Speech, voice and language in Parkinson’s disease: changes and interventions

ParkinSong Online: Feasibility of Telehealth Delivery and Remote Data Collection for a Therapeutic Group Singing Study in Parkinson's

BACKGROUND

Parkinson's disease can negatively affect vocal functioning and social wellbeing, particularly in the latter stages of disease progression. Face-to-face group singing interventions can improve communication and wellbeing outcomes, yet not all people can access in-person sessions. To help overcome barriers to participation, exploration of the feasibility and utility of online therapeutic singing programs is needed.

OBJECTIVES

To evaluate the feasibility, acceptability, and preliminary efficacy of a 12-week ParkinSong Online intervention on speech and wellbeing for people with Parkinson's disease.

METHODS

A total of 28 participants with idiopathic Parkinson's disease were recruited to a single-arm feasibility study. Weekly 90-minute online sessions were co-facilitated by a music therapist and speech pathologist. Speech and wellbeing assessments were conducted pre and post intervention. Participant and facilitator surveys were administered after each session, with focus group interviews at the end of the program.

RESULTS

The recruitment rate was high (90%) with no attrition, adverse events, or safety issues. There was good intervention fidelity, attendance (average 89%), and positive participant experience. Feasibility was good, with technology reported as the main challenge (connecting and navigating Zoom). No improvements were seen in voice measures or wellbeing outcomes in this small trial. The online format used in this study did not provide the same benefits as in-person ParkinSong sessions.

CONCLUSIONS

ParkinSong Online is feasible for recreational purposes and social engagement provided that people have adequate technological knowledge or support. The optimal online delivery format to achieve communication improvements in Parkinson's awaits confirmation.

Deep Brain Stimulation Impact on Voice and Speech Quality in Parkinson's Disease: A Systematic Review

OBJECTIVE

Deep brain stimulation (DBS) has considerable efficacy for the motor dysfunction of idiopathic Parkinson's disease (PD) on patient quality of life. However, the benefit of DBS on voice and speech quality remains controversial. We carried out a systematic review to understand the influence of DBS on parkinsonian dysphonia and dysarthria.

DATA SOURCES

A PubMed/MEDLINE and Cochrane systematic review was carried out following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Population, Intervention, Comparison, Outcome, Timing, and Setting (PICOTS) statements.

REVIEW METHODS

Three investigators screened studies published in the literature from inception to May 2022. The following data were retrieved: age, demographic, sex, disease duration, DBS duration, DBS location, speech, and voice quality measurements.

RESULTS

From the 180 studies identified, 44 publications met the inclusion criteria, accounting for 866 patients. Twenty-nine studies focused on voice/speech quality in subthalamic DBS patients, and 6 included patients with stimulation of pallidal, thalamic, and zona incerta regions. Most studies (4/6) reported a deterioration of the vocal parameters on subjective voice quality evaluation. For speech, the findings were more contrasted. There was an important heterogeneity between studies regarding the voice and speech quality outcomes used to evaluate the impact of DBS on voice/speech quality.

CONCLUSION

The impact of DBS on voice and speech quality significantly varies between studies. The stimulated anatomical region may have a significant role since the stimulation of the pallidal area was mainly associated with voice quality improvement, in contrast with other regions. Future controlled studies comparing all region stimulation are needed to get reliable findings.

LEVEL OF EVIDENCE

Level III: evidence from evidence summaries developed from systematic reviews.

Cognitive Determinants of Dysarthria in Parkinson's Disease: An Automated Machine Learning Approach

BACKGROUND

Dysarthric symptoms in Parkinson's disease (PD) vary greatly across cohorts. Abundant research suggests that such heterogeneity could reflect subject-level and task-related cognitive factors. However, the interplay of these variables during motor speech remains underexplored, let alone by administering validated materials to carefully matched samples with varying cognitive profiles and combining automated tools with machine learning methods.

OBJECTIVE

We aimed to identify which speech dimensions best identify patients with PD in cognitively heterogeneous, cognitively preserved, and cognitively impaired groups through tasks with low (reading) and high (retelling) processing demands.

METHODS

We used support vector machines to analyze prosodic, articulatory, and phonemic identifiability features. Patient groups were compared with healthy control subjects and against each other in both tasks, using each measure separately and in combination.

RESULTS

Relative to control subjects, patients in cognitively heterogeneous and cognitively preserved groups were best discriminated by combined dysarthric signs during reading (accuracy = 84% and 80.2%). Conversely, patients with cognitive impairment were maximally discriminated from control subjects when considering phonemic identifiability during retelling (accuracy = 86.9%). This same pattern maximally distinguished between cognitively spared and impaired patients (accuracy = 72.1%). Also, cognitive (executive) symptom severity was predicted by prosody in cognitively preserved patients and by phonemic identifiability in cognitively heterogeneous and impaired groups. No measure predicted overall motor dysfunction in any group.

CONCLUSIONS

Predominant dysarthric symptoms appear to be best captured through undemanding tasks in cognitively heterogeneous and preserved cohorts and through cognitively loaded tasks in patients with cognitive impairment. Further applications of this framework could enhance dysarthria assessments in PD. © 2021 International Parkinson and Movement Disorder Society.

Attitudes Toward the Use of Voice-Assisted Technologies Among People With Parkinson Disease: Findings From a Web-Based Survey

BACKGROUND

Speech problems are common in people living with Parkinson disease (PD), limiting communication and ultimately affecting their quality of life. Voice-assisted technology in health and care settings has shown some potential in small-scale studies to address such problems, with a retrospective analysis of user reviews reporting anecdotal communication effects and promising usability features when using this technology for people with a range of disabilities. However, there is a need for research to establish users' perspectives on the potential contribution of voice-assisted technology for people with PD.

OBJECTIVE

This study aims to explore the attitudes toward the use of voice-assisted technology for people with PD.

METHODS

A survey was approved for dissemination by a national charity, Parkinson's UK, to be completed on the web by people living with the condition. The survey elicited respondent demographics, PD features, voice difficulties, digital skill capability, smart technology use, voice-assisted technology ownership and use, confidentiality, and privacy concerns. Data were analyzed using descriptive statistics and summative content analysis of free-text responses.

RESULTS

Of 290 participants, 79.0% (n=229) indicated that they or others had noticed changes in their speech or voice because of the symptoms of their condition. Digital skills and awareness were reported on 11 digital skills such as the ability to find a website you have visited before. Most participants (n=209, 72.1%) reported being able to perform at least 10 of these 11 tasks. Similarly, of 70.7% (n=205) participants who owned a voice-assisted device, most of them (166/205, 80.9%) used it regularly, with 31.3% (52/166) reporting that they used the technology specifically to address the needs associated with their PD. Of these 166 users, 54.8% (n=91) sometimes, rarely, or never had to repeat themselves when using the technology. When asked about speech changes since they started using it, 25% (27/108) of participants noticed having to repeat themselves less and 14.8% (16/108) perceived their speech to be clearer. Of the 290 respondents, 90.7% (n=263) were not concerned, or only slightly concerned, about privacy and confidentiality.

CONCLUSIONS

Having been added to the homes of Western society, domestic voice assist devices are now available to assist those with communication problems. People with PD reported a high digital capability, albeit those who responded to a web-based survey. Most people have embraced voice-assisted technology, find it helpful and usable, and some have found benefit to their speech. Speech and language therapists may have a virtual ally that is already in the patient's home to support future therapy provision.

A Comparison of Speech Amplification and Personal Communication Devices for Hypophonia

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

Delivering group speech maintenance therapy via telerehabilitation to people with Parkinson's disease: A pilot study

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.

The Importance of Connection to Others in QoL in MSA and PSP

Multiple System Atrophy (MSA) and Progressive Supranuclear Palsy (PSP) are atypical Parkinsonian disorders with extended morbidity and reduced lifespan, known to have marked and early impact upon quality of life (QoL). This study aimed to address the lack of studies in the literature regarding personal perspectives on QoL in MSA and PSP in both patients and carers. Participants took part in qualitative, in-depth interviews in the North East of England, exploring what impacts their QoL and their experiences of living with these complex conditions. Connection to others was found to be a prevailing theme, encompassing difficulty communicating, social isolation, impact on personal relationships, and stigma. This work is helpful in that it emphasises the personal experiences of these patients and carers, which can provide insights into important areas for clinical service planning and best clinical management of individual patients as well as considerations for future research into QoL in these rare disorders.

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

PURPOSE

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

METHOD

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

RESULT

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

CONCLUSION

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

Subjective Experiences of Speech and Language Therapy in Patients with Parkinson's Disease: A Pilot Study

Purpose. Parkinson's disease can produce a range of speech-language pathologies, which may require intervention. While evaluations of speech-language therapy have been undertaken, no work has been undertaken to capture patients' experiences of therapy. This was the aim of the present study. Methods. Semistructured interviews, using themes derived from the literature, were conducted with nine Parkinson's disease patients, all of whom had undergone speech-language therapy. Participants' responses were analysed in accordance with Thematic Network Analysis. Results. Four themes emerged: emotional reactions (frustration, embarrassment, lack of confidence, disappointment, and anxiety); physical impact (fatigue, breathing and swallowing, and word production); practical aspects (cost of treatment, waiting times, and the actual clinical experience); and expectations about treatment (met versus unmet). Conclusions. While many benefits of speech-language therapy were reported, several negative issues emerged which could impact adversely on rehabilitation. Parkinson's disease is associated with a range of psychological and physical sequelae, such as fatigue and depression; recognising any individual experiences which could exacerbate the existing condition and incorporating these into treatment planning may improve rehabilitation outcomes.