Exploring the outcomes of a ‘Loud and Proud’ maintenance group following treatment for speech difficulties associated with Parkinson’s disease

The treatment approach with the highest level of evidence that has been found to be effective for speech and voice difficulties associated with Parkinson's Disease is the Lee Silverman Voice Technique (LSVT LOUD - an intensive therapy and LSVT X- a less intensive version) (Ramig, 2001; Ramig, Countryman, O’Brien, Hoehn, & Thompson, 1996) https://www.lsvtglobal.com/LSVTLoud in which clients are encouraged to practice "speaking loudly" in a variety of different activities e.g. with background noise, in reading, in a monologue etc.. They are taught to recalibrate their perception of how loud their voice is. Significant gains in measures of loudness and articulation have been found immediately following treatment. However, when participants were tested 2 years post treatment, loudness levels were found to have reduced significantly (Ramig, 2001; Wight & Miller, 2015). There is therefore a need for maintenance therapy following loudness therapy. One method for maintaining gains is to have a Loud and Proud group. This continues to encourage clients to "speak loudly" in a face to face group environment in activities similar to that used in LSVT LOUD and LSVT X e.g. with background noise, when reading, in a monologue, in a conversation, when calling out to a partner to get attention, when making a request to a partner etc. The effectiveness of these groups has not been explored. In the proposed study participants will attend a loud and proud group once a week for 1 hour for 8 weeks at their local hospital. The activities selected in which participants will speak loudly will be determined by the group and will target the activities the participants and their communication partners determine are challenging for them. Participants will also be given activities at home in which to practice "speaking loudly". The treatment will be delivered by a speech pathologist who has completed training in LSVT LOUD and LSVT X. An attendance checklist will be kept and participants will also complete a homework checklist. Home practice exercises will include diaphragmatic breathing, sustained phonation, speaking functional phrases in a loud voice, reading in a loud voice and conversing in a loud voice. Participants will be encouraged to practice for 30 minutes a day, 5 days a week, whilst participating in the group.