Objective: To determine whether Lee Silverman Voice Treatment (LSVT-LOUD^(R)) combined with Transcranial Magnetic Stimulation in individuals with Parkinson’s disease (PD) improves phonation to a greater extent than LSVT alone.

Background: Individuals with PD exhibit dysphonia. LSVT is a behavioral treatment for improving voice in PD. TMS is a noninvasive procedure for influencing brain activity that enhances motor learning. LSVT is typically evaluated using voice intensity (dB) as the primary outcome measure. It is also of interest to examine the impact of LSVT+TMS on acoustic voice harmonic structure (cepstral peak prominence, CPP), perceived voice quality, and voice related quality of life.

Method: Twenty-two participants with PD aged 50 – 78 years were randomized into 3  groups: Right (RTMS), Left (LTMS) and Sham (STMS). All participants exhibited hypophonia. More than mild depression or cognitive impairment were excluded. Medication schedules were maintained throughout the study. TMS was administered using 3000 pulses at the rate of 5 Hz with intensity of 80 V/m to the primary motor cortex (M1) larynx area in the LTMS and RTMS conditions, but at < 25 V/m in the STMS, determined via MRI/FMRI co-registration. STMS was applied with a plastic spacer, 30 mm thick placed between the TMS coil and subjects’ scalp. TMS was applied prior to LSVT. LSVT was administered by a LSVT certified SLP for 16 one-hour sessions. Patient were recorded on two different days at pre-treatment (tx), post-tx, and at FU in a sound treated booth for 3 trials of sustained vowel “ah”. Intensity (dB) was measured using the LSVT Companion^TM. CPP measures were obtained with Assessment of Dysphonia in Speech and Voice software. Participants rated their Voice-Related Quality of Life. Vowels were rated by two experienced voice clinicians for overall severity, breathiness, and roughness.

Results: dB, CPP, voice quality and VRQOL increased significantly from pre-to-post treatment that was maintained at FU (p < .01). Actual and Sham TMS groups were not significantly different, indicating that improvements were due to LSVT alone.

Conclusion: LSVT significantly improved voice harmonic structure, perceived voice quality, and voice related quality of life to a similar degree with or without concurrent TMS.

Previously presented at the Annual Convention of the American Speech-Language-Hearing Association, Orlando, FL. Nov 21-23, 2019.

References: 1. Awan, S.N. (2011). Analysis of Dysphonia in Speech and Voice (ADSV TM). Montvale, NJ: KayPENTAX. 2. Hogikyan, N.D., Sethuraman,G. (1999). Validation of an instrument to measure voice-related quality of life (V-RQOL) Journal of Voice, 13, 557-569. 3,Kempster, G.B., Gerratt, B.R., Verdolini Abbott, K., Barkmeier-Kraemer, J., & Hillman, R.E. (2009). Consensus auditory-perceptual evaluation of voice: Development of a standardized clinical protocol. American Journal of Speech-Language Pathology, 18, 124–132. 4. Narayana, S., Zhang, W.,Rogers, W., Strickland, C., Franklin, C., Lancaster, J.L., Fox, P.T. (2014). Concurrent TMS to the primary motor cortex augments slow motor learning. Neuroimage, 85(30), 971-984. 5.Ramig, L.O., Halpern, A., Spielman, J., Fox, C., Freeman, K. (2018). Speech treatment in Parkinson’s Disease: Randomized control trial (RCT). Movement Disorders, 16, 79-83.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-combined-modality-treatment-on-sustained-phonation-in-parkinsons-disease/