Background: Swallowing difficulties or dysphagia is the main cause of aspiration pneumonia and death in patients with Parkinson's disease (PD). Although dysphasia occurs in 90% of patients with PD, there is insufficient evidence to support the effectiveness of behavioral speech therapy in this disease. Objectives: This study aimed to investigate the effect of a new telerehabilitation program that was a combination of speech and music therapy on dysphagia in patients with PD. Methods: This study was a 3-arm randomized controlled trial (RCT). Thirty-three subjects with PD (mean age, 58.88 years; 25 men and 8 women with complaints of swallowing problems) were randomly assigned to the combination therapy (including breathing, speech, voice, and singing exercises), conventional speech therapy, and music therapy groups. Each patient participated in 12 telerehabilitation sessions over 4 weeks. Swallowing Disturbance Questionnaire (SDQ) and Dysphagia Handicap Index (DHI), as the outcomes of this study, were evaluated 1 week before the first intervention session, 1 week after the last intervention session, and 3 months after the last evaluation. Results: The results showed a significant improvement in SDQ and all sub-tests (functional, physical, and emotional), as well as the total score of DHI in the combination therapy and conventional speech therapy groups after treatment (P < 0.05). Also, the music therapy group had a significant improvement in the SDQ score, emotional sub-test, and the total score of DHI (P < 0.05). The combination therapy group demonstrated a significant outperform in the SDQ score compared to the other 2 groups, as well as in all sub-tests and the total score of DHI compared to the music therapy group (P < 0.05). The combination therapy group also showed more improvement in all sub-tests, as well as the total score of DHI, compared to the music therapy group (P < 0.05). The results also indicated that the speech therapy group had a more significant effect on the physical sub-test of DHI compared to the music therapy group (P < 0.05). Conclusions: Although swallowing function improved in all 3 groups, this improvement was more in the combination therapy group than in the other groups. Therefore, it can be concluded that combination therapy has the potential to provide additional benefits for swallowing efficiency in this patient group. The results also suggest that the telerehabilitation method is feasible to deliver intensive therapy to individuals with PD to improve swallowing functions.

BackgroundAlthough speech and voice disorders are common in Parkinson's disease (PD), there is insufficient evidence to support the effectiveness of behavioural speech therapies in these patients.AimsThis study aimed to examine the effects of a new tele‐rehabilitation program, a combining of conventional speech therapy and singing intervention, on voice deficits in patients with PD.Methods & ProceduresThis study was a three‐armed, assessor‐masked, randomised controlled trial. Thirty‐three people with PD were randomly assigned to the combination therapy, conventional speech therapy, or singing intervention group. This study followed the Consolidated Standards of Reporting Trials guidelines for non‐pharmacological treatment. Each patient participated in 12 tele‐rehabilitation sessions over 4 weeks. The combination therapy group received speech and singing interventions simultaneously (respiratory, speech, voice, and singing exercises). Voice intensity as a primary outcome and the voice handicap index (VHI), maximum frequency range, jitter and shimmer as secondary outcomes were evaluated 1 week before the first intervention session, 1 week after the last intervention session and 3 months after the last evaluation.Outcomes & ResultsThe results of repeated measures analysis of variance showed a significant main effect of time on all outcomes in all three groups after treatment (p < 0.001). There was a significant group effect for voice intensity (p < 0.001), VHI (p < 0.001), maximum frequency range (p = 0.014) and shimmer (p = 0.001). The combination therapy group demonstrated a significant outperformance in the VHI and shimmer than the speech therapy (p = 0.038) and singing intervention (p < 0.001) groups. The results of this study also indicated that combination therapy group compared to singing intervention group had a larger effect on voice intensity (p < 0.001), shimmer (p < 0.001) and maximum frequency range (p = 0.048).Conclusions & ImplicationThe results demonstrated that combining speech therapy with a singing intervention delivered through tele‐rehabilitation might be more effective in improving voice problems in patients with PD.What this paper addsWhat is already known on the subject Parkinson's disease (PD) is a neurological disorder that frequently causes disturbances in speech and voice, which negatively affect patients’ quality of life. Although speech difficulties occur in 90% of patients with PD, evidence‐based treatment options for speech and language problems in these patients are limited. Therefore, further studies are required to develop and assess evidence‐based treatment programs.What this study adds The findings of this study showed that a combination therapy program including conventional speech therapy approaches and individual singing intervention provided through tele‐rehabilitation may have a greater effect on the improvement of voice problems in people with PD compared to speech therapy and singing intervention alone.What are the clinical implications of this work? Tele‐rehabilitation combination therapy is an inexpensive and enjoyable behavioural treatment. The advantages of this method are that it is easy to access, appropriate for many stages of voice problems in PD, requires no prior singing training, encourages voice health and self‐management and maximises treatment resources available to people with PD. We believe that the results of this study can provide a new clinical basis for treatment of voice disorders in people with PD.