Objective: This study evaluated the impact of voice treatment (LSVT LOUD) and articulation treatment (LSVT ARTIC) on voice quality in Parkinson’s disease (PD) measured by the Acoustic Voice Quality Index (AVQI) immediately post-treatment and at six month follow-up. These data were compared to untreated controls with PD (UNTXPD) and untreated healthy controls (HC).

Background: Poor voice quality, imprecise articulation and the hallmark sign of decreased vocal loudness are commonly observed in PD. The current standard treatment is LSVT LOUD. While LSVT LOUD has been demonstrated to improve vocal loudness and articulation, its impact on objective measures of voice quality has not been established.

Methods: Eighty-five individuals participated in this study: 65 with mild-moderate PD randomized to three groups (LSVT LOUD, LSVT ARTIC, and UNTXPD), and 20 age- and gender-matched controls (HC). Acoustic data were collected in a sound-treated booth while the subjects read and sustained phonation for subsequent analysis by AVQI. Treatments were: LSVT LOUD or LSVT ARTIC which mirrored LSVT LOUD in all aspects but with a focus on articulatory effort and precision.

Results: At baseline, AVQI did not differ significantly among the PD groups or between the combined PD (2.57) and HC (2.16). Values above 2.43 have been shown to indicate dysphonia. At post and follow-up, the LSVT LOUD group demonstrated a significant change from baseline (pre = 2.47, post = 1.02, fu = 1.47; p < 0.0001). The pre to post-treatment change for the LSVT ARTIC group was not significant (pre = 3.06, post = 2.77; p = 0.1306), the pre to follow-up was significant (pre = 3.06, fu = 2.70; p = 0.0480). The LSVT LOUD group was significantly different from both the LSVT ARTIC and UNTXPD groups at post and follow-up. There was no significant difference between the LSVT ARTIC and UNTXPD groups at post and follow-up, and no significant changes within the UNTXPD group.

Conclusions: LSVT LOUD can improve voice quality on an objective measure of dysphonia severity, the Acoustic Voice Quality Index. Voice quality changes were both immediate (post) and lasting (after 6 months) for the LSVT LOUD group, and significantly different from the groups receiving intensive articulation treatment (LSVT ARTIC) and no treatment (UNTXPD). NIH-NIDCD R01 DC1150. These data were presented at the American Speech Language Hearing Association Convention in 2017.

References: Barsties B, and Maryn Y. External Validation of the Acoustic Voice Quality Index Version 03.01 With Extended Representativity. Ann Otol Rhinol Laryngol. 2016 Jul;125(7):571-83. Sapir S, Ramig LO, Fox CM. Intensive voice treatment in Parkinson’s disease: Lee Silverman Voice Treatment. Expert Rev Neurother. 2011 Jun;11(6):815-30.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-intensive-voice-and-articulation-treatments-on-voice-quality-in-parkinsons-disease/