Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2012 Aug 15;2012(8):CD002814.
doi: 10.1002/14651858.CD002814.pub2.

Comparison of speech and language therapy techniques for speech problems in Parkinson's disease

Clare P Herd  1 , Claire L Tomlinson, Katherine H O Deane, Marian C Brady, Christina H Smith, Catherine M Sackley, Carl E Clarke
Affiliations
Comparative Study

Comparison of speech and language therapy techniques for speech problems in Parkinson's disease

Clare P Herd et al. Cochrane Database Syst Rev. .

Abstract

Background: Patients with Parkinson's disease commonly suffer from speech and voice difficulties such as impaired articulation and reduced loudness. Speech and language therapy (SLT) aims to improve the intelligibility of speech with behavioural treatment techniques or instrumental aids.

Objectives: To compare the efficacy and effectiveness of novel SLT techniques versus a standard SLT approach to treat Parkinsonian speech problems.

Search methods: We identified relevant, published prior to 11(th) April 2011, by electronic searches of numerous literature databases including CENTRAL, MEDLINE and CINAHL, as well as handsearching relevant conference abstracts and examining reference lists in identified studies and other reviews.

Selection criteria: Only randomised controlled trials (RCT) of one type of speech and language therapy versus another were included.

Data collection and analysis: Two review authors independently extracted data and resolved differences by discussion.

Main results: Six trials involving 159 patients satisfied the inclusion criteria. Data could not be analysed from one trial due to changes in patient numbers and from a second because the data provided were not in a usable format. All trials reported intelligibility measures but a statistically significant result was only reported for the diagnostic rhyme test used in the study of Lee Silverman Voice Treatment -LOUD (LSVT-LOUD) versus a modified version of this therapy (LSVT-ARTIC). In this case a difference of 12.5 points (95% confidence interval (CI) -22.2 to -2.8; P = 0.01) between the mean changes in favour of the LSVT-LOUD group was reported for a speech sample overlaid with Babble noise; this difference was not reproduced for the two additional noise conditions under which the speech samples were assessed. LSVT-LOUD also outperformed LSVT-ARTIC and Respiration therapy (RT) in improving loudness, with a difference in reading a sample text of 5.0 dB (95%CI -8.3 to -1.7; P = 0.003) and 5.5 dB (95% CI 3.4 to 7.7; P < 0.00001) respectively, and a difference in monologue speech of 2.9 dB (95% CI 0.6 to 5.2; P = 0.01) versus RT.

Authors' conclusions: Considering the small patient numbers in these trials, there is insufficient evidence to support or refute the efficacy of any form of SLT over another to treat speech problems in patients with Parkinson's disease.

PubMed Disclaimer

Conflict of interest statement

Authors C P Herd, C H Smith, M C Brady, C Sackley and C E Clarke are part of a team performing a pilot trial comparing LSVT versus NHS SLT versus attention control (PD COMM). The views expressed here are those of the authors and not necessarily those of the Chief Scientist Office.

Figures

1
1
PRISMA diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 1 Patient assessed loudness.
1.2
1.2. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 2 Carer assessed loudness.
1.3
1.3. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 3 Patient assessed monotonicity.
1.4
1.4. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 4 Carer assessed monotonicity.
1.5
1.5. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 5 Patient assessed intelligibility.
1.6
1.6. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 6 Carer assessed intelligibility.
1.7
1.7. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 7 SPL Reading.
1.8
1.8. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 8 SPL Monologue.
1.9
1.9. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 9 Fundamental frequency reading.
1.10
1.10. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 10 Frequency variability monologue.
1.11
1.11. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 11 Frequency variability reading.
1.12
1.12. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 12 Fundamental frequency monologue.
1.13
1.13. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 13 BDI self rating of depression.
1.14
1.14. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 14 SIP Communication.
1.15
1.15. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 15 SIP social interaction.
1.16
1.16. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 16 Hoarseness.
1.17
1.17. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 17 Breathiness.
1.18
1.18. Analysis
Comparison 1 LSVT versus high respiratory effort treatment, Outcome 18 SPL sustained phonation.
2.1
2.1. Analysis
Comparison 2 LSVT Artic versus LSVT Loud, Outcome 1 SPL Reading Pre/Post.
2.2
2.2. Analysis
Comparison 2 LSVT Artic versus LSVT Loud, Outcome 2 DRT Score Babble Noise Pre/Post.
2.3
2.3. Analysis
Comparison 2 LSVT Artic versus LSVT Loud, Outcome 3 DRT Score Shopping Mall Noise Pre/Post.
2.4
2.4. Analysis
Comparison 2 LSVT Artic versus LSVT Loud, Outcome 4 DRT Score No Noise Pre/Post.
3.1
3.1. Analysis
Comparison 3 Altered Auditory Feedback versus Traditional Rate Reduction Therapy, Outcome 1 Speech Rate Reading Pre/Post.
3.2
3.2. Analysis
Comparison 3 Altered Auditory Feedback versus Traditional Rate Reduction Therapy, Outcome 2 Speech Rate Reading Pre/6 Week Follow‐up.
3.3
3.3. Analysis
Comparison 3 Altered Auditory Feedback versus Traditional Rate Reduction Therapy, Outcome 3 Intelligibility Reading Pre/Post.
3.4
3.4. Analysis
Comparison 3 Altered Auditory Feedback versus Traditional Rate Reduction Therapy, Outcome 4 Intelligibility Reading Pre/6 Week Follow‐up.
3.5
3.5. Analysis
Comparison 3 Altered Auditory Feedback versus Traditional Rate Reduction Therapy, Outcome 5 Intelligibility Monologue Pre/Post.
3.6
3.6. Analysis
Comparison 3 Altered Auditory Feedback versus Traditional Rate Reduction Therapy, Outcome 6 Intelligibility Monologue Pre/6 Week Follow‐up.
4.1
4.1. Analysis
Comparison 4 Online LSVT versus face‐to‐face LSVT, Outcome 1 SPL Monologue.
4.2
4.2. Analysis
Comparison 4 Online LSVT versus face‐to‐face LSVT, Outcome 2 SPL sustained vowel phonation.
4.3
4.3. Analysis
Comparison 4 Online LSVT versus face‐to‐face LSVT, Outcome 3 SPL reading.
4.4
4.4. Analysis
Comparison 4 Online LSVT versus face‐to‐face LSVT, Outcome 4 Duration of phonation.
4.5
4.5. Analysis
Comparison 4 Online LSVT versus face‐to‐face LSVT, Outcome 5 Max fundamental frequency range.
4.6
4.6. Analysis
Comparison 4 Online LSVT versus face‐to‐face LSVT, Outcome 6 Breathiness.
4.7
4.7. Analysis
Comparison 4 Online LSVT versus face‐to‐face LSVT, Outcome 7 Roughness.
4.8
4.8. Analysis
Comparison 4 Online LSVT versus face‐to‐face LSVT, Outcome 8 Loudness level.
4.9
4.9. Analysis
Comparison 4 Online LSVT versus face‐to‐face LSVT, Outcome 9 Loudness variability.
4.10
4.10. Analysis
Comparison 4 Online LSVT versus face‐to‐face LSVT, Outcome 10 Pitch variability.
4.11
4.11. Analysis
Comparison 4 Online LSVT versus face‐to‐face LSVT, Outcome 11 Overall articulatory precision.
4.12
4.12. Analysis
Comparison 4 Online LSVT versus face‐to‐face LSVT, Outcome 12 Overall speech intelligibility in conversation.
4.13
4.13. Analysis
Comparison 4 Online LSVT versus face‐to‐face LSVT, Outcome 13 Percentage word intelligibility.
4.14
4.14. Analysis
Comparison 4 Online LSVT versus face‐to‐face LSVT, Outcome 14 Percentage sentence intelligibility.
4.15
4.15. Analysis
Comparison 4 Online LSVT versus face‐to‐face LSVT, Outcome 15 Communication efficiency ratio.
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Constantinescu 2011 {published data only}
    1. Constantinescu G, Theodoros D, Russell T, Ward E, Wilson S, Wootton R. Treating disordered speech and voice in Parkinson's disease online: a randomized controlled non‐inferiority trial. International Journal of Language & Communication Disorders 2011;46(1):1‐16. - PubMed
Halpern 2007 {published data only}
    1. Halpern A, Spielman J, Ramig L, Cable J, Panzer I, Sharpley A. The effects of loudness and noise on speech intelligibility in Parkinson's disease. Movement Disorders 2007;22(16):S105.
Healy 2002 {published data only}
    1. Healy V. A comparison of the efficacy of two methods of rate control in the speech of people with Parkinson's disease. Internal report, Manchester Royal Infirmary 2002.
Lowit 2010 {published data only}
    1. Lowit A, Dobinson C, Timmins C, Howell P, Kroger B. The effectiveness of traditional methods and altered auditory feedback in improving speech rate and intelligibility in speakers with Parkinson's disease. International Journal of Speech‐Language Pathology 2010;12(5):426‐36. - PubMed
Ramig 1995 {published and unpublished data}
    1. Baumgartner CA, Sapir A, Ramig LO. Perceptual voice quality changes following phonatory‐respiratory effort treatment (LSVT) vs. respiratory effort treatment for individuals with Parkinson's disease. Submitted to Journal of Voice. - PubMed
    1. Ramig LO, Countryman S. O'Brien C, Hoehn M, Thompson L. Intensive speech treatment for patients with Parkinson's disease: Short‐ and long‐term comparison of two techniques. Neurology 1996;47:1496‐1504. - PubMed
    1. Ramig LO, Dromey C. Aerodynamic mechanisms underlying treatment‐related changes in vocal intensity in patients with Parkinson's disease. Journal of Speech and Hearing Research 1996;39:798‐807. - PubMed
    1. Ramig LO, Hoyt P, Seeley E, Sapir S. Voice treatment (LSVT) for IPD: Perceptual findings. Parkinsonism and related disorders 1999;5(Supplement):S42.
    1. Ramig LO, Sapir S, Countryman S, Pawlas AA, O'Brien C, Hoehn M, et al. Intensive voice treatment (LSVT (R)) for patients with Parkinson's disease: a 2 year follow up. Journal of Neurology Neurosurgery and Psychiatry 2001;71(4):493‐8. - PMC - PubMed
Scott 1983 {published and unpublished data}
    1. Scott S, Caird FI. Speech therapy for Parkinson's disease. Journal of Neurology, Neurosurgery and Psychiatry 1983;46:140‐4. - PMC - PubMed
    1. Scott S, Caird FI, Williams BO. The effect of speech therapy on communication. In: S. Scott, F.I. Caird, B.O. Williams editor(s). Communication in Parkinson's disease. Beckenham, Kent: Croom Helm Ltd, 1985:47‐60.

References to studies excluded from this review

Adams 2002 {published data only}
    1. Adams SG, Page AD, Jog M. Summary feedback schedules and speech motor learning in Parkinson's disease. Journal of Medical Speech‐Language Pathology 2002;10(4):215‐20.
de Swart 2003 {published data only}
    1. Swart BJM, Willemse SC, Maassen BAM, Horstink MWIM. Improvement of voicing in patients with Parkinson's disease by speech therapy. Neurology 2003;60(3):498‐500. - PubMed
Pacchetti 2000 {published data only}
    1. Pacchetti C, Mancini F, Aglieri R, Fundaro C, Martignoni E, Nappi G. Active music therapy in Parkinson's disease: An integrative method for motor and emotional rehabilitation. Psychosomatic Medicine 2000;62(3):386‐93. - PubMed
Tindall 2009 {published data only}
    1. Tindall LR, Huebner RA. The impact of an application of telerehabilitation technology on caregiver burden. International Journal of Telerehabilitation 2009;1(1):3‐7. - PMC - PubMed

Additional references

Beck 1961
    1. Beck AT, Ward CH, Mendelsohn M, Mock J, Erbaugh J. An inventory for measuring depression. Archives of General Psychiatry 1961;4(6):561‐71. - PubMed
Bergner 1981
    1. Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of a health status measure. Medical Care 1981;19(8):787‐805. - PubMed
Biary 1988
    1. Biary, N, P.A. Pimental, P.W. Langenberg. A double‐blind trial of clonazepam in the treatment of parkinsonian dysarthria.. Neurology 1988;38:255‐258. - PubMed
CONSORT 1996
    1. Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I, et al. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. Journal of the American Medical Association 1996;276(8):637‐9. - PubMed
Dann 1994
    1. Dann N. Saunders H, Hunter PC, Hughes AJ. The response of parkinsonian dysarthria to dopaminergic stimulation. Movement Disorders 1994;9(Supplement 1):83.
Darley 1969
    1. Darley, Aronson, Brown. Motor Speech Disorders. Philadelphia: Saunders, 1969.
Fleiss 1993
    1. Fleiss JL. The statistical basis of meta‐analysis. Statistical Methods in Medical Research 1993;2(2):121‐45. - PubMed
Gibb 1988
    1. Gibb WRG, Lees AJ. The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson's disease. Journal of Neurology, Neurosurgery and Psychiatry 1988;51:745‐52. - PMC - PubMed
Golding 1989
    1. Golding E. The Middlesex Elderly Assessment of Mental State (MEAMS). Suffolk, UK: Thames ValleyTest Company. Suffolk, England: Thames Valley Test Company, 1989.
GPDS 2000
    1. The Global Parkinson's Disease Survey. An insight into quality of life with Parkinson's disease. The Parkinson's Disease Society of the United Kingdom 2000.
Halliday 1970
    1. Halliday MAK. A course in spoken English: Intonation. London: Oxford University Press, 1970.
Herd In Press
    1. Herd C, Tomlinson CL, Deane KH O, Brady MC, Smith C, Sackley C, Clarke CE. Speech and language therapy versus placebo or no intervention for speech problems in Parkinson's disease.. Cochrane Database of Systematic Reviews In Press. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. The Cochrane Collaboration 2011, 2011.
Karlsen 1999
    1. Karlsen KH, Larsen JP, Tandeburg E, Maeland JG. Influence of clinical and demographic variables on quality of life in patients with Parkinson's disease. Journal of Neurology, Neurosurgery and Psychiatry 1999;66(4):431‐5. - PMC - PubMed
Lloyd 1999
    1. Lloyd M. The new community care for people for people with Parkinson's disease and their carers. In: Percival R, P. Hobson editor(s). Parkinson's Disease. Studies in Psycological and Social Care. London: BPS Books, 1999:13‐59.
Logemann 1978
    1. Logemann JA, Fisher HB, Boshes B, Blonsky ER. Frequency and cooccurance of vocal tract dysfunctions in the speech of a large sample of Parkinson patients. Journal of Speech and Hearing Disorders 1978;43:47‐57. [MEDLINE: ] - PubMed
Mawdsley 1971
    1. Mawdsley C, Gamsu CV. Periodicity of speech in Parkinson's disease. Nature 1971;231(5301):315‐6. [MEDLINE: ] - PubMed
Miller 2011
    1. Miller N, Noble E, Jones D, Deane KHO, Gibb C. Survey of speech and language therapy provision for people with Parkinson's disease in the United Kingdom: patients' and carers' perspectives. International Journal of Language & Communication Disorders 2011;46(2):179‐88. - PubMed
Miller 2011b
    1. Miller N, Deane KHO, Jones D, Noble E, Gibb C. National survey of speech and language therapy provision for people with Parkinson's disease in the United Kingdom: therapists' practices. International Journal of Language & Communication Disorders 2011;46(2):189‐201. - PubMed
NCC‐CC 2006
    1. The national collaborating centre for chronic conditions. Parkinson's disease: National clinical guideline for diagnosis and management in primary and secondary care. Royal College of Physicians, London. London: Royal College of Physicians, 2006.
O'Reilly 1996
    1. O'Reilly F, Finnan F, Allwright S, Davey Smith G, Ben‐Shlomo Y. The effects of caring for a spouse with Parkinson's disease on social, psychological and physical well‐being. British Journal of General Practice 1996;46:507‐12. - PMC - PubMed
Parkinson's disease society 2008
    1. Parkinson's disease society. Life with Parkinson's today ‐room for improvement. Parkinson's disease society, London 2008.
Ramig 1995b
    1. Ramig LO, Pawlas A, Countryman S. The Lee Silverman Voice Treatment (LSVT): A practical guide to treating the voice and speech disorders in Parkinson's disease. Iowa City: University of Iowa, 1995.
Rosenbek 1985
    1. Rosenbek, LaPointe. The dysarthrias: Description, diagnosis and treatment. In: Johns DF editor(s). Clinical management of neurogenic communicative disorders. 2nd Edition. Boston: Little Brown and Co, 1985.
Sapir 2001
    1. Sapir S, Pawlas AA, Ramig LO, Countryman S, O'Brien C, Hoehn MM, et al. Voice and speech abnormalities in Parkinson disease: Relation to severity of motor impairment, duration of disease, medication, depression, gender, and age. Journal of Medical Speech‐Language Pathology 2001;9(4):213‐26.
Stewart 1995
    1. Stewart C, Winfield L, Hunt A, Bressman SB, Fahn S, Blitzer A, et al. Speech dysfunction in early Parkinson's disease. Movement Disorders 1995;10(5):562‐5. [MEDLINE: ] - PubMed
Streifler 1984
    1. Streifler M, Hofman S. Disorders of verbal expression in Parkinsonism. Advances in Neurology 1984;40:385‐93. [MEDLINE: ] - PubMed
Tanner 1996
    1. Tanner CMJ, Hubble P, Chan P. Epidemiology and genetics of Parkinson's disease. In: Watts R. L, W. C. Koller editor(s). Movement Disorders. Neurologic Principles and Practise. New York: McGraw Hill, 1996:137‐60. [ISBN: 0‐07‐035203‐8]
Visser 2008
    1. Visser M, Rooden SM, Verbaan D, Marinus J, Stiggelbout AM, Hilten JJ. A comprehensive model of health‐related quality of life in Parkinson's disease. Journal of Neurology 2008;255(10):1580‐7. - PubMed
Yorkston 1981
    1. Yorkston KM, Beukelman DR. Assessment of Intelligibility of Dysarthric Speech. Austin, TX: PRO‐ED, 1981.
Zach 2004
    1. Zach M, Friedman A, Slawek J, Derejko M. Quality of life in polish patients with long‐lasting Parkinson's disease. Movement Disorders 2004;19(6):667‐72. - PubMed

References to other published versions of this review

Deane 2001b
    1. Deane K, Whurr R, Playford ED, Ben‐Shlomo Y, Clarke CE. Speech and language therapy for dysarthria in Parkinson's disease: a comparison of techniques. Cochrane Database of Systematic Reviews 2001, Issue 2. [DOI: 10.1002/14651858.CD002814] - DOI - PubMed

Publication types