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

Objective: The purpose of the present retrospective study was to examine the effects of intensive voice therapy on facial expression in Parkinson disease.

Background: 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.

Method: 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.

Results: 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.

Conclusions: 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.