseline, the combined PD group (n = 64) was significantly worse than healthy controls (n = 20) for SPL (P < 0.05) and CETI-M (P = 0.0001). At 1 and 7 months, SPL between-group comparisons showed greater improvements for LSVT LOUD (n = 22) than LSVT ARTIC (n = 20; P < 0.05) and UNTXPD (n = 22; P < 0.05). Sound pressure level differences between LSVT ARTIC and UNTXPD at 1 and 7 months were not significant (P > 0.05). For CETI-M, between-group comparisons showed greater improvements for LSVT LOUD and LSVT ARTIC than UNTXPD at 1 month (P = 0.02; P = 0.02). At 7 months, CETI-M between-group differences were not significant (P = 0.08). Within-group CETI-M improvements for LSVT LOUD were maintained through 7 months (P = 0.0011). CONCLUSIONS LSVT LOUD showed greater improvements than both LSVT ARTIC and UNTXPD for SPL at 1 and 7 months. For CETI-M, both LSVT LOUD and LSVT ARTIC improved at 1 month relative to UNTXPD. Only LSVT LOUD maintained CETI-M improvements at 7 months. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Lorraine Ramig
- University of Colorado‐BoulderBoulderColoradoUSA
- National Center for Voice and Speech‐DenverDenverColoradoUSA
- Columbia University‐New York CityNew YorkNew YorkUSA
- LSVT Global, Inc.‐TucsonTucsonArizonaUSA
| | - Angela Halpern
- University of Colorado‐BoulderBoulderColoradoUSA
- National Center for Voice and Speech‐DenverDenverColoradoUSA
- LSVT Global, Inc.‐TucsonTucsonArizonaUSA
| | - Jennifer Spielman
- University of Colorado‐BoulderBoulderColoradoUSA
- National Center for Voice and Speech‐DenverDenverColoradoUSA
| | - Cynthia Fox
- National Center for Voice and Speech‐DenverDenverColoradoUSA
- LSVT Global, Inc.‐TucsonTucsonArizonaUSA
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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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El Moudden I, Ouzir M, ElBernoussi S. Feature selection and extraction for class prediction in dysphonia measures analysis:A case study on Parkinson's disease speech rehabilitation. Technol Health Care 2017; 25:693-708. [PMID: 28826194 DOI: 10.3233/thc-170824] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Speech disorders such as dysphonia and dysarthria represent an early and common manifestation of Parkinson's disease. Class prediction is an essential task in automatic speech treatment, particularly in the Parkinson's disease case. Many classification experiments have been performed which focus on the automatic detection of Parkinson's disease patients from healthy speakers but results are still not optimistic. A major problem in accomplishing this task is high dimensionality of speech data. OBJECTIVE In this work, the potential of Principal Component Analysis (PCA) based modeling in dimensionality reduction is taken into consideration as the data smoothening tool with multiclass target expression data. METHODS On the basis of suggested PCA-based modeling, the power of class prediction using logistic regression (LR) and C5.0 in numeric data is investigated in publicly available Parkinson's disease dataset Silverman voice treatment (LSVT) to develop an advanced classification model. RESULTS The main advantage of our model is the effective reduction of the number of factors from p= 309 to k= 32 for LSVT Voice Rehabilitation dataset, with a fine classification accuracy of 100% and 99.92% for PCA-LR and PCA-C5.0 respectively. In addition, using only 9 dysphonia features, classification accuracy was (99.20%) and (99.11%) for PCA-LR, and PCA-C5.0 respectively. CONCLUSIONS Our combined dimension reduction and data smoothening approaches have significant potential to minimize the number of features and increase the classification accuracy and then automatically classify subjects into Parkinson's disease patients or healthy speakers.
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Affiliation(s)
- Ismail El Moudden
- Laboratory of Mathematics, Computer Science and Applications, Department of Mathematics, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco
| | - Mounir Ouzir
- Laboratory of Biochemistry and Immunology, Department of Biology, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco
| | - Souad ElBernoussi
- Laboratory of Mathematics, Computer Science and Applications, Department of Mathematics, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco
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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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Matheron D, Stathopoulos ET, Huber JE, Sussman JE. Laryngeal Aerodynamics in Healthy Older Adults and Adults With Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:507-524. [PMID: 28241225 PMCID: PMC5544190 DOI: 10.1044/2016_jslhr-s-14-0314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 08/07/2015] [Accepted: 06/23/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The present study compared laryngeal aerodynamic function of healthy older adults (HOA) to adults with Parkinson's disease (PD) while speaking at a comfortable and increased vocal intensity. METHOD Laryngeal aerodynamic measures (subglottal pressure, peak-to-peak flow, minimum flow, and open quotient [OQ]) were compared between HOAs and individuals with PD who had a diagnosis of hypophonia. Increased vocal intensity was elicited via monaurally presented multitalker background noise. RESULTS At a comfortable speaking intensity, HOAs and individuals with PD produced comparable vocal intensity, rates of vocal fold closure, and minimum flow. HOAs used smaller OQs, higher subglottal pressure, and lower peak-to-peak flow than individuals with PD. Both groups increased speaking intensity when speaking in noise to the same degree. However, HOAs produced increased intensity with greater driving pressure, faster vocal fold closure rates, and smaller OQs than individuals with PD. CONCLUSIONS Monaural background noise elicited equivalent vocal intensity increases in HOAs and individuals with PD. Although both groups used laryngeal mechanisms as expected to increase sound pressure level, they used these mechanisms to different degrees. The HOAs appeared to have better control of the laryngeal mechanism to make changes to their vocal intensity.
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Affiliation(s)
- Deborah Matheron
- Department of Communicative Disorders and Sciences, SUNY University at Buffalo, NY
- Department of Communication Disorders and Sciences, SUNY College at Cortland, NY
| | | | - Jessica E. Huber
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Joan E. Sussman
- Department of Communicative Disorders and Sciences, SUNY University at Buffalo, NY
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Theodoros DG, Constantinescu G, Russell TG, Ward EC, Wilson SJ, Wootton R. Treating the speech disorder in Parkinson's disease online. J Telemed Telecare 2016. [DOI: 10.1258/135763306779380101] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Lee Silverman Voice Treatment (LSVT) has been shown to be highly effective in treating the speech disorder in Parkinson's Disease (PD). However, patient access to this treatment remains limited in Australia, due to availability of speech pathologists, patient mobility and distance issues. We have investigated the feasibility and effectiveness of an Internet-based telerehabilitation application (eREHAB) for the delivery of the LSVT to persons with PD and disordered speech. Ten participants with PD and dysarthria were treated online with the LSVT for a total of 16 sessions. There were significant improvements in sound pressure levels for vowel prolongation, reading and conversational monologue (P<0.01), pitch range (P<0.05) and in perceptual features of pitch and loudness variability, loudness level (P<0.01) and breathiness (P<0.05). A participant satisfaction questionnaire indicated that 70% of participants expressed overall satisfaction with the online treatment. Telerehabilitation was feasible and effective in delivering the LSVT to people with PD.
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Affiliation(s)
| | | | - Trevor G Russell
- Division of Physiotherapy, University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- Division of Speech Pathology, University of Queensland, Brisbane, Australia
| | - Stephen J Wilson
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
| | - Richard Wootton
- Centre for Online Health, University of Queensland, Brisbane, 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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Theodoros DG, Hill AJ, Russell TG. Clinical and Quality of Life Outcomes of Speech Treatment for Parkinson's Disease Delivered to the Home Via Telerehabilitation: A Noninferiority Randomized Controlled Trial. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 25:214-232. [PMID: 27145396 DOI: 10.1044/2015_ajslp-15-0005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 11/30/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE This study investigated the noninferiority and validity of an intensive speech treatment for people with Parkinson's disease (PD) delivered via telerehabilitation to the home. The effect of location on online delivery was also investigated. METHOD In this single-blinded, randomized controlled noninferiority trial, 31 participants with dysarthria associated with PD from a metropolitan area were randomly assigned to either face-to-face or online Lee Silverman Voice Treatment (LSVT LOUD). A cohort of 21 participants from nonmetropolitan areas was also recruited and treated online. Outcomes were assessed using acoustic, perceptual, and quality of life measures. RESULTS Noninferiority of online treatment was confirmed through comparable clinical and quality of life outcomes for the metropolitan online and face-to-face treatment groups. Significant improvements posttreatment were achieved for several acoustic, perceptual, and quality of life measures across the groups. No significant effect of online treatment location was identified. CONCLUSIONS Clinical and quality of life outcomes supported the noninferiority and validity of online delivery of intensive speech treatment to people with PD in the home. Future research should address the implementation of online treatment in a clinical service, cost analyses, and potentially technology-enabled clinical pathways for people with PD in order to maintain optimal communication and quality of life.
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Fava G, Oliveira G, Baglione M, Pimpinella M, Spitzer JB. The Use of Sound Level Meter Apps in the Clinical Setting. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 25:14-28. [PMID: 26882093 DOI: 10.1044/2015_ajslp-13-0137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 08/25/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE The purpose of this study was to compare sound level meter (SLM) readings obtained using a Larson-Davis (Depew, NY) Model 831 Type 1 SLM, a RadioShack (Fort Worth, TX) SLM, and iPhone 5 (Apple, Cupertino, CA) SLM apps. METHOD In Procedure 1, pure tones were measured in an anechoic chamber (125, 250, 500, 1000, 2000, 4000, and 8000 Hz); sound pressure levels (SPLs) ranged from 60 to 100 dB SPL in 10-dB increments. In Procedure 2, human voices were measured. Participants were 20 vocally healthy adults (7 women, 13 men; mean age = 25.1 years). The task was to sustain a vowel "ah" at 3 intensity levels: soft, habitual, and loud. Microphones were lined up equal distances from the participant's mouth, and recordings were captured simultaneously. RESULTS Overall, the 3 SLM apps and the RadioShack SLM yielded inconsistent readings compared with the Type 1 SLM. CONCLUSION The use of apps for SPL readings in the clinical setting is premature because all 3 apps adopted were incomparable with the Type 1 SLM.
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Martens H, Van Nuffelen G, Dekens T, Hernández-Díaz Huici M, Kairuz Hernández-Díaz HA, De Letter M, De Bodt M. The effect of intensive speech rate and intonation therapy on intelligibility in Parkinson's disease. JOURNAL OF COMMUNICATION DISORDERS 2015; 58:91-105. [PMID: 26519934 DOI: 10.1016/j.jcomdis.2015.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/08/2015] [Accepted: 10/08/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Most studies on treatment of prosody in individuals with dysarthria due to Parkinson's disease are based on intensive treatment of loudness. The present study investigates the effect of intensive treatment of speech rate and intonation on the intelligibility of individuals with dysarthria due to Parkinson's disease. METHODS A one group pretest-posttest design was used to compare intelligibility, speech rate, and intonation before and after treatment. Participants included eleven Dutch-speaking individuals with predominantly moderate dysarthria due to Parkinson's disease, who received five one-hour treatment sessions per week during three weeks. Treatment focused on lowering speech rate and magnifying the phrase final intonation contrast between statements and questions. Intelligibility was perceptually assessed using a standardized sentence intelligibility test. Speech rate was automatically assessed during the sentence intelligibility test as well as during a passage reading task and a storytelling task. Intonation was perceptually assessed using a sentence reading task and a sentence repetition task, and also acoustically analyzed in terms of maximum fundamental frequency. RESULTS After treatment, there was a significant improvement of sentence intelligibility (effect size .83), a significant increase of pause frequency during the passage reading task, a significant improvement of correct listener identification of statements and questions, and a significant increase of the maximum fundamental frequency in the final syllable of questions during both intonation tasks. CONCLUSION The findings suggest that participants were more intelligible and more able to manipulate pause frequency and statement-question intonation after treatment. However, the relationship between the change in intelligibility on the one hand and the changes in speech rate and intonation on the other hand is not yet fully understood. Results are nuanced in the light of the operated research design. LEARNING OUTCOMES The reader will be able to: (1) describe the effect of intensive speech rate and intonation treatment on intelligibility of speakers with dysarthria due to PD, (2) describe the effect of intensive speech rate treatment on rate manipulation by speakers with dysarthria due to PD, and (3) describe the effect of intensive intonation treatment on manipulation of the phrase final intonation contrast between statements and questions by speakers with dysarthria due to PD.
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Affiliation(s)
- Heidi Martens
- Antwerp University, Faculty of Medicine and Health Sciences, Universiteitsplein 1, B-2610 Wilrijk, Belgium.
| | - Gwen Van Nuffelen
- Antwerp University, Faculty of Medicine and Health Sciences, Universiteitsplein 1, B-2610 Wilrijk, Belgium; Antwerp University Hospital, Rehabilitation Centre for Communication Disorders, Wilrijkstraat 10, B-2650 Edegem, Belgium; Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185, B-9000 Ghent, Belgium.
| | - Tomas Dekens
- Vrije Universiteit Brussel, Department of ETRO-DSSP, Pleinlaan 2, B-1050 Brussels, Belgium.
| | - Maria Hernández-Díaz Huici
- Antwerp University, Faculty of Medicine and Health Sciences, Universiteitsplein 1, B-2610 Wilrijk, Belgium.
| | | | - Miet De Letter
- Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185, B-9000 Ghent, Belgium.
| | - Marc De Bodt
- Antwerp University, Faculty of Medicine and Health Sciences, Universiteitsplein 1, B-2610 Wilrijk, Belgium; Antwerp University Hospital, Rehabilitation Centre for Communication Disorders, Wilrijkstraat 10, B-2650 Edegem, Belgium; Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185, B-9000 Ghent, Belgium.
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