Intensive voice treatment (LSVT®LOUD) for Parkinson's disease following deep brain stimulation of the subthalamic nucleus

PurposeIntensive voice therapy (LSVT®LOUD) can effectively manage voice and speech symptoms associated with idiopathic Parkinson disease (PD). This small-group study evaluated voice and speech in individuals with and without deep brain stimulation of the subthalamic nucleus (STN-DBS) before and after LSVT LOUD, to determine whether outcomes for surgical subjects were comparable to non-surgical cohorts.MethodsEight subjects with PD (four with STN-DBS and four without) received LSVT LOUD four times a week for four weeks. Four additional subjects with PD remained untreated. Voice intensity (SPL), Vowel Articulation Index (VAI), the Voice Handicap Index (VHI), and a structured interview were evaluated before and after treatment and again six months later.ResultsBoth treated groups showed significant increases in SPL from pre to post and six-month follow up. VAI was significantly higher for the treated groups compared to the untreated subjects at follow up. Several treated individuals had significant clinical improvement in VHI scores, particularly within the LSVT-DBS group. Treated individuals reported improvements in voice and speech in structured interviews; however, answers suggest more variable long-term maintenance within the LSVT-DBS group. The untreated group exhibited no significant changes in any measure throughout the study.ConclusionsResults support LSVT LOUD for treating voice and speech in individuals with PD following STN-DBS surgery. However, modifications may be required to maintain functional improvements.Learning outcomes: As a result of this activity, the participant will be able to (1) describe how deep brain stimulation of the subthalamic nucleus may affect voice and speech in Parkinson disease; (2) describe the effects of intensive voice therapy (LSVT®LOUD) on people with PD both with and without STN-DBS; (3) describe how individuals with STN-DBS maintained treatment effects over time.

► We compared 12 subjects with Parkinson disease before and after LSVT®LOUD.
► 4 treated subjects had subthalamic nucleus (STN) DBS, 8 other treated or untreated subjects did not.
► Both treated groups responded well to LSVT LOUD based on acoustic and perceptual measures.
► LSVT LOUD may be a viable speech treatment option for people with PD and STN-DBS.
► Additional research is needed to evaluate long-term maintenance of speech and voice improvements.