Effects of Resonance Tube Voice Therapy on Parkinson's Disease: Clinical Trial

  • Author Footnotes
    1 This manuscript has not been published and is not under consideration by another journal. Part of this results were presented in The Voice Foundation Symposium (2019; 2021)
    Ana Paula dos Santos
    Address correspondence and reprint requests to Al. Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, São Paulo, 17012-901, Brazil.
    1 This manuscript has not been published and is not under consideration by another journal. Part of this results were presented in The Voice Foundation Symposium (2019; 2021)
    Speech-Language Pathology and Audiology Department at Faculdade de Odontologia de Bauru School of Dentistry, Sao Paulo College, Bauru, Sao Paulo, Brazil
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  • Michelle Shevon Troche
    Speech-Language Pathology Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York
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  • Giédre Berretin-Felix
    Speech-Language Pathology and Audiology Department at Bauru School of Dentistry, Sao Paulo College, Bauru, Sao Paulo, Brazil
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  • Fabio Augusto Barbieri
    Department of Physical Education, School of Sciences, São Paulo State University (UNESP) – Bauru, São Paulo, Brazil
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  • Alcione Ghedini Brasolotto
    Speech-Language Pathology and Audiology Department at Bauru School of Dentistry, Sao Paulo College, Bauru, Sao Paulo, Brazil
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  • Kelly Cristina Alves Silverio
    Speech-Language Pathology and Audiology Department at Bauru School of Dentistry, Sao Paulo College, Bauru, Sao Paulo, Brazil
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  • Author Footnotes
    1 This manuscript has not been published and is not under consideration by another journal. Part of this results were presented in The Voice Foundation Symposium (2019; 2021)



      To verify the effect of resonance tube voice therapy on the vocal aspects of patients with Parkinson's Disease (PD).


      Intra-subject comparative controlled clinical trial with a single group assignment. Fourteen individuals with PD (10 men, mean age 66.1 years; four women, mean age 73.75 years) received eight 45-minute sessions of voice therapy, twice a week for 4 weeks. The therapy consisted of semi-occluded vocal tract exercises – phonation method in a resonance tube (glass, 27 cm x 9 mm) in water. Tube depth in water ranged from 2 cm to 9 cm, as the difficulty in carrying out the exercises increased (usual pitch, high pitch, low pitch, ascending/descending glissandos), followed by sentence production. The assessments were made three times: at baseline (Time0), after 30 days without intervention (Time1), and 1 day after eight intervention sessions (Time2). The following aspects were assessed: vocal intensity; acoustic parameters (Smoothed Cepstral Peak Prominence – CPPs, alpha ratio, and L1-L0 difference); auditory-perceptual analysis of the overall degree of vocal quality deviation; voice symptoms (Voice Symptom Scale protocol - VoiSS) and voice-related quality of life (Voice-Related Quality of Life Protocol – V-RQOL). The results were compared at the three times of assessment Time0/Time1/Time2 using one-way repeated measures ANOVA test and Tukey test (5% significance).


      intervention significantly increased: vocal intensity, L1-L0 value of vowel /a/ and counting, CPP value in counting, and decreased: the overall degree of vocal quality deviation in 78% of participants, the total score of VoiSS protocol, the limitation, and emotional subscales. In addition, the intervention increased the score of all the domains of V-RQOL protocol - physical, socio-emotional, and total.


      Resonance tube phonation in voice therapy was effective in increasing vocal intensity and long-term acoustic parameters, the improved overall degree of vocal quality, reducing voice symptoms, and increasing voice-related quality of life in individuals with PD.

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