Comprehensive Speech Treatment Program for Patients with Parkinson’s Disease (CPD): A Pilot Study

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Authors (including presenting author) :
Lai J(1), Ngan C(1), Wong G(1), Ip A(1), Lee J(1)
Affiliation :
(1)Speech Therapy Department, Ruttonjee and Tang Shiu Kin Hospitals
Introduction :
Apart from motor impairments, dysphagia and dysarthria are common in patients with Parkinson’s disease (PD). While dysphagia may be life-threatening, dysarthria affects patients’ quality of life as it limits patients' communication ability with others. Lee Silverman Voice Treatment (LSVT) is widely used worldwide as speech treatment for PD patients. It has been proved to improve their speech ability and swallowing function. However, LSVT consists of 16 intensive sessions within 4 weeks, which is rather difficult to implement in outpatient settings in local hospitals.
Objectives :
To develop an effective speech treatment program for PD patients
Methodology :
Nine PD patients participated in the speech treatment program in outpatient clinic of speech therapy department in Ruttonjee Hospital. They attended 10 treatment sessions weekly or biweekly in individual or group basis. Each treatment session adapted the content of LSVT with modifications, in particular “think loud, speak loud”, clinician's modeling, taking deep breaths and home practice were always stressed. Pre-treatment and post-treatment baselines were measured in different parameters. Patients’ self-perception of their speech problem was evaluated with Voice Handicap Index-10 (VHI-10). Their maximum loudness in sustained phonation was measured post-treatment, and half-year post-treatment. Their maximum phonation time was also measured. Their swallowing function was rated according to the impairment scale of dysphagia in Therapy Outcome Measure (TOM) that describes the severity of dysphagia. Paired sample t-tests and repeated ANOVA were carried out to examine the differences between pre-treatment and post-treatment baselines.
Result & Outcome :
The maximum phonation time did not manifest significant difference after treatment. The maximum loudness in sustained phonation significantly increased(F=5.090, p< 0.05) with maintenance effect. The VHI-10 score also significantly decreased (t=4.031, p< 0.05) reflecting improved self-perception of speech problem. The dysphagia TOM also showed significant improvement (t=-3.162, p< 0.05). The speech treatment program significantly improved PD patients’ vocal loudness, perception towards their voice problem and severity of dysphagia. The increased loudness could be maintained 6 months post-treatment. More PD patients can be benefited with this speech treatment program based on the positive results of this pilot study. Besides, this program can be administered in group training that would be more cost-effective. Larger sample size is anticipated in future studies.

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