Effect of Conventional Speech Therapy Combined with Music Therapy on Swallowing in Patients with Parkinson's Disease (Telerehabilitation): A Randomized-Controlled Trial

Abstract

Background: Swallowing difficulties or dysphagia is the main cause of aspiration pneumonia and death in patients with Parkinson's disease (PD). Although dysphasia occurs in 90% of patients with PD, there is insufficient evidence to support the effectiveness of behavioral speech therapy in this disease. Objectives: This study aimed to investigate the effect of a new telerehabilitation program that was a combination of speech and music therapy on dysphagia in patients with PD. Methods: This study was a 3-arm randomized controlled trial (RCT). Thirty-three subjects with PD (mean age, 58.88 years; 25 men and 8 women with complaints of swallowing problems) were randomly assigned to the combination therapy (including breathing, speech, voice, and singing exercises), conventional speech therapy, and music therapy groups. Each patient participated in 12 telerehabilitation sessions over 4 weeks. Swallowing Disturbance Questionnaire (SDQ) and Dysphagia Handicap Index (DHI), as the outcomes of this study, were evaluated 1 week before the first intervention session, 1 week after the last intervention session, and 3 months after the last evaluation. Results: The results showed a significant improvement in SDQ and all sub-tests (functional, physical, and emotional), as well as the total score of DHI in the combination therapy and conventional speech therapy groups after treatment (P < 0.05). Also, the music therapy group had a significant improvement in the SDQ score, emotional sub-test, and the total score of DHI (P < 0.05). The combination therapy group demonstrated a significant outperform in the SDQ score compared to the other 2 groups, as well as in all sub-tests and the total score of DHI compared to the music therapy group (P < 0.05). The combination therapy group also showed more improvement in all sub-tests, as well as the total score of DHI, compared to the music therapy group (P < 0.05). The results also indicated that the speech therapy group had a more significant effect on the physical sub-test of DHI compared to the music therapy group (P < 0.05). Conclusions: Although swallowing function improved in all 3 groups, this improvement was more in the combination therapy group than in the other groups. Therefore, it can be concluded that combination therapy has the potential to provide additional benefits for swallowing efficiency in this patient group. The results also suggest that the telerehabilitation method is feasible to deliver intensive therapy to individuals with PD to improve swallowing functions.

ParkinSong Online: Feasibility of Telehealth Delivery and Remote Data Collection for a Therapeutic Group Singing Study in Parkinson’s

“…Our feasibility results are consistent with other recent studies 23 , 25 indicating that therapeutic singing interventions can be delivered remotely to increase accessibility for people with Parkinson’s. The differences in intervention effect can possibly be explained by the various delivery methods.…”

“…The differences in intervention effect can possibly be explained by the various delivery methods. The Mohseni study 25 used an individual intervention and was thus not limited by latency. Facilitators could hear participants and provide targeted feedback, however, a critique for this approach is that individual therapy is less cost effective than group therapy.…”

“…24 Another small randomized trial reported a reduction in dysphagia symptoms following a combined singing and speech therapy program for 35 individuals with Parkinson's delivered via telehealth. 25 Recent surveys have shown that many different formats for online choirs were used during the COVID-19 pandemic and that similar themes emerged for therapeutic and nontherapeutic choirs alike, particularly surrounding technology issues. 26,27 The primary limitation for online group singing is latency, or lag time, necessitating the use of the mute function while participants sing along with a facilitator.…”

“… 24 Another small randomized trial reported a reduction in dysphagia symptoms following a combined singing and speech therapy program for 35 individuals with Parkinson’s delivered via telehealth. 25 …”

Voice disorders in persons with Parkinson's disease: Characteristics, assessment, and treatment

“…Parametri koji su procenjivani pre i nakon tretmana jesu intenzitet glasa, maksimalni opseg fonacije i džiter. Rezultati su pokazali da su sve tri grupe imale pozitivna postignuća, ali je grupa koja je imala kombinovanu terapiju pokazala značajno bolje rezultate u odnosu na druge dve grupe, pogotovo u intenzitetu glasa i maksimalnom opsegu fonacije (42). Di Benedeto i sad.…”