Intensive voice treatment in parkinson disease: Laryngostroboscopic findings

  • Marshall E. Smith
    Correspondence
    Address correspondence and reprint requests to Dr. M. Smith, Gould Voice Research Center, The Denver Center for the Performing Arts, 1245 Champa St., Denver, CO 80204, U.S.A.
    Affiliations
    Department of Otolaryngology/Head and Neck Surgery, University of Colorado Health Sciences Center, U.S.A.

    Department of Communication Disorders and Speech Science, University of Colorado-Boulder, U.S.A.
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  • Lorraine Olson Ramig
    Affiliations
    Department of Otolaryngology/Head and Neck Surgery, University of Colorado Health Sciences Center, U.S.A.

    Department of Communication Disorders and Speech Science, University of Colorado-Boulder, U.S.A.
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  • Christopher Dromey
    Affiliations
    Department of Otolaryngology/Head and Neck Surgery, University of Colorado Health Sciences Center, U.S.A.

    Department of Communication Disorders and Speech Science, University of Colorado-Boulder, U.S.A.
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  • Kathe S. Perez
    Affiliations
    Department of Otolaryngology/Head and Neck Surgery, University of Colorado Health Sciences Center, U.S.A.

    Department of Communication Disorders and Speech Science, University of Colorado-Boulder, U.S.A.
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  • Ráz Samandari
    Affiliations
    University of Colorado School of Medicine, Denver, Colorado, U.S.A.
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      Summary

      As part of ongoing research to investigate and document the efficacy of intensive voice therapy to improve functional communication in patients with idiopathic Parkinson disease, 45 patients were enrolled in a controlled, randomized, prospective study. Pre- to posttreatment comparisons are presented here on 22 of those patients who underwent laryngeal imaging examination. Of the 22 patients, 13 patients received intensive therapy aimed at increasing vocal and respiratory effort (VR), whereas nine received intensive therapy aimed at increasing respiratory effort (R) only. All patients had a pretreatment evaluation that included two (but sometimes only one) voice recordings and an otolaryngologic examination with laryngostroboscopy. At the completion of 4 weeks of therapy (16 sessions), two voice recordings were made, and laryngostroboscopy was again performed. The pre- and posttherapy videolaryngostroboscopy tapes were then randomized and rated by four judges. Raters' findings were then compared with vocal intensity measured before and after therapy. The VR therapy group showed improvements on laryngostroboscopic variables: less glottal incompetence and no significant change in supraglottal hyperfunction after therapy. No differences were observed in the R-only group. The mean intensity increase in the VR therapy group was 12.5 dB, compared with a decrease of 1.9 dB in the R-only group. These findings suggest that in patients with Parkinson disease, intensive therapy focusing on phonatory effort improves adduction of the vocal folds as assessed by laryngostroboscopy. Differences in laryngeal function in these patients observed with fiberoptic laryngoscopy and rigid telescopic laryngoscopy are discussed.
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