Voice Treatment for Parkinson's Disease

Ratings of physical and mental effort will be assigned by participants on treatment days using the modified NASA-Task Load Index. Participants rate how much physical effort and mental effort it took to complete treatment each day. Participants will indicate their response using a visual analogue scale (0-100) with the endpoints no effort (0) to significant effort (100). Data are not reported for the clinical control group as these participants did not receive treatment. Ratings of mental and physical effort are reported separately at baseline and post-treatment.

Time frame: Change from baseline after 8 weeks of treatment

Population: Controls were excluded as the goal was to ascertain the impact of voice intervention on self-perception of physical and mental effort.

Movement of air through the vocal folds will also be assessed during a vowel and sentence production task using a vented mask that fits over the nose and mouth. This allows us to derive estimates of how quickly the vocal folds are closing (maximum flow declination rate). Pre-treatment and post-treatment values are reported. Maximum flow declination rate (MFDR) is reported in liters per second per second (L/s/s).

Time frame: Change from baseline after 8 weeks of treatment

Population: The primary goal was to ascertain the impact of internal cueing (SpeechVive) and external cueing (Lee Silverman Voice Treatment) on laryngeal aerodynamics. To achieve this goal, and to ensure adequate statistical power was maintained, a direct treatment group comparison was undertaken. As a result, the clinical controls, who did not receive any form of intervention, were excluded from this analysis.

Movement of air through the vocal folds will also be assessed during a vowel and sentence production task using a vented mask that fits over the nose and mouth. This allows us to derive estimates of how long the vocal folds are open (open quotient). Pre-treatment and post-treatment values are reported. Open quotient is a unit-less measure.

Time frame: Change from baseline after 8 weeks of treatment

Population: The primary goal was to ascertain the impact of internal cueing (SpeechVive) and external cueing (Lee Silverman Voice Treatment) on laryngeal aerodynamics. To achieve this goal, and to ensure adequate statistical power was maintained, a direct treatment group comparison was undertaken. As a result, the clinical controls, who did not receive any form of intervention, were excluded from this analysis.

Changes in speech breathing will be assessed by examining movement in the ribcage and abdominal walls (respiratory kinematics) during speech. Non-invasive elasticized bands are fitted around the chest and abdominal walls to monitor movement. Respiratory kinematic measures will be in percentage of vital capacity relative to end-expiratory level. Negative values for lung volume termination indicate that speech was terminated below end-expiratory level. Positive values for lung volume termination indicate that speech was terminated above end-expiratory level. The data reported show the baseline and post-treatment values for lung volume initiation, termination, and excursion as a percentage of vital capacity relative to end-expiratory level.

Time frame: Change from baseline after 8 weeks of treatment

Population: The primary goal was to ascertain the impact of internal cueing (SpeechVive) and external cueing (Lee Silverman Voice Treatment) on respiratory mechanics. To achieve this goal, and to ensure adequate statistical power was maintained, a direct treatment group comparison was undertaken. As a result, the clinical controls, who did not receive any form of intervention, were excluded from this analysis.

Vocal intensity (dB SPL) will be measured during a reading task and a monologue task. The vocal intensity data reported will be collapsed across the reading and monologue task. Recorded speech samples are captured using a head-mounted microphone. The speech signals are analyzed for vocal intensity using Praat. The pre- to post-treatment change in vocal intensity is reported in decibels. A positive value indicates an increase in vocal intensity post-treatment. A negative value indicates a decrease in vocal intensity post-treatment. We expected to see no change in vocal intensity for the control group as they did not receive voice intervention.

Time frame: Change from baseline after 8 weeks of treatment

The Voice-related Quality of Life VR-QOL instrument is a 10-item self-report questionnaire that examines the impact of a persons voice impairment on activities of daily living. For each item, participants assign a score between 1 (Not a problem) and 5 (Problem is as bad as can be). A total score is calculated by summing the assigned scores across the 10 items. The minimum total score is 10 and the maximum total score is 50. Higher scores indicate that the voice problem interferes with activities of daily living. The overall VR-QOL score ranges from 10 to 15 (excellent), 16 to 20 (very good), 21 to 25 (good), 26-30 (fair) and scores more than 30 and up to 50 is poor.

Time frame: Change from baseline after 8 weeks of treatment

The Communicative Participation Item Bank-Short Form is a 10-item self-report questionnaire that examines how a given condition (e.g. Parkinson's disease) interferes with communication in various situations (e.g. noisy environment). The questionnaire has 10 questions that depict a variety of speaking situations. Each of the 10 questions is assigned a score between 0 (very much) to 3 (not at all). Participants are asked to indicate how much their condition interferes with participation in each situation. The scores are summed to come up with a summary score between 0 and 30. High scores indicate less interference in participation.

Time frame: Change from baseline after 8 weeks of treatment

This 39-item self-report questionnaire is designed to address aspects of functioning and well-being for those affected by Parkinson's disease. The PDQ-39 scores each item on a 5 point scale (0=never, 4=always) and is scored along 8 different scales: mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort. A summary index score is calculated by averaging the scores across these 8 difference scales. The minimum score is 0 and the maximum score is 100. Lower scores indicate a better quality of life and higher scores indicate a lower quality of life. Summary index scores are reported for baseline and post-treatment.

Time frame: Change from baseline after 8 weeks of treatment

While wearing a microphone, participants will read a short passage. These recorded speech samples will be analyzed for the frequency of pauses using an acoustic analysis software program. Pauses are reported as a frequency count (how many occur in a given sample).

Time frame: Change from baseline after 8 weeks of treatment

While wearing a microphone, participants will read a short passage. The speech samples will be analyzed for speech rate using an acoustic software program. Speech rate is measured and reported in syllables per second. Higher values indicate a faster speech rate and lower values indicate a slower speech rate.

Time frame: Change from baseline after 8 weeks of treatment

Population: The primary goal was to ascertain the impact of internal cueing (SpeechVive) and external cueing (Lee Silverman Voice Treatment) on speech rate. To achieve this goal, and to ensure adequate statistical power was maintained, a direct treatment group comparison was undertaken. As a result, the clinical controls, who did not receive any form of intervention, were excluded from this analysis.