Feasibility of speech telerehabilitation for a patient with Parkinson's Disease in a low-resource country during the pandemic: A case report

@#Parkinson’s disease (PD) is a chronic, neurodegenerative condition resulting in various motor impairments, including speech disorders. However, at the height of the coronavirus disease 2019 pandemic, a patient with PD could not access traditional in-person neurorehabilitation care. This case report highlights the feasibility of telerehabilitation to deliver speech therapy over a distance using available resources in a developing country. We describe a Filipino elderly woman, public speaker, and marriage counselor, seeking teleconsultation for her voice problems (slow and soft) attributed to PD. At that time, most center-based outpatient rehabilitation centers in Manila were closed due to the pandemic, and the patient preferred to stay at home for safety reasons. Hence, she was evaluated and managed remotely by an interdisciplinary team (neurologist, physiatrist, speech-language pathologist) through video calls. Since the ideal rehabilitation set up (in-person evaluation and therapy; use of Lee Silverman Voice Therapy) could not be done, the clinicians had to find practical alternatives, such as remotely administering subjective perceptual voice assessments, objective speech analysis using the Praat™ computer application, and speech teletherapy through synchronous (videocalls, phone calls) and asynchronous (e-mails, text messages, pre-recorded exercise videos) techniques. Notable speech improvements were observed by the clinicians, patient, and patient’s frequent communicative partners after at least four teletherapy sessions. However, the carry-over of the improvements was affected by the patient’s lack of compliance with the prescribed home exercise program. Telerehabilitation using synchronous and asynchronous techniques for speech disorders due to PD was found feasible, beneficial, safe, and practical amid social distancing and low resources in a developing country

Atuação fonoaudiológica na doença de Machado-Joseph: relato de caso / Effect of speech-language therapy in Machado-Joseph disease: case report

RESUMO A doença de Machado-Joseph é a forma de ataxia espinocerebelar de maior prevalência no Brasil e tem como alguns dos principais sinais clínicos a disfagia e a disartria. Este relato de caso objetivou verificar os efeitos da intervenção intensiva fonoaudiológica em um paciente com a doença de Machado-Joseph. A coleta de dados foi realizada a partir de protocolos de avaliação de fala e deglutição e protocolos de autoavaliação de qualidade de vida, em relação à deglutição e comunicação. Também foram realizadas avaliações quantitativas de parâmetros acústicos. A intervenção foi administrada por meio do método Lee Silverman, programa intensivo que visa ao aumento da intensidade vocal. A partir das avaliações clínicas e instrumentais, os resultados demonstraram melhora em todas as bases motoras de fala, respiratória, fonatória, ressonantal, articulatória e a prosódia, além da diminuição dos sinais disfágicos. Na qualidade vocal, houve diminuição de rouquidão e instabilidade, regularização de jitter e shimmer, aumento da intensidade vocal, melhora na coordenação de palavras e frases por expiração e, ainda, melhora discreta da diadococinesia. Após intervenção, a autoavaliação de qualidade de vida relacionada à deglutição apresentou valores iguais ou maiores nos domínios diretamente ligados à alimentação, porém, os domínios emocionais diminuíram. O paciente relatou satisfação em todos os domínios da qualidade de vida em voz e foram obtidos valores maiores em todos os domínios. Concluiu-se que a intervenção intensiva beneficiou o participante e impactou positivamente sua qualidade de vida.

ABSTRACT Machado-Joseph disease is the most prevalent form of spinocerebellar ataxia in Brazil, and has dysphagia and dysarthria among its main clinical signs. This case report aims to ascertain the effects of intensive speech-language intervention in a patient with Machado-Joseph disease. Data collection was performed based on speech and swallowing assessment protocols and self-assessment protocols specific to swallowing-related and communication-related quality of life. Quantitative assessments of acoustic parameters were also performed. The intervention was administered through the Lee Silverman method, which is an intensive program aimed at increasing vocal intensity. The results of clinical and instrumental evaluations showed improvement in all motor parameters of speech (respiration, phonation, resonance, articulation, and prosody), besides a reduction in dysphagic signs. Regarding vocal quality, there was a decrease in hoarseness and instability, regularization of jitter and shimmer, increased vocal intensity, and improved coordination of words and phrases by expiration, as well as slight improvement of diadochokinesis. After intervention, self-assessment of swallowing-related quality of life was unchanged or improved in the domains directly related to food, but reduced in emotional domains. The patient reported satisfaction in all domains of voice-related quality of life, and scores were increased in all domains. We conclude that intensive intervention was beneficial for the participant and positively impacted their quality of life.

Lee Silverman voice treatment can improve the speech and the life quality of patients with Parkinson'sdisease / 中华物理医学与康复杂志

Objective To explore the effect of Lee Silverman voice treatment on the speech and life quality of Parkinson's disease patients.Methods A total of 98 patients with Parkinson's disease anddifferent degrees of speech disorder (Hoehn-Yahr clinical stages 1 to 3) were randomly divided into an intervention group and a control group,each of 49,according to a random number table.The control group was given routine speech therapy covering tongue and lip movement,rhythm,sound,volume,speed and respiratory control.The intervention group was provided with 12 weeks of Lee Silverman voice treatment aimed at abnormal voice and emphasizing pronunciation,4 times a week and 1 hour each time.During the treatment,all patients were required to practice once at home on treatment days and twice on days without treatment.The voice handicap index (VHI),the western aphasia battery (WAB),the speech function portion of UPDRS-Ⅲ and the speech articulation assesstnent were used to evaluate the 2 groups before and after the 12 weeks ofintervention.Results Beforethe intervention there was no significant differencebetween the two groups in any of the measurements.After the interventionsignificant improvement was ohserved in all of these indicesin bothgroups.After treatment the average total VHI score of the intervention group (60.39±9.84) had improved significantly more than that of the control group,as did the WAB score for spontaneous speech (14.64±1.98),listening comprehension (112.67± 19.43),repeating (65.31±7.98),Name (39.89±9.84) and the average AQ scores (69.19±10.78) and UPDRS-scores [(1.39±0.61)] [of the intervention group than the control group [(71.03±11.01),(13.67±1.06),(111.53±29.61),(63.75±7.41),(37.89± 9.29),(62.14±10.21) and (1.82±0.82)].After the intervention,the average speech articulation scores of the intervention and control group were (77.61± 11.72) and (59.67± 10.04),significantly higher than those before the intervention [(54.36±10.71) and (53.98±9.92)],with the improveinent of the intervention group significantly higher than the control group.Conclusion Lee Silverman voice treatment can effectively improve the speech and life quality of patients with Parkinson's disease.