Summary
Objectives
The majority of individuals with Parkinson's disease (PD) experience voice and speech
problems during the course of the disease. Despite the importance of voice quality
in communication and the documented disordered voice quality in PD, few studies have
explored the effects of speech treatment on this variable.
Study Design/Methods
A parallel arm, unblinded randomized controlled trial (RCT) was conducted with two
active comparators, LSVT LOUD (n = 23) and LSVT ARTIC (n = 20), and an inactive comparator group of untreated individuals with PD (n = 22). A group of 20 healthy adults was also included for pre-treatment analysis.
Voice recordings were obtained pre-treatment, immediately post-treatment and at 6-month
follow-up. The acoustic voice quality index (AVQI) is reported here as a secondary
outcome measure of the RCT. Linear mixed-effects regression analysis was performed
with AVQI and sound pressure level (SPL) as dependent variables. Pearson correlation
coefficient analysis was also conducted to explore the relationship between voice
quality and SPL.
Results
Statistically significant improvements in AVQI and SPL from pre-treatment to post-treatment
and follow-up were only observed in the LSVT LOUD group. Voice quality significantly
improved only from pre-treatment to follow-up in the LSVT ARTIC group, whilst significant
improvements in SPL were observed during maximum phonation only immediately post-treatment.
No significant changes were observed in the untreated group.
Discussion
This study investigated the effects of intensive speech treatment targeting voice
or targeting articulation on voice quality, as measured by the AVQI, in individuals
with PD. Findings indicate that voice-focused treatment leads to greater improvements
in voice quality in this population.
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 accessOne-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 VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Frequency and co-occurrence of vocal tract dysfunctions in the speech of a large sample of Parkinson patients.J Speech Hearing Disord. 1978; 43: 47-57https://doi.org/10.1044/jshd.4301.47
- Motor Speech Disorders: Substrates, Differential Diagnosis, and Management.Fourth ed. Elsevier, St. Louis, Missouri2020
- 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
- Regulation of parkinsonian speech volume: the effect of interlocuter distance.J Neurol Neurosurg Psychiatry. 1999; 67: 199-202
- A study of voice profiles and acoustic signs in patients with Parkinson's disease in North India.J Clin Neurosci. 2012; 19: 1125-1129
- Rate and loudness manipulations in dysarthria: acoustic and perceptual findings.J Speech Lang Hearing Res. 2004; 47: 766-783https://doi.org/10.1044/1092-4388(2004/058
- Vowel acoustics in dysarthria: speech disorder diagnosis and classification.J Speech Lang Hearing Res. 2014; 57: 57-67https://doi.org/10.1044/1092-4388(2013/12-0262
- 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.J Speech Lang Hearing Res. 2007; 50: 899-912https://doi.org/10.1044/1092-4388(2007/064)
- Kinematic, acoustic, and perceptual analyses of connected speech produced by Parkinsonian and normal geriatric adults.J Acoust Soc Am. 1989; 85: 2608-2622
- Speech and swallowing symptoms associated with Parkinson's disease and multiple sclerosis: a survey.Folia Phoniatr Logop. 1994; 46: 9-17
- Prevalence and pattern of perceived intelligibility changes in Parkinson's disease.J Neurol Neurosurg Psychiatry. 2007; 78: 1188-1190
- Speech and communication changes reported by people with Parkinson's disease.Folia Phoniatr Logop. 2017; 69: 131-141https://doi.org/10.1159/000479927
- Variables associated with communicative participation in Parkinson's disease and its relationship to measures of health-related quality-of-life.Int J Speech Lang Pathol. 2017; 19: 407-417
- The acoustic vowel space in speech disorders: data and interpretation.J Acoust Soc Am. 2007; 122 (3015-3015)
- The impact of dysphonic voices on healthy listeners: listener reaction times, speech intelligibility, and listener comprehension.Am J Speech Lang Pathol. 2016; 25: 561-575https://doi.org/10.1044/2016_AJSLP-14-0183
- External validation of the acoustic voice quality index version 03.01 with extended representativity.Ann Otol Rhinol Laryngol. 2016; 125: 571-583https://doi.org/10.1177/0003489416636131
- The dysphonia severity index: an objective measure of vocal quality based on a multiparameter approach.J Speech Lang Hearing Res. 2000; 43: 796-809
- The value of the Acoustic Voice Quality Index as a measure of dysphonia severity in subjects speaking different languages.Eur Arch Otorhinolaryngol. 2014; 271: 1609-1619
- Speech therapy and Parkinson's disease: a review and further data.Br J Disord Commun. 1990; 25: 183-194
- The response of the apparent receptive speech disorder of Parkinson-disease to speech-therapy.J Neurol Neurosurg Psychiatry. 1984; 47: 302-304
- The effect of SPEAK OUT! And The LOUD Crowd on dysarthria due to Parkinson's disease.Am J Speech Lang Pathol. 2020; 29: 1448-1465
- HiCommunication as a novel speech and communication treatment for Parkinson's disease: a feasibility study.Brain Behav. 2021; 11: 1-9
- Comparison of two forms of intensive speech treatment for Parkinson's disease.J Speech Hearing Res. 1995; 38: 1232-1251
- Intensive voice treatment for patients with Parkinson's disease: short- and long-term comparison of two techniques.Neurology. 1996; 47: 1496-1504
- Intensive voice treatment (LSVT®) for individuals with Parkinson's disease: a two-year follow-up.J Neurol Neurosurg Psychiatry. 2001; 71 (a): 493-498
- 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 (b): 79-83
- Innovative technology for the assisted delivery of intensive voice treatment (LSVT®LOUD) for Parkinson disease.Am J Speech Lang Pathol. 2012; 21: 354-367
- Speech treatment in Parkinson's disease: randomized controlled trial (RCT).Mov Disord. 2018; 33: 1777-1791https://doi.org/10.1002/mds.27460
S Narayana, C Franklin, E Peterson, et al, Immediate and long-term effects of speech treatment targets and intensive dosage on Parkinson's disease dysphonia and the speech motor network: Randomized controlled trial, Hum Brain Mapp (In press).
- Aerodynamic mechanisms underlying treatment-related changes in vocal intensity in patients with Parkinson disease.J Speech Hearing Res. 1996; 39: 798-807
- Effectiveness of Lee Silverman Voice Treatment® LOUD on Japanese-speaking patients with Parkinson's disease.Rehabil Res Pract. 2020; 658: 52-64https://doi.org/10.1155/2020/6585264
- Impact of the LSVT on vowel articulation and coarticulation in Parkinson's disease.Clin Linguist Phon. 2015; 29: 424-440https://doi.org/10.3109/02699206.2015.1012301
- Effect of LSVT on lexical tone in speakers with Parkinson's disease.Parkinson's Dis. 2011; 897494https://doi.org/10.4061/2011/897494
- Intensive voice treatment in Parkinson disease: laryngostroboscopic findings.J Voice. 1995; 9: 453-459
- Improvement of voicing in patients with Parkinson's disease by speech therapy.Neurology. 2003; 61: 1316-1317
- Neural correlates of hypokinetic dysarthria and mechanisms of effective voice treatment in Parkinson disease.Neurorehabil Neural Repair. 2018; 32: 1055-1066https://doi.org/10.1177/1545968318812726
- Neural correlates of efficacy of voice therapy in Parkinson's disease identified by performance-correlation analysis.Hum Brain Mapp. 2010; 31: 222-236https://doi.org/10.1002/hbm.20859
- The effects of intensive speech treatment on conversational intelligibility in Spanish speakers with Parkinson's disease.Am J Speech Lang Pathol. 2018; 27: 154-165https://doi.org/10.1044/2017_AJSLP-17-0032
- Preliminary data on two voice therapy interventions in the treatment of presbyphonia.Laryngoscope. 2014; 124: 1869-1876https://doi.org/10.1002/lary.24548
- Voice quality changes following phonatory-respiratory effort treatment (LSVT®) versus respiratory effort treatment for individuals with Parkinson disease.J Voice. 2001; 15: 105-114
- Voice harmonic amplitude differences before and after LSVT LOUDTM in Parkinson's disease [abstract].Mov Disord. 2016; 31
- Sentence intelligibility before and after voice treatment in speakers with idiopathic Parkinson's disease.J Voice. 2012; 26: 214-219
- Spectral/Cepstral analyses of phonation in parkinson's disease before and after voice treatment.Folia Phoniatr Logop. 2019; 71: 275-285
- Impact of clear, loud, and slow speech on scaled intelligibility and speech severity in Parkinson's disease and multiple sclerosis.J Speech Lang Hearing Res. 2014; 57: 779-792
- Mini-mental state: a practical method for grading the cognitive state of patients for the clinician.J Psych Res. 1975; 12: 189-198https://doi.org/10.1016/0022-3956(75)90026-6
- Beck Depression Inventory.Second ed. The Psychological Corporation, San Antonio, Texas1996
- Parkinsonism: onset, progression, and mortality.Neurol. 1967; 17: 427-442https://doi.org/10.1212/wnl.17.5.427
- Effectiveness of home-based and remotely supervised aerobic exercise in Parkinson's disease: a double-blind, randomized controlled trial.Lancet Neurol. 2019; 18: 998-1008
- The effects of intensive speech treatment on intelligibility in Parkinson's disease: a randomised controlled trial (RCT).Lancet E-Clin Med. 2020; 24: 1-11
- Single word intelligibility of individuals with Parkinson's disease in noise: pre-specified secondary outcome variables from a randomized controlled trial (RCT) comparing two intensive speech treatments (LSVT LOUD vs. LSVT ARTIC).Brain Sci. 2021; 11: 857
- Measurement of vocal doses in speech: experimental procedure and signal processing.Logoped Phoniatr Vocol. 2003; 28: 181-192https://doi.org/10.1080/14015430310018892
- Recommended protocols for instrumental assessment of voice.Am J Speech Lang Pathol. 2018; 27: 887-905
- Voice and Articulation Drillbook.Harder and Brothers, New York1960
- Mixed-Effects Models in S and S-PLUS.Springer, New York, New York2000https://doi.org/10.1007/0-387-22747-4_1
- Hierarchical Linear Models: Applications and Data Analysis Methods.Second ed. Sage, London2002
- R: A Language and Environment for Statistical Computing (4.1.1) [Computer software].R Foundation for Statistical Computing, 2021 (Available at:)
- Fitting linear mixed-effects models using lme4.J Stat Softw. 2015; 67: 1-48https://doi.org/10.18637/jss.v067.i01
RV Lenth, Emmeans: eEstimated marginal means, aka least-squares means (R package version 1.6.3) [Computer software], 2021. Available at: https://CRAN.R-project.org/package=emmeans
- The aging voice: a review, treatment data and familial and genetic perspectives.Folia Phoniatr Logop. 2001; 53: 252-265
- Efficacy of conversation training therapy for patients with benign vocal fold lesions and muscle tension dysphonia compared to historical matched control patients.J Speech Lang Hear Res. 2019; 22: 4062-4079
- Hybridizing conversational and clear speech to investigate the source of increased intelligibility in speakers with Parkinson's disease.J Speech Lang Hearing Res. 2014; 57: 1191-1205https://doi.org/10.1044/2014_JSLHR-S-13-0086
- De invloed van intensiteit op akoestische stemkwaliteitsmetingen [The influence of vocal intensity on acoustic measures of voice quality].Stem- Spraak- en Taalpathologie. 2013; 18: 1-8
- Effects of vocal intensity and fundamental frequency on cepstral peak prominence in patients with voice disorders and vocally healthy controls.J Voice. 2021; 35: 411-417
Article info
Publication history
Published online: April 18, 2022
Accepted:
March 10,
2022
Publication stage
In Press Corrected ProofFootnotes
This research was funded by the National Institutes of Health-National Institute of Deafness and Other Communicative Disorders (NIH-NIDCD) R01 DC01150 and LSVT Global, Inc.
Identification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
