Prosodic Improvement in Persons with Parkinson Disease Receiving SPEAK OUT!® Voice Therapy

Abstract

Background/Aims: Hypokinetic dysarthria in Parkinson disease (PD) hinders the ability to verbally communicate and interferes with activities of daily living. SPEAK OUT!® is a therapy program designed to improve functional communicative ability. In contrast to the Lee Silverman Voice Treatment program, SPEAK OUT!® promotes speaking with intent to effect loud speech. This study evaluated the efficacy of SPEAK OUT!® in persons with idiopathic PD in 3 domains: self-reported voice handicap, clinical ratings of dysarthria and prosody, and acoustic analysis of prosody. Participants and Methods: Pre-/post-therapy data included PD participants’ scores on the Voice Handicap Index (VHI) and the Voice-Related Quality of Life (V-RQOL) questionnaire, audio recordings, perceptual evaluation scores, and demographic data, such as age, sex, handedness, diagnosis, and onset of PD. Results: Participants achieved a statistically and clinically significant improvement in speech intensity, pitch range, normalized pairwise variability index for pitch, sustained vowel duration, reading intelligibility, and vocal quality after SPEAK OUT!® training, consistent with both of the self-report voice scores, i.e., the VHI and the V-RQOL, and with the perceptual speech evaluation scores. Longer PD duration was associated with lowered efficacy. Conclusions: SPEAK OUT!® is effective and should be administered as early as possible after disease onset.

Group-based intervention of participants with Parkinson disease: Findings from a 6-month LOUD Crowd® program

“…However, the overall difference in live loudness levels was relatively more visible for the TX group for both reading and monologue tasks when compared to the CN group. The findings of improved live loudness levels in the TX group are similar to prior studies [5,10,11]. Results also suggested the presence of a larger vowel space for the TX group compared to the CN group.…”

“…More recently, Boutsen and his colleagues reported the effectiveness of SPEAK OUT! ® and LOUD Crowd ® on the pro-sodic performance of individuals with PD [5]. Results indicated a significant improvement in speech intensity, pitch range, pitch variability, sustained vowel duration, vocal quality, reading intelligibility, and self-reported QOL performance before and after completion of the program.…”

“…® and LOUD Crowd ® was developed in 2010. These programs have goals of improved functional communicative ability by speaking with intent as a vehicle [5]. The intent in this program is typically defined and modeled as a purposeful cognitive focus related to increased vocal loudness and intonation variability during speech tasks [6].…”

(Dys)Prosody in Parkinson’s Disease: Effects of Medication and Disease Duration on Intonation and Prosodic Phrasing

“…The characterization and assessment of prosody in PD have been predominantly based on perceptual impressions and auditory assessment (e.g., [28]), listeners' judgments (e.g., [25,29,30]), self-reports (e.g., [31]), acoustic and articulatory measures (e.g., [32][33][34][35][36][37]), or a combination of these methods. On the basis of listeners' judgments, prior work has shown that PD patients were less effective in conveying contrastive stress, the statement/question sentence type distinction, as well as boundary marking [25,29,38].…”

Research-Based Updates in Swallowing and Communication Dysfunction in Parkinson Disease: Implications for Evaluation and Management

“…Behavioral speech therapy is currently the most effective treatment for improving speech in PD and, similar to gait therapies (Lim et al, 2005), has focused on leveraging external cueing. Speech therapy has shown improvements in both acoustic and auditory-perceptual measures when using external cues for vocal loudness (Lee Silverman Voice Treatment or LSVT® -LOUD; (Ramig et al, 2001;Sapir et al, 2002)) or when asking patients to speak with intent (SPEAK OUT!®; (Boutsen, Park, Dvorak, & Cid, 2018)).…”