Perceptual and qualitative voice alterations detected by GIRBAS in patients with Parkinson's disease: is there a relation with lung function and oxygenation?

BACKGROUND: Impairments in respiration, voice and speech are common in people with Parkinson's disease (PD). AIMS: To evaluate the prevalence of dysphonia, assessed by a specific acoustic evaluation and description of the voice by the speech therapist (GIRBAS), and its relation with lung function and oxygenation, in particular cough ability and during the night or exercise desaturation. METHODS: This is a posthoc analysis of a prospective cross-sectional observational study on PD patients collecting anthropometric and clinical data, comorbidities, PD severity, motor function and balance, respiratory function at rest, during exercise and at night, voice function with acoustic analysis and presence of speech disorders, in addition to the GIRBAS scale. Based on GIRBAS Global dysphonia ('G') score, we divided patients into dysphonic (moderate-to-severe deviance from the euphonic condition) vs. no/mild dysphonic and analyzed the relations with respiratory impairments. RESULTS: We analyzed 55 patients and found significant impairments in both respiratory and voice/speech functions. Most patients (85.5%) presented mild-to-severe deviance from the euphonic condition in at least one GIRBAS perceptual element (80% of cases for Global dysphonia) and only 14.5% did not show deviance in all elements simultaneously. At Odds Ratio analysis, the risk of presenting nocturnal desaturation and reduced peak cough expiratory flow was approximately 24 and 8 times higher, respectively, in dysphonic patients vs. those with no/mild dysphonia. CONCLUSION: Perceptual and qualitative evaluation of the voice with GIRBAS showed that mild-to-severe dysphonia was highly prevalent in PD patients, and associated with nocturnal oxygen desaturation and poor cough ability.

Voice Alterations, Dysarthria, and Respiratory Derangements in Patients With Parkinson's Disease.

PURPOSE: Almost 90% of people with Parkinson's disease (PD) develop voice and speech disorders during the course of the disease. Ventilatory dysfunction is one of the main causes. We aimed to evaluate relationships between respiratory impairments and speech/voice changes in PD. METHOD: At Day 15 from admission, in consecutive clinically stable PD patients in a neurorehabilitation unit, we collected clinical data as follows: comorbidities, PD severity, motor function and balance, respiratory function at rest (including muscle strength and cough ability), during exercise-induced desaturation and at night, voice function (Voice Handicap Index [VHI] and acoustic analysis [Praat]), speech disorders (Robertson Dysarthria Profile [RDP]), and postural abnormalities. Based on an arbitrary RDP cutoff, two groups with different dysarthria degree were identified-moderate-severe versus no-mild dysarthria-and compared. RESULTS: Of 55 patients analyzed (median value Unified Parkinson's Disease Rating Scale Part II 9 and Part III 17), we found significant impairments in inspiratory and expiratory muscle pressure (> 90%, both), exercise tolerance at 6-min walking distance (96%), nocturnal (12.7%) and exercise-induced (21.8%) desaturation, VHI (34%), and Praat Shimmer% (89%). Patients with moderate-severe dysarthria (16% of total sample) had more comorbidities/disabilities and worse respiratory pattern and postural abnormalities (camptocormia) than those with no-mild dysarthria. Moreover, the risk of presenting nocturnal desaturation, reduced peak expiratory flow, and cough ability was about 11, 13, and 8 times higher in the moderate-severe group. CONCLUSIONS: Dysarthria and respiratory dysfunction are closely associated in PD patients, particularly nocturnal desaturation and reduced cough ability. In addition, postural condition could be at the base of both respiratory and voice impairments. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21210944.

The Italian validation of the Communicative Effectiveness Index Questionnaire: a multicentric study.

INTRODUCTION: Common assessment tools for aphasia evaluate single language impairments but not their functional impact on patient's communication skills in daily life. The lack of tools focused on ecological aspects might affect the choice of rehabilitative trainings. The Communicative Effectiveness Index (CETI) represents an attempt to assess the communicative abilities in "ecologic" context. This study aimed to explore psychometrics properties of the Italian translation and adaptation of CETI (I-CETI). METHODS: Sixty-eight patients with aphasia due to left hemispheric stroke admitted to post-acute rehabilitation units and their relatives were included in the study. Data were collected in three different sessions. At study entry, patients were assessed for language, depression, and functional abilities, while their caregivers and speech therapists independently completed the I-CETI to assess inter-rater agreement (baseline). One week later, caregivers and speech therapists completed again I-CETI, to assess test-retest reliability (T1). Last, at discharge, patients completed again the evaluation protocol, and caregivers and speech therapists completed I-CETI (T2). RESULTS: I-CETI showed high internal validity, excellent reliability, and good correlation between scores obtained by speech therapists and caregivers. Moreover, scores of I-CETI had quite good correlations with a traditional tool to assess language, and with measures of functional independence both at study entry and at discharge. DISCUSSION: I-CETI showed good psychometric proprieties. These results allowed considering I-CETI as a reliable tool to assess effects of speech treatments on the communicative abilities in patients with aphasia. Furthermore, I-CETI might help clinicians to develop treatments more tailored on the "ecologic" difficulties of patients.