Intensive voice treatment (LSVT) for patients with Parkinson's disease: a 2 year follow up.
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OBJECTIVES: To assess long term (24 months) effects of the Lee Silverman voice treatment (LSVT), a method designed to improve vocal function in patients with Parkinson's disease. METHODS: Thirty three patients with idiopathic Parkinson's disease were stratified and randomly assigned to two treatment groups. One group received the LSVT, which emphasises high phonatory-respiratory effort. The other group received respiratory therapy (RET), which emphasises high respiratory effort alone. Patients in both treatment groups sustained vowel phonation, read a passage, and produced a monologue under identical conditions before, immediately after, and 24 months after speech treatment. Change in vocal function was measured by means of acoustic analyses of voice loudness (measured as sound pressure level, or SPL) and inflection in voice fundamental frequency (measured in terms of semitone standard deviation, or STSD). RESULTS: The LSVT was significantly more effective than the RET in improving (increasing) SPL and STSD immediately post-treatment and maintaining those improvements at 2 year follow up. CONCLUSIONS: The findings provide evidence for the efficacy of the LSVT as well as the long term maintenance of these effects in the treatment of voice and speech disorders in patients with idiopathic Parkinson's disease. (+info)
Is voice therapy an effective treatment for dysphonia? A randomised controlled trial.
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OBJECTIVES: To assess the overall efficacy of voice therapy for dysphonia. DESIGN: Single blind randomised controlled trial. SETTING: Outpatient clinic in a teaching hospital. PARTICIPANTS: 204 outpatients aged 17-87 with a primary symptom of persistent hoarseness for at least two months. INTERVENTIONS: After baseline assessments, patients were randomised to six weeks of either voice therapy or no treatment. Assessments were repeated at six weeks on the 145 (71%) patients who continued to this stage and at 12-14 weeks on the 133 (65%) patients who completed the study. The assessments at the three time points for the 70 patients who completed treatment and the 63 patients in the group given no treatment were compared. MAIN OUTCOME MEASURES: Ratings of laryngeal features, Buffalo voice profile, amplitude and pitch perturbation, voice profile questionnaire, hospital anxiety and depression scale, clinical interview schedule, SF-36. RESULTS: Voice therapy improved voice quality as assessed by rating by patients (P=0.001) and rating by observer (P<0.001). The treatment effects for these two outcomes were 4.1 (95% confidence interval 1.7 to 6.6) points and 0.82 (0.50 to 1.13) points. Amplitude perturbation showed improvement at six weeks (P=0.005) but not on completion of the study. Patients with dysphonia had appreciable psychological distress and lower quality of life than controls, but voice therapy had no significant impact on either of these variables. CONCLUSION: Voice therapy is effective in improving voice quality as assessed by self rated and observer rated methods. (+info)
Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT): a pilot study.
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OBJECTIVE: To define the effects of Lee Silverman Voice Treatment (LSVT on swallowing and voice in eight patients with idiopathic Parkinson's disease. METHODS: Each patient received a modified barium swallow (MBS) in addition to voice recording before and after 1 month of LSVT. Swallowing motility disorders were defined and temporal measures of the swallow were completed from the MBS. Voice evaluation included measures of vocal intensity, fundamental frequency, and the patient's perception of speech change. RESULTS: before LSVT, the most prevalent swallowing motility disorders were oral phase problems including reduced tongue control and strength. Reduced tongue base retraction resulting in residue in the vallecula was the most common disorder in the pharyngeal stage of the swallow. Oral transit time (OTT) and pharyngeal transit time (PTT) were prolonged. After LSVT, there was an overall 51% reduction in the number of swallowing motility disorders. Some temporal measures of swallowing were also significantly reduced as was the approximate amount of oral residue after 3 ml and 5 ml liquid swallows. Voice changes after LSVT included a significant increase in vocal intensity during sustained vowel phonation as well as during reading. CONCLUSIONS: LSVT seemingly improved neuromuscular control of the entire upper aerodigestive tract, improving oral tongue and tongue base function during the oral and pharyngeal phases of swallowing as well as improving vocal intensity. (+info)
Fear recognition in the voice is modulated by unconsciously recognized facial expressions but not by unconsciously recognized affective pictures.
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Multisensory integration is a powerful mechanism for increasing adaptive responses, as illustrated by binding of fear expressed in a face with fear present in a voice. To understand the role of awareness in intersensory integration of affective information we studied multisensory integration under conditions of conscious and nonconscious processing of the visual component of an audiovisual stimulus pair. Auditory-event-related potentials were measured in two patients (GY and DB) who were unable to perceive visual stimuli consciously because of striate cortex damage. To explore the role of conscious vision of audiovisual pairing, we also compared audiovisual integration in either naturalistic pairings (a facial expression paired with an emotional voice) or semantic pairings (an emotional picture paired with the same voice). We studied the hypothesis that semantic pairings, unlike naturalistic pairings, might require mediation by intact visual cortex and possibly by feedback to primary cortex from higher cognitive processes. Our results indicate that presenting incongruent visual affective information together with the voice translates as an amplitude decrease of auditory-event-related potentials. This effect obtains for both naturalistic and semantic pairings in the intact field, but is restricted to the naturalistic pairings in the blind field. (+info)
Truth and character: sources that older adults can remember.
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Are age differences in source memory inevitable? The two experiments reported here examined the hypothesis that the type of source information being tested mediates the magnitude of age differences in source memory. In these studies, participants listened to statements made by two different speakers. We compared younger and older adults' source memory in a traditional perceptual source task (memory for voice) and in two affective, conceptually based source tasks (truth of the statements, character of a person in a photo). In both studies, the perceptual and conceptual source information were conveyed in the same manner, as one speaker was associated with one type of information (e.g., female voice speaks truth). Age differences were robust for decisions regarding who said each statement but were negligible or truth or character decisions. These findings are provocative because they suggest that the type of information can influence age-related patterns of performance for source-conveyed information. (+info)
Prospective functional voice assessment in patients undergoing thyroid surgery.
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OBJECTIVE: To analyze voice function before and after thyroidectomy for patients with normal preoperative voice using a standardized multidimensional voice assessment protocol. SUMMARY BACKGROUND DATA: The natural history of post-thyroidectomy voice disturbances for patients with preserved laryngeal nerve function has not been systematically studied and characterized with the intent of using the data for postoperative voice rehabilitation. METHODS: During a prospective single-arm study, patients with normal voice underwent functional voice testing using a standardized voice grading scale and a battery of acoustic, aerodynamic, glottographic, and videostroboscopic tests before, 1 week after, and 3 months after thyroidectomy. Differences in observed sample means were evaluated using analysis of covariance or t test; categorical data was analyzed using the Fisher exact or chi-square test. RESULTS: Fifty-four patients were enrolled; 50 and 46 were evaluable at 1 week and 3 months, respectively. No patient developed recurrent laryngeal nerve injury; one had superior laryngeal nerve injury. Fifteen (30%) patients reported early subjective voice change and seven (14%) reported late (3-month) subjective voice change. Forty-two (84%) patients had significant objective change in at least one voice parameter. Six (12%) had significant alterations in more than three voice measures, of which four (67%) were symptomatic, whereas 25% with three or fewer objective changes had symptoms. Patients with persistent voice change at 3 months had an increased likelihood of multiple (more than three) early objective changes (43% vs. 7%). Early maximum phonational frequency range and vocal jitter changes from baseline were significantly associated with voice symptoms at 3 months. CONCLUSIONS: Early vocal symptoms are common following thyroidectomy and persist in 14% of patients. Multiple (more than three) objective voice changes correlate with early and late postoperative symptoms. Alterations in maximum phonational frequency range and vocal jitter predict late perceived vocal changes. Factors other than laryngeal nerve injury appear to alter post-thyroidectomy voice. The variability of patient symptoms underscores the importance of understanding the physiology of dysphonia. (+info)
Quantitative analysis of professionally trained versus untrained voices.
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The aim of this study was to compare healthy trained and untrained voices as well as healthy and dysphonic trained voices in adults using combined voice range profile and aerodynamic tests, to define the normal range limiting values of quantitative voice parameters and to select the most informative quantitative voice parameters for separation between healthy and dysphonic trained voices. Three groups of persons were evaluated. One hundred eighty six healthy volunteers were divided into two groups according to voice training: non-professional speakers group consisted of 106 untrained voices persons (36 males and 70 females) and professional speakers group--of 80 trained voices persons (21 males and 59 females). Clinical group consisted of 103 dysphonic professional speakers (23 males and 80 females) with various voice disorders. Eighteen quantitative voice parameters from combined voice range profile (VRP) test were analyzed: 8 of voice range profile, 8 of speaking voice, overall vocal dysfunction degree and coefficient of sound, and aerodynamic maximum phonation time. Analysis showed that healthy professional speakers demonstrated expanded vocal abilities in comparison to healthy non-professional speakers. Quantitative voice range profile parameters- pitch range, high frequency limit, area of high frequencies and coefficient of sound differed significantly between healthy professional and non-professional voices, and were more informative than speaking voice or aerodynamic parameters in showing the voice training. Logistic stepwise regression revealed that VRP area in high frequencies was sufficient to discriminate between healthy and dysphonic professional speakers for male subjects (overall discrimination accuracy--81.8%) and combination of three quantitative parameters (VRP high frequency limit, maximum voice intensity and slope of speaking curve) for female subjects (overall model discrimination accuracy--75.4%). We concluded that quantitative voice assessment with selected parameters might be useful for evaluation of voice education for healthy professional speakers as well as for detection of vocal dysfunction and evaluation of rehabilitation effect in dysphonic professionals. (+info)
Diagnostic test with omeprazole in patients with posterior laryngitis.
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The aim of the study was to evaluate the merit of empiric omeprazole therapy in patients with suspected laryngopharyngeal reflux (LPR), to determine the optimal dose and duration of diagnostic test, to compare the diagnostic value of upper gastrointestinal (GI) endoscopy and omeprazole test (OT). One hundred out-patients with posterior laryngitis and more than one atypical symptom of LPR, aged 14-68 years were treated with omeprazole for 4 weeks (clinical group). According to received omeprazole dose (20 mg, 40 mg, > 40 mg), three clinical subgroups were selected. Twenty patients treated only with life style modifications and diet composed dietary group. At the entry to the study, a symptom questionnaire (5 laryngeal and 3 esophageal scored from 0 to 3 points), well being in general (W-B(VAS) on 100-mm VAS scale), videolaryngoscopy, upper endoscopy, and voice assessment (4 voice range profile parameters and overall vocal dysfunction degree (VDD)) were completed. Total symptom index (TSI) was calculated multiplying sum of symptoms severity score by number of presented symptoms. Normal values of efficacy parameters were obtained from 113 healthy voice subjects (control group). Patients were evaluated twice during the treatment: after 1-2 weeks and after 4-5 weeks. Patients were confirmed as responders, if TSI improved at least 50%, and patients were satisfied with results. According to our data, the 1st control assessment showed significant improvement on symptoms, laryngoscopy scores, VDD, and W-B(VAS) only for clinical group patients (p<0.05). Responders rate also was advantageous for the clinical group patients in comparison to the dietary group (36.0% vs. 15%). The second control assessment showed significantly better results for the clinical group patients in comparison to the 1st (p<0.05 2nd vs. the 1st). Sixty five percent of them (65/100) were classified as responders (p<0.05). The better results were in patients receiving omeprazole more than 20 mg daily. Erosive esophagitis during upper GI endoscopy was found for 21.0% (21/100) clinical group patients, 18 of them were responders to omeprazole 4-week test (accuracy of OT with regard to confirmed diagnosis with upper endoscopy was 85.7%). At week 4, efficacy parameters were not in normal range. We concluded that short-term treatment with omeprazole might be useful in confirming the clinically based diagnosis of laryngopharyngeal reflux. (+info)