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Randomized Controlled Trial
. 2018 Nov;33(11):1777-1791.
doi: 10.1002/mds.27460. Epub 2018 Sep 28.

Speech treatment in Parkinson's disease: Randomized controlled trial (RCT)

Lorraine Ramig  1   2   3   4 , Angela Halpern  1   2   4 , Jennifer Spielman  1   2 , Cynthia Fox  2   4 , Katherine Freeman  5
Affiliations
Randomized Controlled Trial

Speech treatment in Parkinson's disease: Randomized controlled trial (RCT)

Lorraine Ramig et al. Mov Disord. 2018 Nov.

Abstract

Background: As many as 89% of people with Parkinson's disease (PD) develop speech disorders.

Objectives: This randomized controlled trial evaluated two speech treatments for PD matched in intensive dosage and high-effort mode of delivery, differing in subsystem target: voice (respiratory-laryngeal) versus articulation (orofacial-articulatory).

Methods: PD participants were randomized to 1-month LSVT LOUD (voice), LSVT ARTIC (articulation), or UNTXPD (untreated) groups. Speech clinicians specializing in PD delivered treatment. Primary outcome was sound pressure level (SPL) in reading and spontaneous speech, and secondary outcome was participant-reported Modified Communication Effectiveness Index (CETI-M), evaluated at baseline, 1, and 7 months. Healthy controls were matched by age and sex.

Results: At baseline, the combined PD group (n = 64) was significantly worse than healthy controls (n = 20) for SPL (P < 0.05) and CETI-M (P = 0.0001). At 1 and 7 months, SPL between-group comparisons showed greater improvements for LSVT LOUD (n = 22) than LSVT ARTIC (n = 20; P < 0.05) and UNTXPD (n = 22; P < 0.05). Sound pressure level differences between LSVT ARTIC and UNTXPD at 1 and 7 months were not significant (P > 0.05). For CETI-M, between-group comparisons showed greater improvements for LSVT LOUD and LSVT ARTIC than UNTXPD at 1 month (P = 0.02; P = 0.02). At 7 months, CETI-M between-group differences were not significant (P = 0.08). Within-group CETI-M improvements for LSVT LOUD were maintained through 7 months (P = 0.0011).

Conclusions: LSVT LOUD showed greater improvements than both LSVT ARTIC and UNTXPD for SPL at 1 and 7 months. For CETI-M, both LSVT LOUD and LSVT ARTIC improved at 1 month relative to UNTXPD. Only LSVT LOUD maintained CETI-M improvements at 7 months. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

Keywords: Parkinson's disease; RCT; articulation; speech treatment; voice.

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Conflict of interest statement

See relevant conflicts of interest/financial disclosures.

Throughout the active phase of the study, funding was provided by The National Institutes of Health‐National Institute for Deafness and other Communication Disorders (NIH‐NIDCD) (R01 DC01150) through the University of Colorado‐Boulder/National Center for Voice and Speech, the primary place of employment for Ramig (Full Professor), Halpern, and Spielman, and where Fox was a consultant. Freeman was a Full Professor at Albert Einstein College of Medicine, Bronx, New York, USA. During poststudy data analysis and manuscript preparation, Ramig, Halpern, and Fox have had employment roles with LSVT Global, and Spielman and Freeman have been paid consultants. Full financial disclosures can be found in the online version of the article.

Figures

Figure 1
Figure 1
CONSORT diagram outlining the flow of participants through the trial. PD‐Parkinson's disease; HC‐Healthy Control; BDI‐II Beck Depression Inventory‐II; MMSE‐Mini Mental Status Exam; ENT‐Ear Nose Throat examination.
Figure 2
Figure 2
(A) Means and SDs for dB of SPL at 30 cm for LSVT LOUD, LSVT ARTIC, and UNTXPD at baseline, 1, and 7 months. The monologue task was plotted as most representative of spontaneous speech. (B) Medians and interquartile ranges from the 25th to the 75th percentile for the CETI‐M scaled 0 to 100 for LSVT LOUD, LSVT ARTIC, and UNTXPD at baseline, 1, and 7 months.
See this image and copyright information in PMC

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