Advertisement

Conversational Vocal Intensity in Parkinson's Disease: Treatment and Environmental Comparisons

      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.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Marras C.
        • Beck J.C.
        • Bower J.H.
        • et al.
        Prevalence of parkinson's disease across north america.
        NPJ Parkinsons Dis. 2018; 4: 21
        • Duffy J.R
        Motor speech disorders: substrates, differential diagnosis, and management.
        3rd Edn. Elsevier Mosby, St. Louis, MO2013: 6
        • Liotti M.
        • Ramig L.O.
        • Vogel D.
        • et al.
        Hypophonia in Parkinson's disease: neural correlates of voice treatment revealed by PET.
        Neurology. 2003; 60: 432-440
        • Pinto S.
        • Thobois S.
        • Costes N.
        • et al.
        Subthalamic nucleus stimulation and dysarthria in Parkinson's disease: a PET study.
        Brain. 2004; 127: 602-615
        • Darley F.L.
        • Aronson A.E.
        • Brown J.R
        Clusters of deviant speech dimensions in the dysarthrias.
        J Speech Hear Res. 1969; 12: 462-496
        • Logemann J.A.
        • Fisher H.B.
        • Boshes B.
        • et al.
        Frequency and cooccurrence of vocal tract dysfunctions in the speech of a large sample of Parkinson patients.
        J Speech Hear Disord. 1978; 43: 47-57
        • Atkinson-Clement C.
        • Sadat J.
        • Pinto S
        Behavioral treatments for speech in Parkinson's disease: meta-analyses and review of the literature.
        Neurodegener Dis Manag. 2015; 5: 233-248
        • Darley F.L.
        • Aronson A.E.
        • Brown J.R
        Differential diagnostic patterns of dysarthria.
        J Speech Hear Res. 1969; 12: 246-269
        • Darley F.L.
        • Aronson A.E.
        • Brown J.R
        Clusters of deviant speech dimensions in the dysarthrias.
        J Speech Hear Res. 1969; 12: 462-496
        • Fox C.M.
        • Ramig L.O
        Vocal sound pressure level and self-perception of speech and voice in men and women with idiopathic Parkinson disease.
        Am J Speech Lang Pathol. 1997; 6: 85-94
        • Baumgartner C.A.
        • Sapir S.
        • Ramig L.O
        Voice quality changes following phonatory-respiratory effort treatment (LSVT®) versus respiratory effort treatment for individuals with Parkinson disease.
        J Voice. 2001; 15: 105-114
        • Midi I.
        • Dogan M.
        • Koseoglu M.
        • et al.
        Voice abnormalities and their relation with motor dysfunction in Parkinson's disease.
        Acta Neurol Scand. 2008; 117: 26-34
        • Sewall G.K.
        • Jiang J.
        • Ford C.N
        Clinical evaluation of Parkinson's-related dysphonia.
        Laryngoscope. 2006; 116: 1740-1744
        • Sapir S
        Multiple factors are involved in the dysarthria associated with Parkinson's disease: a review with implications for clinical practice and research.
        J Speech Lang Hear Res. 2014; 57: 1330-1343
        • Sapir S.
        • Ramig L.O.
        • Fox C.M
        Intensive voice treatment in Parkinson's disease: Lee Silverman voice treatment.
        Expert Rev Neurother. 2011; 11: 815-830
        • Ho A.K.
        • Bradshaw J.L.
        • Iansek R.
        Volume perception in parkinsonian speech.
        Mov Disord. 2000; 15: 1125-1131
        • Kwan L.C.
        • Whitehill T.L
        Perception of speech by individuals with Parkinson's disease: a review.
        Parkinson's Disease. 2011; 2011
        • Mollaei F.
        • Shiller D.M.
        • Gracco V.L
        Sensorimotor adaptation of speech in Parkinson's disease.
        Mov Disord. 2013; 28: 1668-1674
        • Arnold C.
        • Gehrig J.
        • Gispert S.
        • et al.
        Pathomechanisms and compensatory efforts related to Parkinsonian speech.
        Neuroimage Clin. 2014; 4: 82-97
        • Liu H.
        • Wang E.Q.
        • Metman L.V.
        • et al.
        Vocal responses to perturbations in voice auditory feedback in individuals with Parkinson's disease.
        PloS one. 2012; 7: e33629
        • Houde J.F.
        • Nagarajan S.
        • Heinks T.
        • et al.
        The effect of voice therapy on feedback control in Parkinsonian speech.
        Movement Disorders. 19. Wiley-Liss, Div John Wiley & Sons Inc, 111 River St, Hoboken, NJ 07030 USA2004 (S403-S403)
        • Ramig L.O.
        • Countryman S.
        • Thompson L.L.
        • et al.
        Comparison of two forms of intensive speech treatment for Parkinson disease.
        J Speech Lang Hear Res. 1995; 38: 1232-1251
        • Schalling E.
        • Gustafsson J.
        • Ternström S.
        • et al.
        Effects of tactile biofeedback by a portable voice accumulator on voice sound level in speakers with Parkinson's disease.
        J Voice. 2013; 27: 729-737
        • Donovan N.J.
        • Boudreaux D.M.
        • Savage M.C
        Objective measurement of vocal parameters in older people with and without parkinson's disease in their natural environments: a pilot study.
        Contemp Issues Commun Sci Disord. 2015; 42: 100-109
        • Gustafsson J.K.
        • Södersten M.
        • Ternström S.
        • et al.
        Voice use in daily life studied with a portable voice accumulator in individuals with parkinson's disease and matched healthy controls.
        J Speech Lang Hear Res. 2019; 62: 4324-4334
        • Rountrey C.E
        Speech function in persons with parkinson's disease: effects of environment, task and treatment.
        James Madison University, Virginia, USA2015 (Unpublished doctoral dissertation Retrieved from)
        • Searl and Dietch
        In-clinic vs. at-home voice intensity estimates in parkinson disease.
        Presented at the American Speech and Language Hearing Association convention, SanDiego, CA, USA2011
        • Bottalico P.
        • Ipsaro Passione I.
        • Astolfi A.
        • et al.
        Accuracy of the quantities measured by four vocal dosimeters and its uncertainty.
        J Acoust Soc Am. 2018; 143: 1591-1602
        • Searl J.
        • Dietsch A
        Testing of the VocaLog vocal monitor.
        J Voice. 2014; 28: 523-e27
        • Searl J.
        • Dietsch A.M
        Tolerance of the vocalog™ vocal monitor by healthy persons and individuals with parkinson disease.
        J Voice. 2015; 29: 518-e13
        • Van Stan J.H.
        • Gustafsson J.
        • Schalling E.
        • et al.
        Direct comparison of three commercially available devices for voice ambulatory monitoring and biofeedback.
        Perspectives Voice Voice Disord. 2014; 24: 80-86
        • Miller N.
        • Noble E.
        • Jones D.
        • et al.
        Life with communication changes in Parkinson's disease.
        Age ageing. 2006; 35: 235-239
        • Schulz G.M.
        • Grant M.K
        Effects of speech therapy and pharmacologic and surgical treatments on voice and speech in Parkinson's disease: a review of the literature.
        J Commun Disord. 2000; 33: 59-88
        • Fox C.M.
        • Morrison C.E.
        • Ramig L.O.
        • et al.
        Current perspectives on the lee silverman voice treatment (LSVT) for individuals with idiopathic parkinson disease.
        Am J Speech Lang Pathol. 2002; 11: 111-123
        • Ramig L.O.
        • Countryman S.
        • O'Brien C.
        • et al.
        Intensive speech treatment for patients with Parkinson's disease: short-and long-term comparison of two techniques.
        Neurology. 1996; 47: 1496-1504
        • Ramig L.O.
        • Sapir S.
        • Fox C.
        • et al.
        Changes in vocal loudness following intensive voice treatment (LSVT®) in individuals with Parkinson's disease: A comparison with untreated patients and normal age-matched controls.
        Mov Disord. 2001; 16: 79-83
        • Ramig L.
        • Halpern A.
        • Spielman J.
        • et al.
        Speech treatment in Parkinson's disease: Randomized controlled trial (RCT).
        Mov Disord. 2018; 33: 1777-1791
        • Gustafsson J.
        • Södersten M.
        • Ternström S.
        • et al.
        Long-term effects of lee silverman voice treatment on daily voice use in parkinson's disease as measured with a portable voice accumulator.
        Logoped Phoniatr Vocol. 2018; 44: 1-10
        • Scott S.
        • Caird F.I
        Speech therapy for Parkinson's disease.
        J Neurol Neurosurg Psychiatry. 1983; 46: 140-144
        • Rubow R.
        • Swift E
        A microcomputer-based wearable biofeedback device to improve transfer of treatment in Parkinsonian dysarthria.
        J Speech Hear Disord. 1985; 50: 178-185
        • Rubow R
        Role of feedback, reinforcement, and compliance on training and transfer in biofeedback-based rehabilitation of motor speech disorders.
        The dysarthrias: Physiology, acoustics, perception, management. 1984; 58: 207-230
        • Van Stan J.H.
        • Mehta D.D.
        • Hillman R.E
        The effect of voice ambulatory biofeedback on the daily performance and retention of a modified vocal motor behavior in participants with normal voices.
        J Speech Lang Hear Res. 2015; 58: 713-721
        • Swaminathan S
        Role of Therapeutic Devices in Enhancing Speech Intelligibility and Vocal Intensity in an Individual with Parkinson's Disease.
        East Tennessee State University, Johnson City, Tennessee, USA2012 (Unpublished thesisRetrieved from)
        • Gustafsson J.
        • Ternström S.
        • Södersten M.
        • et al.
        Motor-learning-based adjustment of ambulatory feedback on vocal loudness for patients with Parkinson's disease.
        J Voice. 2016; 30: 407-415
        • Schmidt R.A.
        • Lee T.D.
        Motor control and learning: A behavioral emphasis.
        5th ed. Human kinetics, Champagne, IL2011
        • Van Stan J.H.
        • Mehta D.D.
        • Sternad D.
        • et al.
        Ambulatory voice biofeedback: Relative frequency and summary feedback effects on performance and retention of reduced vocal intensity in the daily lives of participants with normal voices.
        J Speech Lang Hear Res. 2017; 60: 853-864
        • Nieuwboer A.
        • Rochester L.
        • Müncks L.
        • et al.
        Motor learning in Parkinson's disease: limitations and potential for rehabilitation.
        Parkinsonism relat disord. 2009; 15: S53-S58
        • Zraick R.I.
        • Kempster G.B.
        • Connor N.P.
        • et al.
        Establishing validity of the consensus auditory-perceptual evaluation of voice (CAPE-V).
        Am J Speech Lang Pathol. 2011; 20: 14-22
        • Jacobson B.H.
        • Johnson A.
        • Grywalski C.
        • et al.
        The voice handicap index (VHI) development and validation.
        Am J Speech Lang Pathol. 1997; 6: 66-70
        • Szcześniak D.
        • Rymaszewska J.
        The usefulness of the SLUMS test for diagnosis of mild cognitive impairment and dementia.
        Psychiatr Pol. 2016; 50: 457-472
        • Mehta D.D.
        • Listfield R.W.
        • Cheyne II, H.A.
        • et al.
        Duration of ambulatory monitoring needed to accurately estimate voice use.
        (September) Paper presented at the Interspeech conference, Portland, OR2012 (Retrieved from)
        • Franke R.H.
        • Kaul J.D
        The hawthorne experiments: first statistical interpretation.
        Am Sociol Rev. 1978; 43: 623-643
        • Hauser C.W
        Use of ambulatory biofeedback to supplement Lee Silverman voice treatment in patients with idiopathic Parkinson's disease.
        MGH Institute of Health Professions, Boston, USA2005 (Unpublished thesisAvailable from ProQuest Dissertations & Theses Global Database)
        • Ramig L.
        • Sapir S.
        • Countryman S.
        • et al.
        Intensive voice treatment (LSVT®) for patients with Parkinson's disease: A 2 year follow up.
        J Neurol Neurosurg Psychiatry. 2001; 71: 493-498
        • Spielman J.
        • Ramig L.
        • Mahler L.
        • et al.
        Effects of an extended version of the lee silverman voice treatment on voice and speech in parkinson's disease.
        Am J Speech Lang Pathol. 2007; 16: 95-107
        • Wight S.
        • Miller N
        Lee silverman voice treatment for people with parkinson's: audit of outcomes in a routine clinic.
        Int J Lang Commun Disord. 2015; 50: 215-225
        • Litvan I.
        • Aarsland D.
        • Adler C.H.
        • et al.
        MDS task force on mild cognitive impairment in parkinson's disease: critical review of PD-MCI.
        Mov Disord. 2011; 26: 1814-1824
        • Baken R.J.
        • Orlikoff R.F
        Clinical measurement of speech and voice.
        2nd Edn. Cengage Learning, 2000: 108-109