Objective: Examine speech treatment outcomes in people with Parkinson’s disease (PD) across different languages to explore the plausibility of a universal speech treatment approach.

Background: The impact of sensorimotor speech deficits across different languages in people with PD has received little attention. Recently, Rusz [1] explored patterns of hypokinetic dysarthria in PD across languages to address the question of “do we need language specific management of dysarthria in PD?” He studied 146 speakers with PD across five languages (Czech, English, French, German, Italian) on a range of acoustic measures. Rusz reported that while speech patterns were language specific, the patterns of PD speech were highly consistent across different languages. The conclusion was that no language specific management of PD dysarthria may be required.

LSVT LOUD is an evidence-based speech treatment for people with PD with three RCTs documenting short and long-term improvements in vocal loudness and self-perception of speech [2-5]. There are over 25,000 speech therapists in over 60 countries trained in this treatment approach. Thus, the purpose of this study was to explore LSVT LOUD outcomes across languages to see if a universal speech treatment approach is plausible.

Method: Published studies of LSVT LOUD in 7 different languages were reviewed (Spanish, Cantonese, Japanese, Persian, German, Italian, and French) [6-12]. A comparison of acoustic, perceptual and neural imaging outcome measures was examined. Data were compared to outcomes from speakers of American English with PD.

Results: Across studies, speech outcomes were generally positive and consistent with previously published literature. For example, Spanish speakers improved speech intelligibility [6], Cantonese speakers improved loudness and intonation, but not lexical tone [7], Quebecois French speakers increased vowel space area [12] as did German speakers [10]. Persian speakers improved self-perception of voice [9] and Japanese speakers had short and long-term improvements in vocal loudness [8].

Conclusion: LSVT LOUD addresses core sensorimotor deficits in PD that underly hypokinetic dysarthria. As such, it appears that the benefits from this treatment may be “universal” regardless of language background. Prospective language comparison studies are needed to further clarify these findings.

References: [1] Rusz, J. (2019). Speech Patterns Across Multiple European Languages in Parkinson’s Disease. Presentation at the 3rd Speech and Swallowing in Parkinson’s Disease School, Prague, Czech Republic. July, 2019. [2] Ramig, L., Countryman, S., Thompson, L., & Horii, Y. (1995). A comparison of two forms of intensive speech treatment for Parkinson disease. Journal of Speech and Hearing Research, 38, 1232-1251. [3] Ramig, L., Sapir, S., Countryman, S., Pawlas, A., O’Brien, C., Hoehn, M., & Thompson, L. (2001). Intensive voice treatment (LSVT®) for patients with Parkinson’s disease: a 2 year follow up. Journal of Neurology, Neurosurgery, and Psychiatry, 71(4), 493–498. http://doi.org/10.1136/jnnp.71.4.493 [4] Ramig, L., Sapir, S., Fox, C., & Countryman, S. (2001). Changes in vocal intensity following intensive voice treatment (LSVT®) in individuals with Parkinson disease: A comparison with untreated patients and normal age-matched controls. Movement Disorders, 16, 79-83. [5] Ramig, L.O., Halpern, A., Spielman, J., Fox, C., & Freeman, K. (2018). Speech treatment in Parkinson’s Disease: Randomized Controlled Trial (RCT). Movement Disorders, 1-15. https://doi.org/10.1002/mds.27460 [6] Moya-Galé, G., Goudarzi, A., Bayés, A., McAuliffe, M., Bulté, B., & Levy, E. S. (2018). The effects of Intensive Speech Treatment on Conversational Intelligibility in Spanish Speakers with Parkinson’s Disease. American Journal of Speech-Language Pathology, 27, 154-165. doi:10.1044/2017_AJSLP-17-0032 [7] Whitehill, T. L., Kwan, L., Lee, F. P.-H., & Chow, M. M.-N. (2011). Effect of LSVT on Lexical Tone in Speakers with Parkinson’s Disease. Parkinson’s Disease, 2011, 897494. http://doi.org/10.4061/2011/897494 [8] Nakayama, K., Yanamoto, T., Oda, C., Sato, M., Murakami, T., & Horiguchi, S. (2020). Effectiveness of Lee Silverman voice Treatment LOUD on Japanese-Speaking patients with Parkinson’s Disease. Rehabilitation Research and Practice. Epub ahead of print. https://doi.org/10.1155/2020/6585264 [9] Saffarian A, Amiri Shavaki Y, Shahidi GA, Hadavi S, Jafari Z. (2019). Lee Silverman voice treatment (LSVT) mitigates voice difficulties in mild Parkinson’s disease. Medical Journal of the Islamic Republic of Iran,13. doi: 10.34171/mjiri.33.5. eCollection 2019. [10] Baumann A, Nebel A, Granert O, Giehl K, Wolff S, Schmidt W, Baasch C, Schmidt G, Witt K, Deuschl G, Hartwigsen G, Zeuner KE, van Eimeren T. (2018) Neural Correlates of Hypokinetic Dysarthria and Mechanisms of Effective Voice Treatment in Parkinson Disease. Neurorehabilitation and Neural Repair, 32(12),1055-1066. doi: 10.1177/1545968318812726. [11] Sale P, Castiglioni D, De Pandis MF, Torti M, Dall’armi V, Radicati FG, Stocchi F. (2015). The Lee Silverman Voice Treatment (LSVT®) speech therapy in progressive supranuclear palsy. European Journal of Physical and Rehabilitation Medicine, 51(5), 569-74. PMID: 26138088 [12] Sauvageau VM, Roy JP, Langlois M, Macoir J. (2015). Impact of the LSVT on vowel articulation and coarticulation in Parkinson’s disease. Clinical Linguistics & Phonetics, 29(6), 424-40. PMID: 25688915

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