Intensive Voice Treatment (LSVT®LOUD) for Parkinson's Disease Following Deep Brain Stimulation of the Subthalamic Nucleus

Overview

Journal J Commun Disord

Specialty Otorhinolaryngology

Date 2011 Jul 5

PMID 21724193

Citations 13

Authors

Jennifer Spielman

Leslie Mahler

Angela Halpern

Phllip Gilley

Olga Klepitskaya

Lorraine Ramig

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

The Effectiveness of Lee Silverman Voice Treatment (LSVT LOUD) on Children's Speech and Voice: A Scoping Review.

Papadopoulos A, Voniati L, Ziavra N, Tafiadis D Brain Sci. 2024; 14(9).

PMID: 39335431 PMC: 11429989. DOI: 10.3390/brainsci14090937.

A neurocomputational view of the effects of Parkinson's disease on speech production.

Manes J, Bullock L, Meier A, Turner R, Richardson R, Guenther F Front Hum Neurosci. 2024; 18:1383714.

PMID: 38812472 PMC: 11133703. DOI: 10.3389/fnhum.2024.1383714.

Bridging the Gap: Association between Objective and Subjective Outcomes of Communication Performance in People with Parkinson's Disease Evaluated for Deep Brain Stimulation.

Rodriguez-Porcel F, Schwen Blackett D, Hickok G, Bonilha L, Turner T Mov Disord Clin Pract. 2023; 10(12):1795-1799.

PMID: 38094653 PMC: 10715351. DOI: 10.1002/mdc3.13921.

Lee Silverman Voice Treatment to Improve Speech in Parkinson's Disease: A Systemic Review and Meta-Analysis.

Pu T, Huang M, Kong X, Wang M, Chen X, Feng X Parkinsons Dis. 2022; 2021:3366870.

PMID: 35070257 PMC: 8782619. DOI: 10.1155/2021/3366870.

Lee Silverman voice treatment (LSVT) mitigates voice difficulties in mild Parkinson's disease.

Saffarian A, Amiri Shavaki Y, Shahidi G, Hadavi S, Jafari Z Med J Islam Repub Iran. 2019; 33:5.

PMID: 31086784 PMC: 6504915. DOI: 10.34171/mjiri.33.5.

References

Miller N, Noble E, Jones D, Burn D . Life with communication changes in Parkinson's disease. Age Ageing. 2006; 35(3):235-9. DOI: 10.1093/ageing/afj053. View

Narayana S, Jacks A, Robin D, Poizner H, Zhang W, Franklin C . A noninvasive imaging approach to understanding speech changes following deep brain stimulation in Parkinson's disease. Am J Speech Lang Pathol. 2008; 18(2):146-61. PMC: 2779712. DOI: 10.1044/1058-0360(2008/08-0004). View

Dromey C, Kumar R, Lang A, Lozano A . An investigation of the effects of subthalamic nucleus stimulation on acoustic measures of voice. Mov Disord. 2000; 15(6):1132-8. DOI: 10.1002/1531-8257(200011)15:6<1132::aid-mds1011>3.0.co;2-o. View

Fox C, Ramig L, Ciucci M, Sapir S, McFarland D, Farley B . The science and practice of LSVT/LOUD: neural plasticity-principled approach to treating individuals with Parkinson disease and other neurological disorders. Semin Speech Lang. 2006; 27(4):283-99. DOI: 10.1055/s-2006-955118. View

Santens P, De Letter M, Van Borsel J, De Reuck J, Caemaert J . Lateralized effects of subthalamic nucleus stimulation on different aspects of speech in Parkinson's disease. Brain Lang. 2003; 87(2):253-8. DOI: 10.1016/s0093-934x(03)00142-1. View

Ramig L, Sapir S, Countryman S, Pawlas A, OBrien C, Hoehn M . Intensive voice treatment (LSVT) for patients with Parkinson's disease: a 2 year follow up. J Neurol Neurosurg Psychiatry. 2001; 71(4):493-8. PMC: 1763504. DOI: 10.1136/jnnp.71.4.493. View

DAlatri L, Paludetti G, Contarino M, Galla S, Marchese M, Bentivoglio A . Effects of bilateral subthalamic nucleus stimulation and medication on parkinsonian speech impairment. J Voice. 2007; 22(3):365-72. DOI: 10.1016/j.jvoice.2006.10.010. View

Rosen K, Kent R, Delaney A, Duffy J . Parametric quantitative acoustic analysis of conversation produced by speakers with dysarthria and healthy speakers. J Speech Lang Hear Res. 2006; 49(2):395-411. DOI: 10.1044/1092-4388(2006/031). View

Tripoliti E, Zrinzo L, Martinez-Torres I, Frost E, Pinto S, Foltynie T . Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease. Neurology. 2010; 76(1):80-6. PMC: 3262409. DOI: 10.1212/WNL.0b013e318203e7d0. View

10.

Sapir S, Spielman J, Ramig L, Hinds S, Countryman S, Fox C . Effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on ataxic dysarthria: a case study. Am J Speech Lang Pathol. 2003; 12(4):387-99. DOI: 10.1044/1058-0360(2003/085). View

11.

Sapir S, Ramig L, Hoyt P, Countryman S, OBrien C, Hoehn M . Speech loudness and quality 12 months after intensive voice treatment (LSVT) for Parkinson's disease: a comparison with an alternative speech treatment. Folia Phoniatr Logop. 2002; 54(6):296-303. DOI: 10.1159/000066148. View

12.

Baumgartner C, Sapir S, Ramig T . Voice quality changes following phonatory-respiratory effort treatment (LSVT) versus respiratory effort treatment for individuals with Parkinson disease. J Voice. 2002; 15(1):105-14. DOI: 10.1016/s0892-1997(01)00010-8. View

13.

Klostermann F, Ehlen F, Vesper J, Nubel K, Gross M, Marzinzik F . Effects of subthalamic deep brain stimulation on dysarthrophonia in Parkinson's disease. J Neurol Neurosurg Psychiatry. 2007; 79(5):522-9. DOI: 10.1136/jnnp.2007.123323. View

14.

Hammer M, Barlow S, Lyons K, Pahwa R . Subthalamic nucleus deep brain stimulation changes velopharyngeal control in Parkinson's disease. J Commun Disord. 2010; 44(1):37-48. PMC: 3010465. DOI: 10.1016/j.jcomdis.2010.07.001. View

15.

Schulz G . The effects of speech therapy and pharmacological treatments on voice and speech in Parkinson s disease: a review of the literature. Curr Med Chem. 2002; 9(14):1359-66. DOI: 10.2174/0929867023369808. View

16.

Sapir S, Ramig L, Spielman J, Fox C . Formant centralization ratio: a proposal for a new acoustic measure of dysarthric speech. J Speech Lang Hear Res. 2009; 53(1):114-25. PMC: 2821466. DOI: 10.1044/1092-4388(2009/08-0184). View

17.

Tomlinson C, Stowe R, Patel S, Rick C, Gray R, Clarke C . Systematic review of levodopa dose equivalency reporting in Parkinson's disease. Mov Disord. 2010; 25(15):2649-53. DOI: 10.1002/mds.23429. View

18.

Spielman J, Borod J, Ramig L . The effects of intensive voice treatment on facial expressiveness in Parkinson disease: preliminary data. Cogn Behav Neurol. 2003; 16(3):177-88. DOI: 10.1097/00146965-200309000-00005. View

19.

Ho A, Bradshaw J, Iansek R . For better or worse: The effect of levodopa on speech in Parkinson's disease. Mov Disord. 2008; 23(4):574-80. DOI: 10.1002/mds.21899. View

20.

Ball L, Beukelman D, Pattee G . Communication effectiveness of individuals with amyotrophic lateral sclerosis. J Commun Disord. 2004; 37(3):197-215. DOI: 10.1016/j.jcomdis.2003.09.002. View