<p>Voice treatment in Parkinson’s disease: patient perspectives</p>

Abstract

Speech and voice changes are a central feature of the symptom complex of people with Parkinson's disease (pwPD). Speaking is a social activity involving the pwPD, family, and the wider communicative context. Sensory-motor, cognitive-linguistic, and affective changes in Parkinson's disease (PD) combine to alter communication, impacting on psychosocial quality-of-life, leading to risks of social withdrawal and increased depression and anxiety. The underlying pathophysiology of speech, voice, and communication difficulties in pwPD is multi-factorial and complex. Sensory-motor changes in the respiratory, phonatory, and articulatory subsystems, underscaling of effort, and central processing problems are further affected by broader cognitive-linguistic difficulties, and non-speech motor deficits. Many studies show that, when pwPD are asked to rate their own voice and how it functions in everyday situations, they show increased voice-related disability and negative impact relative to healthy controls. Voice treatment is integral to improving communication in pwPD. Studies show positive benefits from the perspective of pwPD and carers. Treatment approaches vary from one-to-one to group interventions, a singular focus on increasing loudness to more general voice exercises, and choral singing. The nature and underlying pathophysiology of speech, voice, and communication changes in pwPD are reviewed before exploring the effects of voice treatment programs and pwPD and carer perceptions of their effect. Larger scale, better powered, controlled trials of intervention for voice and speech that measure clinically and socially relevant outcomes are finally underway. Future research should also focus on issues of treatment compliance, practicality (for service delivery and use), and long-term follow-up outcomes. The role of carers in longer-term maintenance represents a further important area of exploration.

How does prosodic deficit impact naïve listeners recognition of emotion? An analysis with speakers affected by Parkinson’s disease

“…The judgments by naïve listeners about expressiveness, ability to discriminate, and perceived communicative effectiveness showed a significant difference between HC participants, whose utterances achieved the highest scores, he PD+ participants, and finally he PD− participants. This data is fully consistent with previous research on this topic, highlighting the speech of PD patients as largely intelligible and ineffective in terms of expressive and communicative competence (Dykstra et al, 2015;Gillivan-Murphy et al, 2019). In this sense, HC subjects were perceived to be more expressive, precise, and effective in communicating emotions than PD+ patients, and considerably more so than PD− patients.…”

“…This data demonstrates how PD can result in a significant impairment in communicative processes. In particular, these impairments harm the ability to express emotions in a competent and effective way, thus increasing the risk of relational and social barriers from both the perspective of the patient and that of their conversational partners, which can exacerbate the patient's withdrawal from the relational and social dimension (Gillivan-Murphy et al, 2019;Miller, 2017). Measuring expressiveness added some meaningful data to the results from the emotion recognition task.…”

“…It has been suggested that, while having the capacity to produce the same sentences, speakers with PD are perceived to be less "intense" by naïve listeners during a spontaneous language generation task (Blonder et al, 1989). Previous studies also suggest a possible distorted perception of their own vocal abilities by the patients themselves (Kwan & Whitehill, 2011) and their frustrations in failing to convey their affective intentions (Gillivan-Murphy et al, 2019). Collectively, these findings consolidate that "disprosody is intrinsic to Idiopathic Parkinson's disease" (Darkins et al,1988) and that this phenomenon could act as a serious relational and social barrier for these individuals.…”

Attitudes Toward the Use of Voice-Assisted Technologies Among People With Parkinson Disease: Findings From a Web-Based Survey

“…It is interesting to consider the possibility that speech improvements reported by participants were experienced beyond the voice interaction with VAT. It is widely recognized that there are problems for people with Parkinson disease with maintenance and generalization of speech improvements from therapy tasks into everyday contexts [ 34 ]. The potential for VAT to improve social participation warrants further investigation.…”

Self-perceptions of speech, voice, and swallowing in motor phenotypes of Parkinson's disease

“…Results from this study are not in agreement with previous reports, which have indicated that PWPD demonstrated an impaired ability to consistently perceive and identify communication and swallow impairment. Rationale for that impairment was associated with changes to both central and peripheral sensorimotor feedback loops [ 23 , 24 ]. However, we found that a set of questionnaires with questions specific to communication (speech and voice) and swallowing function increased the likelihood that participants would be able to identify impairments…”