RecruitingACTRN12620000157976

Exploring the outcomes of a ‘Loud and Proud’ maintenance group following treatment for speech difficulties associated with Parkinson’s disease

Exploring the outcomes of a ‘Loud and Proud’ maintenance group following treatment for hypokinetic dysarthria associated with Parkinson’s disease

Sponsor

Bentley Health Service

Enrollment

30 participants

Start Date

Nov 1, 2023

Study Type

Interventional

Conditions

Dysarthria Dysphonia

Summary

This proposed pre-post test intervention study will investigate the effectiveness of Loud and Proud maintenance group therapy for speech difficulties associated with Parkinson's Disease. The goal of this therapy approach is to increase the loudness of someone with Parkinson's Disease's speech. This project will explore gains made by 20 participants following attendance at a maintenance group. It will also refine our understanding of factors influencing the gains following this therapy. This study will include participants who completed LSVT X (a less intensive version of LSVT LOUD) or LSVT LOUD intervention less than 2 years previously. the study will include cognitive measures to explore the influence of cognitive skills on outcomes, and offer home practice. Multiple baseline measurements will be carried out in order to determine if any improvements in speech made post-treatment are due to therapy.

Eligibility

Sex: Both males and femalesMin Age: 18 Yearss

Plain Language Summary

Simplified for easier understanding

Parkinson's disease often affects the voice, making speech quieter, less clear, and harder for others to understand. A well-established speech therapy called LSVT LOUD trains people with Parkinson's to speak louder by thinking about and practising volume. Over time, though, the gains from intensive therapy can fade. This study is looking at whether a 'Loud and Proud' maintenance group program — which people attend after completing LSVT LOUD or its less intensive version, LSVT X — can help sustain or rebuild those speech improvements. Twenty participants will attend the group sessions and researchers will track changes in speech loudness and quality over time, including how cognitive skills influence results. Multiple baseline measurements are taken to make sure any improvements are genuinely linked to the therapy. You may be eligible if you have a Parkinson's disease diagnosis, completed either LSVT LOUD or LSVT X between 6 months and 2 years ago, and are on a stable medication routine. People who cannot understand written or spoken English, have significant cognitive impairment, or have another neurological condition alongside Parkinson's are not eligible.

This is a simplified summary. Always discuss eligibility with your doctor before enrolling in a clinical trial.

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Interventions

The treatment approach with the highest level of evidence that has been found to be effective for speech and voice difficulties associated with Parkinson's Disease is the Lee Silverman Voice Technique (LSVT LOUD - an intensive therapy and LSVT X- a less intensive version) (Ramig, 2001; Ramig, Countryman, O’Brien, Hoehn, & Thompson, 1996) https://www.lsvtglobal.com/LSVTLoud in which clients are encouraged to practice "speaking loudly" in a variety of different activities e.g. with background noise, in reading, in a monologue etc.. They are taught to recalibrate their perception of how loud their voice is. Significant gains in measures of loudness and articulation have been found immediately following treatment. However, when participants were tested 2 years post treatment, loudness levels were found to have reduced significantly (Ramig, 2001; Wight & Miller, 2015). There is therefore a need for maintenance therapy following loudness therapy. One method for maintaining gains is to have a Loud and Proud group. This continues to encourage clients to "speak loudly" in a face to face group environment in activities similar to that used in LSVT LOUD and LSVT X e.g. with background noise, when reading, in a monologue, in a conversation, when calling out to a partner to get attention, when making a request to a partner etc. The effectiveness of these groups has not been explored. In the proposed study participants will attend a loud and proud group once a week for 1 hour for 8 weeks at their local hospital. The activities selected in which participants will speak loudly will be determined by the group and will target the activities the participants and their communication partners determine are challenging for them. Participants will also be given activities at home in which to practice "speaking loudly". The treatment will be delivered by a speech pathologist who has completed training in LSVT LOUD and LSVT X. An attendance checklist will be kept and participants will also complete a homework checklist. Home practice exercises will include diaphragmatic breathing, sustained phonation, speaking functional phrases in a loud voice, reading in a loud voice and conversing in a loud voice. Participants will be encouraged to practice for 30 minutes a day, 5 days a week, whilst participating in the group.