Intensive Voice Therapy Research Articles

Feasibility of Intensive Voice Therapy for Pediatric Vocal Fold Nodules Delivered via Telepractice: Pilot Study

PurposeThe aim of this study is to assess the feasibility of an intensive voice therapy delivered via telepractice for pediatric vocal fold nodules (VFNs). MethodTen children with VFNs (mean age = 6 years, range = 5-8 years) were recruited in this study. Assessments including stroboscopic ratings, acoustic parameters, aerodynamic and auditory perceptual measures, and parent-reported Pediatric Voice Handicap Index were administered pretreatment and within 1 week post treatment. Eight resonant voice therapy sessions were provided three times a week via a secure online platform, which were completed within 3 weeks. The assessments were conducted in a clinical face-to-face modality in China, whereas the therapy sessions were all conducted online, with the participants and their caregivers in China and the speech-language pathologist in Taiwan. ResultsAll participants completed the therapy sessions as scheduled, and there were no dropouts. Statistical analyses showed that significant improvements in acoustic and aerodynamic parameters, as well as stroboscopic and auditory-perceptual ratings. ConclusionThis study provides positive preliminary results indicating intensive voice therapy delivered via telepractice may be feasible and effective for the pediatric VFN population. Service providers and families may consider this delivery modality for ease of access when voice therapy is recommended.

Intensive Voice Treatment following Botulinum Neurotoxin Injection for a Speaker with Abductor Laryngeal Dystonia: An Exploratory Case Study.

Abductor laryngeal dystonia (ABLD) is a rare neurological voice disorder which results in sporadic opening of the vocal folds during speech. Etiology is unknown, and to date there is no identified effective behavioral treatment for it. It is hypothesized that LSVT LOUD®, which was developed to treat dysphonia secondary to Parkinson's disease, may have application to speakers with ABLD to improve outcomes beyond that with botulinum neurotoxin (BoNT) treatment alone. The participant received one injection of BoNT in each vocal fold 2 to 3 months prior to initiating intensive voice therapy via teletherapy. Objective measures of vocal loudness (dB sound pressure level), maximum phonation time, and high/low pitch frequency (Hz) were recorded in all treatment sessions and follow-up sessions. Over the course of treatment, the participant showed steady gains in phonation time, volume, pitch range, and vocal quality with a substantial reduction in aphonic voice breaks by the end of the treatment program. Perceptual symptoms of ABLD were nearly undetectable by the participant and the clinicians up to 12 months posttreatment, with no additional BoNT injections. The results suggest that LSVT LOUD® following BoNT was effective, with long-lasting improvement in vocal function, for this speaker with ABLD.

Voice Outcomes of Intensive Voice Feminization Therapy for Transgender Women Delivered via Telepractice: Pilot Study

ObjectivesThe aim of this pilot study is to investigate the efficacy of an intensive voice feminization therapy program provided via telepractice. MethodsA total of 10 transgender women participated, with 9 completing the therapy program. All participants received 12 sessions of resonant voice therapy in combination with Vocal Function Exercises and voice hygiene, which were completed within four weeks. Acoustic and aerodynamic measures, auditory-perceptual ratings, Trans Woman Voice Questionnaire (TWVQ) and self-rated voice femininity were conducted before and after treatment. ResultsStatistical analysis showed significant improvements in acoustic measures such as fundamental frequency and semitones, TWVQ scores, auditory-perceptual ratings and self-perception of voice femininity after intensive voice therapy. ConclusionsThis study provides preliminary evidence to suggest that transgender women can benefit from intensive voice therapy when provided via telepractice, with a more feminine voice and better self-perceived voice-related quality of life. The limitations of this study were that the single-group study design lacked a control group for comparison, and the small sample size. Therefore, a randomize controlled and follow-up study with a larger sample size, exploring the effects of different treatment modalities on transgender women's voices is warranted.

Effects of Intensive Voice Treatment on Perceived Swallowing Abilities in Parkinson's Disease: Clinical Case Series

<h3>Research Objectives</h3> The purpose of this study was to determine the change in perception of swallowing abilities in patients with Parkinson's disease (PD) after completion of an intensive voice therapy program as evidenced by self-rated perception scales and interview data. <h3>Design</h3> A prospective mixed methods case study design. <h3>Setting</h3> Hospital based outpatient speech language pathology clinic. <h3>Participants</h3> Four PD patients with varying medical histories, therapeutic needs, and clinical presentations. <h3>Interventions</h3> The Lee Silverman Voice Treatment (LSVT LOUD) program which uses high effort exercises for improved voice production. The program requires completion per protocol, daily homework and carryover assignments. <h3>Main Outcome Measures</h3> The voice handicap index (VHI), the perceptual rating scale, and the dysphagia handicap index (DHI), interview forms that are part of the voice program, and additional interview questions related to this project. <h3>Results</h3> Changes from pre- and post- LSVT LOUD sessions for voice, dysphagia, and communication abilities as measured by all self-rated scales and interview data. The physical (sensations of choking), emotional (fear of choking), and functional (avoidance of eating) perceptions as measured by the DHI were improved. Each patient, regardless of medical history or treatment program format, reported improved emotional perceptions of their swallowing problems. This was consistent even for those patients without changes to their diet consistency status. <h3>Conclusions</h3> The incorporation of a dysphagia perception self-rating scale may contribute to improved outcomes even for those PD patients not seeking out dysphagia treatment specifically. Other benefits may include clarifying the treatment plan by ensuring to address all issues, education for the patient in regard to their dysphagia concerns, and education for the family by expanding the objective measures to include subjective perceptions which may help explain the scope of the disability. <h3>Author(s) Disclosures</h3> Nothing to disclose.

The effects of surface electrical stimulation plus voice therapy in Parkinson's disease.

This study aimed to assess the effects of surface electrical stimulation plus voice therapy on voice in dysphonic patients with idiopathic Parkinson's disease. Patients were assigned to 3 treatment groups (n = 28 per group) and received daily treatment for 3 weeks on 5 days a week. All three groups received voice therapy (usual care). In addition, two groups received surface electrical stimulation, either motor-level or sensory-level stimulation. A standardised measurement protocol to evaluate therapeutic effects included the Voice Handicap Index and videolaryngostroboscopy. Voice Handicap Index and videolaryngostroboscopic assessment showed statistically significant differences between baseline and post-treatment across all groups, without any post-treatment differences between the three groups. Intensive voice therapy (usual care) improved idiopathic Parkinson's disease patients' self-assessment of voice impairment and the videolaryngostroboscopic outcome score. However, surface electrical stimulation used as an add-on to usual care did not improve idiopathic Parkinson's disease patients' self-assessment of voice impairment or the videolaryngostroboscopic outcome scores any further.

Endoscopic treatment of anterior laryngeal web using keel designed from ePTFE followed by voice therapy: a refined technique

BackgroundTreatment of laryngeal web is challenging due to possibility of recurrence and affected voice quality. Optimal treatment of laryngeal web should emphasize on improving both airway and vocal function. We refined the traditional endoscopic method using a new keel designed from expanded polytetrafluoroethylene (ePTFE) membrane. Our objective is to evaluate the voice outcomes following the endoscopic treatment and voice therapy.ResultsTen subjects presented with anterior laryngeal web. Auditory perceptual assessment, stroboscopic examination and acoustic studies were performed pre- and postoperatively. Endoscopic excision of laryngeal web was performed with cold instruments. An individually designed ePTFE keel was fixed by Nylon thread 2–0 at the anterior commissure and tied subcutaneously in the neck. The keel left for 3–5 weeks followed by voice therapy using abdomino-diaphragmatic breathing exercise and relaxation method. Vocal parameters measured were perceptual voice quality using Grade-Roughness-Breathiness-Asthenia-Strain voice scale (GRBAS), stroboscopic score, fundamental frequency (F0), jitter, shimmer, pitch perturbation question (PPQ), amplitude perturbation question (APQ) and harmonics-to-noise ratio (HNR). Significant decrease in GRBAS (P < 0.001) and significant increase in stroboscopic scores (P < 0.001) were noticed after operation and voice therapy. Also, acoustic voice parameters showed significant improvements. The mean jitter, shimmer, PPQ and APQ showed significant decrease (p = 0.0028, 0.0032, 0.0026, 0.0014, and 0.006 respectively). Overall, 90 % of our subjects have satisfactory voice outcome.ConclusionEndoscopic excision of anterior laryngeal with cold instrument followed by ePTFE keel fixation achieved good long-term voice results. The ePTFE is soft biocompatible material which does not make reaction. The keel should be left in place for sufficient period of time (3–5 weeks). This ensures perfect healing with less or no recurrence. Absence of foreign body reactions in the vocal folds is important for mucosal integrity and good voice outcome. So, the ePTFE could be good alternative for laryngeal keel. Hyperfunctional dysphonia with ventricular hypertrophy may develop in longstanding anterior laryngeal web which needs intensive voice therapy after operation. Our treatment targeted both the organic etiology of dysphonia and the underlying cause of the possible associated functional element of dysphonia.

Intensive Voice Therapy for Patients with Dysphonia

Intensive Voice Therapy for Patients with Dysphonia

Effect of Intensive Voice Therapy in a Patient With Multiple System Atrophy

Introduction: Multiple System Atrophy (MSA) is a degenerative neurogenic disorder characterized by multiple symptoms affecting the movements and autonomic nervous system. It reduces the function of various types of nerve cells in the brain and spinal cord. MSA causes some movement disorders such as dysarthria that is one of the most common symptoms in these patients. The first neurological sign that sometimes progresses is the complete inability to produce speech. This study aimed to evaluate the effect of an intensive voice therapy based on the principles of Lee Silverman Voice Therapy (LSVT) on improving acoustic features, intelligibility, and quality of life index of the patients with MSA. Materials and Methods: The patient was a 57-year-old woman with MSA disorder. Acoustic assessments of voice, intelligibility, and voice handicap index were performed before and after the treatment program according to LSVT principles. Results: Acoustic values such as intensity, frequency, and harmonic to noise ratio increased, and jitter and shimmer parameters decreased. Amount of perception of intelligibility increased. A significant decrease in the scores of the quality of life index related to voice handicap was observed. Conclusion: After treatment by intensive voice therapy, the acoustic assessment revealed improvement in all voice parameters. The perceptual assessment showed improved intelligibility and increased the patient’s quality of life. Intensive voice therapy based on LSVT principles effectively improves the acoustic features, which subsequently cause intelligibility to be more comprehensible. It generally improves verbal communication, which has a positive effect on the patient’s quality of life.

Effectiveness of Intensive Voice Therapy Versus Weekly Therapy for Muscle Tension Dysphonia: A Noninferiority Randomised Controlled Trial With Nested Focus Group

To investigate the noninferiority of intensive voice therapy and compare its effects with weekly voice therapy on multidimensional outcomes of voice and well-being, satisfaction, and attendance in people with muscle tension dysphonia (MTD). The study further aimed to explore clinician's perceptions of barriers and enablers to implementation of intensive therapy. Noninferiority randomised controlled trial with nested focus group. Twenty adults with MTD were randomised to receive either weekly voice therapy (1 hour per week for 8 weeks) or intensive voice therapy (1 hour, 4 days per week for 2 weeks). Participants were assessed by a blinded assessor twice before treatment, once post treatment and once at 4 weeks follow up on the primary outcome measure VHI and a range of secondary auditory-perceptual, acoustic, and patient (i.e., VoiSS, satisfaction) and clinician reported outcome measures (i.e., AusTOMs, attendance rates). Five Speech Language Pathologists also participated in a focus group to explore barriers and enablers to implementing intensive therapy, with questions and analyses guided by the Theoretical Domains Framework. While noninferiority for the primary outcome measure VHI was not confirmed, secondary outcome measures revealed comparable within group clinically important improvements for VoiSS and the AusTOMs, as well as selected acoustic and auditory-perceptual measures for both groups. A trend of more improvements being maintained in the intensive group was identified. Comparably high satisfaction and attendance was also found between groups. Clinicians reported more enablers than barriers to providing intensive therapy which included beliefs that it led to greater progression and consolidation of patient learning, was supported by the local context and was associated with positive emotions. Barriers related to difficulties with booking and scheduling and the belief that intensive therapy was not for all patients. While the current study was likely underpowered to establish non-inferiority of intensive therapy, secondary outcomes suggested that intensive therapy may produce comparable benefits to voice, wellbeing, satisfaction and attendance compared to weekly therapy and may be a viable therapy option for individuals with MTD. When implementing intensive therapy, clinicians should consider patient's preferences and availability, as well as systems which allow for flexible booking and therapy provision for patients. Clear recommendations for future research including the use of a larger sample and telehealth are also provided.

The Patient's Opinion Regarding Different Service Delivery Models for Voice Therapy.

Purpose The purpose of this study was to compare the voice patient's opinion regarding three service delivery models for voice therapy: a short-term intensive voice therapy with individual sessions (IVT-I), a short-term intensive voice therapy with group sessions (IVT-G), or a long-term traditional voice therapy with individual sessions (TVT). Method Forty-six adult voice patients who followed either IVT-I, IVT-G, or TVT were contacted by e-mail with the request to fill in an online questionnaire reviewing their opinion about the received therapy. Several items concerning satisfaction, progress, time-related variables, transfer, and need for further therapy were scored by means of visual analog scales. Participants were also asked whether or not they continued voice therapy after the study. Results There were no significant differences between the three groups regarding the patients' perception of vocal quality improvement, degree of resolution of the voice disorder, duration of one session, total therapy duration, degree of transfer, need for further therapy, and actual continuation of therapy. A higher satisfaction rate was found for patients of the IVT-I and TVT groups than patients of the IVT-G group. The IVT-I group rated the therapy as too frequent compared with the TVT group who rated the frequency as optimal. Conclusion Results suggest that patients are equally satisfied and perceive a similar progress after individual short-term intensive voice therapy and individual long-term traditional voice therapy. This finding creates flexibility in selecting time-related variables depending on the specific case and situation. Patients who received individual therapy were more satisfied than patients who received group therapy. Future larger scale investigation is needed to confirm these results.

Voice therapy for Parkinson’s disease via smartphone videoconference in Malaysia: A preliminary study

Introduction Intensive voice therapy is one of the best evidence-based treatments to improve speech and voice difficulties to individuals with Parkinson’s disease (PD). However, accessibility to intensive voice therapy is highly challenging in Malaysia due to the lack of voice specialised speech-language therapists. This study examined the feasibility of using smartphone videoconference to deliver intensive voice therapy to individuals with PD in Malaysia. Methods Intensive voice therapy was delivered to 11 adults with PD using a smartphone videoconference method via WhatsApp Messenger freeware. The therapy consisted of 12 sessions over four weeks and focused on increasing vocal loudness. Outcomes were assessed using objective, perceptual and quality-of-life measures pre and post treatment. Participant satisfaction with the telerehabilitation method was obtained via the Smartphone-Based Therapy Satisfaction Questionnaire. Results Significant gains were reported for sound pressure level in sustained vowels and monologue. Perceptual ratings showed significant improvements in overall mean severity and loudness after treatment. Mean scores of speech intelligibility and Voice Handicap Index-10 were significantly better post treatment. Overall, participants were highly satisfied with the smartphone videoconference method. Discussion Present results suggest that the smartphone videoconference method is feasible to deliver intensive voice therapy to individuals with PD to gain better speech and voice functions. Future studies need to address the standardisation of the system protocol to optimise this novel service delivery method in Malaysia.

Reduction of Parkinson's-related dysphonia by thyroplasty

Parkinson's-related dysphonia has a negative impact on the quality of speech by increasing the effects of the associated dysarthria. When this dysphonia is related to vocal fold adduction defect, constituting a real glottic insufficiency, vocal fold medialization can be proposed after failure of intensive voice and speech therapy. Acoustic and aerodynamic voice and speech analysis techniques, perceptual evaluation and estimation of vocal handicap, associated with fiberoptic laryngoscopy were performed to determine the indication for vocal fold medialization in these patients with glottic insufficiency. Vocal fold medialization by Montgomery thyroplasty implant was performed under local anesthesia and neuroanalgesia in two patients with Parkinson's disease presenting a dysphonia refractory to speech therapy. Postoperative evaluation showed improvement of voice quality with an increased number of harmonics and improvement of aerodynamic parameters. Vocal fold medialization by Montgomery thyroplasty implant effectively improved voice quality in these two patients allowing a more effective vocal fold adduction. The reducing of the hypophonia has a positive effect on the quality of oral communication. The medialization thyroplasty technique, under local anesthesia, allows intraoperative control of the voice as well as removal of the implant when necessary.

Analysis of Temporal Change in Voice Quality After Thyroidectomy: Single-institution Prospective Study

This study analyzed the temporal changes of voice quality after thyroidectomy and assessed the predictive perioperative parameters of postthyroidectomy voice disorder (PTVD). This is a prospective cohort study. From March 2011 to July 2014, 559 patients who underwent thyroidectomy with or without central neck dissection were prospectively enrolled. All patients underwent prospective voice evaluation using the subjective and objective comprehensive battery of assessments, preoperatively and postoperatively at 1 week, 1 month, 3 months, 6 months, and 12 months. Fundamental frequency (F0) was not significantly decreased during the postoperative follow-up. Maximal vocal pitch (MVP) and maximal intensity were not recovered, even at 1 year postoperatively, whereas the Grade, Roughness, Breathiness, Asthenia, Strain scale reached preoperative value at postoperative 3-6 months and voice handicap index at 1 year. Postoperative 1-month MVP was the best predictor for PTVD, and the cut-off value was 80% of preoperative value. Wide surgical extent and high preoperative F0 were the parameters that significantly correlated with PTVD (P = 0.021 and P < 0.001, respectively), and large tumor, higher preoperative MVP, and lower postoperative 1-month F0 were significantly associated with permanent PTVD (P = 0.028, P < 0.001, and P = 0.003, respectively). Different recovery patterns of voice parameters should be considered in preoperative counseling. Intensive voice therapy may be needed for patients with the ability to produce higher pitch than normal preoperatively and wide surgical extent.

Delivery of Intensive Voice Therapy for Vocal Fold Nodules Via Telepractice: A Pilot Feasibility and Efficacy Study

This pilot study examined voice outcomes and patient perceptions after intensive voice therapy for vocal fold nodules via telepractice. Pilot, within-subjects experimental trial. Participants included 10 women diagnosed with bilateral vocal fold nodules who received intensive voice treatment via a free videoconferencing platform Skype, (Microsoft Corp., Redmond, WA). All participants completed one vocal hygiene session in person, followed by eight sessions of therapy via telepractice over 3 weeks. Before and immediately after treatment, patients attended a clinic in person to complete perceptual, stroboscopic, acoustic, and physiological assessments of vocal function. Analyses were performed by a speech-language pathologist and an otolaryngologist independent to and blinded to the study. Participants also completed the Voice Handicap Index and a telepractice satisfaction questionnaire, or an anticipated satisfaction questionnaire, before and after the treatment. Significant improvements were found in perceptual, vocal fold function, acoustic, and physiological parameters as well as nodule sizes and patient perceptions of voice-related quality of life post-treatment. Participants were highly positive about their first experience with telepractice. Results were similar to those from a separate study investigating the effects of an intensive voice therapy delivered in conventional face-to-face (FTF) format. This study is consistent with possible benefits of telepractice in the delivery of intensive treatment for vocal fold nodules. Pending final verification with a FTF comparison group, telepractice could be recommended as an alternate treatment modality for patients with vocal fold nodules.

Intensive Versus Traditional Voice Therapy for Vocal Nodules: Perceptual, Physiological, Acoustic and Aerodynamic Changes

To investigate the perceptual, physiological, acoustic, and aerodynamic outcomes of patients with vocal nodules following intensive voice treatment compared with traditional voice treatment. Pragmatic randomized clinical trial. Fifty-three women diagnosed with bilateral vocal nodules participated in the study. Voice recordings, stroboscopic recordings, acoustic, and aerodynamic assessments were made before voice treatment, after vocal hygiene education, and immediately postvoice treatment. All participants completed one session of vocal hygiene and eight sessions of direct voice therapy, however the delivery of the treatment between the two groups differed in treatment intensity. Physiological improvements were observed after vocal hygiene alone, whereas physiological, perceptual, and acoustic parameters all improved to some degree in both treatment groups immediately posttreatment. There were no differences in the extent of change observed between the two groups at any point following treatment. The investigation provided initial evidence that individuals with vocal nodules are able to recover voice function, vocal health, and vocal communication through intensive voice treatment. The results suggest comparable positive perceptual, physiological, and acoustic outcomes from intensive voice therapy compared with traditional voice therapy. Further investigation is required to determine the long-term effects of intensive treatment.

Combined type IIIB with bilateral type I thyroplasty for pitch lowering with maintenance of vocal fold tension.

To evaluate type IIIB thyroplasty using the excised larynx bench apparatus and determine how altering vocal fold contour by performing bilateral medialization of the inferior vocal fold affects phonation. This procedure could be performed in patients for whom pitch lowering is desirable, such as female-to-male transsexuals or male patients with mutational falsetto in whom intensive voice therapy was insufficient. Aerodynamic, acoustic, and high-speed videokymographic data were collected for nine larynges at three subglottal pressure inputs for each of three conditions: normal; type IIIB thyroplasty; and combined type IIIB with modified bilateral type I thyroplasty intended to create a more rectangular glottal configuration. Each larynx served as its own control. Phonation threshold flow (p=0.005), phonation threshold power (p=0.031), and airflow varied across conditions with highest values for type IIIB thyroplasty and lowest for the combined procedure. Fundamental frequency was significantly different (p<0.001), decreasing by approximately 100Hz from control to type IIIB trials, and then by approximately 15Hz from IIIB to combined procedure trials. Vibratory amplitudes and intrafold phase difference were highest for type IIIB trials. Addition of bilateral inferior medialization to type IIIB thyroplasty provided some further decrease in frequency, but mostly served to increase tension, reduce airflow, and produce a vibratory pattern which more closely mirrored control trials. Exploration of this combined procedure in patients may be warranted if not completely satisfied with the results from type IIIB thyroplasty alone.

Intensive voice treatment (LSVT ®LOUD) for Parkinson's disease following deep brain stimulation of the subthalamic nucleus

Purpose Intensive voice therapy (LSVT ®LOUD) can effectively manage voice and speech symptoms associated with idiopathic Parkinson disease (PD). This small-group study evaluated voice and speech in individuals with and without deep brain stimulation of the subthalamic nucleus (STN-DBS) before and after LSVT LOUD, to determine whether outcomes for surgical subjects were comparable to non-surgical cohorts. Methods Eight subjects with PD (four with STN-DBS and four without) received LSVT LOUD four times a week for four weeks. Four additional subjects with PD remained untreated. Voice intensity (SPL), Vowel Articulation Index (VAI), the Voice Handicap Index (VHI), and a structured interview were evaluated before and after treatment and again six months later. Results Both treated groups showed significant increases in SPL from pre to post and six-month follow up. VAI was significantly higher for the treated groups compared to the untreated subjects at follow up. Several treated individuals had significant clinical improvement in VHI scores, particularly within the LSVT-DBS group. Treated individuals reported improvements in voice and speech in structured interviews; however, answers suggest more variable long-term maintenance within the LSVT-DBS group. The untreated group exhibited no significant changes in any measure throughout the study. Conclusions Results support LSVT LOUD for treating voice and speech in individuals with PD following STN-DBS surgery. However, modifications may be required to maintain functional improvements. Learning outcomes: As a result of this activity, the participant will be able to (1) describe how deep brain stimulation of the subthalamic nucleus may affect voice and speech in Parkinson disease; (2) describe the effects of intensive voice therapy (LSVT ®LOUD) on people with PD both with and without STN-DBS; (3) describe how individuals with STN-DBS maintained treatment effects over time.

Boot Camp: A Novel Intensive Approach to Voice Therapy

It is well known in the disciplines of neurobiology, exercise physiology, motor learning, and psychotherapy that desirable learning and behavior changes occur primarily from practice that involves high-intensity overload, variability, and specificity of training. We propose a novel treatment approach called intensive short-term voice therapy that uses these practice parameters for recalcitrant dysphonia. Intensive short-term voice therapy involves multiple sessions with a variety of clinicians, incorporating multiple simultaneous therapeutic approaches. The intensive short-term voice therapy approach is characterized by voice therapy for 1-4 successive days each with an average of 5 hours of therapy and five clinicians. This form of intensive voice therapy provides rigorous practice, involving not only overload but also opportunities for specificity and individuality thereby facilitating better transfer of learned skills. This article discusses the conceptual, theoretical, and practical foundations of this novel therapy approach.

Effect of intensive voice treatment on tone‐language speakers with Parkinson's disease

The aim of this study was to investigate the effect of intensive voice therapy on Cantonese speakers with Parkinson's disease. The effect of the treatment on lexical tone was of particular interest. Four Cantonese speakers with idiopathic Parkinson's disease received treatment based on the principles of Lee Silverman Voice Treatment (LSVT). Outcome measures included perceptual measures and acoustic correlates of loudness, pitch, intonation, and tone (only intonation and tone are detailed in this study). All four participants demonstrated an increase in loudness, an increase in pitch and pitch range, and improved intonation during connected speech, as measured perceptually and acoustically. However, there were no obvious changes in the accuracy of lexical tone production, based on either phonetic transcription or acoustic analysis. The lack of improvement in lexical tones may support previous claims of a dissociation in fundamental frequency control for intonation and lexical tone production.

The Effects of Intensive Voice Treatment on Facial Expressiveness in Parkinson Disease

The purpose of the present retrospective study was to examine the effects of intensive voice therapy on facial expression in Parkinson disease. Parkinson disease (PD) often presents with symptoms that reduce communicative effectiveness on multiple levels, including decreased vocal loudness and reduced facial mobility. Recent advances in voice treatment have provided the first short- and long-term efficacy data indicating improvements in voice and speech following intensive voice therapy (Lee Silverman Voice Treatment [LSVT]). Anecdotal reports from both clinicians and patients indicate that the LSVT also has a positive impact on facial expression. These observations suggest a need to investigate more directly the effects of voice therapy on facial movement and expressiveness in PD. Forty-four individuals with idiopathic PD participated in this study. Video data were taken from recordings of individuals with PD who had received either one month of phonation-based treatment (LSVT) or respiratory treatment (RT) as part of a large treatment efficacy study designed to examine the effects of different types of therapy on speech and voice in PD. Twenty-second video samples of all subjects taken before and after treatment were paired and played at random without sound to trained raters, who judged each pair of video clips for facial mobility and engagement. All recordings were made while subjects were engaged in conversational speech. Inter-rater reliability was extremely high (0.90) for both the rating of facial mobility and engagement. Overall, members of the LSVT group received more ratings of increased facial mobility (P = 0.036) and engagement (P = 0.056) following treatment relative to members of the RT group. In addition, the extent of change for facial mobility after treatment was perceived as greater (P = 0.05) for the LSVT group than for the RT group. These results indicate that intensive voice therapy may have a positive effect on facial expressivity in PD. Such findings lend support to contemporary theories relating multiple expressive modalities (e.g., voice, face, and gesture) and suggest that targeting voice may be an effective and efficient way to influence expressive output in general.