Article

Effects of singing on voice, respiratory control and quality of life in persons with Parkinson’s disease

Disability and Rehabilitation

March 2016
39(6):1-7

DOI:10.3109/09638288.2016.1152610

Authors:

Paul Hibbing

University of Illinois at Chicago

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Purpose Interventions focused on singing may provide additional benefits to established voice and respiratory therapies, due to their greater emphasis on the respiratory muscle control system in those with Parkinson’s disease (PD) progresses. The purpose of this study was to examine if singing can improve voice, respiratory pressure and quality of life (QOL) in persons with PD. Methods This pilot study measured the effects of a singing intervention in 27 participants with PD. Participants were assigned to a high (met twice weekly) or low (met once weekly) dosage group. Voice, respiratory and QOL measures were recorded before and after an 8-week singing intervention. Sessions were led by board-certified music therapists and included a series of vocal and articulation exercises and group singing. Results Both groups demonstrated significant improvements in maximum inspiratory and expiratory pressure, as well as phonation time. While other voice measures improved, they did not reach statistical significance. Voice QOL and whole health QOL also significantly improved. Conclusion These results suggest singing may be a beneficial and engaging treatment choice for improving and maintaining vocal function and respiratory pressure in persons with PD. • Implications for Rehabilitation • In a small sample, group singing proved beneficial for improving voice and respiratory impairment in persons with Parkinson’s disease. • Completing group singing one time per week for 8 weeks was as effective as completing group singing two times per week for 8 weeks in persons with Parkinson’s disease. • Group singing is an effective means of improving overall quality of life in persons with Parkinson’s disease.

Effectiveness of Singing-Based Therapy on Voice Outcomes in Parkinson's Disease: A Systematic Review and Meta-Analysis

Article

Nov 2024

Background Communication impairments significantly impact the quality of life for individuals with Parkinson's disease (PD), underscoring the need for effective interventions. Singing, by engaging shared neural networks and structural mechanisms involved in speech production, holds therapeutic potential for addressing speech disorders in this population. This study explores the effects of singing-based therapeutic intervention on voice in patients diagnosed with PD. Methods We systematically searched four electronic databases to find relevant studies. Data extraction and analysis involved calculating mean differences (MD) or standardized mean difference (SMD) for pre- and post-singing interventions, including their 95% confidence intervals (CI). Statistical significance was evaluated with a P-value threshold >0.05. Results Our systematic review and meta-analysis included 21 studies, encompassing 449 patients. Singing showed no significant effect on speaking fundamental frequency (MD 2.98, 95% CI: − 6.79, 12.75, P = 0.55), jitter (MD − 0.13, 95% CI: − 0.47, 0.22, P = 0.47), shimmer (MD − 0.71, 95% CI: − 1.68, 0.26, P = 0.15), or health-related quality-of-life outcomes: Voice Handicap Index (MD − 4.60, 95% CI: − 9.29, 0.09, P = 0.05) and Voice-Related Quality of Life (SMD 0.08, 95% CI: − 0.28, 0.44, P = 0.65). However, singing significantly improved vocal frequency range (MD 2.60, 95% CI: 1.17, 4.03, P = 0.0004), maximum expiratory pressure (MD 14.26, 95% CI: 9.57, 18.96, P < 0.00001), maximum inspiratory pressure (MD 6.22, 95% CI: 2.96, 9.48, P = 0.0002), and maximum phonation time (MD 1.83, 95% CI: 0.73, 2.92, P = 0.001). Vocal intensity showed no significant difference (MD 1.09, 95% CI: − 0.71, 2.88, P = 0.24). Conclusion Our study found that singing interventions positively affect vocal frequency range and respiratory outcomes. However, significant changes were not observed in other speech metrics.

Therapeutic Singing and Semi-Occluded Vocal Tract Exercises for Individuals with Parkinson's Disease: A Randomized Controlled Trial of a Single Session Intervention

Article

Full-text available

Mar 2024
J MUSIC THER

Individuals with Parkinson’s disease (PD) experience speech and voice-related symptoms that diminish communication and quality of life. Semi-occluded vocal tract (SOVT) exercises are targeted interventions that, when combined with the positive psychosocial benefits of therapeutic group singing (TGS), may affect outcomes. The purpose of this study was to explore the effectiveness of SOVT exercises, specifically straw phonation combined with TGS, to improve voice quality and mood for individuals with PD. We used a true experimental pretest–posttest between-subjects design (i.e., randomized controlled trial) facilitated by a board-certified music therapist. All participants (N = 27) were randomly assigned to one of three groups (a) straw phonation combined with TGS (SP + TGS, n = 10), (b) TGS (n = 10), and (c) speaking-only control group (n = 7). Participants completed voice recordings for acoustic measures and the Visual Analogue Mood Scale for mood analysis before and after a 30-min intervention. The results demonstrated significant improvement in voice quality evidenced by decreasing Acoustic Voice Quality Index scores following a single session for both SP + TGS and TGS intervention groups when compared to the control. Happiness scores improved in the experimental groups when compared to control. Although not statistically significant, participants in the experimental groups (SP + TGS, TGS) demonstrated better mean mood scores on happiness, anxiety, and angry when compared to control, indicating a positive psychological response to the singing interventions. Overall, this study indicated the effectiveness of SP + TGS and TGS as promising therapeutic interventions for voice quality and mood in individuals with PD.

Identifying Non-Traditional Approaches to Swallowing Rehabilitation: A Scoping Review

Article

Full-text available

Oct 2023
Dysphagia

In recent years, dysphagia care has shifted toward a more patient-centered approach. This means that dysphagia clinicians are considering more factors in the treatment process including the goals of care, quality of life, and cultural values. The purpose of this scoping review was to examine relevant research and identify dysphagia interventions outside of those traditionally used by dysphagia clinicians that may improve swallowing function. A review of relevant studies was conducted using search terms related to swallowing and treatment. The search yielded 8439 unique studies. Of the 283 articles that underwent a full-text review, 37 articles were included in the final review. These articles highlighted three potential areas of non-traditional dysphagia intervention that may serve to provide holistic care, while also aiming to improve swallowing mechanisms: acupuncture and Eastern medicine interventions, vocal exercises, and physical function exercises. The results suggest that dysphagia clinicians should work collaboratively with other allied health professionals and consider non-traditional approaches to dysphagia care. Through the identification of potentially effective but non-traditional or non-Eurocentric interventions for dysphagia care, clinicians may promote a culturally relevant, patient-centered approach, in turn increasing patient acceptance of treatment plans and compliance. Future research should explore the efficacy and feasibility of these interventions in dysphagia rehabilitation, as well as their effectiveness compared to more traditional approaches.

Voice improvement following conventional speech therapy combined with singing intervention in people with Parkinson's disease: A three-arm randomised controlled trial

Article

Jun 2023
INT J LANG COMM DIS

Background: Although 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. Aims: This 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 & procedures: This 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 & results: The 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 & implication: The 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 adds: What 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.

Parkinsonics: A Randomized, Blinded, Cross-Over Trial of Group Singing for Motor and Nonmotor Symptoms in Idiopathic Parkinson Disease

Article

Full-text available

Sep 2022

Introduction: Parkinson's disease (PD) frequently causes communication difficulties due to various voice impairments and there are few treatment options for vocal/communication complaints. We assessed the effects of weekly group singing on PD patients' objective vocal and motoric function, cognition, mood, self-efficacy, and quality of life. Methods: Thirty-two participants were randomly assigned to either a singing group or a facilitated discussion group weekly over 12 weeks. After 12 weeks, participants crossed over for an additional 12 weeks. Evaluations were performed at baseline and every six weeks for 30 weeks. Objective voice measures included volume/loudness (decibels), held vowel duration, jitter, shimmer, and harmonic-to-noise ratio. Additional outcome measures included patient-centered quality of life, voice-related quality of life, MDS-UPDRS, Montreal Cognitive Assessment, and questionnaires assessing depression, self-efficacy, and overall well-being. Results: Twenty-six participants (16 M/10F; Hoehn & Yahr stage 2.3 (range 2-3); and age 68.6 (55-89)) completed the study. Across participants in both groups (intention-to-treat analyses), there was significant improvement from baseline in average loudness on the Cookie Theft picture description at 24 weeks (end of interventions), corresponding with improved minimal reading volumes at 24 weeks and 30 weeks (end of study). Similarly, there were improvements in minimal loudness on Rainbow passage reading at 24 and 30 weeks. There were improvements observed in the Emotional Well-Being (mean delta -12.7 points, p = 0.037) and Body Discomfort (mean delta -18.6 points, p = 0.001) domains of the PDQ-39 from baseline to week 24 in the overall cohort and greater improvement in the Communication domain for Group S than Group D after 12 weeks of singing (delta -12.9 points, p = 0.016). Baseline differences between the participant groups (age, gender, Hoehn & Yahr stage, and several voice loudness measures) and observed improvements during the weekly discussion group period limited our ability to attribute all of the above results specifically to singing (per-protocol analyses). No significant changes in other assessed outcome measures were found. Conclusions: Weekly group singing may improve some aspects of conversational voice volume and quality of life in PD. Some improvements were sustained at least six weeks after interventions ended. Further investigations of the mechanism of benefit and randomized controlled studies (without crossover) to assess the longitudinal effects of singing in PD are necessary.

Music therapy in voice and speech disorders in patients with Parkinson‘s disease

Article

Full-text available

Apr 2022

Voice and speech disorders are common accompanying symptoms of Parkinson‘s disease. They limit the opportunities of patients to participate in many activities in their personal and social lives. However, they receive little attention in the intervention offer. One of the promising non-pharmacological therapeutic approaches in this area is music therapy. The presented review paper provides information on the course, results and limits of implemented music therapy interventions focused on the treatment of voice and speech disorders in patients with Parkinson‘s disease. Based on a search of the available literature in the English-language internet databases, nine studies describing music therapy intervention aimed at achieving changes in voice and speech in patients with Parkinson‘s disease were included in this review. Results showed improvement in the following areas: increase in voice strength, maximum phonation time, speech intelligibility, speech fluency, speech prosody, and respiratory functions. Although statistically significant changes in these areas were not observed in all included protocols, the evaluation of the results of individual studies showed that patients did not worsen in the monitored areas, despite the progressive nature of the disease. These findings suggest that music therapy intervention is a promising and beneficialnon-pharmacological approach in comprehensive therapy of Parkinson‘s disease. (1) (PDF) Music therapy in voice and speech disorders in patients with Parkinson‘s disease. Available from: https://www.researchgate.net/publication/361957721_Music_therapy_in_voice_and_speech_disorders_in_patients_with_Parkinson%27s_disease [accessed Feb 13 2024].

The effects of therapeutic group singing on voice, cough and quality of life in parkinson’s disease

Article

Aug 2021

Purpose: To examine the effect of a group therapeutic singing intervention on voice, cough, and quality of life in persons with Parkinson Disease (PD) in a community-based outpatient setting using a repeated measures design.Methods: 19 volunteer participants with PD completed the study. Ten participants participated in the intervention and nine served voluntarily as controls. Participants completed one hour group singing sessions over 12 weeks led by a music therapist. Sessions consisted of 30 min of high intensity vocal exercise and 15 to 20 minutes of group singing. Data on phonation, speech, cough, and quality of life were collected pre-intervention and one week post intervention with final data collection 12 weeks post-intervention.Results: No significant change in voice measures although 50% of participants showed improvement. A main effect was found for breathiness (p=0.023), appropriate pitch level (p=0.037) and speaking rate (p=0.009). No main effect for cough but pairwise comparisons were nearly significant pre to post intervention (p=0.053) and pre-intervention to final follow up (p=0.023). No main effect found for QOL but singing participants demonstrated better QOL scores than controls.Conclusions: Results from this small sample suggest that there are some speech benefits from singing intervention as well as potential improvement in cough for airway clearance. Additional study is needed to confirm these results.

A systematic review of group intervention for acquired dysarthria in adults

Article

Dec 2020

Purpose This review aimed to evaluate the evidence for group therapy in improving speech production in adults with acquired dysarthria. Secondary outcomes included communication effectiveness and/or wellbeing. Materials and methods A review protocol was prospectively published on PROSPERO. Fourteen electronic databases were searched to identify experimental studies investigating adults with acquired dysarthria participating in group intervention with outcomes related to communication and/or wellbeing. The quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT) or the McMaster University’s Critical Review Form, and the TIDieR template for intervention description and replication. Results 21 studies were identified involving 330 individuals with dysarthria, from mostly Parkinson’s disease (PD) (97%; n = 321). Treatment approaches included singing therapy (n = 10), loudness therapy (n = 5) and multi-components therapy (including a combination of impairment and/or compensatory approaches) (n = 4). Studies varied in intensity and outcome measures used. Statistically significant improvements to speech production and/or wellbeing were reported following most approaches. Conclusion There is some preliminary moderate-quality evidence to suggest that group therapy may improve speech production and in some cases communication effectiveness or wellbeing in people with dysarthria following PD, with more consistent improvements being found for loudness approaches. Singing approaches were frequently studied in PD with some improvements to intelligibility evident. Further well-designed controlled studies including individuals with non-progressive aetiologies is warranted to establish the effectiveness of group treatment. • IMPLICATIONS FOR REHABILITATION • Group therapy may be an effective means of improving speech production and/or wellbeing in individuals with dysarthria following Parkinson’s disease. • Studies’ employing loudness-based group therapy for PD demonstrated more consistent improvements to intensity measures. • Some controlled studies utilising singing group therapy resulted in improved intelligibility in PD. PROSPERO registration number: CRD42015029374.

A systematic review of active group-based dance, singing, music therapy and theatrical interventions for quality of life, functional communication, speech, motor function and cognitive status in people with Parkinson’s disease

Article

Full-text available

Oct 2020
BMC NEUROL

Background Parkinson’s disease (PD) is a common neurodegenerative condition associated with a wide range of motor and non-motor symptoms. There has been increasing interest in the potential benefit of performing arts as a therapeutic medium in PD. While there have been previous reviews, none have considered all performing arts modalities and most have focused on dance. This systematic review examined the potential benefit of all active group-based performing arts interventions for quality of life, functional communication, speech, motor function and cognitive status. Methods Searches were conducted in February 2020 on five scholarly databases. Supplementary searches were conducted. Included studies were quantitative in design, and assessed the potential benefit of any active group-based performing arts intervention for quality of life, functional communication, speech, motor function or cognitive status in people with PD. Full text papers were eligible for inclusion, as were conference abstracts since January 2018. Screening, data extraction, narrative synthesis and quality assessment were conducted independently by two reviewers. Quality assessment used the SURE checklists. Results Fifty-six studies were eligible for inclusion in this systematic review, reported in 67 publications. Published from 1989 to 2020, these studies included a total of 1531 people with PD from 12 countries, and covered four broad performing arts modalities: dance, singing, music therapy and theatre. Dance remains the most commonly studied performing arts modality for PD (38 studies), while there were 12 studies on singing interventions, four on music therapy, and only two on theatrical interventions. There was evidence for a beneficial effect of all four performing arts modalities on at least some outcome domains. Conclusions This is the first systematic review to assess the potential benefit of all active group-based performing arts interventions in PD. The evidence suggests that performing arts may be a useful therapeutic medium in PD. However, a substantial limitation of the evidence base is that no studies compared interventions from different performing arts modalities. Moreover, not all performing arts modalities were assessed for all outcome domains. Therefore it is not currently possible to determine which performing arts modalities are most beneficial for which specific outcomes.

Preprint

Full-text available

Jul 2020

Background: Parkinson’s disease (PD) is a common neurodegenerative condition associated with a wide range of motor and non-motor symptoms. There has been increasing interest in the potential benefit of performing arts as a therapeutic medium in PD. While there have been previous reviews, none have considered all performing arts modalities and most have focused on dance. This systematic review examined the potential benefit of all active group-based performing arts interventions for quality of life, functional communication, speech, motor function and cognitive status. Methods: Searches were conducted in February 2020 on five scholarly databases. Supplementary searches were conducted. Included studies were quantitative in design, and assessed the potential benefit of any active group-based performing arts intervention for quality of life, functional communication, speech, motor function or cognitive status in people with PD. Full text papers were eligible for inclusion, as were conference abstracts since January 2018. Screening, data extraction, narrative synthesis and quality assessment were conducted independently by two reviewers. Quality assessment used the SURE checklists. Results: 56 studies were eligible for inclusion in this systematic review, reported in 67 publications. Published from 1989 to 2020, these studies included a total of 1531 people with PD from 12 countries, and covered four broad performing arts modalities: dance, singing, music therapy and theatre. Dance remains the most commonly studied performing arts modality for PD (38 studies), while there were 12 studies on singing interventions, four on music therapy, and only two on theatrical interventions. There was evidence for a beneficial effect of all four performing arts modalities on at least some outcome domains. Conclusions: This is the first systematic review to assess the potential benefit of all active group-based performing arts interventions in PD. The evidence suggests that performing arts may be a useful therapeutic medium in PD. However, a substantial limitation of the evidence base is that no studies compared interventions from different performing arts modalities. Moreover, not all performing arts modalities were assessed for all outcome domains. Therefore it is not currently possible to determine which performing arts modalities are most beneficial for which specific outcomes.

Can Singing Evoke a Significant Cardiovascular Response on a Six-minute Treadmill Walk Test?: A Crossover Study

Article

Full-text available

Sep 2023

Objectives: This study compared the effects of the Six-minute Treadmill Walk Test (6MTWT) and Six-Minute Treadmill Sing Walk Test (6MTSWT) on cardiovascular parameters. Study design: Crossover study. Setting: Undergraduates of Obafemi Awolowo University, Ile-Ife, Nigeria. Subjects: Thirty-five healthy individuals. Methods: The participants performed both the 6MTWT and the 6MTSWT in random order with a 10-minute rest interval between. The 6MTSWT was the same as the 6MTWT with the exception that the participants were required while walking to sing along to a popular local song rendered at 80 beats per minute through a headset and synchronized to the treadmill speed. Pre-and-post-walk systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR), rate of perceived exertion (RPE), and rate pressure product (RPP) were recorded. Results: Each test resulted in a significant difference in SBP, RPP, and RPE (p < 0.05). There were also significant differences between the groups in mean change of PR with 6MTWT and 6MTSWT (2.37±3.90 vs. 0.54±3.24; t= 2.133; p = 0.037, respectively) and RPP (776.80±602.24 vs. 483.86±399.28; t = 2.398; p = 0.019, respectively). Conclusions: Slow-tempo singing decreases PR and RPP significantly during 6MTWT among healthy young individuals.

A Pilot Study of the Effect of a Non-Contact Boxing Exercise Intervention on Respiratory Pressure and Phonation Aerodynamics in People with Parkinson’s Disease

Article

Full-text available

Jul 2023

Unlabelled: This study investigated the effects of a non-contact boxing exercise program on maximum expiratory pressure and aerodynamic voice measurements. Methods: Eight adult males diagnosed with Parkinson's disease participated in the study. Individuals participated in twice-weekly exercise classes lasting one hour across 12-months. Dependent variables were measured on three baseline days and then at six additional time points. A pressure meter acquired maximum expiratory pressure, and a pneumotachograph system acquired transglottal airflow and subglottal air pressure. Results: Measures of average maximum expiratory pressure significantly increased after 9- and 12- months of exercise when compared to baseline. There was an increasing trend for these measures in all participants, with a corresponding large effect size. Measures of transglottal airflow and subglottal pressure did not change over the course of 9- or 12-months, although their stability may indicate that the exercise program influenced maintenance of respiratory-phonatory coordination during voicing. Conclusions: A non-contact boxing exercise program had a significant effect on maximum expiratory pressure in people with Parkinson's disease. The aerobic nature of the program and challenges to the respiratory muscles potentially explain the "ingredient" causing this effect. The small sample size of this pilot study necessitates future research incorporating larger and more diverse participants.

Singen als therapeutische Intervention bei Menschen mit Parkinson. Ein systematisches Review

Article

Nov 2022

Das ideopathische Parkinsonsyndrom (iPS) ist die zweihäufigste neurodegenerative Erkrankung. Neben den motorischen Symptomen ist die Sprechstörung (Dysarthrie) ein weit verbreitetes Symptom. Damit verbunden sind Einschränkungen in der Kommunikationsfähigkeit und der Lebensqualität. Musik wirkt unmittelbar auf die durch das iPS gestörte Motorik und spielt generell in der aktivierenden Therapie dieser Klientele eine große Rolle. Singen als therapeutische Intervention (STI) stellt eine verbreitete Methode für die Therapie der Dysarthrie beim iPS dar. Für einen Überblick zur aktuellen Evidenzlage wurde eine systematische Literaturrecherche durchgeführt. Es wurden 12 klinische Verlaufsstudien ausgewertet und hinsichtlich der Vorgehensweise von STI und der Therapieeffekte verglichen. Dabei wurden empirische Hinweise auf mögliche positive Effekte auf die Atem- und Stimmfunktion festgestellt. Schließlich haben die Autor.innen praktische Hinweise für das STI mit Betroffenen des iPS zusammengetragen.

Group therapeutic singing improves clinical motor scores in persons with Parkinson’s disease

Article

Full-text available

Aug 2022

Background Previous reports suggest that group therapeutic singing (GTS) may have a positive effect on motor symptoms in persons with Parkinson’s disease (PD). Objective To determine the effect of a single session of GTS on clinical motor symptoms. Methods Clinical motor symptom assessment was completed immediately before and after 1 hour of GTS in 18 participants. Results A significant decrease in average scores for gait and posture and tremor, but not speech and facial expression or bradykinesia was revealed. Conclusion These results support the notion that GTS is a beneficial adjuvant therapy for persons with PD that warrants further research.

QUALIDADE DE VIDA RELACIONADA À SAÚDE: ASPECTOS GERAIS E IMPACTOS DE INTERVENÇÕES

Book

Full-text available

Jan 2022

Este opúsculo intitulado “Qualidade de vida relacionada à saúde: aspectos gerais e impactos de intervenções” foi proposto para trazer, de forma simples e didática, uma reflexão sobre a qualidade de vida, em uma abordagem interdisciplinar e contemporânea. Afi- nal, tem sido cada vez mais latente a busca humana por melhores padrões de vida. Ademais, é fundamental compreender que a qualidade de vida não necessariamente está presente exclusivamente em in- divíduos considerados saudáveis. É possível gozar de um bom padrão de vida ainda que sejamos doentes crônicos. É preciso reconhecer os caminhos para uma vida com mais qualidade e descobrir como vencer as dificuldades inerentes aos processos de adoecimento. Propomos, portando, falar sobre a temática em 11 capítulos, os quais foram distribuídos em três partes: Parte I – aspectos gerais sobre a qualidade de vida de indivíduos com agravos; Parte II – impactos de intervenções na qualidade de vida; e Parte III – qualidade de vida relacionada ao trabalho. Desejamos uma boa leitura!

Improving speech characteristics of young adults with congenital dysarthria: An exploratory study comparing articulation training and the Beatalk method

Article

Aug 2021
J COMMUN DISORD

Michal Icht

Introduction This exploratory study compared the effects of two speech therapy approaches on speech characteristics of young adults with congenital dysarthria resulting from various etiologies: a) articulation training focusing on consonant articulation exercises at various levels (isolation, syllables, and words), and b) the Beatalk method, based on human beatboxing, i.e., producing various instrumental sounds in an a-cappella musical context. Both interventions were designed to increase participants’ speech intelligibility. Methods Twelve adults with congenital dysarthria and reduced speech intelligibility participated in treatment groups for eight weeks. Six participants were assigned to the articulation training group, and six to the Beatalk group. Intelligibility of single words and continuous speech, voice measures, and oral-diadochokinesis rates were measured before and after the treatment. Results The results showed that the Beatalk intervention yielded a significant overall pre- to post-treatment effect. Specifically, it resulted in gains in articulatory accuracy and intelligibility for single words. Improvements were not noted following articulation training. Conclusions The results present initial evidence of the positive effect of the Beatalk method as an intervention tool for adults with congenital dysarthria. This relatively easy-to-learn technique shows promise, as it involves intense and repetitive production of speech sounds while controlling rhythm and breathing in an enjoyable context.

Classifying Technologies during the Assessment, Treatment Planning, Documentation and Evaluation Phases of Music Therapy: A Survey of Board-Certified Practitioners

Article

Nov 2024

Music therapists (MT-BCs) use diverse technologies to provide evidence-based personalized interventions to a wide variety of people. Most studies on the technological practices of MT-BCs report a general overview of the tools they use in their daily work. This study offers an new way of understanding technologies used by MT-BCs, classified and situated in the phases of music therapy (MT) practice: Assessment, Treatment Planning, In-Session, Documentation and Evaluation. An online survey was sent to a mailing list of 1,951 board-certified music therapists (MT-BC), and we received 104 responses. Results support distinct functions in technological practices between each of the phases of MT, revealing categories of notetaking and data entry that characterize planning, documentation and evaluation tasks, and a wider diversity of technology configurations in assessment and in-session work. We end by discussing design implications for HCI researchers and designers of music technologies for health, as well as HCI-MT design collaboration to better support the work of the MT-BC community.

ParkinSong Online: Feasibility of Telehealth Delivery and Remote Data Collection for a Therapeutic Group Singing Study in Parkinson’s

Article

Dec 2023

Background Parkinson’s disease can negatively affect vocal functioning and social wellbeing, particularly in the latter stages of disease progression. Face-to-face group singing interventions can improve communication and wellbeing outcomes, yet not all people can access in-person sessions. To help overcome barriers to participation, exploration of the feasibility and utility of online therapeutic singing programs is needed. Objectives To evaluate the feasibility, acceptability, and preliminary efficacy of a 12-week ParkinSong Online intervention on speech and wellbeing for people with Parkinson’s disease. Methods A total of 28 participants with idiopathic Parkinson’s disease were recruited to a single-arm feasibility study. Weekly 90-minute online sessions were co-facilitated by a music therapist and speech pathologist. Speech and wellbeing assessments were conducted pre and post intervention. Participant and facilitator surveys were administered after each session, with focus group interviews at the end of the program. Results The recruitment rate was high (90%) with no attrition, adverse events, or safety issues. There was good intervention fidelity, attendance (average 89%), and positive participant experience. Feasibility was good, with technology reported as the main challenge (connecting and navigating Zoom). No improvements were seen in voice measures or wellbeing outcomes in this small trial. The online format used in this study did not provide the same benefits as in-person ParkinSong sessions. Conclusions ParkinSong Online is feasible for recreational purposes and social engagement provided that people have adequate technological knowledge or support. The optimal online delivery format to achieve communication improvements in Parkinson’s awaits confirmation.

The effect of voice training interventions on patients with oropharyngeal dysphagia: a systematic review

Article

Full-text available

Nov 2022
Eur Arch Oto Rhino Laryngol

Background Voice training has been proposed as an intervention to improve swallowing function in patients with dysphagia. However, little is known about the effects of voice training on swallowing physiology. Objectives This systematic review investigates the effect of voice training on the swallowing function of patients with oropharyngeal dysphagia and provides the theoretical basis for improving the swallowing function and life quality of patients with oropharyngeal dysphagia. Data sources A systematic review using a narrative synthesis approach of all published studies was sought with no date restrictions. Five electronic databases (EMBASE, PubMed, CINAHL, Web of Science, and The Cochrane Library) were searched from inception to April 2022. Study selection Eight studies were included. Two researchers screened the literature according to inclusion and exclusion criteria, extracted data, and carried out quality control according to the Cochrane handbook5.1.0. Data were analyzed narratively and descriptively. Conclusions In general, statistically significant positive therapy effects were found. Voice training improves the oral and pharyngeal stages of swallowing in patients with neurological causes of dysphagia, such as stroke, and in patients with non-neurological causes of dysphagia, such as head and neck cancer. However, the current literature is limited and further primary research is required to provide more evidence to support voice training intervention in dysphagia. Future studies could further refine the content of voice training interventions, increase the number of patients enrolled, assess the long-term effects of voice training interventions and add associated assessments of the quality of life after treatment.

Singing Therapy Improving Peak Flow, Speech and Eating Abilities in Adults with Cerebral Palsy

Article

Full-text available

Oct 2022

Jessica Pingel

ClearSpeechTogether: a Rater Blinded, Single, Controlled Feasibility Study of Speech Intervention for People with Progressive Ataxia

Article

Full-text available

Aug 2022
CEREBELLUM

Background Progressive ataxias frequently lead to speech disorders and consequently impact on communication participation and psychosocial wellbeing. Whilst recent studies demonstrate the potential for improvements in these areas, these treatments generally require intensive input which can reduce acceptability of the approach. A new model of care—ClearSpeechTogether—is proposed which maximises treatment intensity whilst minimising demands on clinician. This study aimed to establish feasibility and accessibility of this approach and at the same time determine the potential benefits and adverse effects on people with progressive ataxias. Method This feasibility study targeted people with progressive ataxia and mild-moderate speech and gross motor impairment. ClearSpeechTogether consisted of four individual sessions over 2 weeks followed by 20 patient-led group sessions over 4 weeks. All sessions were provided online. Quantitative and qualitative data were collected for evaluation. Results Nine participants completed treatment. Feasibility and acceptability were high and no adverse effects were reported. Statistical tests found significantly reduced vocal strain, improved reading intelligibility and increased participation and confidence. Participant interviews highlighted the value of group support internalisation of speech strategies and psycho-social wellbeing. Discussion ClearSpeechTogether presented a feasible, acceptable intervention for a small cohort of people with progressive ataxia. It matched or exceeded the outcomes previously reported following individual therapy. Particularly notable was the fact that this could be achieved through patient led practice without the presence of a clinician. Pending confirmation of our results by larger, controlled trials, ClearSpeechTogether could represent an effective approach to manage speech problems in ataxia.

ClearSpeechTogether: a rater blinded, single, controlled feasibility study of speech intervention for people with progressive ataxia

Preprint

Full-text available

Apr 2022

Background Progressive ataxias frequently lead to speech disorders and consequently impact on communication participation and psychosocial wellbeing. Whilst recent studies demonstrate the potential for improvements in these areas, these treatments generally require intensive input which can reduce acceptability of the approach. A new model of care – ClearSpeechTogether – is proposed which maximises treatment intensity whilst minimising demands on clinician. This study aimed to establish feasibility and accessibility of this approach and at the same time determine the potential benefits and adverse effects on people with progressive ataxias. Method The study targeted people with progressive ataxia and mild-moderate speech and gross motor impairment. ClearSpeechTogether consisted of four individual sessions over two weeks followed by 20 patient-led group sessions over four weeks. All sessions were provided online. Quantitative and qualitative data were collected for evaluation. Results Nine participants completed treatment. Feasibility and acceptability were high and no adverse effects were reported. Statistical tests found significantly reduced vocal strain, improved intelligibility for reading, and increased participation and confidence. Participant interviews highlighted the value of group support, from psychosocial perspectives and in supporting speech strategy internalisation and generalisation. Discussion ClearSpeechTogether presented an effective intervention in a small group of people with progressive ataxia. It matched or exceeded the outcomes previously reported for intensive, individual therapy while minimising clinician time demands. Furthermore, its unique peer led group intervention design appeared effective in addressing intractable psychosocial issues. ClearSpeechTogether is potentially cost-effective, providing intensive delivery with few clinician sessions, thus maximising the input available from health care providers.

Recognising and responding to communication and swallowing difficulties in Parkinson's disease

Article

Full-text available

Apr 2022

Background: Communication difficulties, including hypokinetic dysarthria and swallowing difficulties (dysphagia), affect a large percentage of people diagnosed with Parkinson's disease. Onset of these symptoms has been identified in up to 78% of people with early-stage Parkinson's disease. Communication difficulties are frequently disregarded until they have a significant impact on quality of life, while the person may often be unaware of indicators of dysphagia and the associated risk of aspiration pneumonia. Objective: The aim of this article is to increase awareness of the importance of identifying and addressing the communication and swallowing difficulties experienced by people living with Parkinson's disease. Discussion: Early identification, regular review and monitoring enable the clinician to support the implementation of evidence-based, effective interventions. Collaboration with the multidisciplinary team, including speech pathology, is needed to enable the person to live well with Parkinson's disease and to prevent aspiration pneumonia, a leading cause of death in Parkinson's disease. A vignette prepared in collaboration with a person living with Parkinson's disease and his wife provides an 'insider perspective' of the pervasive impact of difficulties with communication and swallowing.

Speech treatment for Hebrew‐speaking adolescents and young adults with developmental dysarthria: A comparison of m SIT and Beatalk

Article

Apr 2022

Background: Individuals with developmental dysarthria typically demonstrate reduced functioning of one or more of the speech subsystems, which negatively impacts speech intelligibility and communication within social contexts. A few treatment approaches are available for improving speech production and intelligibility among individuals with developmental dysarthria. However, these approaches have only limited application and research findings among adolescents and young adults. Aims: To determine and compare the effectiveness of two treatment approaches, the modified Speech Intelligibility Treatment (mSIT) and the Beatalk technique, on speech production and intelligibility among Hebrew-speaking adolescents and young adults with developmental dysarthria. Methods & procedures: Two matched groups of adolescents and young adults with developmental dysarthria participated in the study. Each received one of the two treatments, mSIT or Beatalk, over the course of 9 weeks. Measures of speech intelligibility, articulatory accuracy, voice and vowel acoustics were assessed both pre- and post-treatment. Outcomes & results: Both the mSIT and Beatalk groups demonstrated gains in at least some of the outcome measures. Participants in the mSIT group exhibited improvement in speech intelligibility and voice measures, while participants in the Beatalk group demonstrated increased articulatory accuracy and gains in voice measures from pre- to post-treatment. Significant increases were noted post-treatment for first formant values for select vowels. Conclusions & implications: Results of this preliminary study are promising for both treatment approaches. The differentiated results indicate their distinct application to speech intelligibility deficits. The current findings also hold clinical significance for treatment among adolescents and young adults with motor speech disorders and application for a language other than English. What this paper adds: What is already known on the subject Developmental dysarthria (e.g., secondary to cerebral palsy) is a motor speech disorder that negatively impacts speech intelligibility, and thus communication participation. Select treatment approaches are available with the aim of improving speech intelligibility in individuals with developmental dysarthria; however, these approaches are limited in number and have only seldomly been applied specifically to adolescents and young adults. What this paper adds to existing knowledge The current study presents preliminary data regarding two treatment approaches, the mSIT and Beatalk technique, administered to Hebrew-speaking adolescents and young adults with developmental dysarthria in a group setting. Results demonstrate the initial effectiveness of the treatment approaches, with different gains noted for each approach across speech and voice domains. What are the potential or actual clinical implications of this work? The findings add to the existing literature on potential treatment approaches aiming to improve speech production and intelligibility among individuals with developmental dysarthria. The presented approaches also show promise for group-based treatments as well as the potential for improvement among adolescents and young adults with motor speech disorders.

Respiratory Abnormalities in Parkinson’s Disease: What Do We Know from Studies in Humans and Animal Models?

Article

Full-text available

Mar 2022
INT J MOL SCI

Parkinson’s disease (PD) is the second most common progressive neurodegenerative disease characterized by movement disorders due to the progressive loss of dopaminergic neurons in the ventrolateral region of the substantia nigra pars compacta (SNpc). Apart from the cardinal motor symptoms such as rigidity and bradykinesia, non-motor symptoms including those associated with respiratory dysfunction are of increasing interest. Not only can they impair the patients’ quality of life but they also can cause aspiration pneumonia, which is the leading cause of death among PD patients. This narrative review attempts to summarize the existing literature on respiratory impairments reported in human studies, as well as what is newly known from studies in animal models of the disease. Discussed are not only respiratory muscle dysfunction, apnea, and dyspnea, but also altered central respiratory control, responses to hypercapnia and hypoxia, and how they are affected by the pharmacological treatment of PD.

Functional Expansion of Music Education Technologies (through the example of music rehabilitation therapy of neurology ward patients)

Article

Full-text available

May 2019

This article presents a research of the possibility to apply music education activities for rehabilitation of patients with neurodegenerative disease.The purpose of this work was development of a music psychotherapy program for rehabilitation of patients with Parkinson’s neurodegenerative disease.We suggested “target objects” for music rehabilitation therapy at all levels of manifestation of symptoms of illness:1) physical restriction and rigidness which includes well-aimed work with breathing and movement symptoms, loss of control, lack of coordination, inflexibility, tremor;2) emotional deprivation (realization and expression of emotions and feelings) through plastics of movements to music and singing – seeking catharsis through vivified contact with oneself and intensification of feelings;3) social deprivation: well-aimed work on resocialization of the patient.Сonclusions:Results we obtained contribute to further understanding and wider application of music education methods, technologies and approaches that may add to rehabilitation practices.

Music Therapy and Parkinson’s Disease: A Systematic Review from 2015–2020

Article

Full-text available

Nov 2021
Int J Environ Res Publ Health

Parkinson’s disease can be approached from various points of view, one of which is music therapy—a complementary therapy to a pharmacological one. This work aims to compile the scientific evidence published in the last five years (2015–2020) on the effects of music therapy in patients with Parkinson’s disease. A systematic review has been performed using the Web of Science and Scopus databases with the descriptors “music therapy” and “Parkinson’s disease”. A total of 281 eligible articles were identified, which, after applying the inclusion and exclusion criteria, were reduced to 58 papers. The results display a great diversity of evidence, confirming positive effects on various spheres. All mentioned patients with Parkinson’s disease had experienced different music therapy programs. Some studies focused on the motor component, which can be addressed through listening, body rhythm, and rhythmic auditory stimulation. Other studies confirm effects on communication, swallowing, breathing, and the emotional aspect through programs that focus on singing, either individually or in groups, in order to improve the quality of life of people with PD. It was concluded that music therapy programs can achieve improvements in various areas of patients with Parkinson’s.

The Effects of Group Therapeutic Singing on Cortisol and Motor Symptoms in Persons With Parkinson's Disease

Article

Full-text available

Jul 2021
FRONT HUM NEUROSCI

The inclusion of music into the treatment plan for persons with Parkinson's disease (PD) may be a viable strategy to target multiple motor symptoms. However, potential mechanisms to explain why music has an impact on multiple motor symptoms in persons with PD remain understudied. The purpose of this study was to examine the acute effects of 1 h of group therapeutic singing (GTS) on physiological measures of stress and clinical motor symptoms in persons with PD. We posit that improvement in motor symptoms after GTS may be related to stress reduction. Seventeen participants with PD completed 1 h of GTS and eight participants completed 1 h of a quiet reading (control session). Cortisol was collected via passive drool immediately before and after the singing and control session. The Unified Parkinson's Disease Rating Scale (UPDRS) Part-III (motor examination) was also video-recorded immediately before and after the singing and control session and scored by two raters masked to time and condition. Secondary outcome measures for quality of life, depression, and mood were collected. Results revealed no significant change in cortisol or motor UPDRS scores, as well as no significant relationship between cortisol and motor UPDRS scores. There was a trend for the singing group to report feeling less sad compared to the control group after the 1-h session (effect size = 0.86), and heart rate increased in the singing group while heart rate decreased in the control group after the 1-h session. These results suggest that an acute session of GTS is not unduly stressful and promotes the use of GTS for persons with PD. Multiple mechanisms may underlie the benefits of GTS for persons with PD. Further exploring potential mechanisms by which singing improves motor symptoms in persons with PD will provide greater insight on the therapeutic use of music for persons with PD.

Respiratory Dysfunctions in Parkinson's Disease Patients

Article

Full-text available

May 2021
BSRCCS

Respiratory dysfunctions have been associated with Parkinson's disease since the first observations of the disease in 1817. Patients with Parkinson's disease frequently present respiratory disorders with obstructive ventilatory patterns and restrictive modifications, as well as limitations in respiratory volumes. In addition, respiratory impairments are observed due to the rigidity and kyphosis that Parkinson's disease patients experience. Subsidiary pulmonary complications can also appear as side effects of medication. Silent aspiration can be the cause of pneumonia in Parkinson's disease. Pulmonary dysfunction is one of the main factors that leads to the morbidity and mortality of patients with Parkinson's disease. Here, we performed a narrative review of the literature and reviewed studies on dyspnea, lung volumes, respiratory muscle function, sleep breathing disorders, and subsidiary speech and swallow impairments related to pulmonary dysfunction in patients with Parkinson's disease.

Do Singing and Talking Arise From the Same or Different Neurological Systems? Dissociations of Pitch, Timing, and Rhythm in Two Dysprosodic Singers

Article

Full-text available

Jan 2021

The relationship between speech and singing in cerebral function is not fully understood. The effects of focal brain damage on pitch, timing, and rhythm in speech and singing were retrospectively investigated in 2 persons diagnosed with dysprosodic speech following cerebral vascular accidents; both were experienced singers. Participant 1 suffered a large right hemisphere infarct encompassing frontal, parietal, and temporal lobes extending partly into subcortical structures, and Participant 2 sustained a right-sided ischemic subcortical lesion, affecting globus pallidus, caudate and medial putamen. Pitch and timing in lexical contrasts were acoustically analyzed, rhythm and pitch in spontaneous speech were quantified, and accuracies of pitch and rhythm in familiar songs were measured acoustically and rated by listeners. Both participants produced lexical contrasts with disordered pitch but normal timing. Pitch was abnormal in spontaneous speech in both cases, but in singing, pitch was impaired in Participant 1, not in Participant 2. Speech rhythm deviated from normal values for Participant 1 but not for Participant 2, whereas rhythm in singing was accurate for both persons. These studies reveal dissociations between pitch, rhythm, and timing in speech versus singing, suggesting that talking and singing arise from disparate neurological systems. Better understanding of these dissociations may lead to improved models of speaking and singing in cerebral function and may assist in assessment and treatment of dysprosody and amusia.

PsychomusicologyPaper

Article

Full-text available

Jan 2021

The relationship between speech and singing in cerebral function is not fully understood. The effects of focal brain damage on pitch, timing, and rhythm in speech and singing were retrospectively investigated in two persons diagnosed with dysprosodic speech following cerebral vascular accidents; both were experienced singers. Participant 1 suffered a large right hemisphere infarct encompassing frontal, parietal and temporal lobes extending partly into subcortical structures; and Participant 2 sustained a right-sided ischemic subcortical lesion, affecting globus pallidus, caudate and medial putamen. Pitch and timing in lexical contrasts were acoustically analyzed, rhythm and pitch in spontaneous speech were quantified, and accuracies of pitch and rhythm in familiar songs were measured acoustically and rated by listeners. Both participants produced lexical contrasts with disordered pitch but normal timing. Pitch was abnormal in spontaneous speech in both cases but in singing, pitch was impaired in Participant 1, not in Participant 2. Speech rhythm deviated from normal values for Participant 1 but not for Participant 2, while rhythm in singing was accurate for both persons. These studies reveal dissociations between pitch, rhythm, and timing in speech versus singing, suggesting that talking and singing arise from disparate neurological systems. Better understanding of these dissociations may lead to improved models of speaking and singing in cerebral function and may assist in assessment and treatment of dysprosody and amusia.

Functional electrical stimulation+iPad-based music therapy for upper limb recovery after stroke: Study protocol for a mixed methods randomised controlled trial Functional electrical stimulation+iPad-based music therapy for upper limb recovery after stroke: Study protocol for a mixed methods randomised controlled trial

Article

Sep 2020

Introduction Music therapy offers an effective avenue for simultaneously addressing goals of upper limb function and wellbeing post stroke. However, there are currently no trials of therapeutic music-making interventions for stroke survivors with a very weak upper limb (Grade 0–3 level of strength). This randomised controlled trial will examine the effect of Functional Electrical Stimulation (FES) with iPad-based music therapy on upper limb recovery and wellbeing outcomes for stroke survivors. Method This convergent mixed methods study will take place at seven participating hospitals in Sydney, Australia. Forty participants will be randomly allocated to usual care only or usual care plus daily FES+iPad-based music therapy for four weeks (20 sessions). Standardised assessments of the paretic upper limb and self-report wellbeing measures will be administered at three time points (pre- and post- intervention, and at three months follow up) by a blinded assessor. All participants will be interviewed about their perceptions of the way the treatment they received (usual care only or usual care plus daily FES+iPad-based music therapy) supported their recovery. Results Ethics approval has been granted and data collection has commenced. Discussion This treatment approach has the potential to improve upper limb function and wellbeing for stroke survivors. The intervention is novel in its capacity to engage stroke survivors with a very weak upper limb in therapeutic music-making.

Personalized Beta HD-tACS Over the Left SMA Surpasses HD-tDCS in Improving Speech and Limb Reaction Times

Preprint

Full-text available

Sep 2024

Purpose: Beta activity (13-30 Hz) in the supplementary motor area (SMA) plays a crucial role in the planning and execution of speech and limb movements. Abnormal beta oscillations within SMA have been associated with impaired speech and limb movement in neurological conditions wherein speech and limb movements are impaired. Normalizing aberrant neural activity through non-invasive techniques such as transcranial direct/alternating current stimulation over SMA demonstrated promising effects in ameliorating motor and non-motor functions. However, these improvements are somewhat limited due to significant between-subject variability, highlighting the need for personalized brain stimulation protocols. This study examined the modulatory effects of personalized beta (13-30 Hz) high-definition transcranial alternating current stimulation (HD-tACS) vs. High-definition transcranial direct current stimulation (HD-tDCS) targeting the left SMA on speech and limb reaction times. Method: In a sham-controlled dual-experiment design, two groups of neurologically intact adult participants underwent multiple stimulation sessions: Experiment 1) sham HD-tACS, HD-tACS tuned to each individual’s frequency of maximal SMA beta activity during speech (tuned-to-speech) or limb (tuned-to-limb), or high-definition transcranial random noise stimulation (HD-tRNS); Experiment 2) sham, anodal or cathodal HD-tDCS. For the experiment 1 source-localized EEG was employed to identify each individual’s peak beta activity within the left SMA. Results: Findings revealed that personalized beta HD-tACS – but not HD-tDCS – over left SMA significantly improved reaction times for both speech and limb movement compared to sham. Moreover, reaction times significantly improved for HD-tACS vs. anodal and cathodal HD-tDCS. However, there was no difference in reaction times between sham HD-tACS and HD-tDCS. Conclusion: Overall, these findings demonstrated superior neuromodulatory effects of personalized beta HD-tACS over HD-tDCS in improving speech and limb reaction times which may have clinical implications for protocols aimed to alleviate neurological conditions.

A systematic review of behavioural therapies for improving swallow and cough function in Parkinson’s disease

Article

Aug 2023

Purpose: This systematic review evaluated the efficacy of therapeutic interventions on improving swallow, respiratory, and cough functions in Parkinson's disease (PD).Method: A PRISMA systematic search was implemented across six databases. We selected studies reporting pre- and post-assessment data on the efficacy of behavioural therapies with a swallow or respiratory/cough outcome, and excluded studies on medical/surgical treatments or single-session design. Cross-system outcomes across swallow, respiratory, and cough functions were explored. Cochrane's risk of bias tools were utilised to evaluate study quality.Result: Thirty-six articles were identified and further clustered into four treatment types: swallow related (n = 5), electromagnetic stimulation (n = 4), respiratory loading (n = 20), and voice loading (n = 7) therapies. The effects of some behavioural therapies were supported with high-quality evidence in improving specific swallow efficiency, respiratory pressure/volume, and cough measures. Only eleven studies were rated with a low risk of bias and the remaining studies failed to adequately describe blinding of assessors, missing data, treatment adherence, and imbalance assignment to groups.Conclusion: Behavioural therapies were diverse in nature and many treatments demonstrated broad cross-system outcome benefits across swallow, respiratory, and cough functions. Given the progressive nature of the condition, the focus of future trials should be evaluating follow-up therapy effects and larger patient populations, including those with more severe disease.

It's quite good fun: A qualitative study of a singing/songwriting programme for people with Parkinson's disease and their spouses

Article

Jul 2023
INT J LANG COMM DIS

Background: Group singing for people with Parkinson's disease (PD) is an established intervention not only to improve voice and speech difficulties but also for emotional and social benefit. Less is known about the experiences of group singing on the couple-the person with PD and their spouse or partner together-and studies have not specifically tracked impact through time or in combination with songwriting. Aims: To understand the impact of group singing/songwriting on couples (participants with PD and their spouses) to unpack whether this broader view might help explain why such interventions are reported as beneficial. Using a trajectory approach, a form of longitudinal research and focused ethnography, the research sought a deeper appreciation of participation through time for the couple in a singing/songwriting group. Methods & procedures: Four couples attending a singing/songwriting programme were observed for 10 weeks, and interviewed formally and informally weekly. Data were analysed thematically across-case through framework analysis but also within-case to explore the couples' experiences and narratives over time. Outcomes & results: The theme of 'improved relationships' between the couples was new and extended previous studies' findings of positivity, physical benefit, sense of self and social opportunity. The stories of each couple highlighted the importance of musical reminiscence and emotional respite, and demonstrated changes with time through the singing and songwriting group. Conclusions & implications: The benefits of offering singing/songwriting groups may be felt not only by participants with PD but also by their spouses/partners even if they choose not to attend themselves. Such benefits may include improved relationships related to the shared joy of music, musical reminiscence and emotional respite. The addition of songwriting encourages creativity and agency. A longitudinal trajectory approach is one way to appreciate how these benefits may unfold over time for participants. What this paper adds: What is already known on the subject Group singing for people with PD has been shown to have physical, emotional and social benefits as measured on mainly pre-post-assessments of vocal, speech, respiratory function and quality of life questionnaires. What this study adds to the existing knowledge This study adds three new aspects: studying the benefits for the couple (both people with PD and their spouse/partner); taking an in-depth focused ethnographic approach over time to collect couples' narratives and experiences; and exploring the potential for adding songwriting to the intervention. What are the potential or actual clinical implications of this work? A qualitative trajectory approach may help clinicians understand why such interventions are experienced as beneficial. Clinicians running singing groups for people with PD should offer attendance to spouses/partners because of the potential for such groups to improve relationships and build new points of connection for the couple, as well as provide peer support for spouses. Songwriting is a useful addition for creativity, cognitive flexibility and self-expression.

Virtual Group Music Therapy for Apathy in Parkinson's Disease: A Pilot Study

Article

May 2023

Objective: To evaluate the effect of virtual group music therapy on apathy in people with Parkinson's disease (PD). Introduction: Apathy affects 40% of people with PD, lacks effective therapies, and independently predicts poorer quality of life and greater caregiver burden. Music therapy is the clinical application of music to address a person's physical or emotional needs and is effective in treating apathy in dementia. Methods: People with idiopathic PD and apathy (Movement Disorders Society-Unified Parkinson's Disease Rating Scale, apathy item ≥ 2) and their caregivers participated in twelve, weekly virtual group music therapy sessions, with session attendance signifying adherence. Participants completed pre- and post-intervention assessments of apathy (Apathy Scale (AS)), quality of life (Parkinson's Disease Questionnaire-short form), functional ability (Schwab & England Activities of Daily Living Scale), depression (Beck Depression Inventory (BDI-II)), and cognition (Montreal Cognitive Assessment-Blind). Among secondary outcomes, we assessed caregiver burden (Zarit Burden Interview-short form) and strain (Multidimensional Caregiver Strain Index). Results: Sixteen PD participants (93.8% men, mean age 68.3 ± 8.4 years, median 6 years PD duration) and their caregivers (93.8% women, mean age 62.6 ± 11 years) completed the study. All PD participants and 88% of caregivers were >70% adherent to the intervention. Apathy (AS, effect size = 0.767, P = 0.002) and depression (BDI-II, effect size = 0.542, P = 0.03) improved, with no change in caregiver measures. Conclusion: Group music therapy is an effective treatment for apathy in PD and may improve mood. The virtual format is a feasible alternative to in-person sessions with high adherence and satisfaction.

Integrative Review of Introductory Guitar Teaching Research and Recommendations for Music Therapy Education

Article

Apr 2023

Guitar is a primary clinical instrument for many music therapists; however, minimal research focuses on effective guitar teaching methods (GTMs) in music therapy education. The purpose of this integrative review was to synthesize and critically evaluate the existing literature on GTMs to develop recommendations for music therapy guitar education. The research questions included: (a) What are the characteristics (i.e. participants, study design, teaching method, course type, dosage) of studies using GTMs in music therapy education and training? (b) What are the measures, outcomes, and de/limitations from GTMs studies in music therapy education? Three studies met the criteria. These studies included GTMs of behavioral contracting, audio and video modeling, and learning music “by ear.” Studies indicated that (a) playing “by ear” may improve student musicianship, (b) experienced instructor modeling improves learning, (c) evaluation could include accuracy behavioral markers, and (d) experiential and social learning benefit students in introductory guitar courses. Implications for music therapy education and training and recommendations for further research are discussed.

Phonatory Analysis on Parkinson's Disease Patients Attending Singing and Discussion Therapy (Parkinsonics) using Signal Processing Techniques

Conference Paper

Dec 2022

Community Choir Improves Vocal Production Measures in Individuals Living with Parkinson's Disease

Article

Full-text available

Jan 2023
J Voice

Objectives Parkinson's disease (PD) is a neurodegenerative disease leading to motor impairments and dystonia across diverse muscle groups including vocal muscles. The vocal production challenges associated with PD have received considerably less research attention than the primary gross motor symptoms of the disease despite having a substantial effect on quality of life. Increasingly, people living with PD are discovering group singing as an asset-based approach to community building that is purported to strengthen vocal muscles and improve vocal quality. Study design/Methods The present study investigated the impact of community choir on vocal production in people living with PD across two sites. Prior to and immediately following a 12-week community choir at each site, vocal testing included a range of vocal-acoustic measures, including lowest and highest achievable pitch, duration of phonation, loudness, jitter, and shimmer. Results Results showed that group singing significantly improved some, though not all, measures of vocal production. Group singing improved lowest pitch (both groups), duration (both groups), intensity (one group), and jitter (one group) and shimmer (both groups). Conclusions These findings support community choir as a feasible and scalable complementary approach to managing vocal production challenges associated with PD.

NIH Music-Based Intervention Toolkit: Music-Based Interventions for Brain Disorders of Aging

Article

Jan 2023

Music-based interventions (MBIs) show promise for managing symptoms of various brain disorders. To fully realize the potential of MBIs and dispel the outdated misconception that MBIs are rooted in “soft science,” the National Institutes of Health (NIH) is promoting rigorously designed, well-powered MBI clinical trials. The pressing need of guidelines for scientifically rigorous studies with enhanced data collection brought together the Renée Fleming Foundation, the Foundation for the NIH, the Trans-NIH Music and Health Working Group, and an interdisciplinary scientific expert panel to create the NIH MBI Toolkit for research on music and health across the lifespan. The Toolkit defines the building blocks of MBIs, including a consolidated set of common data elements for MBI protocols, and core datasets of outcome measures and biomarkers for brain disorders of aging that researchers may select for their studies. Utilization of the guiding principles in this Toolkit will be strongly recommended for NIH-funded studies of MBIs.

CultureForHealth Report. Culture’s contribution to health and well-being. A report on evidence and policy recommendations for Europe

Technical Report

Full-text available

Nov 2022

There is a growing awareness in the European Union (EU) of the critical role of culture and the arts in improving health and well-being at both the individual and collective level. Concurrently, the ambition to harness the positive effects of cultural approaches to well-being is growing at the policy level. Yet, designing sustainable interventions at a policy level that reliably implement a change of approach and strategy at practitioner level is no trivial task. This requires knowledge of recent developments in methods and evidence across disciplines, and an empirically based understanding of the enablers and barriers in the implementation of existing interventions with the aim of transforming approaches. The research covering this field is vast, rapidly expanding and highly interdisciplinary. This scoping review aims to narrow the gap between the fast-growing knowledge on the positive impact of culture and arts on human health and well-being, and the policies at EU level. The aim of this scoping review is to synthesise existing evidence on the positive effect of arts and cultural activities on health and well-being. This means the review is not limited to a few research questions but seeks to provide a clear indication of the volume of existing literature, the key concepts, focus points and the types of studies that exist. It also identifies knowledge gaps in the existing literature. Finally, it gathers policy recommendations and identifies challenges, further expanding the scope of the report beyond the proposed policy directions and specific policy measures. This scoping review is carried out within the framework of the CultureForHealth project and responds to the criteria set out in the guidelines of the Preparatory Action – Bottom-Up Policy Development for Culture & Well-being in the EU, launched by the European Union (European Union, 2020).

“Out and proud…. in all your shaking glory” the wellbeing impact of a dance program with public dance performance for people with Parkinson’s disease: a qualitative study

Article

Sep 2022

Purpose To explore if and how Parkinson’s disease dance class participation and public performance contributes to perceptions of wellbeing. Materials and Methods A qualitative design using audio-recorded one-on-one semi-structured interviews with five class participants and three teachers/volunteers from two metropolitan Dance for Wellbeing class locations. Data were inductively thematically analysed by three researchers. Results Five themes illustrated the experience of dance class and performance for people with Parkinson’s Disease: 1) ‘the enabling learning environment’; 2) ‘physical benefits from class participation; 3) ‘mental/psychological benefits from class participation’; 4) ‘social benefits from class participation; 5) ‘sense of self and life engagement from class participation’. Themes 4 and 5 in particular were considered to be ‘magnified by public performance’, providing an opportunity for solidarity within the group and a supportive avenue for “coming out” and living publicly with the PD diagnosis. Conclusion Dance performance magnifies health and wellbeing experiences of people with Parkinson’s disease when part of an enabling, inclusive and emotionally and physically safe learning dance class environment. Elements of holistic benefits, as well as the fun and playful nature of the experience may be important elements to consider for motivation, recruitment and retention in this population. • IMPLICATIONS FOR REHABILITATION • Rehabilitation professionals should consider the use of dance class as an art-based activity that has a holistic therapeutic benefit. • Flexible and fun environments are constructive for dancers to sustain attendance and interest. • Rehabilitation professionals can be cognisant of the impact of public dance performance as ‘coming out’ with Parkinson’s Disease.

Breathing disorders in neurodegenerative diseases

Chapter

Aug 2022

Soumya Ghosh

Neurodegenerative disorders are a diverse group of conditions caused by progressive degeneration of neurons resulting in cognitive, motor, sensory, and autonomic dysfunction, leading to severe disability and death. Pulmonary dysfunction is relatively common in these conditions, may be present early in the disease, and is less well recognized and treated than other symptoms. There are variable disorders of upper and lower airways, central control of ventilation, strength of respiratory muscles, and breathing during sleep which further impact daily activities and quality of life and have the potential to injure vulnerable neurons. Laryngopharyngeal dysfunction affects speech, swallowing, and clearance of secretions, increases the risk of aspiration pneumonia, and can cause stridor and sudden death. In Parkinson's disease, L-Dopa benefits some pulmonary symptoms but there are limited pharmacological treatment options for pulmonary dysfunction. Targeted treatments include strengthening of respiratory muscles, positive airway pressure in sleep and techniques to improve cough efficacy. Well-designed clinical trials are needed to evaluate the long-term benefits of these interventions. Challenges for the future include earlier identification of pulmonary dysfunction in the clinic, institution of the most effective treatments (based on clinical trials that measure long-term meaningful outcomes) and the development of neuroprotective treatment.

Participants' perspective on a COVID-19 online vocal group stimulation for people with Parkinson's disease

Article

Full-text available

Aug 2022

The COVID-19 related confinement and social distancing had negative consequences on the health of individuals living with Parkinson's Disease (PD). In collaboration with a non-profit organization, we developed and implemented a daily online vocal stimulation group named “Musculation de la Voix” (MdlV) in April 2020. To better understand the potential of MdlV to diversify existing services available to people with PD experiencing vocal symptoms, this study aimed to explore participants' experience and perception of MdlV in terms of participation, motivations, feelings, perceived changes, and appreciation. The 45 individuals who registered to the Summer 2020 Semester of MdlV were invited to complete an online ten-question survey. Responses to the four close-ended questions were analyzed using descriptive statistics while statements provided in response to the six open-ended questions were subjected to an inductive qualitative content analysis. Thirty seven participants completed the survey. Results revealed that the sample of respondents was mostly constituted of individuals who were engaged in this activity since its very beginning (62,2%), participated daily (59,5%), intended to keep participating in the activity (97,3%), and had never received speech-language therapy (SLT) services before (72,97%). The qualitative analysis yielded one theme relating to prior services: “Previous SLT services are variable and perceived as beneficial but with limitations,” and three themes pertaining to MdlV: “Seeking improvement and support as initial motivations to engage in MdlV,” “Unanticipated benefits and desired gains catalyzing motivation to participate in MdlV,” and “Perceived limitations of MdlV and persisting needs.” Our study participants' engagement and motivation toward MdlV as well as the benefits they perceived in relation to this activity suggest that an online vocal stimulation group may be a promising complement to currently limited SLT services. As limitations and persisting needs were also identified, future studies are required to elucidate what aspect of MdlV works, for whom and how.

Physiological changes related to 10 weeks of singing for lung health in patients with COPD

Article

Full-text available

May 2022

Background: Singing for Lung Health (SLH) was non-inferior to physical exercise training in improving 6-minute walking test distance (6MWD) and quality of life (St. George's Respiratory Questionnaire (SGRQ)) within a 10-week pulmonary rehabilitation (PR) programme for COPD in our recent randomised controlled trial (RCT) (NCT03280355). Previous studies suggest that singing improves lung function, respiratory control and dyspnoea, however this has not yet been convincingly confirmed. Therefore, this study aimed to explore the impact of SLH on physiological parameters and the associations with achieving the minimal important difference (MID) in 6MWD and/or SGRQ. Methods: We conducted post hoc, per-protocol analyses mainly of the SLH group of the RCT, exploring associations with 6MWD and SGRQ results by stratifying into achieving versus not-achieving 6MWD-MID (≥30 m) and SGRQ-MID (≤-4 points): changes in lung function, inspiratory muscle strength/control, dyspnoea, and heart rate response using logistic regression models. Further, we explored correlation and association in achieving both 6MWD-MID and SGRQ-MID (or in neither/nor) using Cohen's κ and Cochran-Mantel-Haenszel Test. Results: In the SLH study group (n=108), 6MWD-MID was achieved by 31/108 (29%) and in SGRQ by 53/108 (49%). Baseline factors associated with achieving MID in either outcome included short baseline 6MWD and high body mass index. Achieving 6MWD-MID was correlated with improved heart rate response (OR: 3.14; p=0.03) and achieving SGRQ-MID was correlated with improved maximal inspiratory pressure (OR: 4.35; p=0.04). Neither outcome was correlated with significant spirometric changes. Agreement in achieving both 6MWD-MID and SGRQ-MID was surprisingly insignificant. Conclusions: This explorative post hoc study suggests that SLH is associated with physiological changes after short-term PR for COPD. Future physiological studies will help us to understand the mechanisms of singing in COPD. Our study furthermore raises concern about poor agreement between subjective and objective benefits of PR despite state-of-the-art tools.

Does the Perception of Own Voice Affect Our Behavior?

Article

Mar 2022
J Voice

This study aimed to investigate what are the factors that influence the perception of one's own voice, and if there are any differences using voice between speaking and singing. Further the study purported to examine how these attitudes affect individuals’ vocal behavior in personal and social contexts. A total of 100 participants completed the survey which comprised 23 questions about demographics, music experience, speaking voice, and singing voice. The quantitative data were analyzed by correlations and paired t test. For qualitative analyses, content analysis was conducted. The results revealed an even distribution among negative, neutral, and positive attitudes regarding singing and speaking voices and their effects on vocal behavior. For their negative/positive perceptions of their voices, participants referenced factors related to vocal attributes, personal features, social or external validation, emotional quality of the voice, etc. Lastly, result showed that one's perception of the speaking voice has some influence on behaviors ranging from the personal (expressing oneself) to social (interacting with people) aspects. The findings of this study implies that one's attitude toward one's own voice substantially impacts one's personal, interpersonal and social-presentation.

ParkinSong Online: Protocol for a telehealth feasibility study of therapeutic group singing for people with Parkinson's disease

Article

Full-text available

Dec 2021

Introduction Parkinson’s disease can be associated with speech deterioration and low communication confidence which in turn compromises social interaction. Therapeutic singing is an engaging method for combatting speech decline; however, face-to-face delivery can limit access to group singing. The aim of this study is to test the feasibility and acceptability of an online mode of delivery for a Parkinson’s singing intervention (ParkinSong) as well as remote data collection procedures. Methods and analysis This ParkinSong Online feasibility trial is a single-arm, pre–post study of online singing delivery and remote data collection for 30 people living with Parkinson’s. The primary outcome measure is feasibility: recruitment, retention, attendance, safety, intervention fidelity, acceptability and associated costs. Secondary outcomes are speech (loudness, intelligibility, quality, communication-related quality of life) and wellbeing (apathy, depression, anxiety, stress, health-related quality of life). This mode of delivery aims to increase the accessibility of singing interventions. Ethics and dissemination Ethics approval was obtained from The University of Melbourne Human Research Ethics Committee (2021-14465-16053-3) and the trial has been prospectively registered. Results will be presented at national and international conferences, published in a peer-reviewed journal, and disseminated to the Parkinson’s community, researchers and policymakers. Trial registration number ACTRN12621000940875.

Together in song: Designing a singing for health group intervention for older people living in the community

Article

Full-text available

Nov 2021

Introduction International research evidence on the physical, cognitive and social benefits of group singing for older people is growing rapidly. However, singing interventions are inconsistently reported, with details of intervention development, musical content and structure often omitted, impeding replicability and synthesis. This paper poses two research questions: (a) What specific guidelines for singing groups can the research team recommend for older people aged over 65 living in the community who have health and well-being concerns? (b) What recommendations can the research team make for singing group facilitators, building on two pilot studies and over 20 years of experience running singing groups? Method A detailed three-stage process of intervention development and evaluation was undertaken, following Medical Research Council (MRC) guidance. Results The findings of each stage of intervention development and the resultant tested intervention, which aims to meet the physical and psychological health and well-being needs of older people, are presented. Key features of the final intervention include flexible, person-centred musical content; opportunities for social interaction; and appropriate resources, such as large print songbooks. The results of the pilot studies indicate the capacity of group singing to benefit interpersonal relationships and social connection among older people, contributing to increased well-being. Discussion This intervention aims to contribute to the possibility of replicable large-scale studies of the impact of singing for health groups on the health and well-being of older people.

Acoustic Analysis and Voice Quality in Parkinson Disease

Chapter

Jan 2020

Investigators and clinicians have long sought to apply acoustic analysis to track changes in voice quality in Parkinson disease (PD), in order to evaluate or document treatment effects, track disease progression, or to attempt remote automatic diagnosis. These studies have often had disappointing results, so that the best way to apply acoustics to Parkinsonian voice remains an open question. In this paper we argue that past approaches have not lived up to expectations due to a lack of theory relating voice quality to either acoustics or to the physiological changes associated with disease progression. We review the history of acoustic analysis in PD and describe the motivations that have been presented for each measure. We then describe a psychoacoustic model of voice quality, and explore how this model could be applied to develop a comprehensive model of voice in PD. Such a model would explain how acoustics, quality, and voice production interrelate. Without such an understanding, we contend, the goal of meaningful evaluation of voice in PD will remain unachieved.

Immediate Effect of the Finger-Kazoo Technique Associated with Glissandos in the Voice of Individuals with Parkinson's Disease

Article

Aug 2020
J Voice

Objective To verify the immediate effect of the Finger Kazoo technique associated with glissandos in the voice of individuals with Parkinson's disease. Method Thirty subjects with Parkinson's Disease comprised of 15 men and 15 women with a mean age of 63.8 years (± 6.88) and mean time of diagnosis of 97.33 (± 63.53) months, all with preserved cognition. The subjects' voice range profile (VRP), speech range profile (SRP), and the maximum phonation time were assessed, before and after applying the Finger Kazoo technique associated with ascending and descending glissando. After the technique, a vocal satisfaction questionnaire was completed. Results After the applied technique there was an increase in the minimum and maximum fundamental frequency recorded respectively in the SRP and in the VRP; there was an increase in the vocal range (measured in Hertz and semitones) of the women, recorded in the VRP; in the male population, there was an increase in maximum phonation time. A higher percentage of positive references to vocal improvement was observed after the exercise. Conclusion In patients with Parkinson's Disease, the Finger Kazoo with glissando technique promoted an increase in the minimum fundamental frequency of the SRP and in the vocal extensions of women, as well as increasing the maximum phonatory time of men. In addition, patients reported satisfaction with the use of the technique and its results.

Choral singing therapy following stroke or Parkinsons disease: An exploration of participants experiences

Article

Full-text available

Jul 2015
DISABIL REHABIL

People with stroke or Parkinson's disease (PD) live with reduced mood, social participation and quality of life (QOL). Communication difficulties affect 90% of people with PD (dysarthria) and over 33% of people with stroke (aphasia). These consequences are disabling in many ways. However, as singing is typically still possible, its therapeutic use is of increasing interest. This article explores the experiences of and factors influencing participation in choral singing therapy (CST) by people with stroke or PD and their significant others. Participants (eight people with stroke, six with PD) were recruited from a community music therapy choir running CST. Significant others (seven for stroke, two for PD) were also recruited. Supported communication methods were used as needed to undertake semi-structured interviews (total N = 23). Thematic analysis indicated participants had many unmet needs associated with their condition, which motivated them to explore self-management options. CST participation was described as an enjoyable social activity, and participation was perceived as improving mood, language, breathing and voice. Choral singing was perceived by people with stroke and PD to help them self-manage some of the consequences of their condition, including social isolation, low mood and communication difficulties. Implications for Rehabilitation Choral singing therapy (CST) is sought out by people with stroke and PD to help self-manage symptoms of their condition. Participation is perceived as an enjoyable activity which improves mood, voice and language symptoms. CST may enable access to specialist music therapy and speech language therapy protocols within community frameworks.

Functional outcomes associated with expiratory muscle strength training: Narrative review

Article

Full-text available

Jul 2014
J REHABIL RES DEV

This review presents the available evidence for the effects of expiratory muscle strength training (EMST) with the use of a pressure threshold device. The investigators used computerized database searches for studies reporting the outcomes of pressure threshold EMST published after 1994. A total of 24 selected articles presented outcomes related but not limited to respiratory function, such as speech, swallow, voice, and cough function in persons with neurologic conditions such as Parkinson disease, multiple sclerosis, and Lance-Adams syndrome; in persons with respiratory diseases, such as chronic obstructive pulmonary disease; and in healthy young adults and sedentary and active elderly. Several studies demonstrated promising outcomes of EMST as a non-task-specific training for airway protection in persons with dysphagia secondary to neuromuscular impairments; however, further research is needed to confirm and generalize the reported findings.

Effect of Subthalamic Stimulation on Voice and Speech in Parkinson’s Disease: For the Better or Worse?

Article

Full-text available

Jan 2014

Background: Deep brain stimulation of the subthalamic nucleus, although highly effective for the treatment of motor impairment in Parkinson’s disease (PD), can induce speech deterioration in a subgroup of patients. The aim of the current study was to survey (1) if there are distinctive stimulation effects on the different parameters of voice and speech and (2) if there is a special pattern of preexisting speech abnormalities indicating a risk for further worsening under stimulation. Methods: N = 38 patients with PD had to perform a speech test without medication with stimulation ON (StimON) and stimulation OFF (StimOFF). Speech samples were analyzed: (1) according to a four-dimensional perceptual speech score and (2) by acoustic analysis to obtain quantifiable measures of distinctive speech parameters. Results: Quality of voice was ameliorated with StimON, and there were trends of increased loudness and better pitch variability. N = 8 patients featured a deterioration of speech with StimON, caused by worsening of articulation or/and fluency. These patients already had more severe overall speech impairment with characteristic features of articulatory slurring and articulatory acceleration under StimOFF condition. Conclusion: The influence of subthalamic StimON Parkinsonian speech differs considerably between individual patients, however, there is a trend to amelioration of voice quality and prosody. Patients with stimulation-associated speech deterioration featured higher overall speech impairment and showed a distinctive pattern of articulatory abnormalities at baseline. Further investigations to confirm these preliminary findings are necessary to allow neurologists to pre-surgically estimate the individual risk of deterioration of speech under stimulation.

The Effect of Group Music Therapy on Mood, Speech, and Singing in Individuals with Parkinson's Disease -- A Feasibility Study

Article

Full-text available

Sep 2012

Parkinson's disease (PD) is a progressive neurodegenerative disorder where patients exhibit impairments in speech production. Few studies have investigated the influence of music interventions on vocal abilities of individuals with PD. To evaluate the influence of a group voice and singing intervention on speech, singing, and depressive symptoms in individuals with PD. Ten patients diagnosed with PD participated in this one-group, repeated measures design study. Participants received the sixty-minute intervention, in a small group setting once a week for 20 consecutive weeks. Speech and singing quality were acoustically analyzed using a KayPentax Multi-Dimensional Voice Program, voice ability using the Voice Handicap Index (VHI), and depressive symptoms using the Montgomery and Asberg Depression rating scale (MADRS). Measures were taken at baseline (Time 1), after 10 weeks of weekly sessions (Time 2), and after 20 weeks of weekly sessions (Time 3). Significant changes were observed for five of the six singing quality outcomes at Time 2 and 3, as well as voice range and the VHI physical subscale at Time 3. No significant changes were found for speaking quality or depressive symptom outcomes; however, there was an absence of decline on speaking quality outcomes over the intervention period. Significant improvements in singing quality and voice range, coupled with the absence of decline in speaking quality support group singing as a promising intervention for persons with PD. A two-group randomized control study is needed to determine whether the intervention contributes to maintenance of speaking quality in persons with PD.

Singing in groups for Parkinson's disease (SING-PD): A pilot study of group singing therapy for PD-related

Article

Full-text available

Mar 2012

Parkinson's disease related speech and voice impairment have significant impact on quality of life measures. LSVT(®)LOUD voice and speech therapy (Lee Silverman Voice Therapy) has demonstrated scientific efficacy and clinical effectiveness, but musically based voice and speech therapy has been underexplored as a potentially useful method of rehabilitation. We undertook a pilot, open-label study of a group-based singing intervention, consisting of twelve 90-min weekly sessions led by a voice and speech therapist/singing instructor. The primary outcome measure of vocal loudness as measured by sound pressure level (SPL) at 50 cm during connected speech was not significantly different one week after the intervention or at 13 weeks after the intervention. A number of secondary measures reflecting pitch range, phonation time and maximum loudness also were unchanged. Voice related quality of life (VRQOL) and voice handicap index (VHI) also were unchanged. This study suggests that a group singing therapy intervention at this intensity and frequency does not result in significant improvement in objective and subject-rated measures of voice and speech impairment.

Respiratory Strength Training: Concept and Intervention Outcomes

Article

Full-text available

Feb 2011
Semin Speech Lang

Respiratory muscle strength training (RMST) focuses on increasing the force-generating capacity of the inspiratory and expiratory muscles. The choice of respiratory muscles that are targeted using RMST depends on the outcome desired. For example, if an individual has reduced inspiratory muscle strength due to a neurogenic injury and is unable to ventilate the lungs, then inspiratory muscle strength training may be the chosen rehabilitation target. On the other hand, if a professional voice user is complaining of difficulty generating adequate vocal loudness during song production and is suffering from laryngeal dysfunction, then an expiratory muscle strength training paradigm may be the chosen rehabilitation target. Our most recent work with RMST has focused on increasing expiratory muscle force generation for those with Parkinson's disease who have difficulty with breathing, swallowing, and cough production. This difficulty typically worsens as the disease progresses. Highlights of these outcomes are summarized in this article.

The Therapeutic Effects of Singing in Neurological Disorders

Article

Full-text available

Apr 2010
MUSIC PERCEPT

Music making (playing an instrument or singing) is a multimodal activity that involves the integration of auditory and sensorimotor processes. The ability to sing in humans is evident from infancy, and does not depend on formal vocal training but can be enhanced by training. Given the behavioral similarities between singing and speaking, as well as the shared and distinct neural correlates of both, researchers have begun to examine whether singing can be used to treat some of the speech-motor abnormalities associated with various neurological conditions. This paper reviews recent evidence on the therapeutic effects of singing, and how it can potentially ameliorate some of the speech deficits associated with conditions such as stuttering, Parkinson's disease, acquired brain lesions, and autism. By reviewing the status quo, it is hoped that future research can help to disentangle the relative contribution of factors to why singing works. This may ultimately lead to the development of specialized or "gold-standard" treatments for these disorders, and to an improvement in the quality of life for patients.

Voice and choral singing treatment: A new approach for speech and voice disorders in Parkinson's disease

Article

Full-text available

Dec 2008

The aim of this study was to propose a new voice rehabilitation program for Parkinson's Disease (PD) patients based on voice and choral singing treatment (VCST). The authors carried out a pilot test-retest non-controlled study with twenty PD patients that voluntarily took part to the speech rehabilitation treatment. Patients underwent 20 hours of speech therapy, two sessions of one hour every week, and 26 hours of choral singing, one session of two hours every week. The speech and choral activity were directed by a speech therapist expert in PD and choral singing. The pre- and post-treatment assessment included neurological and otolaryngological evaluation, voice and speech acoustic analysis, auditory quality of voice analysis, respiratory function evaluation, that were carried out within two weeks before and after VCST. The authors observed a significant improvement (P<0.05) of functional residual capacity (FRC%), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), maximum duration of sustained vowel phonation (MDPh), prosodia reading a passage, using paired t-test; and of fatigue reading a passage using Wilcoxon Signed Rank Test. No significant difference was found in the other variables. VCST for PD patients can improve specific abnormalities with an amusing, agreeable, and collective approach, but a randomized controlled trial (RCT) is necessary to find evidence of efficacy.

The perceived benefits of singing

Article

Full-text available

Jan 2002
J R SOC PROMO HEALTH

Two exploratory studies are reported on the perceived benefits associated with active participation in choral singing. In the first study, 84 members of a university college choral society completed a brief questionnaire that asked whether they had benefited personally from their involvement in the choir and whether there were ways in which participation could benefit their health. A large majority of respondents agreed they had benefited socially (87%) and emotionally (75%), with 58% agreeing they had benefited in some physical way, and 49% spiritually. A content analysis of written comments served to elaborate the ways in which choir members felt they had benefited. Common themes expressed were: meeting new people, feeling more positive, increased control over breathing, feeling more alert and feeling spiritually uplifted. With respect to health benefits, 84% of participants gave answers, the main themes of which related to improved lung function and breathing, improved mood and stress reduction. In the second study, 91 members of the choir completed a structured questionnaire consisting of 32 statements about singing reflecting the ideas expressed in the first study. Over 40% of respondents strongly agreed that 'singing helps to make my mood more positive', 'singing is a moving experience for me sometimes', 'singing makes me feel a lot happier' and 'singing is good for my soul'. A principal components analysis followed by Oblimin rotation identified six dimensions of benefit associated with singing. These were labelled as: benefits for well-being and relaxation, benefits for breathing and posture, social benefits, spiritual benefits, emotional benefits, and benefits for heart and immune system. Cronbach alpha coefficients were satisfactory for all components except the third, social benefits, due primarily to the small number of items loading on this component. Women were significantly more likely to experience benefits for well-being and relaxation, younger people were more likely to report social benefits, and those professing religious beliefs were more likely to experience spiritual benefits. The present studies have a number of limitations, but they provide a useful foundation for future larger scale surveys, more sophisticated qualitative studies, and experimental investigations of the impact of singing on psycho-physiological functioning.

The Effects of Speech Therapy and Pharmacological Treatments on Voice and Speech in Parkinsons Disease: A Review of the Literature

Article

Full-text available

Aug 2002

Geralyn M Schulz

The purpose of this paper was to examine the effects of speech therapy and various pharmacological treatment approaches on the voice and speech of persons with Parkinson s disease (PD). Approximately 80% of PD patients have voice and speech problems including reduced vocal intensity, reduced vocal pitch, monopitch and monoloudness, and imprecise articulation. Research prior to 1970's had not demonstrated significant improvements following speech therapy. However, recent research has shown that speech therapy (when persons with PD are optimally medicated) has proven to be the most efficacious therapeutic method for improving voice and speech function. Across research studies, pharmacological methods of treatment in isolation do not appear to significantly improve voice and speech function in PD. In a single subject study, however, the dopamine agonist Mirapex was shown to have beneficial effects on vocal intensity. Possible explanations for the differential responses to treatment are discussed. It is suggested that the goal of future studies should be investigations of the effects of combined treatment approaches.

Patterns of Breath Support in Projection of the Singing Voice

Article

Full-text available

Apr 2001
J Voice

Recordings of the rib cage and abdominal motions and acoustic output were obtained from five professional opera singers during performance of an aria recorded with two levels of voice projection. The condition of greater projection resulted in a significant increase in the acoustic power in the frequency band 2-4 kHz, relative to the power in the 0-2 kHz band, and a decrease in the mean expiratory flow, implying a move to more efficient vocalization with the greater projection. Also, the condition of greater projection resulted in a larger rib cage, particularly in the lateral dimension, but only a small decrease in the abdominal lateral dimension, suggesting that the greater abdominal support required for a larger projection is obtained by increased activation of abdominal muscles acting medially.

Control of voice fundamental frequency in speaking versus singing

Article

Full-text available

Apr 2003

In order to investigate control of voice fundamental frequency (F0) in speaking and singing, 24 adults had to utter the nonsense word ['ta:tatas] repeatedly, while in selected trials their auditory feedback was frequency-shifted by 100 cents downwards. In the speaking condition the target speech rate and prosodic pattern were indicated by a rhythmic sequence made of white noise. In the singing condition the sequence consisted of piano notes, and subjects were instructed to match the pitch of the notes. In both conditions a response in voice F0 begins with a latency of about 150 ms. As predicted, response magnitude is greater in the singing condition (66 cents) than in the speaking condition (47 cents). Furthermore the singing condition seems to prolong the after-effect which is a continuation of the response in trials after the frequency shift. In the singing condition, response magnitude and the ability to match the target F0 correlate significantly. Results support the view that in speaking voice F0 is monitored mainly supra-segmentally and controlled less tightly than in singing.

The World Health Organization's WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A Report from the WHOQOL Group

Article

Full-text available

Apr 2004

Quality of life (QOL) assessments that are easily administered and which do not impose a great burden on the respondent are needed for use in large epidemiological surveys, clinical settings and clinical trials. Using data from the WHOQOL-BREF field trials, the objectives of this work are to examine the performance of the WHOQOL-BREF as an integrated instrument, and to test its main psychometric properties. The WHOQOL-BREF is a 26-item version of the WHOQOL-100 assessment. Its psychometric properties were analysed using cross-sectional data obtained from a survey of adults carried out in 23 countries (n = 11,830). Sick and well respondents were sampled from the general population, as well as from hospital, rehabilitation and primary care settings, serving patients with physical and mental disorders and with respect to quotas of important socio-demographic variables. The WHOQOL-BREF self-assessment was completed, together with socio-demographic and health status questions. Analyses of internal consistency, item-total correlations, discriminant validity and construct validity through confirmatory factor analysis, indicate that the WHOQOL-BREF has good to excellent psychometric properties of reliability and performs well in preliminary tests of validity. These results indicate that overall, the WHOQOL-BREF is a sound, cross-culturally valid assessment of QOL, as reflected by its four domains: physical, psychological, social and environment.

Effects of an Extended Version of the Lee Silverman Voice Treatment on Voice and Speech in Parkinson’s Disease

Article

Full-text available

Jun 2007

The present study examined vocal SPL, voice handicap, and speech characteristics in Parkinson's disease (PD) following an extended version of the Lee Silverman Voice Treatment (LSVT), to help determine whether current treatment dosages can be altered without compromising clinical outcomes. Twelve participants with idiopathic PD received the extended treatment version (LSVT-X), similar to LSVT except that it was administered twice a week in 1-hr sessions over 8 weeks and required substantially more home practice. Recordings were made in a sound-treated booth immediately before and after treatment, and again 6 months later. Vocal SPL was measured for 4 different tasks and compared with data from a previous study, in which participants with PD received traditional LSVT 4 times a week for 4 weeks. Listener ratings were conducted with audio samples from both studies, using sentence pairs from a standard passage. LSVT-X participants completed the Voice Handicap Index (VHI) before each set of recordings. Participants receiving LSVT-X significantly increased vocal SPL by 8 dB after treatment and maintained increased vocal SPL by 7.2 dB at 6 months. VHI scores improved for 25% of the LSVT-X participants following treatment, and listener ratings indicated audible improvement in speech. LSVT-X successfully increased vocal SPL (which was consistent with improvements following traditional LSVT), decreased perceived voice handicap, and improved functional speech in individuals with PD. Further large-scale research is required to truly establish LSVT-X efficacy.

A Pilot Study of Respiration and Swallowing Integration in Parkinson’s Disease: “On” and “Off” Levodopa

Article

Full-text available

Apr 2008

Parkinson's disease is associated with both swallowing and respiratory dysfunction, increasing the risk of aspiration and pneumonia. Previous studies have shown improvements in measurements of swallowing and respiration with levodopa; however, the studies are small and some studies show conflicting reports. The aim of this study was to further investigate the effect of levodopa on respiration. Ten patients with Parkinson's disease were tested "On" and "Off" levodopa. Assessments included Unified Parkinson's Disease Rating Scale (UPDRS), coordination of swallowing and respiration, timed-test of swallowing, lung function testing, and, qualitative assessment of swallowing. There was a nonsignificant trend to lower volume per swallow when "On" levodopa, significant reduction in lung function when "On" levodopa, but no difference in coordination of swallowing and respiration or qualitative assessment of swallowing. There was a significant increase in motor examination score of the UPDRS when "Off" levodopa compared to "On." There may be a reduction in efficiency of swallowing with levodopa medication without any apparent increase in risk of aspiration. These pilot data suggest that further evaluation with larger numbers of participants is justified.

Music, Language, and the Brain

Article

Jan 2012

Aniruddh D. Patel

In the first comprehensive study of the relationship between music and language from the standpoint of cognitive neuroscience, the author challenges the widespread belief that music and language are processed independently. Since Plato's time, the relationship between music and language has attracted interest and debate from a wide range of thinkers. Recently, scientific research on this topic has been growing rapidly, as scholars from diverse disciplines including linguistics, cognitive science, music cognition, and neuroscience are drawn to the music-language interface as one way to explore the extent to which different mental abilities are processed by separate brain mechanisms. Accordingly, the relevant data and theories have been spread across a range of disciplines. This book provides the first synthesis, arguing that music and language share deep and critical connections, and that comparative research provides a powerful way to study the cognitive and neural mechanisms underlying these uniquely human abilities.

Non-motor symptoms of Parkinson's disease: Diagnosis and management

Article

Jan 2006
LANCET NEUROL

Quantitative Analysis of Voice in Parkinson Disease Compared to Motor Performance: A Pilot Study

Article

Sep 2015

Background: Characteristic features of hypokinetic dysarthria develop in Parkinson disease (PD). We hypothesized that quantified acoustic changes of voice might provide a correlate of disease severity. Objective: To determine if there are significant differences in acoustic measures of voice between mild and moderate PD; 2) To evaluate correlations between acoustic parameters of voice and subtests of the UPDRS in mild and moderate PD. Methods: Twenty six participants with PD underwent vocal acoustic testing while off PD medication, for comparison to 22 healthy controls. Participants with PD were divided into two groups based upon UPDRS activities of daily living (ADL) ratings: summed scores were used to define mild and moderate PD. Participants voiced /i/ ("ee") at comfort, high, and low pitch (3 trials/pitch). The CSpeechWaveform Analysis Program was used to analyze cycle-to-cycle frequency ("jitter") and amplitude ("shimmer") irregularities of the vocal signal, signal-to-noise ratio, and maximum phonation frequency range converted to semitones. Sections of UPDRS scores were correlated to acoustic variables of voice. Results: Key findings included a significant difference between the semitone range of the control subjects and the moderate PD group (p = 0.036). Further analyses revealed significant differences in semitone range for males between the controls vs. mild PD (p = 0.014), and controls vs. moderate PD (p = 0.005). Significant correlations were also found between acoustic findings and both the ADL and motor portions of the UPDRS. Conclusions: Acoustic analysis of voice, particularly frequency range, may provide a quantifiable correlate of disease progression in PD.

Evidence-based treatment of voice and speech disorders in Parkinson disease

Article

Jun 2015
Curr Opin Otolaryngol Head Neck Surg

Voice and speech impairments are present in nearly 90% of people with Parkinson disease and negatively impact communication and quality of life. This review addresses the efficacy of Lee Silverman Voice Treatment (LSVT) LOUD to improve vocal loudness (as measured by vocal sound pressure level vocSPL) and functional communication in people with Parkinson disease. The underlying physiologic mechanisms of Parkinson disease associated with voice and speech changes and the strength of the current treatment evidence are discussed with recommendations for best clinical practice. Two randomized control trials demonstrated that participants who received LSVT LOUD were significantly better on the primary outcome variable of improved vocSPL posttreatment than alternative and no treatment groups. Treatment effects were maintained for up to 2 years. In addition, improvements have been demonstrated in associated outcome variables, including speech rate, monotone, voice quality, speech intelligibility, vocal fold adduction, swallowing, facial expression and neural activation. Advances in technology-supported treatment delivery are enhancing treatment accessibility. Data support the efficacy of LSVT LOUD to increase vocal loudness and functional communication in people with Parkinson disease. Timely intervention is essential for maximizing quality of life for people with Parkinson disease.

Development of the World Health Organization WHO QoL_BREF quality of life assessment

Article

May 1998
PSYCHOL MED

THE WHOQOL GROUP

Background: The paper reports on the development of the WHOQOL-BREF, an abbreyiated version of the WHOQOL-100 quality of life assessment. Method: The WHOQOL-BREF was derived from data collected using the WHOQOL-100. It produces scores for four domains related to quality of life: physical health, psychological, social relationships and environment. It also includes one facet on overall quality of life and general health. Results: Domain scores produced by the WHOQOL-BREF correlate highly (0.89 or above) with WHOQOL-100 domain scores (calculated on a four domain structure). WHOQOL-BREF domain scores demonstrated good discriminant validity, content validity, internal consistency and test-retest reliability. Conclusion: These data suggest that the WHOQOL-BREF provides a valid and reliable alternative to the assessment of domain profiles using the WHOQOL-100. It is envisaged that the WHOQOL-BREF will be most useful in studies that require a brief assessment of quality of life, for example, in large epidemiological studies and clinical trials where quality of life is of interest. In addition, the WHOQOL-BREF may be of use to health professionals in the assessment and evaluation of treatment efficacy.

Quality of life (QOL) of older adult community choral singers in Finland

Article

Apr 2013
INT PSYCHOGERIATR

Background: Enhancing quality of life (QOL) of older adults is an international area of focus. Identifying factors and experiences that contribute to QOL of older adults helps promote optimal levels of functioning. This study examines the relationship between perceived benefits associated with choral singing and QOL among community-dwelling older adults. Methods: One hundred seventeen older adults who sing in community choirs in Jyväskylä, Finland, completed self-report measures of QOL (WHOQOL-Bref), depressive symptoms, and a questionnaire about the benefits of singing in choir. Correlational analyses and linear regression models were used to examine the association between the benefits of singing in choir and QOL. Results: Both correlation and regression analyses found significant relationships between the benefits of choral singing and three QOL domains: psychological, social relationships, and environment. These associations remained significant after adjusting for age and depressive symptoms. As hypothesized, older choral singers who reported greater benefits of choir singing had higher QOL in multiple domains. The older choral singers in the study also reported few symptoms of depression and high overall QOL and satisfaction with health. Conclusion: Results suggest that singing in a community choir as an older adult may positively influence several aspects of QOL. These results suggest that community choral singing may be one potential avenue for promoting QOL in older adults.

Survey of UK speech and language therapists' assessment and treatment practices for people with progressive dysarthria

Article

Nov 2012
INT J LANG COMM DIS

Background: Dysarthria knowledge is predominantly impairment-based. As a result, speech and language therapists (SLTs) have traditionally adopted impairment-focused management practices. However, guidance for best practice suggests that SLTs should consider the client holistically, including the impact of dysarthria beyond the impairment. Aims: To investigate the current assessment and treatment practices used by UK SLTs with clients with progressive dysarthria and to identify whether these satisfy the needs of SLTs in their everyday practice. To investigate the extent to which they consider oromotor abilities, intelligibility, functional communication, participation and interaction to be important regarding assessment and treatment decisions. To explore whether management decisions are affected by level of clinical experience or settings in which SLTs work. Methods & Procedures: An online survey of UK SLTs working with adults with progressive dysarthria. Outcomes & Results: A total of 119 SLTs completed the survey. Respondents considered that targeting the levels of impairment, activity and participation are important in the management of clients with progressive dysarthria, as recommended by clinical guidelines and recent research. However a particularly high proportion of respondents reported the use of impairment-based assessments. Respondents reported lacking the necessary tools to target interaction in assessment and intervention. The intervention that respondents use with clients varies according to the progressive disorder and dysarthria severity. There is evidence for a trend that less experienced SLTs and those working predominantly in hospital-based settings focus on the impairment, whereas more SLTs with more experience and those based in predominantly community-based settings look beyond the impairment. Conclusions & Implications: The values held by SLTs match guideline recommendations for best practice, however the clinical reality is that the assessment of progressive dysarthria remains predominantly impairment-focused. New tools need to be developed and integrated into practice to target interaction in assessment and intervention, to reduce the gap between best practice recommendations and clinical reality. Ongoing research into the effectiveness of SLT intervention with clients with progressive dysarthria is required to guide clinical management decisions.

The Value of Speech Amplification in Parkinson’s Disease Patients

Article

Jan 1968

Different electronic amplifier systems which do not engage the hands are described and compared. Their usefulness in Parkinson’s Disease Patients is discussed in relation to the degree of speech impairment. When failure in vocal volume is the only symptom considerable benefit is gained from amplification. If, however, speech propulsion, lack of rhythm and inflection and slurred articulation are present little benefit may be gained from amplification. In such cases guidance and encouragement from a speech therapist is essential in the use of the amplifier as a speech aid which provides instantaneous feed-back and this assists the patient’s monitoring of his own speech. The importance of the patient’s morale and psychological stale in maintaining intelligible speech is emphasised.

Frequency and Cooccurrence of Vocal Tract Dysfunctions in the Speech of a Large Sample of Parkinson Patients

Article

Mar 1978

In this study, the frequency of occurrence of speech and voice symptoms in 200 Parkinson patients was defined by two expert listeners from high-fidelity tape recordings of conversational speech samples and readings of the sentence version of the Fisher-Logemann Test of Articulation Competence. Specific phonemes that were misarticulated were catalogued. Other vocal-tract dysfunctions, including laryngeal disorders, rate disorders, and hypernasality, were also recorded. Cooccurrence of symptoms in each patient was tabulated. Examination of the patterns of cooccurring dysfunctions permitted classifying the 200 patients into five groups: Group 1 (45% of the patients) with laryngeal dysfunction as their only vocal-tract symptom; Group 2 (13.5% of the patients) with laryngeal and back-tongue involvement; Group 3 (17% of the patients) with laryngeal, back-tongue, and tongue-blade dysfunction; Group 4 (5.5% of the patients) with laryngeal dysfunction, back-tongue involvement, tongue-blade dysfunction, and labial misarticulations; and Group 5 (9% of the patients) with laryngeal dysfunction and misarticulations of the back tongue, tongue blade, lips, and tongue tip. Disfluencies and hypernasality did not follow a systematic pattern of cooccurrence with other vocal-tract dysfunctions.

Can the Lombard effect be used to improve low voice intensity in Parkinson's disease?

Article

Feb 1992
Eur J Disord Comm

ABSTRACTS Low voice intensity is a common problem in Parkinson's disease. It is typically resistant to drug therapy and often persists despite extensive behavioural speech and language therapy. Based on previous findings that masking noise will produce a consistent increase in voice intensity in most normal individuals, the effects of white masking noise, presented at a sound pressure level of 90 dB, was examined in 10 parkinsonian patients with low voice intensity. Results indicated that all Parkinson's disease patients showed a marked increase in their voice intensity. Given this finding, it is proposed that masking noise may be an effective treatment for reduced voice intensity in parkinsonian speakers, particularly with the future adaptation of portable voice‐activated maskers, such as the Edinburgh Masker. Chez les malades de Parkinson l'insuffisance d'intensité de la voix est un problème fréquent, et particulièrement résistant à la fois à la médication et souvent aussi à tous les efforts de rééducation des orthophonistes. En se fondant sur le fait connu déjà qu'un bruit de masque a pour résultat une augmentation sensible de l'intensité de la voix chez la plupart des individus sains, l'étude présente a porté sur les effets, chez dix malades de Parkinson souffrant d'insuffisance d'intensité de la voix, d'un bruit blanc de masque d'un niveau de pression sonore de 90 dB. Les résultats ont montré que les malades de Parkinson avaient bénéficié d'une augmentation notable de l'intensité de leur voix. Ce résultat permettrait d'envisager l'adjonction d'un bruit de masque comme traitement efficace de l'insuffisance de l'intensité de la voix chez les malades de Parkinson, et l'adaptation éventuelle de masqueurs portatifs activés par la voix, comme par exemple le Masqueur d'Edimbourg. Bei der Parkinsonischen Krankheit stellt die niedrige Stimmintensität ein häufiges Problem dar. Gewöhnlicherweise haben Medikamente keinen Einfluss darauf und sie bleibt oft ungeändert trotz ausreichender logopädischer Verhaltenstherapie. Auf der Grund der Ergebnisse früherer Studien, dass ein deckender Ton bei den meisten normalen Sprechern eine ständige Zunahme der Stimmintensität hervorbringt, untersuchten wir die Auswirkung des weissen Rauschens mit einer Lautstärke von 90 dB bei 10 Patienten mit der Parkinsonischen Krankheit, die eine niedrige Stimmintensität hatten. Die Ergebnisse deuteten darauf, dass alle Patienten mit Parkinsonischer Krankheit eine signifikante Zunahme in der Stimmintensität zeigten. Als Folge dieser Ergebnisse schlagen wir vor, dass der maskierende Ton eine wirkungsvolle Behandlung der verminderten Stimmintensität bei der Parkinsonskrankheit sein könnte, besonders mit der eventuellen Adaptierung eines von der Stimme aktivierten Maskierers, wie zum Beispiel der Edinburgh Masker.

Speech therapy and Parkinson's disease: A review and further data

Article

Sep 1990
Br J Disord Comm

A review is undertaken of recent experimental studies of the effects of speech therapy offered to patients with Parkinson's disease. In contrast to earlier opinions based upon clinical impressions, the results of these studies indicate that the immediate gains from therapy measured within the clinical setting are readily detected, that these are perceived by patient's relatives and that there is reasonable evidence that benefits persist for some period after treatment. A further study is reported which tests the effects of a less intensive treatment regimen. This also gave positive results. Although questions remain regarding the most efficient form of treatment and the extent of its benefits outside the clinic, the existing results warrant greater optimism about the benefits of speech therapy offered to patients with Parkinson's disease.

Parkinson's disease: Disability, review, and management

Article

Oct 1986

Data from a descriptive study of idiopathic Parkinson's disease were analysed aimed at getting a clearer picture of the impact of the disease on the community and the help available to patients and carers. Altogether 267 patients aged 40-92 were identified, and the median duration of disease in those in whom this could be assessed was 7.2 years. Of the 267 patients, 204 (76.4%) were living in the community, 51 alone. A total of 201 patients were taking levodopa, 29 out of 102 had retired early, and 60 out of 84 (71.4%) had given up driving. Most patients had symptoms at the time of study, and signs such as bradykinesia, rigidity, impaired speech, and abnormal gait were often moderate or severe. Of 214 patients whose disease was assessed using the scoring system of Hoehn and Yahr, 78 (36.4%) had grade 4 and 23 (10.7%) grade 5 disability. Despite this, however, 105 of 265 patients (39.6%) were not subject to regular medical review and only 57 of 227 patients (25.1%) had been seen by an occupational therapist, 16 (7.0%) by a physiotherapist, and 10 (4.4%) by a speech therapist. Patients with Parkinson's disease may benefit from regular medical review and being seen by therapists.

Effects of singing on voice, respiratory control and quality of life in persons with Parkinson’s disease

Abstract

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