Effects of voice rehabilitation in people with MS: A double-blinded long-term randomized controlled trial

Abstract

Background: Hypophonia is a prevailing problem in people with multiple sclerosis (PwMS). However, evidence supporting the effectiveness of voice rehabilitation is lacking. Objective: The aim of this study was to identify the most effective method to reduce hypophonia. Methods: In this randomized controlled trial, 44 PwMS were randomized to intensive and high-effort voice treatment groups, the LSVT-LOUD®, and conventional treatment group. Subjects received 16 treatments (4 sessions/week) lasting 45 minutes. The primary outcome was voice intensity (dB) in monologue, vocalization, and sentences while voice handicap index (VHI) measured voice self-perception. Outcomes were assessed by a blinded observer at baseline, post-treatment, and 15-month follow-up (FU). Results: Linear models revealed a significant post-intervention between-group mean difference in favor of LSVT-LOUD for monologue: +6.3 dB (95% CI: 2.5 to 10.1); vocalization: +7.4 dB (95% CI: 2.3 to 12.5); and sentences: +9.5 dB (95% CI: 4.7 to 14.3). However, 43.7% PwMS in the LSVT-LOUD and 10% in the conventional treatment group obtained a full recovery of voice intensity (>60 dB) post-treatment, Fisher’s test = 13.3, p < 0.01. However, these improvements were not maintained at FU. Between-group differences at VHI were −10.8 (95% CI: −21.2 to −0.4) and −11.3 (95% CI: −24.3 to −1.7) in favor of LSVT-LOUD at post and FU. Conclusion: LSVT-LOUD can be a valid treatment to increase voice intensity in PwMS. However, results suggest the need for FU interventions targeting maintenance.

Factors Associated With Treatment-Related Changes in Voice Volume in People With Multiple Sclerosis

“…In the present prospective study, we collected data from a randomized controlled trial. 19 Forty-four consecutive inpatients were recruited from January 2018 to July 2019 at IRCCS Fondazione Don Carlo Gnocchi (Milan, Italy). Details of the study are provided elsewhere.…”

“…Details of the study are provided elsewhere. 19 In brief, people with MS were randomized after completion of a baseline assessment using a randomization list and the following inclusion criteria: (1) a diagnosis of MS according to Thompson and McDonald criteria 20 ; (2) older than 18 years; (3) ability to understand the Italian language and the aims of the study; and 4) impairments in voice intensity during conversation (defined as a maximum voice intensity <60 dB SPL). 21 The exclusion criteria were: (1) the presence of other neurological disorders; (2) visual/hearing impairments that would hinder participation in the rehabilitation program;…”

The Effect of Vocal Intonation Therapy on Vocal Dysfunction in Patients With Cervical Spinal Cord Injury: A Randomized Control Trial

“…A follow up study in this area with 24 patients, found improvements in speech loudness (SPL) and maximum phonation length, supported by improved respiratory function following a therapeutic singing intervention ( Tamplin et al, 2013 ). The Perceptual Voice Profile (PVP) and Voice Handicap Index (VHI), both are subjective rating scale, are used to assess vocal function scores ( Crispiatico et al, 2021 ). The results showed that CSCI patients had low voice quality, insufficient volume in long space, insufficient breath during speech, and common social disorder problems of varying degrees in social situations.…”