Hybrid SPEAK OUT! protocol improves aerodynamic measurements and PROMs in Parkinson's disease.

BACKGROUND: SPEAK OUT! has been shown to enhance various aspects of voice such as intensity, prosody, voice quality and perception of voice. However, their impacts on expiration and communication effectiveness have not yet been evaluated. This study aimed to evaluate the effectiveness of the Hybrid SPEAK OUT! method on aerodynamic measurements and patient-reported outcome measures (PROMs) in individuals with Parkinson's disease (PD). METHODS: This study included 157 participants with PD who underwent an intensive 8-week multidisciplinary treatment program. The Hybrid SPEAK OUT! method consisted of three sessions per week, including two group sessions and one individual treatment session. Voice-related aerodynamic measures included maximum phonation time (MPT), vocal cord function using the S/Z ratio, and expiratory flow measures including peak expiratory flow (PEF) and peak cough flow (PCF). Two PROMs were included: the Hebrew version of the voice handicap index-10 and communication effectiveness questionnaire. RESULTS: The results of 111 participants were analysed. MPT duration increased, PEF and PCF increased, and better scores were found in PROMs. CONCLUSION: These findings would appear to support the effectiveness of the Hybrid SPEAK OUT! methods improving function, activity and participation in individuals with PD. However, further research is needed. WHAT THIS PAPER ADDS: What is already known on the subject Prior research has demonstrated the effectiveness of behavioral therapies, including the SPEAK OUT! program, in managing speech symptoms in individuals with Parkinson's disease (PD). These therapies have shown improvements in voice intensity, fundamental frequency, voice quality, and voice perception. However, the impact on aerodynamic measures, expiratory flow, and patient-reported outcome measures has not been extensively studied. What this paper adds to existing knowledge This study adds to the existing knowledge by demonstrating that a Hybrid SPEAK OUT! approach, can lead to improvements in aerodynamic measures, including maximum phonation time (MPT), expiratory and cough peak flow. In terms of motor learning, we found that two non-speech exhalation-related tasks that were not directly trained improved following the intensive speech training protocol. Furthermore, it shows positive changes in patient-reported outcome measures, with reduced voice-related disability and improved communication efficiency. What are the potential or actual clinical implications of this work? The findings of this study have important clinical implications for the management of speech symptoms in individuals with PD. The Hybrid SPEAK OUT! program, which combines group and individual sessions, can effectively improve voice, aerodynamic measurements and patient-reported outcome measures (PROMs), ultimately enhancing the overall quality of life for patients. These findings support the effectiveness of the Hybrid SPEAK OUT! methods for improving function, activity, and participation in individuals with PD.

An Efficacy Study of Voice Quality Using Cepstral Analyses of Phonation in Parkinson's Disease before and after SPEAK-OUT!®.

INTRODUCTION: SPEAK-OUT!® is a behavioral treatment for hypokinetic dysarthria in persons with Parkinson's disease (PD) that has become an alternative to the gold-standard Lee Silverman Voice Treatment (LSVT) in recent years. Acoustic evaluation of the efficacy of SPEAK-OUT!® therapy has focused on prosody. The purpose of this study was to investigate SPEAK-OUT!® efficacy in terms of vocal quality and its impact on quality of life. Vocal quality was measured acoustically using cepstral peak prominence (CPP) analysis and the Acoustic Voice Quality Index (AVQI) and perceptually using clinical ratings of speech performance. Impact on quality of life was measured with the Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-RQOL). An additional goal of this study was to investigate whether dysarthria severity and disease duration were predictive of changes in voice quality due to SPEAK-OUT!®. METHODS: Pre- and post-therapy data included PD participants' acoustic and perceptual ratings of audio recordings. Demographic data included age, sex, diagnosis, duration of PD, and severity of dysarthria. RESULTS: Participants achieved significant improvement in the vowel and sentence CPP smoothed (CPPS) mean score as well as in their AVQI score post SPEAK-OUT!® treatment. Improvements in AVQI correlated negatively with disease duration and positively with dysarthria severity. DISCUSSION/CONCLUSION: SPEAK-OUT!® is effective in improving voice quality in patients with hypokinetic dysarthria due to idiopathic PD. Patients with more severe dysarthria and with a shorter disease duration may benefit the most, supporting earlier intervention. As for the type of measurement, AVQI combines acoustics from both vowel and sentence contexts and may therefore be the measure of choice over CPPS (vowel) or CPPS (sentence).

Dysarthria treatment for Parkinson's disease: one-year follow-up of SPEAK OUT!® with the LOUD Crowd®.

INTRODUCTION: SPEAK OUT! with The LOUD Crowd is a standardized speech therapy program typically consisting of 12 one-on-one treatments and ongoing weekly group maintenance sessions for patients with dysarthria due to Parkinson's disease (PD). It is based upon the hypothesis that increased attention to speech, which is a goal-directed motor activity, may compensate for the impairment in automatic sequential motor behaviors often demonstrated in patients with PD. We present results on the 1-year response to treatment. METHODS: Forty individuals with idiopathic PD received SPEAK OUT! delivered in 12 one-on-one 40-min treatment sessions 3 times per week for four consecutive weeks in addition to ongoing group maintenance sessions called The LOUD Crowd. Evaluations occurred 3 times at baseline, within one and six weeks after completion of the SPEAK OUT! sessions (N = 40) and 1-year later (N = 35). Assessments included mean speech intensity and intonation from reading and monolog, the voice quality acoustic measure called cepstral peak prominence (CPP), and scores on the voice-related quality of life questionnaire. RESULTS: The significant improvements achieved in all outcome measures from baseline to completion of SPEAK OUT! were maintained 1-year later. Participation throughout the year in regular group maintenance sessions (The LOUD Crowd) was positively correlated with level of improvement at 1 year for all measures except patient perception of voice. CONCLUSIONS: These long-term data contribute evidence of the effectiveness of this speech therapy program for improving communication for individuals with PD and emphasize the importance of regular and ongoing group sessions to sustain therapeutic gains.