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McInerney M, Imms C, Carding PN, Reddihough DS. Evaluation of an intensive voice treatment to reduce anterior drooling in children with cerebral palsy: Protocol for a concurrent multiple-baseline, single case experimental design study. Contemp Clin Trials Commun 2021; 24:100872. [PMID: 34825105 PMCID: PMC8605272 DOI: 10.1016/j.conctc.2021.100872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/29/2021] [Accepted: 11/13/2021] [Indexed: 12/04/2022] Open
Abstract
Anterior drooling is common in children with cerebral palsy (CP) and poses significant risks to the child's health. Causes of drooling include oro-motor dysfunction, inefficient swallowing and reduced sensation in the orofacial musculature. Behavioural interventions are frequently recommended to reduce drooling; however, this is in the absence of high-quality research evidence. This paper describes a protocol for evaluating the effectiveness of the Lee Silverman Voice Treatment LOUD (LSVT LOUD®) in reducing drooling; and optimising speech and swallowing in a group of children with CP. A structured and systematic visual analysis supplemented with statistical analyses will be used to analyse the data. The risk of bias in n-of-1 trials (RoBiNT) Scale [1] guided the design and implementation of the study.
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Affiliation(s)
- Michelle McInerney
- Lecturer in Speech Pathology, School of Allied Health, Australian Catholic University, Level 3 TWH, 8-20 Napier Street, North Sydney, NSW, 2060, Australia
| | - Christine Imms
- Apex Australia Chair of Neurodevelopment and Disability, Fellow, Occupational Therapy Australia Research Academy, Department of Paediatrics, The University of Melbourne, Australia
| | - Paul N Carding
- Professor of Speech Pathology, Director, Oxford Institute of Nursing, Midwifery and Allied Health Research (INMAHR), Oxford Brookes University, Oxford, UK
| | - Dinah S Reddihough
- The Royal Children's Hospital Melbourne, Department of Paediatrics, The University of Melbourne, Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia
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Mary Watson R, Pennington L. Assessment and management of the communication difficulties of children with cerebral palsy: a UK survey of SLT practice. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2015; 50:241-59. [PMID: 25652139 PMCID: PMC4371637 DOI: 10.1111/1460-6984.12138] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 09/01/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Communication difficulties are common in cerebral palsy (CP) and are frequently associated with motor, intellectual and sensory impairments. Speech and language therapy research comprises single-case experimental design and small group studies, limiting evidence-based intervention and possibly exacerbating variation in practice. AIMS To describe the assessment and intervention practices of speech-language therapist (SLTs) in the UK in their management of communication difficulties associated with CP in childhood. METHODS & PROCEDURES An online survey of the assessments and interventions employed by UK SLTs working with children and young people with CP was conducted. The survey was publicized via NHS trusts, the Royal College of Speech and Language Therapists (RCSLT) and private practice associations using a variety of social media. The survey was open from 5 December 2011 to 30 January 2012. OUTCOMES & RESULTS Two hundred and sixty-five UK SLTs who worked with children and young people with CP in England (n = 199), Wales (n = 13), Scotland (n = 36) and Northern Ireland (n = 17) completed the survey. SLTs reported using a wide variety of published, standardized tests, but most commonly reported assessing oromotor function, speech, receptive and expressive language, and communication skills by observation or using assessment schedules they had developed themselves. The most highly prioritized areas for intervention were: dysphagia, alternative and augmentative (AAC)/interaction and receptive language. SLTs reported using a wide variety of techniques to address difficulties in speech, language and communication. Some interventions used have no supporting evidence. Many SLTs felt unable to estimate the hours of therapy per year children and young people with CP and communication disorders received from their service. CONCLUSIONS & IMPLICATIONS The assessment and management of communication difficulties associated with CP in childhood varies widely in the UK. Lack of standard assessment practices prevents comparisons across time or services. The adoption of a standard set of agreed clinical measures would enable benchmarking of service provision, permit the development of large-scale research studies using routine clinical data and facilitate the identification of potential participants for research studies in the UK. Some interventions provided lack evidence. Recent systematic reviews could guide intervention, but robust evidence is needed in most areas addressed in clinical practice.
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Affiliation(s)
- Rose Mary Watson
- Institute of Health and Society, Newcastle UniversityNewcastle upon Tyne, UK
| | - Lindsay Pennington
- Institute of Health and Society, Newcastle UniversityNewcastle upon Tyne, UK
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Sapir S, Ramig LO, Fox CM. Intensive voice treatment in Parkinson’s disease: Lee Silverman Voice Treatment. Expert Rev Neurother 2014; 11:815-30. [DOI: 10.1586/ern.11.43] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Tse ACY, Wong AWK, Ma EPM, Whitehill TL, Masters RSW. Influence of analogy instruction for pitch variation on perceptual ratings of other speech parameters. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2013; 56:906-912. [PMID: 23811473 DOI: 10.1044/1092-4388(2012/12-0051)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Analogy is the similarity of different concepts on which a comparison can be based. Recently, an analogy of "waves at sea" was shown to be effective in modulating fundamental frequency (F0) variation. Perceptions of intonation were not examined, as the primary aim of the work was to determine whether analogy instruction had a negative impact on other parameters of the speech signal compared with explicit instruction. The purpose of this study was (a) to determine whether changes in the standard deviation of F0, acoustically, resulted in similar changes in the perception of pitch variability and (b) to determine the perceptual influence of analogy vs. explicit instructions on speech naturalness, loudness, and rate. METHOD Ten speech-language pathologists were asked to listen to and rate pitch variation, speech naturalness, loudness, and rate for 74 Cantonese speech samples using a visual analogue scale, which allowed raters to indicate their subjective perceptions of each parameter. RESULTS It is revealed that listeners perceived pitch variation to be greater and speech to be more natural in analogy-instructed, rather than explicitly instructed, speech. No differences were perceived for ratings of speech loudness or speech rate. CONCLUSION It is concluded that analogy instruction has a less negative impact on the naturalness of speech than explicit instruction and may provide a better method by which to manipulate desired pitch variation.
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Mu L, Sobotka S, Chen J, Su H, Sanders I, Adler CH, Shill HA, Caviness JN, Samanta JE, Beach TG. Alpha-synuclein pathology and axonal degeneration of the peripheral motor nerves innervating pharyngeal muscles in Parkinson disease. J Neuropathol Exp Neurol 2013; 72:119-29. [PMID: 23334595 PMCID: PMC3552335 DOI: 10.1097/nen.0b013e3182801cde] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Parkinson disease (PD) is a neurodegenerative disease primarily characterized by cardinal motor manifestations and CNS pathology. Current drug therapies can often stabilize these cardinal motor symptoms, and attention has shifted to the other motor and nonmotor symptoms of PD that are resistant to drug therapy. Dysphagia in PD is perhaps the most important drug-resistant symptom because it leads to aspiration and pneumonia, the leading cause of death. Here, we present direct evidence for degeneration of the pharyngeal motor nerves in PD. We examined the cervical vagal nerve (cranial nerve X), pharyngeal branch of nerve X, and pharyngeal plexus innervating the pharyngeal muscles in 14 postmortem specimens, that is, from 10 patients with PD and 4 age-matched control subjects. Synucleinopathy in the pharyngeal nerves was detected using an immunohistochemical method for phosphorylated α-synuclein. Alpha-synuclein aggregates were revealed in nerve X and the pharyngeal branch of nerve X, and immunoreactive intramuscular nerve twigs and axon terminals within the neuromuscular junctions were identified in all of the PD patients but in none of the controls. These findings indicate that the motor nervous system of the pharynx is involved in the pathologic process of PD. Notably, PD patients who have had dysphagia had a higher density of α-synuclein aggregates in the pharyngeal nerves than those without dysphagia. These findings indicate that motor involvement of the pharynx in PD is one of the factors leading to oropharyngeal dysphagia commonly seen in PD patients.
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Affiliation(s)
- Liancai Mu
- Upper Airway Research Laboratory, Department of Research, Hackensack University Medical Center, New Jersey 07601, USA.
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Tse ACY, Masters RSW, Whitehill TL, Ma EPM. The use of analogy in speech motor performance. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2012; 14:84-90. [PMID: 22070672 DOI: 10.3109/17549507.2011.616600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The acoustic correlates of pitch variation were examined in 40 participants who received analogy instructions or explicit instructions that required them to modulate their intonation during speech production. First, using focus group methodology, professional speech-language pathologists were asked to identify analogies that best described minimum pitch variation (monotone), moderate pitch variation (normal intonation), and maximum pitch variation (exaggerated intonation) in speech. The focus group established that an appropriate pitch variation metaphor may be related to imagery of "waves at sea", with minimum pitch variation represented by a flat calm sea, moderate pitch variation represented by a moderate sea, and maximum pitch variation represented by a choppy sea. Forty adult participants without speech impairments were asked to read aloud a standard paragraph using their habitual pitch variation (control condition). They were then allocated randomly to an analogy or an explicit instruction group and were asked to read aloud different paragraphs with minimum, moderate, or maximum pitch variations. Results revealed that acoustic correlates of pitch variation (standard deviation of fundamental frequency, SDF0) were not different for the control condition, or moderate and maximum pitch variation conditions in the two groups. However, the analogy instruction was significantly more effective than the explicit instruction for inducing minimum pitch variation. Analysis of participants in each group who showed higher than normal pitch variation in the control condition (>.5 SD above the group SDF0) revealed that the analogy instruction was more effective than the explicit instruction in the minimum variation condition. It was concluded that analogy instructions may be a useful tool in speech rehabilitation.
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Affiliation(s)
- Andy C Y Tse
- Institute of Human Performance, The University of Hong Kong, Hong Kong, SAR, PR China.
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Abstract
This article outlines the essential features and underlying principles of Lee Silverman Voice Treatment (LSVT®LOUD) and explores the delivery of this treatment via telepractice. A detailed summary of the core features of LSVT®LOUD and the principles underpinning this treatment are presented. Current evidence to support the feasibility and validity of synchronous and asynchronous delivery of LSVT®LOUD to people with Parkinson disease (PD) is reviewed. Technology specifications, cost-benefit analyses, and patient satisfaction are discussed. The challenges involved in delivery of LSVT®LOUD via telepractice, such as inconsistent audio and video quality during videoconferencing, accurate measurement of vocal parameters, technical skill level of the clinician, and patient candidacy, are highlighted. LSVT®LOUD can be effectively and reliably delivered via telepractice. Improvements in telecommunications are required to overcome some of the technology challenges encountered in this mode of delivery. Positive benefits of online treatment in relation to savings in time and money and reduced carer burden are emerging. Patient satisfaction with telepractice in the management of the speech disorder associated with PD is high. The uptake of LSVT®LOUD into telepractice is likely to steadily increase with advances in mobile technologies and web-based applications designed to deliver this treatment.
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Affiliation(s)
- Deborah Theodoros
- School of Health and Rehabilitation Sciences, The University of Queensland St. Lucia, Australia
| | - Lorraine Ramig
- National Center for Voice and Speech, University of Colorado-Boulder Boulder, CO
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Ramig L, Fox C, Sapir S. Speech and Voice Disorders in Parkinson's Disease. PARKINSON'S DISEASE 2011. [DOI: 10.1002/9781444397970.ch31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Ciucci MR, Vinney L, Wahoske EJ, Connor NP. A translational approach to vocalization deficits and neural recovery after behavioral treatment in Parkinson disease. JOURNAL OF COMMUNICATION DISORDERS 2010; 43:319-26. [PMID: 20434728 PMCID: PMC2927630 DOI: 10.1016/j.jcomdis.2010.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 01/28/2010] [Accepted: 02/01/2010] [Indexed: 05/23/2023]
Abstract
UNLABELLED Parkinson disease is characterized by a complex neuropathological profile that primarily affects dopaminergic neural pathways in the basal ganglia, including pathways that modulate cranial sensorimotor functions such as swallowing, voice and speech. Prior work from our lab has shown that the rat model of unilateral 6-hydroxydopamine infusion to the medial forebrain bundle that is useful for studying limb sensorimotor deficits also yields vocalization deficits that may be amenable to treatment with intensive exercise. This affords us an opportunity to explore the potential mechanisms underlying behavioral and neural recovery as a result of intervention for cranial sensorimotor deficits associated with Parkinson disease. Our methods include recording and acoustic analysis of male rat ultrasonic vocalizations in a control condition, after neurotoxin infusion (Parkinson disease model), and after targeted vocalization training. We also use well-established behavioral and immunohistochemical methods to assess the level of neurochemical recovery in the striatum of the basal ganglia after our interventions. Our findings, although preliminary, prompt us to look in other brain regions extraneous to the striatum for potential underlying mechanisms of recovery. Thus, our future work will focus on the underlying mechanisms of behavioral recovery in a Parkinson disease model in the hope that this will lead to improved understanding of brain function and improved treatment for voice and swallowing disorders. LEARNING OUTCOMES Readers will gain an understanding of how a rat model of Parkinson disease is used to study vocalization deficits and interventions.
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Affiliation(s)
- Michelle R Ciucci
- Communicative Disorders, University of Wisconsin-Madison, Madison, WI, USA.
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Ciucci MR, Ma ST, Kane JR, Ahrens AM, Schallert T. Limb use and complex ultrasonic vocalization in a rat model of Parkinson's disease: deficit-targeted training. Parkinsonism Relat Disord 2008; 14 Suppl 2:S172-5. [PMID: 18585950 PMCID: PMC2737701 DOI: 10.1016/j.parkreldis.2008.04.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Recent evidence in animal models of Parkinson's disease (PD) suggests that exercise and other forms of motor enhancement can be beneficial when applied during the degeneration of dopamine neurons. Behaviours that depend on adequate levels of striatal dopamine may provide particularly favourable targets for therapeutic motor interventions. Task-specific motor enrichment procedures have been used to improve functional and neural outcomes following unilateral infusions of 6-hydroxydopamine (6-OHDA) into the nigrostriatal pathway in rats. In contrast, forced non-use procedures can exaggerate the degree of degeneration. Limb-use akinesia and ultrasonic vocalization in the 50-kHz range may be useful behavioural indices of nigrostriatal integrity and may model common deficits found in PD. These deficits in movement initiation and fine sensorimotor control are potential targets for early training interventions.
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Affiliation(s)
- Michelle R Ciucci
- Department of Psychology, University of Texas, 1 University Station A8000, Austin, TX 78712, USA
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Abstract
Researchers estimate that 89% of people with Parkinson's disease (PD) have speech and voice disorders including disorders of laryngeal, respiratory and articulatory function. Despite the high incidence of speech and voice impairment, studies suggest that only 3-4% of people with PD receive speech treatment. Here, we review the literature on the characteristics and features of speech and voice disorders in people with PD and the types of treatment techniques available (medical, surgical and behavioral), with a focus on behavioral therapies. We provide a summary of the current status of the field of speech treatment in PD and recommendations for implementation of the current efficacy of treatment interventions. Directions for future research, including a speculative viewpoint on how the field will evolve in 5 years time, are discussed.
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Affiliation(s)
- Lorraine O Ramig
- Department of Speech, Language, Hearing Sciences, University of Colorado, Campus Box 409, Boulder, CO 80309, USA.
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Ciucci MR, Ma ST, Fox C, Kane JR, Ramig LO, Schallert T. Qualitative changes in ultrasonic vocalization in rats after unilateral dopamine depletion or haloperidol: a preliminary study. Behav Brain Res 2007; 182:284-9. [PMID: 17397940 PMCID: PMC1993917 DOI: 10.1016/j.bbr.2007.02.020] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 02/08/2007] [Accepted: 02/09/2007] [Indexed: 10/23/2022]
Abstract
The sensorimotor speech/voice deficits associated with Parkinson disease have been well documented in humans. They are largely resistant to pharmacological and surgical treatment, but respond to intensive speech therapy. The mechanisms underlying this phenomenon are not well understood and are difficult to systematically test in humans. Thus, we turn to the rat as a model. The purpose of this study is to compare the ultrasonic vocalization (USV) of rats in three conditions: control, haloperidol-induced transient dopamine depletion, and unilateral 6-hydroxydopamine (6-OHDA) induced moderately-severe degeneration of dopamine neurons. It was hypothesized that both dopamine-altered conditions would lead to a change in the features of the USV acoustic signal. Results demonstrated that bandwidth decreased in the dopamine-altered rats. This is the first study to document a degradation of the acoustic signal of frequency-modulated 50-kHz calls as a result of interfering with dopamine synaptic transmission in rats. The data suggest that mild transient dopamine depletion with haloperidol or even unilateral degeneration of dopamine neurons is associated with changes in the USV acoustic signal. Dopaminergic dysfunction influences USV quality without reducing the number of calls. This study provides a foundation to examine the role of dopamine in sensorimotor processes underlying USV production and potentially to explore treatments for dopamine deficiency-related impaired vocal outcome.
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Affiliation(s)
- Michelle R Ciucci
- Department of Communication Sciences and Disorders, University of Texas, Austin, TX 78712, USA.
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Sapir S, Spielman JL, Ramig LO, Story BH, Fox C. Effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on vowel articulation in dysarthric individuals with idiopathic Parkinson disease: acoustic and perceptual findings. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2007; 50:899-912. [PMID: 17675595 DOI: 10.1044/1092-4388(2007/064)] [Citation(s) in RCA: 206] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE To evaluate the effects of intensive voice treatment targeting vocal loudness (the Lee Silverman Voice Treatment [LSVT]) on vowel articulation in dysarthric individuals with idiopathic Parkinson's disease (PD). METHOD A group of individuals with PD receiving LSVT (n = 14) was compared to a group of individuals with PD not receiving LSVT (n = 15) and a group of age-matched healthy individuals (n = 14) on the variables vocal sound pressure level (VocSPL); various measures of the first (F1) and second (F2) formants of the vowels /i/, /u/, and /a/; vowel triangle area; and perceptual vowel ratings. The vowels were extracted from the words key, stew, and Bobby embedded in phrases. Perceptual vowel rating was performed by trained raters using a visual analog scale. RESULTS Only VocSPL, F2 of the vowel /u/ (F2u), and the ratio F2i/F2u significantly differed between patients and healthy individuals pretreatment. These variables, along with perceptual vowel ratings, significantly changed (improved) in the group receiving LSVT only. CONCLUSION These results, along with previous findings, add further support to the generalized therapeutic impact of intensive voice treatment on orofacial functions (speech, swallowing, facial expression) and respiratory and laryngeal functions in individuals with PD.
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Affiliation(s)
- Shimon Sapir
- Department of Communication Sciences and Disorders, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa 39105, Israel.
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