Article

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

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Abstract

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.

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... ey recommended further research to assess wider benefits including on functional communication, cognitive status, motor function, and quality of life. Stegemӧller et al. assigned 27 participants to twice-or once-weekly singing groups and analyzed voice, respiratory, and QoL measures at baseline and after an 8week intervention [39]. ey demonstrated objective improvements in inspiratory and expiratory pressure and phonation duration, though vocal measures investigated (intensity and range) did not improve significantly [39]. ...
... Stegemӧller et al. assigned 27 participants to twice-or once-weekly singing groups and analyzed voice, respiratory, and QoL measures at baseline and after an 8week intervention [39]. ey demonstrated objective improvements in inspiratory and expiratory pressure and phonation duration, though vocal measures investigated (intensity and range) did not improve significantly [39]. Shih et al. assessed the effects of 12 weekly 90-minute group singing sessions, led by a voice and speech therapist/singing instructor on 13 participants via an open-label pilot study [40]. ...
... ese results suggest that the overall cohort of participants experienced a meaningful improvement in conversational voice volume from baseline to the end of the study. e improvement in respiratory function shown by several prior studies may underlie the improvement our data show in the clinically meaningful vocal loudness measures [39,42]. However, as we show significant improvement only 18-24 weeks after intervention, the duration of most prior studies may have been too short to yield similar improvements in vocal volume. ...
Article
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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.
... Tabuľka 1 poskytuje informácie o názve a priebehu jednotlivých intervenčných protokolov [17][18][19][20][21][22][23][24][25]. Uvedené kategórie zahàňajú autorov výskumu, rok realizácie, názov výskumu, dizajn výskumu, výskumnú vzorku, formu a kalibráciu terapie. ...
... Obsah jednotlivých stretnutí tvorili prevažne motorické cvičenia, dychové cvičenia, hlasové cvičenia, spev, cvičenia reči a relaxačné aktivity (tab. 2) [17][18][19][20][21][22][23][24][25]. Každá štúdia mala proLékaře.cz ...
... Názov DV a n Forma a Kalibrácia terapie [18,20,23], zlepšenie zrozumiteľnosti reči [21], plynulosti reči [17], zlepšenie prozódie reči [18], zlepšenie v oblasti respiračných funkcií [18,23,24] a zmeny zazname-nané pri speve, týkajúce sa hlasovej intenzity a zlepšenie intonácie [19]. Pozitívne zmeny zaznamenané v rámci intervencie sú zhrnuté v tab. 3 [17][18][19][20][21][22][23][24][25]. ...
... During singing there is increased neural activation of the same structures and mechanisms used for speech [5,6]. Therapeutic singing intervention has been used in previous studies for persons with PD [12][13][14][15][16][17][18][19] and results have demonstrated significant improvements in vocal duration, intonation, maximum inspiratory and expiratory pressure, swallow function and quality of life. Singing has also been shown to promote louder voice production than typical speech and may assist patients in learning to develop and train their respiratory sufficiency [5,14,15]. ...
... Singing has also been shown to promote louder voice production than typical speech and may assist patients in learning to develop and train their respiratory sufficiency [5,14,15]. Interventions focused on singing may provide additional benefits other than improved voicing and sustained phonation because of the increased emphasis on the respiratory muscle control system [4,5,13]. A study by Di Benedetto's group [16] demonstrated significant pre-and post-treatment differences in 20 subjects with PD who participated in choral singing treatment including improvements in functional residual capacity, maximum inspiratory pressure, maximum expiratory pressure and maximum phonation time. ...
... Stegemoller et al. [17] established that after eight weeks of singing training, participants with PD demonstrated significant improvements in breath control and swallow. In addition, there are cognitive and social benefits that occur with group singing [5,13,14]. Several of these studies compared differences in voice, swallow and respiration in PD groups that sing to those who do not sing. To date, however, there have not been any studies that have examined changes in cough strength following a singing intervention. ...
Article
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 total of 21 studies met the eligibility criteria for the review, with the selection process shown in Figure 1. Two studies were included in data synthesis but combined with studies by the same authors as they provided additional qualitative outcomes from the same treatment programs [20,[36][37][38]. ...
... Ten studies applied a singing approach to improve speech which included a range of similar techniques including opening/physical warm-ups/relaxation, breathing exercises, vocal warm-ups/exercises, followed by singing and closing conversations [19,37,[42][43][44][45][46][47]. Of note, Higgins et al. [47], Yinger and LaPointe [48] who adapted Haneishi's [49] Music Therapy Voice Protocol, and Tanner et al. [46] drew on principles of the LSVT V R , to support a group treatment protocol. ...
... Although not always reported explicitly in the study, intervention was generally delivered by a speech-language pathologist in a face-to-face format. Exceptions included some studies utilizing singing therapy which were facilitated by music therapists or students [37,42,43,48], trained vocal performers or musicians [44,47,52], or a combination of music therapists with speech-language pathologist and allied health assistant support [52]. The size of groups ranged from 3 to 20 participants with therapy delivered in a hospital/medical centre (n ¼ 5), university (n ¼ 2), combination of hospital and university or hospital and chapel (n ¼ 2), Parkinson's centre (n ¼ 2), or community centre (n ¼ 1). ...
Article
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.
... Compared to usual care, Pantelyat et al. [47] found a beneficial effect of the drum circle, while Pohl et al. [44] found the same for RGRM M, as did Spina et al. [45] Compared to physiotherapy, Pacchetti et al. [46] found a beneficial effect of instrumental musical improvisation on health-related quality of life. Four studies assessed the impact of a singing intervention on quality of life [48][49][50][82][83][84][85]. Of these, Matthews et al. [50] used a RCT design compared to a passive music appreciation activity, while Tamplin et al. [48,49] used a non-randomised controlled trial design with various comparators, the limitations of which were discussed above. ...
... General quality of life was assessed by three studies. Both Irons et al. [82,83] and Matthews et al. [50] used the Parkinson's Disease Questionnaire 39 Items (PDQ-39), [86], while Stegemöller et al. [84,85] used the World Health Organization Quality of Life questionnaire (WHO-QOL) [87]. Voicerelated quality of life (VRQoL) [88] was assessed by two studies [48,49,84,85]. ...
... Both Irons et al. [82,83] and Matthews et al. [50] used the Parkinson's Disease Questionnaire 39 Items (PDQ-39), [86], while Stegemöller et al. [84,85] used the World Health Organization Quality of Life questionnaire (WHO-QOL) [87]. Voicerelated quality of life (VRQoL) [88] was assessed by two studies [48,49,84,85]. Additionally, Stegemöller et al. [84,85] assessed swallow-related quality of life (SWAL-QOL), [89] although no significant effect was found on this outcome. ...
Article
Full-text available
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.
... Four studies assessed the impact of a singing intervention on quality of life. [49][50][51][83][84][85][86]. Of these, Matthews et al [51] used a RCT design compared to a passive music appreciation activity, while Tamplin et al [49][50] used a non-randomised controlled trial design with various comparators, the limitations of which were discussed above. ...
... General quality of life was assessed by three studies. Both Irons et al [83][84] and Matthews et al [51] used the Parkinson's Disease Questionnaire 39 Items (PDQ-39), [87], while Stegemöller et al [85][86] used the World Health Organization Quality of Life questionnaire (WHO-QOL). [88] Voice-related quality of life (VRQoL) [89] was assessed by two studies. ...
... [88] Voice-related quality of life (VRQoL) [89] was assessed by two studies. [49][50][85][86] Additionally, Stegemöller et al [85][86] assessed swallowrelated quality of life (SWAL-QOL), [90] although no signi cant effect was found on this outcome. Two studies considered the impact of theatrical interventions on quality of life. ...
Preprint
Full-text available
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.
... Four studies assessed the impact of a singing intervention on quality of life. [49][50][51][83][84][85][86]. Of these, Matthews et al [51] used a RCT design compared to a passive music appreciation activity, while Tamplin et al [49][50] used a nonrandomised controlled trial design with various comparators, the limitations of which were discussed above. ...
... General quality of life was assessed by three studies. Both Irons et al [83][84] and Matthews et al [51] used the Parkinson's Disease Questionnaire 39 Items (PDQ-39), [87], while Stegemöller et al [85][86] used the World Health Organization Quality of Life questionnaire (WHO-QOL). [88] Voice-related quality of life (VRQoL) [89] was assessed by two studies. ...
... [88] Voice-related quality of life (VRQoL) [89] was assessed by two studies. [49][50][85][86] Additionally, Stegemöller et al [85][86] assessed swallow-related quality of life (SWAL-QOL), [90] although no signi cant effect was found on this outcome. Two studies considered the impact of theatrical interventions on quality of life. ...
Preprint
Full-text available
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.
... Alongside the well-recognised gait disorders, slowness, tremor, freezing and postural instability that characterize Parkinsonism [7,8], speech, voice and communication are often affected [9] and neuropsychiatric non-motor symptoms such as depression, anxiety and apathy are prevalent [2]. Debilitating speech and voice sequelae are underrecognised yet surprisingly common, with up to 90% of people with PD and related conditions experi-debilitating disease, which can last for up to [25][26][27][28][29][30] years. ...
... Targeted group therapy programs that utilise singing also afford social participation and active engagement in addition to creative musical expression. There is currently limited evidence on the effects of singing interventions in PD, but some promising preliminary studies have suggested potential to improve vocal loudness and other areas of speech and respiratory function [28][29][30][31]. However, methodological limitations include small samples, short intervention length, selection bias, and lack of control groups. ...
... results from a small study by Yinger et al. [30]. These findings are in contrast to other previous studies that found no significant improvements in vocal loudness following a singing intervention [29,32,46,47]. Further, the improvements in voice-related quality of life seen in weekly ParkinSong participants show the functional benefit of increased vocal loudness and regular practise on communication confidence and participation. ...
Article
Background: Parkinson's disease (PD) frequently causes progressive deterioration in speech, voice and cognitive aspects of communication. These affect wellbeing and quality of life and are associated with caregiver strain and burden. Therapeutic singing groups can ameliorate PD-related communication disorders and increase social interaction and wellbeing for caregivers and care recipients. Objective: To analyse the effects of ParkinSong group singing sessions on Parkinson's communication and wellbeing outcomes for people with PD and caregivers over 12 months. Methods: A 4-armed controlled clinical trial compared ParkinSong with active non-singing control conditions over 12 months. Two dosage levels (weekly versus monthly) were available for each condition. ParkinSong comprised high-effort vocal, respiratory and speech exercises, group singing, and social interaction. PD-specific outcomes included vocal loudness, speech intelligibility, maximum phonation time, respiratory muscle strength, and voice related quality of life (QoL). Wellbeing outcomes were also measured for caregivers and care recipients. Results: We recruited 75 people with PD and 44 caregivers who attended weekly ParkinSong, monthly ParkinSong, weekly control or monthly control groups. We found significant improvements in the primary outcome of vocal loudness (p = 0.032), with weekly singers 5.13 dB louder (p = 0.044) and monthly singers 5.69 dB louder (p = 0.015) than monthly controls at 12 months. ParkinSong participants also showed greater improvements in voice-related QoL and anxiety. Caregivers who attended ParkinSong showed greater reductions in depression and stress scores. Conclusions: This 12-month controlled clinical trial of ParkinSong demonstrated improvements in speech loudness and voice-related QoL for participants with PD, and enhanced wellbeing for both caregivers and care recipients. No adverse effects were reported over 12 months and improvements were sustained.
... Singing can increase neurochemical activity (such as dopamine and oxytocin levels), as singers experience pleasure, motivation, and a sense of reward (Chanda & Levitin, 2013). Moreover, singing is a beneficial exercise for improving speech and communication functions in PwPs (Stegem€ oller, Radig, Hibbing, Wingate, & Sapienza, 2016;Tanner, Rammage, & Liu, 2016). Singing with others can promote positive feelings (Clift & Hancox, 2001, which increases a sense of wellbeing (Ryff & Singer, 2008). ...
... Group singing has the potential to result in clinically significant improvements in people with mental health conditions (Clift, Manship, & Stephens, 2017;Williams, Dingle, & Clift, 2018). Some group singing studies involving PwPs have reported enhanced QoL (Abell, Baird, & Chalmers, 2017;Stegem€ oller et al., 2016), but others have not (Shih et al., 2012). These studies were also limited by the small number of participants. ...
... These studies were also limited by the small number of participants. Moreover, previous singing studies were short-term (e.g. 8 weeks in Stegem€ oller's (2016) study; 12 weeks in Shih's (2012) study), and these studies did not utilise a Parkinson's specific QoL questionnaire (PDQ39) (Shih et al., 2012;Stegem€ oller et al., 2016). Considering there is no cure for Parkinson's disease, and PwPs are faced with extended life expectancy with advanced disabilities, it is essential to focus on enhancing QoL for PwPs. ...
Article
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Objectives: Group singing has been reported to enhance quality of life (QoL) and mental health in older people. This paper explored whether there are differences in the effects of group singing intervention on people with Parkinson’s (PwPs) in Australia, UK and South Korea. Methods: The study included PwPs (N = 95; mean age = 70.26; male 45%) who participated in a standardised 6-month weekly group singing programme. Parkinson’s health-related QoL measure (PDQ39) and mental health assessment (DASS) were administered at baseline and follow-up. ANOVAs were performed with significance set as p < .05. Results: ANOVAs revealed main effects of Time on the Stigma and Social Support subscales of PDQ39; both showed a small but significant improvement over time. However, the social support reduction was moderated by country; social support was improved only in South Korean participants. The reduction in stigma was greater than previously reported minimal clinically important differences, as was the social support reduction in South Korean participants. In terms of mental health, ANOVAs revealed that the scores of Anxiety and Stress domains of DASS significantly decreased from pre-test to post-test with small effect sizes. Conclusion: This first international singing study with PwPs demonstrated that group singing can reduce stigma, anxiety and stress and enhance social support in older adults living with Parkinson’s. The findings are encouraging and warrant further research using more robust designs.
... Where such statistics were missing, we used F-statistics, t-values and p-values to calculate effect sizes; we used Cohen's (1988) suggestions to categorize effect size as small, medium and large. RCT effects were categorized 4 | IRONS using "significantly favours intervention," "trends towards intervention," "no difference," "trends towards control" and "significantly favours control" (Cooper, Hedges, & Valentine, 2009) Authors were contacted when relevant data were not reported in the article; the following authors provided additional data: Kenny and Faunce (2004);Clements-Cortes (2013, 2015; Grape, Töres, Britt-Maj, and Rolf (2009); Morrison et al. (2013); Pongan et al. (2017); Tamplin (2013); Stegemoller (2017) and Reagon (2017). We conducted narrative syntheses based on the framework by Popay and colleagues (Popay et al., 2006). ...
... The electronic database searches found 575 records. After screening abstracts and full-text review, 13 studies met the inclusion criteria ( Figure 1 for PRISMA flow diagram) including five randomized controlled trials (RCTs) (Bradt, Norris, Shim, Gracely, & Gerrity, 2016;Grape et al., 2009;Kenny & Faunce, 2004;Pongan et al., 2017;Tamplin et al., 2013); seven non-randomized controlled trials (non-RCTs) (Clements-Cortes, 2013, 2015Fogg-Rogers et al., 2016;Gale, Enright, Reagon, Lewis, & Van Deursen, 2012;Morrison et al., 2013;Reagon et al., 2017;Stegemoller et al., 2017) and one qualitative study (Hopper, Curtis, Hodge, & Simm, 2016). All RCTs and non-RCTs reported the effects of group singing on pain intensity and/or interference. ...
... All RCTs and non-RCTs reported the effects of group singing on pain intensity and/or interference. Two studies recruited chronic pain patients (Bradt et al., 2016;Kenny & Faunce, 2004), three studies involved old people with Alzheimer's disease (Clements-Cortes, 2013, 2015Pongan et al., 2017), two studies recruited cancer survivors (Gale et al., 2012;Reagon et al., 2017) and two studies were with people with Parkinson's and stroke survivors (Fogg-Rogers et al., 2016;Stegemoller et al., 2017). Descriptions of included studies are presented in Table 1. ...
Article
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Background and objectives: Singing can have a range of health benefits; this paper reviews evidence of the effects of group singing for chronic pain in people with long-term health conditions. Database and data treatment: We searched for published peer-reviewed singing studies reporting pain measures (intensity, interference and depression) using major electronic databases (last search date 31/07/2018). After screening 123 full texts, 13 studies met the inclusion criteria: five RCTs, seven non-RCTs and one qualitative study. Included studies were appraised using Downs and Black and CASP quality assessments. Results: Included studies reported differences in the type of singing intervention, long-term condition and pain measures. Due to the high heterogeneity, we conducted a narrative review. There is a positive trend of singing interventions reducing pain intensity, but more equivocal support for reductions in pain interference and depression. Additionally, qualitative data synthesis identified three key linked and complementary themes: physical, psychological and social benefits. Conclusion: Group singing appears to have potential to reduce pain intensity, pain interference and depression; however, we conclude there is only partial support for singing on some pain outcomes based on the limited available evidence of varied quality. Given the positive findings of qualitative studies, this review recommends that practitioners are encouraged to continue this work. More studies of better quality are needed. Future studies should adopt more robust methodology and report their singing intervention in details. Group singing may be an effective and safe approach for reducing persistent pain and depression in people with long-term health conditions.
... Für das STI in der Gruppe (STI-G) sind nach Schwabe drei Wirkebenen bedeutsam: die emotional-gedankliche, die körperlich-funktionale und die kommunikativ-soziale (Schwabe, 1997, S. 99 (Tamplin, 2020), Italien (Di Benedetto, 2009), Neuseeland (Matthews, 2018), den USA (Butala, 2017; Haneishi, 2001;Yinger, 2012;Shih, 2012;Stegemoeller, 2016), Großbritannien (Evans, 2011), ...
... Die Arbeiten sind insgesamt sehr heterogen: es gibt nur zwei randomisiert-kontrollierte Studien (RCTs) (Matthews, 2018;Butala, 2017), welche STI-G mit Gruppengespräch verglichen haben. Die übrigen Studien waren nicht-kontrollierte prospektive Arbeiten, mit Ausnahme der Studie von Tamplin (2020) (Stegemoeller, 2016;Matthews, 2018;Butala, 2017 Nach dem Cochrane-Review zum LSVT®Loud liegen die klinisch signifikanten Veränderungen bei + 5,0 dB beim Lesen und bei + 2,9 dB beim Monolog-sprechen (Herd, 2012). Verglichen mit diesen Ergebnissen, wurden zu STI vergleichbare (Elefant, 2012;Evans, 2011;Tamplin, 2020;Yinger, 2012) oder stärkere Verbesserungen (Tanner, 2016;Haneishi, 2001) ...
Article
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.
... Various forms of dance and drumming improve functional mobility, postural instability and walking rate, while singing improves voice, respiratory control and swallow. [1][2][3][4][5][6] These results are domain specific demonstrating improvements in outcome measures that are associated with the exercise/therapy or target area. Given that increased physical activity has many positive benefits in persons with PD, 7 detangling the effects of music from the effects of increased physical activity/exercise is difficult. ...
... The vocal exercises and therapist chosen songs have been used in previous GTS studies and a more detailed description can be found in these studies. [1][2][3] Movement Disorders Society Unified Parkinson's Disease Rating Scale Motor examination (part III) of the MDS-UPDRS was videorecorded immediately before and after the GTS session. Videos were coded to mask pre or post intervention order and were scored by two movement disorders neurologists that were masked to the study intervention. ...
Article
Full-text available
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.
... É viável analisar o aumento da intensidade vocal, no artigo Stegemöller et al. (2016), com o tratamento de fonoaudiológico tradicional e de Parkinson. Os distúrbios da fala estão presentes em 60 -80% dos pacientes com DP. ...
... Tillmann et al. (2020) Deglutição Stegemoller et al. Stegemöller et al. (2016) 1 9,0 Fonte: Pesquisa em base de dados, 2021.DISCUSSÃOOs achados dessa revisão contemplaram os impactos relacionados aos aspectos psicológicos (GARCÍA-CASARES; MARTÍN-COLOM;GARCÍA-ARNÉS, 2018; POHL et al., 2019; IRONS et al., 2020;TAMPLIN et al., 2020), motores(ZHANG et al., 2017;PEREIRA et al., 2018;), cognitivos (PEREIRA et al., 2018, às relações sociais(STEGEMÖLLER et al., 2017a;, à deglutição(STEGEMÖLLER et al. 2017b) e à fonação(STEGEMÖLLER et al., 2016). ...
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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!
... Second, as beatboxing shares many features with singing (e.g., vocal techniques and coordinated strategies; De Torcy et al., 2014;Sapthavee et al., 2014), it may promote breath control and respiratory capacities (Decker & Kirk, 1988). Beatboxing involves emphasis on rhythm and tempo, thus requires increased respiratory control and respiratory muscle strength (Stegemöller, Radig, Hibbing, Wingate & Sapienza, 2017). Music, which is an integral part of the beatboxing practice, facilitates a variety of breathing patterns. ...
... Many adults with CP demonstrate reduced voice quality and impaired respiration (Schölderle et al., 2016), features that have been found to be correlated with speech intelligibility and naturalness. The Beatalk method may be suitable for addressing such difficulties, as it may promote breath control and respiratory capacities (Decker & Kirk, 1988;Stegemöller et al., 2017), and may strengthen harmonic resonance (De Torcy et al., 2014). These skills may positively affect vocal loudness and quality (Buescher & Sims, 2011). ...
Article
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.
... Several studies have examined the positive impacts of singing on the human voice. Specifically, it is well established that singing has a huge impact on vocal quality and stability (e.g., Brown, Morris, Hicks, & Howell, 1993;Pabon, Stallinga, Sodersten, & Ternstrom, 2014), phonatory range (Åkerlund, Gramming, & Sundberg, 1992), and respiration (e.g., Mendes, Brown, Sapienza, & Rothman, 2006;Stegemöller, Radig, Hibbing, Wingate, & Sapienza, 2017). But can these benefits have long-lasting effects and outweigh the strong impact of age? ...
... Importantly, these studies used a less intense protocol (see Table 9.2), involving only one session per week, which might account for the discrepancy. However, Stegemöller et al. (2017) compared two choral treatments differing only in intensity and found no difference, suggesting that intensity might not be the key factor. ...
... Several studies have examined the positive impacts of singing on the human voice. Specifically, it is well established that singing has a huge impact on vocal quality and stability (e.g., Brown, Morris, Hicks, & Howell, 1993;Pabon, Stallinga, Sodersten, & Ternstrom, 2014), phonatory range (Åkerlund, Gramming, & Sundberg, 1992), and respiration (e.g., Mendes, Brown, Sapienza, & Rothman, 2006;Stegemöller, Radig, Hibbing, Wingate, & Sapienza, 2017). But can these benefits have long-lasting effects and outweigh the strong impact of age? ...
... Importantly, these studies used a less intense protocol (see Table 9.2), involving only one session per week, which might account for the discrepancy. However, Stegemöller et al. (2017) compared two choral treatments differing only in intensity and found no difference, suggesting that intensity might not be the key factor. Contrary to PD patients, patients with non-degenerative brain damage, such as TBI or stroke, usually suffer from a combination of two or more types of dysarthria (Yorkston et al., 2010). ...
... These networks include the auxiliary motor area and anterior cingulate area, which seem to be associated with swallowing movement [13], and thus, their innervation promotes swallowing recovery. Appropriate voice training intervention can further help promote the self-management ability of patients [14]. In short, voice training is a convenient, inexpensive, and highly beneficial method for patients with OPD. ...
Article
Full-text available
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.
... However, one major advantage of singing compared to feedback-guided respiratory training using a SpiroTiger device is that the participants really enjoyed the singing lessons, and therefore were very engaged in the training [31]. Previous studies have reported up to 100% compliance in singing interventions [32] which speaks in favor of singing interventions. ...
... Whilst a number of studies suggest group intervention can lead to similar speech outcomes as individual therapy, this might come at a cost as studies have shown that higher dosage achieves better outcomes [47,48], thus reducing the cost comparison between the two care models. To address this issue, we developed a novel treatment model-ClearSpeechTogether-that maximises treatment intensity whilst minimising clinician time. ...
Article
Full-text available
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.
... Whilst a number of studies suggest group intervention can lead to similar speech outcomes as individual therapy, this might come at a cost as studies have shown that higher dosage achieves better outcomes [45,46], thus reducing the cost comparison between the two care models. To address this issue, we developed a novel treatment model -ClearSpeechTogether -that maximises treatment intensity whilst minimising clinician time. ...
Preprint
Full-text available
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.
... However, the mechanism of increased vocal effort during the Beatalk treatment is assumed to be different from that of mSIT. The technique of beatboxing is similar in various aspects to singing, in which an emphasis is placed on increased respiratory control and muscle strength (Stegemöller et al., 2017), in order to produce different rhythms and tempos. Practice of the various beatboxing patterns, from simple to complex, promotes integration and coordination of the breath with phonation, leading to improved respiratory control and subsequently MPT (Thorpe et al., 2001). ...
Article
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.
... In addition to the previously mentioned impairments, patients with PD exhibit voice and speech abnormalities such as breathy phonation, hoarseness, imprecise articulation, reduced loudness and prosody, dysfunctions that are directly related to upper airway breathing disorders [13][14][15][16]. The breathing problems that occur in PD not solely are related to upper airway muscle dysfunction they also may be associated with changes in other respiratory muscles and the central nervous system (CNS) [17][18][19]. ...
Article
Full-text available
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.
... Previous research has shown that singing can be a treatment option to detect voice, breathing, and swallowing problems as well as the quality of life [44]. Regarding food intake, group singing was found to be important in prolonging laryngeal elevation, protecting the airway from foreign material for longer periods during swallowing [45]. Group singing is also important for the improvement of language [19,20], in the correction and maintenance of vocal function, as well as in respiratory pressure [44]. ...
Article
Full-text available
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.
... Drumming has been shown to improve walking rate in persons with PD (Pantelyat et al., 2016). Our group has shown that group therapeutic singing (GTS) improved respiratory control, swallow, and quality of life (Stegemöller et al., 2016(Stegemöller et al., , 2017a. The singing groups were enjoyable for participants as they offered a way to relieve stress and have fun (Stegemöller et al., 2017b). ...
Article
Full-text available
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.
... A study by Stegemöller et al. [44] compared the effects of high-and low-dose singing interventions in Parkinson's disease patients. The results surprisingly showed significant improvements in respiratory outcome measures rather than in all vocal outcome measures. ...
Article
Full-text available
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.
... The melodic intonation therapy treatment program uses melody to rehabilitate speech in persons with aphasia; recent studies point to the use of rhythm (pacing) as carried in familiar formulaic expressions as possibly the primary effective aid in that procedure (Stahl & Kotz, 2014). The results reported here point to the possibility that with pitch and rhythm competence, each being dissociated in speech and singing, either might be valuable as a treatment aid (Haneishi, 2001;Stegemöller et al., 2016) for speech production disability, depending on the individual's dysprosodic profile. ...
... The MIT treatment program uses melody to rehabilitate speech in persons with aphasia; recent studies point to the use of rhythm (pacing) as carried in familiar formulaic expressions as possibly the primary effective aid in that procedure (Stahl & Kotz, 2014). The results reported here point to the possibility that with pitch and rhythm competence, each being dissociated in speech and singing, either might be valuable as a treatment aid (Stegemöller, Radig, Hibbing, Wingate, & Sapienza, 2016;Haneishi, 2001) for speech production disability, depending on the individual's dysprosodic profile. ...
Article
Full-text available
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.
... This stream is based upon theories regarding the reported benefits of music for leisure (Särkämö, 2018), familiar song singing (Daykin et al., 2017) and song learning in older adults (Reid et al., 2017). Even though the focus of this music-making stream is to encourage task-specific motor output by learning a song, the wellbeing (Daykin et al., 2017) and rehabilitative benefits of singing (Stegemöller et al., 2017) have also been considered. ...
Article
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.
... No included study evaluated the impact of singing on motor function or cognitive status. Stegemoller et al. performed an open-label 8-week study of group singing (led by music therapists) in 27 patients with PD who were assigned to twice-weekly or once-weekly singing, and found improvements in inspiratory/expiratory pressure, phonation time, voice-related quality of life, and overall quality of life; they found no differences between once-weekly or twice-weekly intervention frequency [59]. Han et al. performed a small open-label study in 9 PD patients that examined the effects of an individual singing program (6 sessions over 2 weeks) administered by a music therapist [60]. ...
Article
Full-text available
Purpose of Review There is emerging evidence that music therapy and other methods using music and rhythm may meaningfully improve a broad range of symptoms in neurological and non-neurological disorders. This review highlights the findings of recent studies utilizing music and rhythm-based interventions for gait impairment, other motor symptoms, and non-motor symptoms in Parkinson disease (PD) and other movement disorders. Limitations of current studies as well as future research directions are discussed. Recent Findings Multiple studies have demonstrated short-term benefits of rhythmic auditory stimulation on gait parameters including gait freezing in PD, with recent studies indicating that it may reduce falls. Demonstration of benefits for gait in both dopaminergic “on” and “off” states suggests that this intervention can be a valuable addition to the current armamentarium of PD therapies. There is also emerging evidence of motor and non-motor benefits from group dancing, singing, and instrumental music performance in PD. Preliminary evidence for music therapy and music-based interventions in movement disorders other than PD (such as Huntington disease, Tourette syndrome, and progressive supranuclear palsy) is limited but promising. Summary Music therapy and other music and rhythm-based interventions may offer a range of symptomatic benefits to patients with PD and other movement disorders. Studies investigating the potential mechanisms of music’s effects and well-controlled multicenter trials of these interventions are urgently needed.
... Studies summarized in Table 1 show that PROMs are utilized to some extent in treatment studies using the LSVT ® programme 56,59-62 variants of LSVT, [63][64][65] and programs based on singing and group voice treatment. [65][66][67][68] The measures are widely used in voice clinics, and include the Voice Handicap Index (VHI), 69 the Voice Activity & Participation Profile (VAPP), 70 and the Voice Related Quality of Life Measure (V-RQoL). 71 PROMs, in addition to measuring disability, allow the clinician to measure the effect of intervention on a person's quality-of-life regarding activity and participation in social situations. ...
Article
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Patricia Gillivan-Murphy,1 Nick Miller,2 Paul Carding31Speech and Language Therapy Department, Mater Misericordiae University Hospital, Dublin, Ireland; 2Newcastle University Institute for Ageing, Speech and Language Sciences, Newcastle University, Newcastle-upon-Tyne, UK; 3Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Institute of Nursing, Oxford, UKAbstract: Speech and voice changes are a central feature of the symptom complex of people with Parkinson’s disease (pwPD). Speaking is a social activity involving the pwPD, family, and the wider communicative context. Sensory-motor, cognitive-linguistic, and affective changes in Parkinson’s disease (PD) combine to alter communication, impacting on psycho-social quality-of-life, leading to risks of social withdrawal and increased depression and anxiety. The underlying pathophysiology of speech, voice, and communication difficulties in pwPD is multi-factorial and complex. Sensory-motor changes in the respiratory, phonatory, and articulatory subsystems, underscaling of effort, and central processing problems are further affected by broader cognitive-linguistic difficulties, and non-speech motor deficits. Many studies show that, when pwPD are asked to rate their own voice and how it functions in everyday situations, they show increased voice-related disability and negative impact relative to healthy controls. Voice treatment is integral to improving communication in pwPD. Studies show positive benefits from the perspective of pwPD and carers. Treatment approaches vary from one-to-one to group interventions, a singular focus on increasing loudness to more general voice exercises, and choral singing. The nature and underlying pathophysiology of speech, voice, and communication changes in pwPD are reviewed before exploring the effects of voice treatment programs and pwPD and carer perceptions of their effect. Larger scale, better powered, controlled trials of intervention for voice and speech that measure clinically and socially relevant outcomes are finally underway. Future research should also focus on issues of treatment compliance, practicality (for service delivery and use), and long-term follow-up outcomes. The role of carers in longer-term maintenance represents a further important area of exploration.Keywords: voice, speech, treatment, quality-of-life, patient perspectives
... For example, music therapy has been shown to mitigate speech impairment in PD by facilitating synchronization of articulatory muscle patterns to rhythm, and training respiratory support and control through singing and other vocal exercises. These types of programs are often provided in a group singing or choir context, allowing for rewarding social interaction and improving quality of life (Yinger and LaPointe, 2012;Buetow et al., 2014;Stegemöller et al., 2016). Cognitive abilities have also been improved through music-based training in this population (Pohl et al., 2013). ...
Article
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Parkinson's disease (PD) is a complex diagnosis commonly associated with motor dysfunction, but known to comprise cognitive, psychiatric, and mood disturbances as well. Music has been successfully used to address motor and non-motor symptoms of PD. Still, little is known about the nature of an individual with PD's experience and relationship with music on conceptual and emotional levels, which may factor into their engagement in music-based techniques to ameliorate impairments. Two surveys were administered to 19 individuals with PD and 15 individuals without PD in order to gauge their subjective impressions and valuations of music. Participants completed The Brief Music Experience Questionnaire (BMEQ), a standard self-report measure pertaining to the role of music in one's life, prior to performing a perception task which involved listening to and making sound adjustments to three music recordings. Following the perception task, a custom Exit Survey was administered to evaluate the experience of listening to and engaging with the music in the perception task. In all six dimensions of the BMEQ, examining aspects of music experience including commitment to music, self-reported musical aptitude, social uplift, affective reactions, positive psychotropic effects, and reactive musical behavior (RMB, pertaining to actions or behaviors in response to music), the mean and the median were greater for the control group than for the PD group, but the difference was only statistically significant in the RMB dimension. On the Exit Survey, both groups assessed recent, specific, and interactive music listening more positively than the imagined, hypothetical or general music experiences addressed on the BMEQ. Additionally, familiarity had a greater effect on listening pleasure for participants with PD than those without PD. We conclude that people with PD may perceive less of an automatic connection between music and activity than their healthy peers. Additionally, they may receive more pleasure and value from music than they anticipate. Taken together, our results suggest that people with PD may require encouragement to participate as well as empowerment to choose familiar selections in order to better access music-based interventions and the benefits they can offer.
Article
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.
Chapter
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.
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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.
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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.
Article
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.
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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.
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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.
Chapter
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.
Article
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.
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Objetivo: Avaliar variáveis espirométricas e capacidade funcional de pacientes com Doença de Parkinson (DP) e comparar com indivíduos saudáveis. Métodos: 17 voluntários, ambos os sexos, entre 50 e 80 anos de idade, divididos em dois grupos: Grupo Parkinson (GP) com 11 indivíduos com DP, classificados até o nível III da Escala de Estágio de Incapacidade de Hoehn e Yahr, na fase ON da medicação e Grupo Controle (GC)com 6 indivíduos saudáveis. Utilizou-se o Espirômetro Portátil OneFlow FVC KIT para variáveis pulmonares (PEF, FEV1, FVC e VEF1/FVC), a escala de esforço BORG modificada para percepção de esforço e oTeste de Atividade de Vida Diária Glittre (TG) a capacidade funcional. Após o teste Shapiro-Wilk, os dados foram analisados pelos testes de Man-Whitney e correlação de Spearman com auxílio do software IBM SPSS Statistics, adotando nível de significância p< 0.05. Resultados: O GP apresentou pior desempenho na FVC (p=0.037) e no TG (p=0.010). No GP também se obteve correlação moderada entre o TG e o índice de Tiffeneau (p=0.034). Conclusão: O GP apresentou pior FVC e capacidade funcional o que pode ser atribuído a diminuição da capacidade respiratória observada na correlação do TG com o índice de Tiffeneau, nesses pacientes.
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Background More than 6,000,000 individuals worldwide are diagnosed with Parkinson's disease (PD). Nearly 90% develop speech signs that may substantially impair their speech intelligibility, resulting in losses in their communication and quality of life. Benefits of intensive speech treatment have been documented for a range of speech signs. However, the critical question of whether speech is more intelligible after treatment has not been investigated in a randomised controlled trial (RCT). We hypothesised that intensive speech treatment would improve speech intelligibility in PD. Method Sixty-four patients with hypokinetic dysarthria secondary to PD participated in this single-centre, parallel arm, statistically-powered RCT. Reporting follows CONSORT guidelines for non-pharmacological treatment. Patients were recruited from US clinics and randomised using a statistician-derived minimisation algorithm, to intensive speech treatment (16 1-hour sessions/1 month) targeting voice (voice group) or targeting articulation (articulation group) or to an untreated group (no treatment group). Speech treatments were delivered by speech clinicians who specialised in treating patients with PD. Trial design minimised bias and supported equipoise. For intelligibility assessment, blinded listeners (n = 117) orthographically transcribed 57 patients’ recorded, self-generated narrative speech samples, randomly presented in multi-talker babble noise. Listeners were American-English speakers, ages 18–35 years, with normal hearing. The primary outcome was baseline (pre-treatment) to post-treatment change in transcription accuracy (TA), recognised as the most objective measure of intelligibility. TA was defined as the percentage of words transcribed correctly. Listeners, data collectors, and data managers were blinded to treatment conditions and groups. Reliability was evaluated using intraclass correlation coefficients and differences amongst groups were evaluated by mixed-effects models, in accordance with the intention-to-treat approach. This trial was registered with ClinicalTrials.gov Identifier: NCT00123084. Findings Between June 23, 2016 and August 14, 2017, blinded listeners transcribed baseline and post-treatment speech samples for intelligibility assessment of 57 patients in the voice (n = 19), articulation (n = 19) and no treatment (n = 19) groups. Between-group differences (d) in changes from baseline to post-treatment in TA indicated significantly greater increases following treatment targeting voice than treatment targeting articulation (d = 26·2%, 95% CI 1·5 − 51·0; p = 0·04; ES=1·0). Differences between TA changes in the treatment targeting voice and in the no treatment group were significant (d = 42·8%, 95% CI 22·4 − 63·2; p = 0·0002; ES=1·8). Differences between TA changes in the treatment targeting articulation and in the no treatment group were not significant (d = 16·5%, 95% CI -6·1 − 39·2; p = 0·147; ES=0·9). Interpretation These findings provide the first RCT evidence that intensive speech treatment targeting voice improves speech intelligibility in PD. Thus, this evidence-based treatment may positively impact health-related quality of life for patients with PD globally when it is included in patient management. Funding NIHNIDCD R01 DC01150 and LSVT Global, Inc.
Article
A university-based, international research project investigating the effects of regular singing group activities for people with Parkinson’s disease (PD) provided a unique opportunity to capture the lived experience of three facilitators of Australian-based singing groups. Using a phenomenological approach, data were collected via facilitators’ reflective journals of singing group activities together with their oral reports at a symposium at the conclusion of the larger research project. Data analysis revealed the skills and attributes described by the three facilitators and the challenges they experienced. Results indicate that targeted skills training around a knowledge of voice function and awareness of the physical and emotional challenges faced by people with PD could assist facilitators to develop best practice interventions.
Chapter
Parkinson disease is the most common neurodegenerative disease reported worldwide and presents multiple diverse and disparate manifestations over a prolonged disease course. At any point, speech and swallowing functions may be disturbed, and dysfunctional swallowing, leading to aspiration pneumonia, is the most common cause of death. Current treatments demonstrate limited benefit for speech and swallowing impairments, but novel approaches and greater insight into disease pathogenesis offer hope of improved management of Parkinson disease and its sequelae.
Article
Background: Acquired brain injury (ABI), such as Parkinson's disease, dementia or stroke, can result in communication difficulties that lead to an impoverished ability to connect meaningfully with others. Choral singing is a complex task that uses multiple brain regions which are also responsible for language and communication skills. The potential therapeutic effects of group singing on communication-related outcomes across ABI aetiologies have not been systematically reviewed. Aims: To examine whether participation in group singing over multiple sessions improves speech, voice, language and/or communication skills in individuals with ABI-related communication disorders. Methods & procedures: A database search was undertaken according to the PRISMA guidelines. Search terms included: stroke OR Parkinson* OR dementia OR 'acquired brain injury' AND choir OR choral OR singing OR sing OR 'choral sing* ' OR group adj3 singing OR community adj3 singing AND speech OR language OR communication. Main contribution: A total of 11 studies were included. Nine were quantitative, including one randomized and one non-randomized control trial, and two were mixed method. Nine studies were scored as level IV (uncontrolled) on the American Academy of Neurology (AAN) Classification of Evidence Matrix and two as level III (e.g., lack of blinded assessors). Eight examined speech and voice skills in Parkinson's disease, two functional communication skills in post-stroke aphasia and one communication between individuals with dementia and a significant other. One level III control trials provided evidence for a therapeutic effect of group singing on communication in individuals with Parkinson's disease. Conclusions & implications: Currently, there is only one study providing support for using group singing to improve speech and voice skills in people with Parkinson's disease, and no studies of adequate quality indicating positive effects on language and functional communication abilities in ABI. Further research using more rigorous experimental designs is required to determine whether group singing can influence communication skills in ABI. What this paper adds What is already known on the subject Music activates widespread, bilateral cortical and subcortical brain regions. Group singing is increasingly understood to have positive benefits on quality of life and health-related well-being in both healthy and clinical populations. Given the crossover in neural networks between singing, speech and language, singing activities are also thought to have positive effect of communication impairments secondary to ABI. However, to date, the research evidence supporting the application of group singing for communication impairments in ABI has not been summarized. What this paper adds to existing knowledge A total of 11 studies have looked at communication outcomes after group singing in ABI. For most of these, the quality of evidence was low (AAN level IV). It also highlights that there is a bias in the literature towards the studying individuals with Parkinson's disease (i.e., nine of the 11 studies). What are the potential or actual clinical implications of this work? This review concludes that, currently, there is emerging evidence to support positive effects of a group singing for speech and voice symptoms in individuals with Parkinson's disease, when provided using the Tamplin protocol. However, there is not yet any evidence for communication benefits for individuals with aphasia or dementia.
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ABSTRACT Objectives Although many studies have shown that psychosocial interventions, such as dance classes, can improve quality of life for people with Parkinson’s disease (PD), few have addressed the role of, and potential benefits to the caregivers in such activities. This mixed methods study explored the reasons for caregiver participation in a variety of activities and considered whether participation in, or abstention from these affected the wellbeing of the caregivers. Method Transcriptions of a focus group (two people with PD, two caregivers) and eight semi-structured interviews (caregivers) were analysed using Grounded Theory (GT). To test the hypotheses derived from the GT, caregivers (n=75) completed an online survey about activities they, and the person they care for participated in, alongside the PDQ-Carer questionnaire to establish the caregiver’s levels of wellbeing. Results Qualitative findings suggested that caregivers tried to balance between caring for the person with PD and in activities their own personal needs. Reasons for participating included being able to socialise in an empathetic safe space, alongside engaging in physical activity that provided some respite distraction, such as dancing with others to music. Reasons for not participating included generating time for oneself and increasing the independence of the person with PD. Quantitative results suggested most of the participants' wellbeing was not compromised, although this was gendered: female caregivers reported lower wellbeing scores than male caregivers. Overall, 62% of caregivers participated in joint activities. Linear regression revealed a significant relationship between non-participation in daily activities and stress levels for female caregivers only, whereby the more independent the person with PD was, the lower the stress of the caregiver. Conclusion This study suggests that caregivers of people with PD can find a healthy balance in terms of their own wellbeing by jointly participating in two thirds of activities whilst ensuring the remaining third is time reserved for themselves. Keywords: Parkinson’s disease, Caregivers, Activities, Participation, Wellbeing
Poster
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To target goals of research collaboration among academic and clinical faculty and graduate student clinicians, we developed and implemented an intra-professional research project. Three supervisors, 12 Aphasia and 11 Voice Clinic students investigated the benefits of weekly choral singing for 12 clients with aphasia. Students gathered voice and motor speech pre-, post-study data and integrated evidence-based treatment into chorus sessions.
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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.
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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.
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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.
Article
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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.
Article
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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.
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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.
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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.
Article
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Thirty-second speech s#x0026les were studied of at least 30 patients in each of 7 discrete neurologic groups, each patient unequivocally diagnosed as being a representative of his diagnostic group. Three judges independently rated each of these s#x0026les on each of 38 dimensions of speech and voice using a 7-point scale of severity. Computer analysis based on the means of the three ratings on each patient on each dimension yielded results leading to these conclusions: (1) Speech indeed follows neuroanatomy and neurophysiology. There are multiple types or patterns of dysarthria, each mirroring a different kind of abnormality of motor functioning. (2) These patterns of dysarthria can be differentiated; they sound different. They consist of definitive groupings of certain dimensions of speech and voice, deviant to distinctive degrees. (3) Five types of dysarthria were delineated: flaccid dysarthria (in bulbar palsy), spastic dysarthria (in pseudobulbar palsy), ataxic dysarthria (in cerebellar disorders), hypokinetic dysarthria (in parkinsonism), and hyperkinetic dysarthria (in dystonia and chorea). Also, a mixed dysarthria combining elements of flaccid and spastic dysarthrias was identified in amyotrophic lateral sclerosis. (4) Observed occurrence of a single dimension uniquely in a given neurologic disease and distinctive co-occurrence of several dimensions can aid diagnostically in identification of neurologic disorders.
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The present study shows that rigor is one of the main causative factors in the parkinsonian speech disorder, whereas tremor ordinarily can only play a minor role. The Fast Fourier Analysis of the frequency spectra demonstrated in parkinsonian speech frequency regions that are energy-deficient and also that the entire frequency spectrum is restricted to a range of 100 to 400 Hz, including the deficient regions, as against the 100- to 700-Hz range in the controls. These analytical findings seem to underline the important role played by the laryngeal and breathing dysfunctions in the parkinsonian voice and speech production.
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Twenty-six patients with the speech disorder of Parkinson's disease received daily speech therapy (prosodic exercises) at home for 2 to 3 weeks. There were significant improvements in speech as assessed by scores for prosodic abnormality and intelligibility' and these were maintained in part for up to 3 months. The degree of improvement was clinically and psychologically important, and relatives commented on the social benefits. The use of a visual reinforcement device produced limited benefit over and above that from prosodic exercises alone, except to patients with severe speech disorder.