Intensive Voice Therapy Outperforms Standard Therapy for Parkinson’s Patients

Learn about a treatment that can help Parkinson’s patients regain their voice.

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Nine out of 10 Parkinson’s patients risk losing their voice, but a new United Kingdom study offers hope.

Researchers at the University of Birmingham found that an intensive voice treatment called Lee Silverman voice treatment (LSVT) LOUD outperformed standard therapy in maintaining speaking ability.

Challenge to Conventional Speech Therapy

The University of Birmingham conducted a trial from September 2016 to March 2020 that involved 388 Parkinson’s patients with dysarthria (difficulty speaking due to weak speech muscles).

Researchers divided participants into three groups: people who received LSVT LOUD treatment, those who underwent conventional UK National Health Service (NHS) therapy, and those who received no treatment. (LSVT LOUD, developed in the United States in the late 1980s, uses LSVT LOUD voice exercises to help patients project their voices at a more normal volume.)

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LSVT LOUD training comprised 16 remote sessions over four weeks, including home-based practice. “This structure ensures that patients receive consistent and focused practice, which is essential for creating lasting changes,” Dr. Jonathan J. Rasouli, a neurosurgeon at Northwell Staten Island University Hospital in New York, told The Epoch Times. This method is highly regarded in Parkinson’s speech therapy, he added.

In contrast, NHS therapy provided speech and language therapy with local therapists, averaging one session every other week over 11 weeks.

Three months into the randomized trial, LSVT LOUD proved more effective at reducing patients’ voice handicap index scores than NHS therapy and no treatment, according to the findings published in the British Medical Journal (BMJ). The index quantifies patients’ self-assessed vocal impairment through a nine-item questionnaire, with scores ranging from zero to 36.

The LSVT LOUD group’s score decreased by eight points, while the NHS treatment and no treatment groups both showed a 1.7-point reduction. “NHS speech and language therapy showed no evidence of benefit compared with no speech and language therapy,” the study authors wrote.

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LSVT LOUD therapy showed “significant benefits” in emotional and functional areas, while NHS therapy showed no measurable advantage over no treatment at all.

Researchers recorded 28 percent nonserious adverse events in the LSVT LOUD group and 12 percent in the NHS therapy group, primarily involving vocal strain.

Parkinson’s Cripples Communication

Parkinson’s disease, the world’s fastest-growing neurological disorder and second-most prevalent brain disease in the United States, impairs muscle control, affecting the complex interplay of facial, oral, throat, and chest muscles used for speaking and swallowing. The condition puts 90 percent of patients at risk of losing their ability to speak. Swallowing complications are a leading cause of death in this population.

Voice changes in Parkinson’s can occur at various stages, often becoming noticeable in mid-to-late stages, Rasouli said. These changes may include softer voice (hypophonia), monotone speech, reduced pitch range, and slurred speech.

Treatment typically involves speech therapy, medications, and sometimes surgical interventions.

One Treatment Doesn’t Fit All: Expert

It is important to consider how success is defined and to identify who benefits most when evaluating speech therapy effectiveness for Parkinson’s patients, Ciara Leydon-Korn, chair of the Department of Communication Disorders and director of the graduate program in speech-language pathology at Sacred Heart University, told The Epoch Times.

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Research studies measure success differently. The UK study focused on patients’ perceptions of how voice problems affect their quality of life, while other studies measure improvements in loudness, voice quality, or speech clarity.

Therapy may vary in effectiveness among people with Parkinson’s, Leydon-Korn said.

“One reason for this is that speaking is complicated,” she added. Speaking involves both muscle movements and cognitive processes, making it complex. Parkinson’s affects both motor and nonmotor symptoms, with varying severity across patients. This variability necessitates tailored treatment plans that consider all symptoms, she noted.

While the UK study is “a helpful addition to [the] literature,” according to Leydon-Korn, its small size calls for larger, more rigorous studies, including comprehensive research involving many patients to help identify the most effective therapy approaches, treatment aspects, and expected benefits.