Voice disorders in persons with Parkinson's disease: characteristics, assessment and treatment
Keywords:
Parkinson's disease, voice disorders, voice assessment, voice treatment
Abstract
Parkinson's disease is a progressive neurodegenerative disease that is primarily manifested by impairment of motor skills and speech. Although voice disorders characterize the speech of people with Parkinson's disease, they are still not sufficiently clarified from a clinical point of view. With that in mind, the aim of this paper is to present the characteristics of the voice in Parkinson's disease, as well as assessment and treatment methods, based on a review of the available literature.
The search of relevant literature was performed on the basis of databases of scientific research works PubMed, KoBSON, Science Direct, Google Scholar, as well as works available in paper version. Papers published from 2000 until today dedicated to voice disorders in people with Parkinson's disease were analyzed.
The results show that voice disorders occur within the clinical picture of Parkinson's disease and that the symptoms progress with the progression of the disease. The basic characteristics of the voice are monotony, hypophonic and hoarseness. Due to the great impact of voice disorders on speech intelligibility, different methods of speech therapy are used in the treatment of these patients. Lee Silverman's method is the best known and most effective method of phonation and respiration rehabilitation in people with Parkinson's disease.
Based on a review and analysis of the available literature, it is evident that vioice disorders are one of the significant simptoms of this disease, and that speech therapy assessment and voice treatent is an essential element of the rehabilitation of these people.
References
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24. Chiaramonte R, Bonfiglio M. Acoustic analysis of voice in Parkinson's disease: a systematic review of voice disability and meta-analysis of studies. Revista de Neurologia, 2020; 11, 393-405. DOI: 10.33588/rn.7011.2019414
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27. Ali AM, Salim F, Saeed F. Parkinson's Disease Detection Using Filter Feature Selection and a Genetic Algorithm with Ensemble Learning. Diagnostics (Basel, Switzerland), 2023; 13(17), 2816. https://doi.org/10.3390/diagnostics13172816
28. Gillivan-Murphy P, Miller N, Carding P. Voice treatment in Parkinson’s disease: patient perspectives. Research and Reviews in Parkinsonism, 2019; 9, 29-42, DOI: 10.2147/JPRLS.S180183
29. Searl J, Dietsch MA. Daily Phonatory Activity of Individuals With Parkinson's Disease. Journal of Voice, 2021; S0892 – 1997(21) https://doi.org/10.1016/j.jvoice.2021.10.004
30. Fox MC, Morrison EC, Ramig OL, Sapir S. Current Perspectives on the Lee Silverman Voice Treatment (LSVT) for Individuals With Idiopathic Parkinson Disease. American Journal of Speech- Language Pathology, 2002; 11(2), 111-123. https://doi.org/10.1044/1058-0360(2002/012)
31. Jovanović Simić N, Arsenić I, Veljković Z. Logopedski tretman osoba saprogresivnom dizartrijom. Nacionalni naučni skup: " Obrazovanje i rehabilitacija odraslih osoba sa smetnjama u razvoju i problemima u ponašanju ", Srbija, 2022; 121-131.
32. Suppa A, Asci F, Costantini G, Bove F, Piano C, et al. Effects of deep brain stimulation of the subthalamic nucleus on patients with Parkinson's disease: a machine-learning voice analysis. Frontiers in neurology, 2023; 14, 1267360. https://doi.org/10.3389/fneur.2023.1267360
33. Lee JM, Pak K. Comparison of UPDRS III score between young and late onset Parkinson disease after deep brain stimulation: A meta-analysis. Medicine, 2023; 102(44), e35861. https://doi.org/10.1097/MD.0000000000035861
34. Antonsson M, Johansson K, Bonde Dalemo A, Ivehorn Axelsson C, Burge Å, Lesueur U, Hartelius L. Effect of expiratory muscle strength training on voice and speech: An exploratory study in persons with Parkinson's disease or multiple sclerosis. International journal of speech-language pathology, 2023; 1–18. https://doi.org/10.1080/17549507.2023.2243402
35. Reyes A, Castillo A, Castillo J, Cornejo I, Cruickshank T. The Effects of Respiratory Muscle Training on Phonatory Measures in Individuals with Parkinson's Disease. Journal of voice : official journal of the Voice Foundation, 2020; 34(6), 894–902. https://doi.org/10.1016/j.jvoice.2019.05.001
36. Marchese MR, Proietti I, Longobardi Y, Mari G, Ausili Cefaro C, D'Alatri L. Multidimensional voice assessment after Lee Silverman Voice Therapy (LSVT®) in Parkinson's disease. Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale, 2022; 42(4), 348–354. https://doi.org/10.14639/0392-100X-N1962
37. Ghadah GA, Michael PC, Eugene HB, Shaheen NA. Spectral/Cepstral Analyses of Phonation in Parkinson’s Disease before and after Voice Treatment: A Preliminary Study. Folia Phoniatr Logop, 2019; 71(5-6): 275–285. https://doi.org/10.1159/000495837
38. Mahler AL, Ramig OL, Fox C. Evidence-based treatment of voice and speech disorders in Parkinson disease. Current Opinion in Otolaryngology & Head and Neck Surgery, 2015; 23(3), 209-215. doi: 10.1097/MOO.0000000000000151
39. Ramig LO, Sapir S, Countryman S, et al. Intensive voice treatment (LSVT) for patients with Parkinson's disease: a 2 year follow up. Journal of Neurology, Neurosurgery & Psychiatry, 2001; 71, 493-498. http://dx.doi.org/10.1136/jnnp.71.4.493
40. Spielman JL, Borod JC, Ramig LO. The Effects of Intensive Voice Treatment on Facial Expressiveness in Parkinson Disease: Preliminary Data. Cognitive and Behavioral Neurology, 2003; 16(3), 177-188. https://doi.org/10.1097/00146965-200309000-00005
41. de Swart BJ, Willemse SC, Maassen BA, Horstink MW. Improvement of voicing in patients with Parkinson's disease by speech therapy. Neurology, 2003; 60(3), 498–500. https://doi.org/10.1212/01.wnl.0000044480.95458.56
42. Mohseni Z, Mohamadi R, Habibi SAH, Saffarian A, Abolghasemi J. Voice improvement following conventional speech therapy combined with singing intervention in people with Parkinson's disease: A three-arm randomised controlled trial. International journal of language & communication disorders, 2023; 58(5), 1752–1767. https://doi.org/10.1111/1460-6984.12900
43. Di Benedetto P, Cavazzon M, Mondolo F, Rugiu G, Peratoner A, Biasutti E. Voice and choral singing treatment: a new approach for speech and voice disorders in Parkinson's disease. European journal of physical and rehabilitation medicine, 2009; 45(1), 13–19
44. Chang HJ, Kim J, Joo JY, Kim HJ. Feasibility and efficacy of video-call speech therapy in patients with Parkinson's disease: A preliminary study. Parkinsonism & related disorders, 2023; 114, 105772. https://doi.org/10.1016/j.parkreldis.2023.105772
45. Constantinescu G, Theodoros D, Russell T, Ward E, Wilson S, Wootton R. Treating disordered speech and voice in Parkinson's disease online: a randomized controlled non-inferiority trial. International journal of language & communication disorders, 2011; 46(1), 1–16. https://doi.org/10.3109/13682822.2010.484848
2. Tysnes O-B, Storstein A. Epidemiology of Parkinson’s disease. Journal of Neural Transmission, 2017; 124(8), 901-905. https://doi.org/10.1007/s00702-017-1686-y
3. Balestino R, Schapira AHV. Parkinson disease. European Journal of Neurology, 2019; 27(1). 27-42. https://doi.org/10.1111/ene.14108
4. Vuković M. Afaziologija (peto dopunjeno izdanje). Planeta print, 2019a.
5. Vuković M. Neurodegenerativni poremećaji govora i jezika. Planeta print, 2019b.
6. Petrović – Lazić M, Kosanović R. Vokalna rehabilitacija glasa. Nova naučna, 2008; 33-34.
7. Manes JL, Kurani AS, Herschel E, et al. Premotor cortex is hypoactive during sustained vowel production in individuals with Parkinson's disease and hypophonia. Frontiers in human neuroscience, 2023; 17, 1250114. https://doi.org/10.3389/fnhum.2023.1250114
8. Atalar MS, Oguz O, Genc G. Hypokinetic Dysarthria in Parkinson's Disease: A Narrative Review. Sisli Etfal Hastanesi tip bulteni, 2023; 57(2), 163–170. https://doi.org/10.14744/SEMB.2023.29560
9. Petrović – Lazić M, Babac S, Vasić M. Rezonatori glasa. Nova naučna. 2012; 97-99.
10. Huber JE, Darling-White M. Longitudinal Changes in Speech Breathing in Older Adults with and without Parkinson's Disease. Seminars in speech and language, 2017; 38(3), 200–209. https://doi.org/10.1055/s-0037-1602839
11. Ma A, Lau KK, Thyagarajan D. Radiological correlates of vocal fold bowing as markers of Parkinson's disease progression: A cross-sectional study utilizing dynamic laryngeal CT. PloS one, 2021; 16(10), e0258786. https://doi.org/10.1371/journal.pone.0258786
12. Blumin JH, Pcolinsky DE, Atkins JP. Laryngeal Findings in Advanced Parkinson’s Disease. Annals of Otology, Rhinology & Laryngology, 2004; 113(4), 253-258. doi:10.1177/000348940411300401
13. Ma A, Lau KK, Thyagarajan D. Voice changes in Parkinson’s disease: What are they telling us?. Journal of Clinical Neuroscience, 2020; 72, 1-7. https://doi.org/10.1016/j.jocn.2019.12.029
14. Jovanović Simić N, Arsenić I, Petrović Lazić M, Šehović I, Drljan B. Samoprocena kvaliteta komunikacije osoba sa Parkisonovom bolešću. Nacionalni naučni skup: „Metode procene u specijalnoj edukaciji i rehabilitaciji”, Srbija, 2018; 133-142.
15. Thijs Z, Dumican M. Laryngeal symptoms related to motor phenotypes in Parkinson's disease: A systematic review. Laryngoscope investigative otolaryngology, 2023; 8(4), 970–979. https://doi.org/10.1002/lio2.1112
16. Midi I, Dogan M, Koesoglu M, Can G, Sehitoglu AM, Gunal I. D. Voice abnormalities and their relation with motor dysfunction in Parkinson’s disease. Acta Neurologica Scandinavica, 2007; 117(1), 26-34. https://doi.org/10.1111/j.1600-0404.2007.00965.x
17. Majdinasab F, Karkeheiran S, Soltani M, Moradi N, Shahdi G. Relationship Between Voice and Motor Disabilities of Parkinson's Disease. Journal of Voice, 2016; 30(6), 768. https://doi.org/10.1016/j.jvoice.2015.10.022
18. Suppa A, Costantini G, Gomez-Vilda P, Saggio G. Editorial: Voice analysis in healthy subjects and patients with neurologic disorders. Frontiers in neurology, 2023; 14, 1288370. https://doi.org/10.3389/fneur.2023.1288370
19. Vuković M, Jerkić L. Kognitivni i jezički deficiti kod osoba sa Parkinsonovom bolešču. Specijalna edukacija i rehabiliatcija, 2021; 20(3), 203-218.
20. Holmes JR, Oates MJ, Phyland JD, Hughes JA. Voice characteristics in the progression of Parkinson's disease. International Journal of Language & Communication Disorders, 2010; 35(3). 407- 418 https://doi.org/10.1080/136828200410654
21. Ikui Y, Nakamura H, Sano D, et al. An Aerodynamic Study of Phonations in Patients With Parkinson Disease (PD). Journal of voice : official journal of the Voice Foundation, 2015; 29(3), 273–280. https://doi.org/10.1016/j.jvoice.2014.08.012
22. Skibińska J, Hosek J. Computerized analysis of hypomimia and hypokinetic dysarthria for improved diagnosis of Parkinson's disease. Heliyon, 2023; 9(11), e21175. https://doi.org/10.1016/j.heliyon.2023.e21175
23. Arsenić I, Jovanović Simić N, Petrović Lazić M, Šehović I. Prisustvo tretmora u glasu odraslih osoba sa hipokinetičkom dizartrijom. 10. Međunarodni naučni skup „Specijalna edukacija i rehabilitacija danas“, Srbija, 2019; 187-193.
24. Chiaramonte R, Bonfiglio M. Acoustic analysis of voice in Parkinson's disease: a systematic review of voice disability and meta-analysis of studies. Revista de Neurologia, 2020; 11, 393-405. DOI: 10.33588/rn.7011.2019414
25. Kowalska – Tacyanowska R, Friedman A, Koyiorowski D. Parkinson's disease or atypical parkinsonism? The importance of acoustic voice analysis in differential diagnosis of speech disorders. Brain and Behavior, 2020; 10(8). https://doi.org/10.1002/brb3.1700
26. Ghaheri P, Nasiri H, Shateri A, Homafar A. Diagnosis of Parkinson's disease based on voice signals using SHAP and hard voting ensemble method. Computer methods in biomechanics and biomedical engineering, 2023; 1–17. Advance online publication. https://doi.org/10.1080/10255842.2023.2263125
27. Ali AM, Salim F, Saeed F. Parkinson's Disease Detection Using Filter Feature Selection and a Genetic Algorithm with Ensemble Learning. Diagnostics (Basel, Switzerland), 2023; 13(17), 2816. https://doi.org/10.3390/diagnostics13172816
28. Gillivan-Murphy P, Miller N, Carding P. Voice treatment in Parkinson’s disease: patient perspectives. Research and Reviews in Parkinsonism, 2019; 9, 29-42, DOI: 10.2147/JPRLS.S180183
29. Searl J, Dietsch MA. Daily Phonatory Activity of Individuals With Parkinson's Disease. Journal of Voice, 2021; S0892 – 1997(21) https://doi.org/10.1016/j.jvoice.2021.10.004
30. Fox MC, Morrison EC, Ramig OL, Sapir S. Current Perspectives on the Lee Silverman Voice Treatment (LSVT) for Individuals With Idiopathic Parkinson Disease. American Journal of Speech- Language Pathology, 2002; 11(2), 111-123. https://doi.org/10.1044/1058-0360(2002/012)
31. Jovanović Simić N, Arsenić I, Veljković Z. Logopedski tretman osoba saprogresivnom dizartrijom. Nacionalni naučni skup: " Obrazovanje i rehabilitacija odraslih osoba sa smetnjama u razvoju i problemima u ponašanju ", Srbija, 2022; 121-131.
32. Suppa A, Asci F, Costantini G, Bove F, Piano C, et al. Effects of deep brain stimulation of the subthalamic nucleus on patients with Parkinson's disease: a machine-learning voice analysis. Frontiers in neurology, 2023; 14, 1267360. https://doi.org/10.3389/fneur.2023.1267360
33. Lee JM, Pak K. Comparison of UPDRS III score between young and late onset Parkinson disease after deep brain stimulation: A meta-analysis. Medicine, 2023; 102(44), e35861. https://doi.org/10.1097/MD.0000000000035861
34. Antonsson M, Johansson K, Bonde Dalemo A, Ivehorn Axelsson C, Burge Å, Lesueur U, Hartelius L. Effect of expiratory muscle strength training on voice and speech: An exploratory study in persons with Parkinson's disease or multiple sclerosis. International journal of speech-language pathology, 2023; 1–18. https://doi.org/10.1080/17549507.2023.2243402
35. Reyes A, Castillo A, Castillo J, Cornejo I, Cruickshank T. The Effects of Respiratory Muscle Training on Phonatory Measures in Individuals with Parkinson's Disease. Journal of voice : official journal of the Voice Foundation, 2020; 34(6), 894–902. https://doi.org/10.1016/j.jvoice.2019.05.001
36. Marchese MR, Proietti I, Longobardi Y, Mari G, Ausili Cefaro C, D'Alatri L. Multidimensional voice assessment after Lee Silverman Voice Therapy (LSVT®) in Parkinson's disease. Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale, 2022; 42(4), 348–354. https://doi.org/10.14639/0392-100X-N1962
37. Ghadah GA, Michael PC, Eugene HB, Shaheen NA. Spectral/Cepstral Analyses of Phonation in Parkinson’s Disease before and after Voice Treatment: A Preliminary Study. Folia Phoniatr Logop, 2019; 71(5-6): 275–285. https://doi.org/10.1159/000495837
38. Mahler AL, Ramig OL, Fox C. Evidence-based treatment of voice and speech disorders in Parkinson disease. Current Opinion in Otolaryngology & Head and Neck Surgery, 2015; 23(3), 209-215. doi: 10.1097/MOO.0000000000000151
39. Ramig LO, Sapir S, Countryman S, et al. Intensive voice treatment (LSVT) for patients with Parkinson's disease: a 2 year follow up. Journal of Neurology, Neurosurgery & Psychiatry, 2001; 71, 493-498. http://dx.doi.org/10.1136/jnnp.71.4.493
40. Spielman JL, Borod JC, Ramig LO. The Effects of Intensive Voice Treatment on Facial Expressiveness in Parkinson Disease: Preliminary Data. Cognitive and Behavioral Neurology, 2003; 16(3), 177-188. https://doi.org/10.1097/00146965-200309000-00005
41. de Swart BJ, Willemse SC, Maassen BA, Horstink MW. Improvement of voicing in patients with Parkinson's disease by speech therapy. Neurology, 2003; 60(3), 498–500. https://doi.org/10.1212/01.wnl.0000044480.95458.56
42. Mohseni Z, Mohamadi R, Habibi SAH, Saffarian A, Abolghasemi J. Voice improvement following conventional speech therapy combined with singing intervention in people with Parkinson's disease: A three-arm randomised controlled trial. International journal of language & communication disorders, 2023; 58(5), 1752–1767. https://doi.org/10.1111/1460-6984.12900
43. Di Benedetto P, Cavazzon M, Mondolo F, Rugiu G, Peratoner A, Biasutti E. Voice and choral singing treatment: a new approach for speech and voice disorders in Parkinson's disease. European journal of physical and rehabilitation medicine, 2009; 45(1), 13–19
44. Chang HJ, Kim J, Joo JY, Kim HJ. Feasibility and efficacy of video-call speech therapy in patients with Parkinson's disease: A preliminary study. Parkinsonism & related disorders, 2023; 114, 105772. https://doi.org/10.1016/j.parkreldis.2023.105772
45. Constantinescu G, Theodoros D, Russell T, Ward E, Wilson S, Wootton R. Treating disordered speech and voice in Parkinson's disease online: a randomized controlled non-inferiority trial. International journal of language & communication disorders, 2011; 46(1), 1–16. https://doi.org/10.3109/13682822.2010.484848