Daily Phonatory Activity of Individuals With Parkinson's Disease

Published:November 21, 2021DOI:https://doi.org/10.1016/j.jvoice.2021.10.004

      Summary

      Purpose

      This study evaluated the amount of phonatory activity of Persons with Parkinson disease (PwPD) compared to adults without Parkinson's disease measured over 3 days. The relationship between the amount of phonatory activity and Voice Handicap Index (VHI) total score was assessed as were differences in voicing activity across 3 days of data collection.

      Methods

      Fifteen PwPD receiving dopaminergic medication and fifteen age and sex matched adults without Parkinson's disease completed the VHI and then wore a VocaLog vocal monitor (VM) for 3 consecutive days. From the VM data, the number of 1-second windows with dB sound pressure level > 0 were summed as a measure of phonatory activity (PA) and reported relative to the time the VM was worn (%PA).

      Results

      The percentage of time the VM was worn did not differ between groups or across days. The PwPD had statistically significantly fewer minutes of PA per day than controls (F = 21.782, P < 0.001) by 54 minutes on average. The %PA also differed significantly (F = 31.825, P < 0.001) with a mean of 11.1% for PwPD and 18.6% for controls. Neither PA nor %PA differed across the 3 days of vocal monitoring. VHI total score was significantly correlated with PA (r = -0.436, P = 0.016) and %PA (r = -0.534, P = 0.002) for all participants.

      Conclusions

      The results indicate that PwPD engaged in less verbal communication in their daily environment compared to adults without Parkinson's disease. The findings support reports in the literature indicating that PwPD often have reduced communication participation. Measures such as %PA could serve as a quantifiable metric in future studies assessing communication changes in PwPD as a function of disease progression or therapeutic interventions.

      Key Words

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      References

        • Smith KM.
        • Caplan DN
        Communication impairment in Parkinson's disease: impact of motor and cognitive symptoms on speech and language.
        Brain Lang. 2018; 185: 38-46https://doi.org/10.1016/j.bandl.2018.08.002
        • Schapira AHV
        • Chaudhuri KR
        • Jenner P
        Non-motor features of Parkinson disease.
        Nat Rev Neurosci. 2017; 18: 435-450https://doi.org/10.1038/nrn.2017.62
        • Mollaei F
        • Shiller DM
        • Baum SR
        • et al.
        Sensorimotor control of vocal pitch and formant frequencies in Parkinson's disease.
        Brain Res. 2016; 1646: 269-277https://doi.org/10.1016/j.brainres.2016.06.013
        • Stathopoulos ET
        • Huber JE
        • Richardson K
        • et al.
        Increased vocal intensity due to the Lombard effect in speakers with Parkinson's disease: simultaneous laryngeal and respiratory strategies.
        J Commun Disord. 2014; 48: 1-17https://doi.org/10.1016/j.jcomdis.2013.12.001
        • Yorkston K
        • Miller RM
        • Strand EA
        • et al.
        Management of Speech and Swallowing in Degenerative Diseases.
        3rd ed. Po-Ed, Austin TX2013
        • Solomon NP
        • Hixon TJ
        Speech breathing in Parkinson's disease.
        J Speech Lang Hear Res. 1993; 36: 294-310https://doi.org/10.1044/jshr.3602.294
        • Huber J
        • Darling-White M
        Longitudinal changes in speech breathing in older adults with and without Parkinson's disease.
        Seminars Speech Lang. 2017; 38: 200-209https://doi.org/10.1055/s-0037-1602839
        • Duffy J
        Motor Speech Disorders: Substrates, Differential Diagnosis, and Management.
        4th ed. Elsevier, Cambridge, MA2019
        • Mollaei F
        • Shiller DM
        • Baum SR
        • et al.
        The relationship between speech perceptual discrimination and speech production in Parkinson's disease.
        J Speech Lang Hear Res. 2019; 62: 4256-4268https://doi.org/10.1044/2019_JSLHR-S-18-0425
        • Yarnall AJ
        • Breen DP
        • Duncan GW
        • et al.
        Characterizing mild cognitive impairment in incident Parkinson disease: the ICICLE-PD Study.
        Neurology. 2014; 82: 308-316https://doi.org/10.1212/WNL.0000000000000066
        • Lee J
        • Huber J
        • Jenkins J
        • et al.
        Language planning and pauses in story retell: evidence from aging and Parkinson's disease.
        J Commun Disord. 2019; 79: 1-10https://doi.org/10.1016/j.jcomdis.2019.02.004
        • Kiran S
        • Larson CR
        Effect of duration of Pitch-Shifted feedback on vocal responses in patients with Parkinson's disease.
        J Speech Lang Hear Res. 2001; 44: 975-987https://doi.org/10.1044/1092-4388(2001/076
      1. World Health Organization (2001). International classification of functioning, disability and health: ICF. Available at: https://apps.who.int/iris/handle/10665/42407 (accessed on 08/01/2021)

        • Barnish MS
        • Whibley D
        • Horton SMC
        • et al.
        Roles of cognitive status and intelligibility in everyday communication in people with Parkinson's disease: a systematic review.
        J Parkinson's Dis. 2016; 6: 453-462https://doi.org/10.3233/JPD-150757
        • Griffiths S
        • Barnes R
        • Britten N
        • et al.
        Investigating interactional competencies in Parkinson's disease: the potential benefits of a conversation analytic approach.
        Int J Lang Commun Disord. 2011; 46: 497-509https://doi.org/10.1111/j.1460-6984.2011.00012.x
        • Griffiths S
        • Barnes R
        • Britten N
        • et al.
        Potential causes and consequences of overlap in talk between speakers with Parkinson's disease and their familiar conversation partners.
        Semin Speech Lang. 2012; 33: 27-43https://doi.org/10.1055/s-0031-1301161
        • Carlsson E
        • Hartelius L
        • Saldert C
        Communicative strategies used by spouses of individuals with communication disorders related to stroke-induced aphasia and Parkinson's disease.
        Int J Lang Commun Disord. 2014; 49: 722-735https://doi.org/10.1111/1460-6984.12106
        • Argaud S
        • Vérin M
        • Sauleau P
        • et al.
        Facial emotion recognition in Parkinson's disease: a review and new hypotheses.
        Mov Disord. 2018; 33: 554-567https://doi.org/10.1002/mds.27305
        • Dykstra AD
        • Adams SG
        • Jog M
        Examining the relationship between speech intensity and self-rated communicative effectiveness in individuals with Parkinson's disease and hypophonia.
        J Commun Disord. 2015; 56: 103-112https://doi.org/10.1016/j.jcomdis.2015.06.012
        • Jin JL
        • Baylor C
        • Yorkston K
        Predicting communicative participation in adults across communication disorders.
        Am J Speech Lang Pathol. 2021; 30: 1301-1313https://doi.org/10.1044/2020_AJSLP-20-00100
        • Mehta DD
        • Cheyne HA
        • Wehner A
        • et al.
        Accuracy of self-reported estimates of daily voice use in adults with normal and disordered voices.
        Am J Speech Lang Pathol. 2016; 25: 634-641https://doi.org/10.1044/2016_AJSLP-15-0105
        • Cantarella G
        • Iofrida E
        • Boria P
        • et al.
        Ambulatory phonation monitoring in a sample of 92 call center operators.
        J Voice. 2014; 28: 393.e1-393.e6https://doi.org/10.1016/j.jvoice.2013.10.002
        • Nusseck M
        • Richter B
        • Spahn C
        • et al.
        Analysing the vocal behaviour of teachers during classroom teaching using a portable voice accumulator.
        Logoped Phoniatr Vocol. 2018; 43: 1-10https://doi.org/10.1080/14015439.2017.1295104
        • Morsomme D
        • Remacle A
        Can ambulatory biofeedback help a transgender woman speak at a higher pitch?.
        Logoped Phoniatr Vocol. 2021; : 1-7https://doi.org/10.1080/14015439.2021.1881158
        • Van Stan JH
        • Mehta DD
        • Ortiz AJ
        • et al.
        Differences in weeklong ambulatory vocal behavior between female patients with phonotraumatic lesions and matched controls.
        J Speech Lang Hear Res. 2020; 63: 372-384https://doi.org/10.1044/2019_JSLHR-19-00065
        • Cortés JP
        • Espinoza VM
        • Ghassemi M
        • et al.
        Ambulatory assessment of phonotraumatic vocal hyperfunction using glottal airflow measures estimated from neck-surface acceleration.
        PLoS One. 2018; 13e0209017https://doi.org/10.1371/journal.pone.0209017
        • Song SA
        • Go CL
        • Acuna PB
        • et al.
        Progressive decline in voice and voice-related quality of life in X-Linked dystonia parkinsonism.
        J Voice. 2020; https://doi.org/10.1016/j.jvoice.2020.11.014
        • Holmes RJ
        • Oates JM
        • Phyland DJ
        • et al.
        Voice characteristics in the progression of Parkinson's disease.
        Int J Lang Commun Disord. 2000; 35: 407-418https://doi.org/10.1080/136828200410654
        • Miller N
        • Andrew S
        • Noble E
        • et al.
        Changing perceptions of self as a communicator in Parkinson's disease: a longitudinal follow-up study.
        Disabil Rehabil. 2011; 33: 204-210https://doi.org/10.3109/09638288.2010.508099
        • Portone CR
        • Hapner ER
        • McGregor L
        • et al.
        Correlation of the Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure (V-RQOL).
        J Voice. 2007; 21: 723-727https://doi.org/10.1016/j.jvoice.2006.06.001
        • Ziegler A
        • Hapner ER
        Vocal dose in older adults with presbyphonia: an analytic, cross-sectional study.
        J Voice. 2020; 34: 221-230https://doi.org/10.1016/j.jvoice.2018.09.005
        • Behrman A
        • Cody J
        • Elandary S
        • et al.
        The effect of SPEAK OUT! and The LOUD crowd on dysarthria due to Parkinson's disease.
        Am J Speech Lang Pathol. 2020; 29: 1448-1465https://doi.org/10.1044/2020_AJSLP-19-00024
        • Boutsen F
        • Park E
        • Dvorak J
        • et al.
        Prosodic improvement in persons with Parkinson disease receiving SPEAK OUT!® voice therapy.
        Folia Phoniatr Logop. 2018; 70: 51-58https://doi.org/10.1159/000488875
        • Ramig
        • Halpern A
        • Spielman J
        • et al.
        Speech treatment in Parkinson's disease: randomized controlled trial (RCT).
        Mov Disord. 2018; 33: 1777-1791https://doi.org/10.1002/mds.27460
      2. Konnai, R, Van Harn, M, Silbergleit, A, et al. (2021). Conversational vocal intensity in Parkinson's disease: treatment and environmental comparisons. https://doi.org/10.1016/j.jvoice.2021.04.019

        • 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: 729-737https://doi.org/10.1016/j.jvoice.2013.04.014
        • Chen OY
        • Lipsmeier F
        • Phan H
        • et al.
        Building a machine-learning framework to remotely assess Parkinson's disease using smartphones.
        IEEE Trans Biomed Eng. 2020; 67: 3491-3500https://doi.org/10.1109/TBME.2020.2988942
        • Sajal MSR
        • Ehsan MT
        • Vaidyanathan R
        • et al.
        Telemonitoring Parkinson's disease using machine learning by combining tremor and voice analysis.
        Brain Inform. 2020; 7: 12https://doi.org/10.1186/s40708-020-00113-1
        • Tougui I
        • Jilbab A
        • Mhamdi JEl
        Analysis of smartphone recordings in time, frequency, and cepstral domains to classify Parkinson's disease.
        Healthc Inform Res. 2020; 26: 274-283https://doi.org/10.4258/hir.2020.26.4.274
        • Gustafsson JK
        • 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: 4324-4334https://doi.org/10.1044/2019_JSLHR-19-00037
        • Cerri S
        • Mus L
        • Blandini F
        Parkinson's disease in women and men: What's the difference?.
        J Parkinson's Dis. 2019; 9: 501-515https://doi.org/10.3233/JPD-191683
        • Hoehn M
        • Yahr M
        Parkinsonism: onset, progression, and mortality.
        Neurology. 1967; 17: 427-442
        • Searl J
        • Dietsch A
        Testing of the VocaLog vocal monitor.
        J Voice. 2014; 28: 523.e27-523.e37https://doi.org/10.1016/j.jvoice.2014.01.009
        • 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: 1591-1602https://doi.org/10.1121/1.5027816
        • Van Stan JH
        • Gustafsson J
        • Schalling E
        • et al.
        Direct comparison of three commercially available devices for voice ambulatory monitoring and biofeedback.
        Perspectives on Voice and Voice Disorders. 2014; 24: 80-86https://doi.org/10.1044/vvd24.2.80
        • Jacobson BH
        • Johnson A
        • Grywalski C
        • et al.
        The Voice Handicap Index (VHI).
        Am J Speech Lang Pathol. 1997; 6: 66https://doi.org/10.1044/1058-0360.0603.66
      3. Thalheimer, W, & Cook, S (2002). How to calculate effect sizes from published research articles: a simplified methodology. Available at: http://work-learning.com/effect_sizes.htm (accessed on 08/01/2021)

        • Cohen J
        Statistical Power Analysis for the Behavioral Sciences.
        Earlbaum, Hillsdale, NJ1988
        • Barnish MS
        • Horton SMC
        • Butterfint ZR
        • et al.
        Speech and communication in Parkinson's disease: a cross-sectional exploratory study in the UK.
        BMJ Open. 2017; 7e014642https://doi.org/10.1136/bmjopen-2016-014642
        • Baylor C
        • Burns M
        • Eadie T
        • et al.
        A qualitative study of interference with communicative participation across communication disorders in adults.
        Am J Speech Lang Pathol. 2011; 20: 269-287https://doi.org/10.1044/1058-0360(2011/10-0084
        • Miller N
        • Noble E
        • Jones D
        • et al.
        Life with communication changes in Parkinson's disease.
        Age Ageing. 2006; 35: 235-239https://doi.org/10.1093/ageing/afj053
        • Yorkston K
        • Baylor C
        • Britton D
        Speech versus speaking: the experiences of people with Parkinson's disease and implications for intervention.
        Am J Speech Lang Pathol. 2017; 26: 561https://doi.org/10.1044/2017_AJSLP-16-0087
        • Sjödahl Hammarlund C
        • Westergren A
        • Åström I
        • et al.
        The impact of living with Parkinson's disease: balancing within a web of needs and demands.
        Parkinson's Disease,. 2018; 2018: 1-8https://doi.org/10.1155/2018/4598651
        • Körner 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; : 1-10https://doi.org/10.1080/14015439.2018.1435718
        • Hogikyan ND
        • Sethuraman G
        Validation of an instrument to measure voice-related quality of life (V-RQOL).
        J Voice. 1999; 13: 557-569https://doi.org/10.1016/S0892-1997(99)80010-1
        • Ramig LO
        • Countryman S
        • Thompson LL
        • et al.
        Comparison of two forms of intensive speech treatment for Parkinson disease.
        J Speech Hear Res. 1995; 38: 1232-1251
        • Levitt JS
        • Chitnis S
        • Walker-Batson D
        The effects of the “SPEAK OUT! ®” and “LOUD Crowd®” voice programs for Parkinson disease.
        International Journal of Health Sciences (IJHS). 2015; 3: 2372-5079https://doi.org/10.15640/ijhs.v3n2a3
        • Murphy R
        • Tubridy N
        • Kevelighan H
        • et al.
        Parkinson's disease: How is employment affected?.
        Ir J Med Sci. 2013; 182: 415-419https://doi.org/10.1007/s11845-013-0902-5
        • Hunter EJ
        • Titze IR
        Variations in intensity, fundamental frequency, and voicing for teachers in occupational versus nonoccupational settings.
        J Speech Lang Hear Res. 2010; 53: 862-875https://doi.org/10.1044/1092-4388(2009/09-0040
      4. Szabo Portela, A, Hammarberg, B, & Södersten, M (2013). E-mail speaking fundamental frequency and phonation time during work and leisure time in vocally healthy preschool teachers measured with a voice accumulator. https://doi.org/10.1159/000354673

        • Baba Y
        • Putzke JD
        • Whaley NR
        • et al.
        Gender and the Parkinson's disease phenotype.
        J Neurol. 2005; 252: 1201-1205https://doi.org/10.1007/s00415-005-0835-7
        • Cholerton B
        • Johnson CO
        • Fish B
        • et al.
        Sex differences in progression to mild cognitive impairment and dementia in Parkinson's disease.
        Parkinsonism Relat Disord. 2018; 50: 29-36https://doi.org/10.1016/j.parkreldis.2018.02.007
        • Martinez-Martin P
        • Falup Pecurariu C
        • Odin P
        • et al.
        Gender-related differences in the burden of non-motor symptoms in Parkinson's disease.
        J Neurol. 2012; 259: 1639-1647https://doi.org/10.1007/s00415-011-6392-3
        • Skodda S
        • Rinsche H
        • Schlegel U
        Progression of dysprosody in Parkinson's disease over time-A longitudinal study.
        Mov Disord. 2009; 24: 716-722https://doi.org/10.1002/mds.22430
        • Skodda S
        • Visser W
        • Schlegel U
        Gender-related patterns of dysprosody in Parkinson disease and correlation between speech variables and motor symptoms.
        J Voice. 2011; 25: 76-82https://doi.org/10.1016/j.jvoice.2009.07.005