Objective: The aim of the study was to determine how patients with essential tremor (ET) evaluate the functional, physical and emotional effects of VIM-DBS on their speech in everyday life. In order to classify these effects relating to ICF (International Classification of Functioning, Disability and Health) the voice handicap index (VHI) was applied. Speech motor skills were additionally assessed by means of the AMDNS in the DBS-ON and -OFF conditions.

Background: Logopedic rehabilitation in Germany is increasingly based on ICF. As a fundamental part of the study, the VHI was used in order to test whether the VHI is suitable to investigate the effects of stimulation induced dysarthria on daily living activities and social participation according to ICF.

Methods: Nine German patients with essential tremor (2 female, 7 male) between 31 and 73 years participated in the study. Besides neurological and phonetic analysis, logopedic data were collected by means of the AMDNS. Data analysis in this test is based on objective measurements and norm data allowing for differences with and without stimulation, as well as deviation from norm data. In addition, patients were asked to complete the VHI in the ON condition as this is the everyday life situation for the patience after DBS implantation. The VHI includes 30 questions, 10 each in the categories: functional, physical, emotional.

Results: Results refer to the 3 VHI categories. Patients reported most difficulties in the physical effects of DBS on their speech. DBS induces a greater effort to speak in 6 out of 9 patients. Functional items of the VHI identified high scores in terms of intelligibility in patients’ speech. Due to DBS induced speech deterioration, most of the patients feel handicapped and tense (emotional items). Results from the AMDNS data focus on respiration and other speech-related motor skills. For sustained vowels and fricatives, results are nearly 100% homogeneous across speakers and conditions. Except for one speaker, none of the patients reached the norm duration of sustained vowels in either DBS condition. Analysis of voiceless fricatives revealed better speech motor performance.

Conclusions: The VHI seems suitable for identifying speech impairment according to ICF. This perspective is a meaningful complement to phonetic and logopedic analysis. The aspect of the increased effort to speak caused by stimulation should be explored in more detail.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/icf-based-effects-of-vim-dbs-on-communication-in-everyday-life-in-patients-with-essential-tremor/