Effects of the Lee Silverman Voice Treatment (LSVT® LOUD) on hypomimia in Parkinson's disease.

Given associations between facial movement and voice, the potential of the Lee Silverman Voice Treatment (LSVT) to alleviate decreased facial expressivity, termed hypomimia, in Parkinson's disease (PD) was examined. Fifty-six participants--16 PD participants who underwent LSVT, 12 PD participants who underwent articulation treatment (ARTIC), 17 untreated PD participants, and 11 controls without PD--produced monologues about happy emotional experiences at pre- and post-treatment timepoints ("T1" and "T2," respectively), 1 month apart. The groups of LSVT, ARTIC, and untreated PD participants were matched on demographic and health status variables. The frequency and variability of facial expressions (Frequency and Variability) observable on 1-min monologue videorecordings were measured using the Facial Action Coding System (FACS). At T1, the Frequency and Variability of participants with PD were significantly lower than those of controls. Frequency and Variability increases of LSVT participants from T1 to T2 were significantly greater than those of ARTIC or untreated participants. Whereas the Frequency and Variability of ARTIC participants at T2 were significantly lower than those of controls, LSVT participants did not significantly differ from controls on these variables at T2. The implications of these findings, which suggest that LSVT reduces parkinsonian hypomimia, for PD-related psychosocial problems are considered.

Innovative technology for the assisted delivery of intensive voice treatment (LSVT®LOUD) for Parkinson disease.

PURPOSE: To assess the feasibility and effectiveness of a newly developed assistive technology system, Lee Silverman Voice Treatment Companion (LSVT(®) Companion™, hereafter referred to as "Companion"), to support the delivery of LSVT(®)LOUD, an efficacious speech intervention for individuals with Parkinson disease (PD). METHOD: Sixteen individuals with PD were randomized to an immediate (n = 8) or a delayed (n = 8) treatment group. They participated in 9 LSVT LOUD sessions and 7 Companion sessions, independently administered at home. Acoustic, listener perception, and voice and speech rating data were obtained immediately before (pre), immediately after (post), and at 6 months post treatment (follow-up). System usability ratings were collected immediately post treatment. Changes in vocal sound pressure level were compared to data from a historical treatment group of individuals with PD treated with standard, in-person LSVT LOUD. RESULTS: All 16 participants were able to independently use the Companion. These individuals had therapeutic gains in sound pressure level, pre to post and pre to follow-up, similar to those of the historical treatment group. CONCLUSIONS: This study supports the use of the Companion as an aid in treatment of hypokinetic dysarthria in individuals with PD. Advantages and disadvantages of the Companion, as well as limitations of the present study and directions for future studies, are discussed.

Impact of four nonclinical speaking environments on a child's fundamental frequency and voice level: a preliminary case study.

PURPOSE: The aim of this study was to investigate how a child's fundamental frequency (F(0)) and estimated voice level (dB SPL) change in distinct speaking environments. METHOD: A child age 5;7 (years;months) wore a National Center for Voice and Speech voice dosimeter for 4 days. The 2 parameters measured were F(0) and dB SPL. During analysis, the F(0) and dB SPL data were segmented to represent 4 typical speaking environments of school-age children: (a) free-play (2.5 hr), (b) preschool (3 hr), (c) home (10.7 hr), and (d) adult (5.6 hr). Unique to this study, the child's voice data were presented as voice use profiles. RESULTS: The child's F(0) and dB SPL patterns within an adult environment were similar to that found in the literature but showed much greater variation in the free-play environment. The preschool environment elicited speech of a lower modal F(0) than did the home, but a higher median and mean F(0), as well as a somewhat elevated mean dB SPL. CONCLUSION: The child produced significantly different F(0) and dB SPL patterns across 4 different speaking environments. If future studies substantiate this pattern, clinicians and researchers must be aware of this difference when working with children.

Formant centralization ratio: a proposal for a new acoustic measure of dysarthric speech.

PURPOSE: The vowel space area (VSA) has been used as an acoustic metric of dysarthric speech, but with varying degrees of success. In this study, the authors aimed to test an alternative metric to the VSA-the formant centralization ratio (FCR), which is hypothesized to more effectively differentiate dysarthric from healthy speech and register treatment effects. METHOD: Speech recordings of 38 individuals with idiopathic Parkinson's disease and dysarthria (19 of whom received 1 month of intensive speech therapy [Lee Silverman Voice Treatment; LSVT LOUD]) and 14 healthy control participants were acoustically analyzed. Vowels were extracted from short phrases. The same vowel-formant elements were used to construct the FCR, expressed as (F2u + F2a + F1i + F1u) / (F2i + F1a), the VSA, expressed as ABS([F1i x (F2a - F2u) + F1a x (F2u - F2i) + F1u x (F2i - F2a)] / 2), a logarithmically scaled version of the VSA (LnVSA), and the F2i /F2u ratio. RESULTS: Unlike the VSA and the LnVSA, the FCR and F2i/F2u ratio robustly differentiated dysarthric from healthy speech and were not gender sensitive. All metrics effectively registered treatment effects and were strongly correlated with each other. CONCLUSION: Albeit preliminary, the present findings indicate that the FCR is a sensitive, valid, and reliable acoustic metric for distinguishing dysarthric from unimpaired speech and for monitoring treatment effects, probably because of reduced sensitivity to interspeaker variability and enhanced sensitivity to vowel centralization.

The inability to produce soft voice (IPSV): a tool to detect vocal change in school-teachers.

PURPOSE: This study investigated whether clinicians could detect voice changes reported by teachers, from self-ratings teachers conducted of their inability to produce soft voice (IPSV). METHODS: Ten teachers wore a vocal dosimeter and completed daily IPSV ratings approximately every 2 hours for 14 days. Following the 2 weeks of dosimetry, two speech clinicians specialized in voice rated the teachers' IPSV from dosimeter recordings. Teacher and clinician ratings were compared for each participant. RESULTS: Although agreement between teacher and clinician ratings was not significant, descriptive analyses demonstrated an average difference score of 1.7 (SD 1.4) between teacher and clinician ratings. CONCLUSIONS: This study supports the potential usefulness of the IPSV as a simple tool to detect voice changes in oneself or others.

Effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on vowel articulation in dysarthric individuals with idiopathic Parkinson disease: acoustic and perceptual findings.

PURPOSE: To evaluate the effects of intensive voice treatment targeting vocal loudness (the Lee Silverman Voice Treatment [LSVT]) on vowel articulation in dysarthric individuals with idiopathic Parkinson's disease (PD). METHOD: A group of individuals with PD receiving LSVT (n = 14) was compared to a group of individuals with PD not receiving LSVT (n = 15) and a group of age-matched healthy individuals (n = 14) on the variables vocal sound pressure level (VocSPL); various measures of the first (F1) and second (F2) formants of the vowels /i/, /u/, and /a/; vowel triangle area; and perceptual vowel ratings. The vowels were extracted from the words key, stew, and Bobby embedded in phrases. Perceptual vowel rating was performed by trained raters using a visual analog scale. RESULTS: Only VocSPL, F2 of the vowel /u/ (F2u), and the ratio F2i/F2u significantly differed between patients and healthy individuals pretreatment. These variables, along with perceptual vowel ratings, significantly changed (improved) in the group receiving LSVT only. CONCLUSION: These results, along with previous findings, add further support to the generalized therapeutic impact of intensive voice treatment on orofacial functions (speech, swallowing, facial expression) and respiratory and laryngeal functions in individuals with PD.

The effects of intensive voice treatment on facial expressiveness in Parkinson disease: preliminary data.

OBJECTIVE: The purpose of the present retrospective study was to examine the effects of intensive voice therapy on facial expression in Parkinson disease. BACKGROUND: Parkinson disease (PD) often presents with symptoms that reduce communicative effectiveness on multiple levels, including decreased vocal loudness and reduced facial mobility. Recent advances in voice treatment have provided the first short- and long-term efficacy data indicating improvements in voice and speech following intensive voice therapy (Lee Silverman Voice Treatment [LSVT]). Anecdotal reports from both clinicians and patients indicate that the LSVT also has a positive impact on facial expression. These observations suggest a need to investigate more directly the effects of voice therapy on facial movement and expressiveness in PD. METHOD: Forty-four individuals with idiopathic PD participated in this study. Video data were taken from recordings of individuals with PD who had received either one month of phonation-based treatment (LSVT) or respiratory treatment (RT) as part of a large treatment efficacy study designed to examine the effects of different types of therapy on speech and voice in PD. Twenty-second video samples of all subjects taken before and after treatment were paired and played at random without sound to trained raters, who judged each pair of video clips for facial mobility and engagement. All recordings were made while subjects were engaged in conversational speech. RESULTS: Inter-rater reliability was extremely high (0.90) for both the rating of facial mobility and engagement. Overall, members of the LSVT group received more ratings of increased facial mobility (P = 0.036) and engagement (P = 0.056) following treatment relative to members of the RT group. In addition, the extent of change for facial mobility after treatment was perceived as greater (P = 0.05) for the LSVT group than for the RT group. CONCLUSIONS: These results indicate that intensive voice therapy may have a positive effect on facial expressivity in PD. Such findings lend support to contemporary theories relating multiple expressive modalities (e.g., voice, face, and gesture) and suggest that targeting voice may be an effective and efficient way to influence expressive output in general.