Effect of Lee Silverman Voice Treatment (LSVT LOUD®) on swallowing and cough in Parkinson's disease: A pilot study

Miles, Anna; Jardine, Marie; Johnston, Felicity; Lisle, Martin de; Friary, Philippa; Allen, Jacqui

doi:10.1016/j.jns.2017.11.015

Cited by 78 publications

(92 citation statements)

References 46 publications

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“…Even if vocal fold atrophy only plays a minor role in airway protection for patients with PD, it represents a potential therapeutic target with well‐established interventions. Behavioral therapy such as Lee Silverman Voice Therapy (LSVT LOUD) and vocal fold injection augmentation have both been utilized as treatments for dysphonia in PD and are more recently being re‐explored as potential interventions for dysphagia in PD …”

Section: Discussionmentioning

confidence: 99%

Relationship of vocal fold atrophy to swallowing safety and cough function in Parkinson's disease

et al. 2019

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Objectives When swallowing function is compromised in patients with Parkinson's disease (PD), cough plays a crucial role in clearing the airway and preventing pulmonary complications. The aim of this study was to determine the influence of vocal fold atrophy severity as measured by the bowing index (BI) on airway protection in PD. Methods Thirty participants with PD completed measures of voluntary and reflex cough. Flexible laryngoscopy with endoscopic evaluation of swallowing allowed for measurement of BI using ImageJ software. Swallowing safety was scored on the Penetration‐Aspiration Scale (PAS). Regression and receiver operating characteristic (ROC) analyses were performed to test our study aim. Results Twenty‐four of 30 participants had some degree of vocal fold atrophy (BI >0). When controlling for age, disease duration did not significantly influence BI. BI was not predictive of any sensorimotor parameters of cough including measures of cough airflow, reflex cough threshold, or urge to cough. BI discriminated participants with near‐normal (PAS 1–3) swallowing safety from participants with impaired (PAS 4–8) swallowing safety (P = .01, sensitivity: 87.0%, specificity: 71.4%, cutoff value BI >4.6). Conclusion Vocal fold atrophy is a potential factor contributing to poor swallowing safety in PD. BI was not associated with cough function in this PD cohort, contrary to prior studies that have shown improved cough measures after vocal fold augmentation. Vocal fold atrophy in PD remains an important area of study as a targetable intervention for patients with airway protective dysfunction. Future studies should include measures of glottic closure during vocal fold adduction. Level of Evidence Level 3 Laryngoscope, 130:303–308, 2020

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Section: Discussionmentioning

confidence: 99%

Relationship of vocal fold atrophy to swallowing safety and cough function in Parkinson's disease

et al. 2019

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“…However, communication and swallowing problems, together with hypomimia, are highly prevalent in PD ( 37 ). A limited number of studies with the Lee Silverman Voice Treatment showed benefits on swallowing and reduced parkinsonian hypomimia ( 38 ). Maintenance of functional communication and swallowing over time is a considerable challenge for PwP, and more technological solutions are urgently required.…”

Section: Technology-enabled Carementioning

confidence: 99%

Technology-Enabled Care: Integrating Multidisciplinary Care in Parkinson's Disease Through Digital Technology

et al. 2020

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Parkinson's disease (PD) management requires the involvement of movement disorders experts, other medical specialists, and allied health professionals. Traditionally, multispecialty care has been implemented in the form of a multidisciplinary center, with an inconsistent clinical benefit and health economic impact. With the current capabilities of digital technologies, multispecialty care can be reshaped to reach a broader community of people with PD in their home and community. Digital technologies have the potential to connect patients with the care team beyond the traditional sparse clinical visit, fostering care continuity and accessibility. For example, video conferencing systems can enable the remote delivery of multispecialty care. With big data analyses, wearable and non-wearable technologies using artificial intelligence can enable the remote assessment of patients' conditions in their natural home environment, promoting a more comprehensive clinical evaluation and empowering patients to monitor their disease. These advances have been defined as technology-enabled care (TEC). We present examples of TEC under development and describe the potential challenges to achieve a full integration of technology to address complex care needs in PD.

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“…Although the rehabilitation of swallowing disorder in PD has been performed conventionally based on the abnormal findings confirmed by objective tests such as VFSS, there is a lack of evidence on the efficacy of these rehabilitations. LSVT is widely used for vocalization and swallowing improvements and in patients with hypokinetic swallowing disorders [63]; however, its efficacy has only been reported in a few small clinical studies [64,65].…”

Section: Key Question 8: When and How Should The Swallowing Function mentioning

confidence: 99%

KSNR Clinical Consensus Statements: Rehabilitation of Patients with Parkinson's Disease

Kim

Bok

et al. 2020

Brain Neurorehabil

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• For setting the therapeutic goals for patients with Parkinson's disease (PD), rehabilitation specialist should confirm the disease diagnosis and progression of individual patients with PD. • It is recommended for clinicians to assess the motor (gait, mobility, or balance), cognition, speech and swallowing function in patients with PD and to include a barrier or facilitator (environmental or personal factors) for evaluating their function and outcomes of the interaction between health condition and those factors. • Assessment of functional status for rehabilitation in patients with PD is recommended at the time of diagnosis. Evaluation of function is recommended regularly every 3 to 6 months for patients who are receiving rehabilitation and every 6 to 12 months if not treated. • The assessments of gait and balance function in patients with PD should be done with the diagnosis of the disease, and periodic assessments as the disease progresses should be performed at least a 3-month interval. The assessments of gait and balance function in patients with PD are recommended using the Unified Parkinson's Disease Rating Scale and Berg Balance Scale near to the same time as possible during the follow-up evaluation. • To improve balance and gait in patients with PD, various rehabilitation approaches including aerobic exercise, balance exercise, aquatic exercise, dancing exercise, virtual reality, activity of daily living (ADL) training, Lee Silverman Voice Treatment (LSVT) BIG program, task-oriented occupational therapy, and self-exercise programs are needed. • Patients with PD should be evaluated regularly regarding their ADLs since the first visit of clinics especially when an evaluation of therapeutic effect or a decision of therapeutic strategies is required. • Occupational therapy is recommended for patients with PD who have limitations in ADLs. And treatment should be provided based on specific knowledge and understanding of PD with consideration of the individual needs and circumstances of the patient. • Patients with PD who are suspected of swallowing disorder or those with a high risk of swallowing disorder (excessive drooling, excessive weight loss, frequent aspiration) need

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Effect of Lee Silverman Voice Treatment (LSVT LOUD®) on swallowing and cough in Parkinson's disease: A pilot study

Cited by 78 publications

References 46 publications

Relationship of vocal fold atrophy to swallowing safety and cough function in Parkinson's disease

Relationship of vocal fold atrophy to swallowing safety and cough function in Parkinson's disease

Technology-Enabled Care: Integrating Multidisciplinary Care in Parkinson's Disease Through Digital Technology

KSNR Clinical Consensus Statements: Rehabilitation of Patients with Parkinson's Disease

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