Authors (including presenting author) :
Lam YL, Wong SY, TMH Speech Therapist Team
Affiliation :
Department of Speech Therapy, Tuen Mun Hospital, Hospital Authority, Hong Kong SAR
Introduction :
Over 89% of patients with Parkinson's disease suffer from voice and speech disorder (Samii et al., 2004) and this causes their lifelong frustration, embarrassment and social isolation (Miller et al., 2006). International guidelines (NICE guideline, 2006; Parkinsonnet guideline, 2011) suggested that early intensive speech therapy should be initiated to help improve patient's speech clarity and reduce their communication deficit. Level I research evidence for voice treatment in Parkinson’s disease is the Lee Silverman Voice Treatment (LSVT®) which required individual intensive 4-week therapy. However, this treatment protocol required individual intensive therapy which was difficult to be implemented in local public hospital outpatient settings.
Objectives :
To develop an intensive voice training program for enhancing speech outcomes of patients with Parkinson’s Disease in local hospital setting
Methodology :
Suitable patients with Parkinsons' Disease were grouped in 2-3 to receive intensive speech treatment course. The intensive group training program was implemented in the format of three 60-min sessions for consecutive four weeks in Speech Therapy outpatient clinic of Tuen Mun Hospital. Assessment and treatment materials for voice training were developed for local use. Treatment content were structured and designed based on high phonatory-respiratory effort and self-recalibration principles. The speech therapists of the department were briefed on the training program and aligned on the treatment frequency. Patient’s caregivers were encouraged to attend the training session and empowered to assist the home practice and carryover.
Result & Outcome :
From October 2018 to May 2019, totally 14 patients with Parkinson's Disease received intensive voice treatment course. Pre- and post-treatment baselines were obtained. Patients showed significant increase in voice loudness in maximum phonation task (from 63.9dB to 82.2dB, p< 0.05), widened pitch range (from 145Hz-252Hz to 129Hz-353Hz, p< 0.05), increased conversational loudness (from 61dB to 69.8dB, p< 0.05) and reduced self-reported Voice Handicap Index (from 21.2 to 16, p< 0.05). Patient satisfaction survey (n=14) was also conducted after treatment block, and more than 75% of the patients reflected the speech training helps to improve their speech clarity, communication efficiency and communication motivation. This pilot result showed that group therapy format can be considered as an alternative form of intensive voice therapy of Parkinson’s Disease. Long-term effects on sustaining voice quality should be evaluated in future.
