Abstract
BackgroundReduced vocal intensity is a core impairment of hypokinetic dysarthria in Parkinson’s disease (PD). Speech treatments have been developed to rehabilitate the vocal subsystems underlying this impairment. Intensive treatment programs requiring high-intensity voice and speech exercises with clinician-guided prompting and feedback have been established as effective for improving vocal function. Less is known, however, regarding long-term outcomes of clinical benefit in speakers with PD who receive these treatments.MethodsA retrospective cohort design was utilized. Data from 78 patient files across a three year period were analyzed. All patients received a structured, intensive program of voice therapy focusing on speaking intent and loudness. The dependent variable for all analyses was vocal intensity in decibels (dBSPL). Vocal intensity during sustained vowel production, reading, and novel conversational speech was compared at pre-treatment, post-treatment, six month follow-up, and twelve month follow-up periods.ResultsStatistically significant increases in vocal intensity were found at post-treatment, 6 months, and 12 month follow-up periods with intensity gains ranging from 5 to 17 dB depending on speaking condition and measurement period. Significant treatment effects were found in all three speaking conditions. Effect sizes for all outcome measures were large, suggesting a strong degree of practical significance.ConclusionsSignificant increases in vocal intensity measured at 6 and 12 moth follow-up periods suggested that the sample of patients maintained treatment benefit for up to a year. These findings are supported by outcome studies reporting treatment outcomes within a few months post-treatment, in addition to prior studies that have reported long-term outcome results. The positive treatment outcomes experienced by the PD cohort in this study are consistent with treatment responses subsequent to other treatment approaches which focus on high-intensity, clinician guided motor learning for voice and speech production in PD. Theories regarding the underlying neurophysiological response to treatment will be discussed.
Highlights
Reduced vocal intensity is a core impairment of hypokinetic dysarthria in Parkinson’s disease (PD)
Hypokinetic dysarthria in PD is characterized by deviations in the rate, range, force, and tone of neuromuscular function in the muscles underlying speech production [1]
The purpose of the present study was to investigate clinical outcomes in a large case series of patients who have received the SPEAK OUT! treatment in an effort to determine if measures of vocal function in patients with PD are positively or negatively impacted by this approach, and to compare results with the previously reported case reports
Summary
Reduced vocal intensity is a core impairment of hypokinetic dysarthria in Parkinson’s disease (PD). Hypokinetic dysarthria in PD is characterized by deviations in the rate, range, force, and tone of neuromuscular function in the muscles underlying speech production [1] These deviations translate to effects on speech that include abnormalities in articulation and phonation. The classic clinical presentation of speech impairment in PD is characterized by a perceptually salient low volume and breathy voice quality, short rushes of speech, and imprecise articulation [2]. These vocal abnormalities result from impairments to neuromuscular control of respiratory and laryngeal muscles which numerous treatments, both medical and behavioral, have aimed to improve.
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