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Abstract
ObjectivesTo evaluate the process and scientific feasibility of using a portable voice accumulator (PVA) to study carry-over of treatment effects on speech and voice in people with mild-moderate Parkinson's disease. MethodsThe study was guided by the checklist in Consolidated Standards of Reporting Trials (CONSORT) 2010 statement: extension to randomized pilot and feasibility trials. Participants with Parkinson's disease were recruited within the context of a randomized controlled trial with random allocation to intervention with either HiCommunication, a program targeting speech and communication, or HiBalance, a program targeting balance and strength. Before and after intervention data was collected from standardized studio recordings of speech and registrations of voice use in daily life with the PVA VoxLog. ResultsFifteen participants were included in the study and sufficient data was yielded from six of them. Reasons for insufficient data included technical issues and difficulties handling the PVA. Changes in voice sound level from pre to post intervention differed at an individual level when assessed in daily life compared to studio recordings. Registrations in daily life provided information on phonation ratio and ability to adapt voice sound level to environmental noise. ConclusionThis study highlights the challenges of studying intervention effects on voice use in daily life using a PVA. Improvements of test protocols in future studies are suggested. We exemplify how PVA data may generate a more detailed and ecologically valid picture of voice use complementing studio recordings of speech. Finally, we encourage technical development of more user-friendly PVAs.
Highlights
Parkinson’s disease (PD) is a progressive, neurodegenerative disease with an incidence rate peaking at 70-79 years of age; 105/100 000 for women and 133/100 000 for men.[1]
In one case the participant reported that she had misunderstood the instructions and only worn the portable voice accumulator (PVA) when she expected to use her voice in conversations
For most periods without registrations the participants reported that they had worn the PVA indicating that the insufficiency of registration was caused by technical issues and/or difficulties handling the device
Summary
Parkinson’s disease (PD) is a progressive, neurodegenerative disease with an incidence rate peaking at 70-79 years of age; 105/100 000 for women and 133/100 000 for men.[1]. Speech changes result in hypokinetic dysarthria, a motor speech disorder, where reduced vocal loudness leading to difficulties making oneself heard is the most common symptom. Cognitive changes and self-regulatory deficits often increase as the disease progresses resulting in individuals with PD not always being aware of their voice sound level which contributes to difficulties with long-term transfer of voice intervention effects.[13,14] Changes in auditory perception of one’s own voice sound level and in somatosensory processing, with a reduced ability to use auditive feedback to update feedforward mechanisms, result in an underestimation of the required effort needed to produce a sufficient voice sound level as well as decreased regulation of the vocal motor system during ongoing speech.[15,16,17].
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