A retrospective study of long-term treatment outcomes for reduced vocal intensity in hypokinetic dysarthria

Abstract Background Reduced vocal intensity is a core impairment of hypokinetic dysarthria in Parkinson’s disease (PD). Speech treatments have been developed to rehabilitate the vocal subsystems underlying this impairment. Intensive treatment programs requiring high-intensity voice and speech exercises with clinician-guided prompting and feedback have been established as effective for improving vocal function. Less is known, however, regarding long-term outcomes of clinical benefit in speakers with PD who receive these treatments. Methods A retrospective cohort design was utilized. Data from 78 patient files across a three year period were analyzed. All patients received a structured, intensive program of voice therapy focusing on speaking intent and loudness. The dependent variable for all analyses was vocal intensity in decibels (dBSPL). Vocal intensity during sustained vowel production, reading, and novel conversational speech was compared at pre-treatment, post-treatment, six month follow-up, and twelve month follow-up periods. Results Statistically significant increases in vocal intensity were found at post-treatment, 6 months, and 12 month follow-up periods with intensity gains ranging from 5 to 17 dB depending on speaking condition and measurement period. Significant treatment effects were found in all three speaking conditions. Effect sizes for all outcome measures were large, suggesting a strong degree of practical significance. Conclusions Significant increases in vocal intensity measured at 6 and 12 moth follow-up periods suggested that the sample of patients maintained treatment benefit for up to a year. These findings are supported by outcome studies reporting treatment outcomes within a few months post-treatment, in addition to prior studies that have reported long-term outcome results. The positive treatment outcomes experienced by the PD cohort in this study are consistent with treatment responses subsequent to other treatment approaches which focus on high-intensity, clinician guided motor learning for voice and speech production in PD. Theories regarding the underlying neurophysiological response to treatment will be discussed

Idiopathic Parkinson's disease: vocal and quality of life analysis

OBJECTIVE: To compare voice and life quality of male patients with idiopathic Parkinson's disease, with individuals without disease (Control Group). METHODS: A cross-sectional study that evaluated the voice of individuals with Parkinson's disease, the group was composed of 27 subjects, aged from 39 to 79 years-old (average 59.96). The Control Group was matched on sex and age. Participants underwent voice recording. Perceptual evaluation was made using GRBASI scale, which considers G as the overall degree of dysphonia, R as roughness, B as breathiness, A as asthenia, S as strain and I as instability. The acoustic parameters analyzed were: fundamental frequency, jitter, shimmer, and harmonic to noise ratio (NHR). For vocal self-perception analysis, we used the Voice Related Quality of Life protocol. RESULTS: Fundamental frequency and jitter presented higher values in the Parkinson's group. NHR values were higher in the Control Group. Perceptual analysis showed a deviation ranging. The vocal disorder self-perception demonstrated a worse impact on quality of life. CONCLUSIONS: Individuals with Parkinson's disease have an altered voice quality and a negative impact on quality of life

Caracterização do padrão de fechamento velofaríngeo em pacientes com fissura palatina

OBJETIVO: Caracterizar o padrão de fechamento velofaríngeo de pacientes operados de fissura palatina e sua relação com gênero, faixa etária, tipo de fissura e diagnóstico da função velofaríngea. MÉTODOS: Estudo retrospectivo realizado a partir de 89 exames de nasofaringoscopia de pacientes operados de fissura palatina, entre 4 e 47 anos (média=17,32±10,50). Os dados foram analisados quanto ao gênero; faixa etária (4 a 8, 9 a 12 anos, 13 a 18 e acima de 18 anos); tipo de fissura (pós-forame e transforame); diagnóstico da função velofaríngea (adequada, marginal e inadequada) e padrão de fechamento velofaríngeo (coronal, circular, circular com prega de Passavant e sagital). Os resultados foram analisados estatisticamente. RESULTADOS: Na amostra estudada, 59,55% eram do gênero feminino; 39,33% tinham mais de 18 anos de idade; 44,94% apresentavam fissura pós-forame e 55,06% transforame; 14,61% fechamento adequado, 53,93% marginal e 31,46% inadequado. Quanto ao padrão de fechamento, 37,08% apresentaram fechamento coronal, 33,71% circular, 15,73% circular com Passavant e 13,48% sagital. Houve relação do padrão de fechamento com o diagnóstico da função velofaríngea (p=0,05). CONCLUSÃO: A maior parte da amostra apresentou fechamento velofaríngeo coronal, seguido pelo circular, circular com Passavant e sagital. Não houve relação entre o padrão de fechamento e as variáveis gênero, faixa etária e tipo de fissura, mas observou-se influência relacionada ao diagnóstico da função velofaríngea.PURPOSE: To characterize the velopharyngeal closure pattern in patients submitted to cleft palate surgery and its relation with gender, age, cleft type, and diagnosis of velopharyngeal function. METHODS: Retrospective study based on 89 nasopharyngoscopy studies of operated cleft palate patients with ages between 4 and 47 years (mean=17.32±10.50). Data were analyzed regarding gender, age range (4 to 8, 9 to 12, 13 to 18 and >18 years), cleft type (postforamen or transforamen), diagnosis of velopharyngeal function (adequate, borderline, and inadequate), and velopharyngeal closure patterns (coronal, circular, circular with Passavant's ridge, and sagittal). Results were statistically analyzed. RESULTS: In the study sample, 59.55% of the patients were women; 39.33% were above 18 years of age; 44.94% had post-foramen cleft and 55.06%, transforamen cleft; 14.61% showed adequate, 53.93% borderline, and 31.46% inadequate velopharyngeal closure. With regards to the velopharyngeal closure pattern, 37.08% of the subjects presented coronal closure; 33.71%, circular closure, 15.73% circular with Passavant's ridge; and 13.48%, sagittal closure pattern. There was a relation between pattern of closure and diagnosis of velopharyngeal function (p=0.05). CONCLUSION: Most of the sample presented coronal pattern of velopharyngeal closure, followed by circular, circular with Passavant's ridge and sagittal patterns. There was no relationship between closure pattern and the variables gender, age, and cleft type, but there was a related influence to the diagnosis of velopharyngeal function