Jessica E. Huber, Ph.D. Associate Professor Purdue University

Size: px

Start display at page:

Download "Jessica E. Huber, Ph.D. Associate Professor Purdue University"

Christian May
5 years ago
Views:

1 Jessica E. Huber, Ph.D. Associate Professor Purdue University

2 Funding: National Institutes of Health, NIDCD (R01 DC9409) National Institutes of Health, NIDCD (R03 DC05731) Research Support Incentive Grant from the Purdue University Summer Faculty Grant from Purdue University NIH training grant, NIDCD (F31 to Meghan Darling) Assistance: Meghan Darling Elaine Stathopoulos and Joan Sussman Jim Jones and Kirk Foster Students working in the Speech Physiology labs at Purdue University and University at Buffalo Disclosure: The PI was supported by the NIH R01 grant to complete the research presented here. The first author does not have a financial interest in the SpeechVive company but may in the future.

4 89% of people with Parkinson s disease will develop voice problems 45% of people with Parkinson s disease will develop articulation problems People with PD sometimes don t recognize that they have speech problems

5 Perceptual features: Reduced loudness (hypophonia) Breathiness (whispery sound to voice) Hoarseness (gravely sound to voice) Monotone (reduced pitch and loudness variation) Fast rate and short rushes of speech Disfluencies

6 Sound pressure level (SPL) is the physical correlate of loudness Some individuals with PD have a lower SPL Impact: Communication partners are hearing impaired, exponentially increasing the effect on communication Darling and Huber (2011)

7 Fundamental frequency (F0): physical correlate of pitch Reduced F0 range and variability Reduced marking of stressed words or focus of sentences n=30 in each group Holmes, Oates, Phyland, and Hughes (2000)

8 Reduced distinction between questions and statements Reduced marking of final and non-final clause boundaries Impact: Reduces listeners ability to parse incoming speech signal n=16 in each group MacPherson, Huber, and Snow (2011)

9 Shorter utterances Faster speech rate Impact: Harder for listeners to distinguish sounds and words, less time to comprehend incoming speech Syllables/Second OC PD n=8 in each group Data from Huber and Darling (in prep)

10 May not perceive their speech and voice problems as severely as their communication partners Individuals with PD have difficulty accurately perceiving their own loudness Do not perceive speech errors as accurately as control subjects Impact: Therapy is difficult because we need to teach them that their speech is impaired

11 External cues: visual or auditory feedback to perform a task Internal cues: unconscious information or self-cueing guides task performance Improvements in gait patterns have been shown in response to both external and internal cues Internal cues did not generalize as well as external ones Similar findings for handwriting and speech as in gait

12 Some cues work better than other cues for achieving a specific goal Most speech therapy for people with PD aims to improve loudness or rate Impact: The cues used in therapy will affect the outcome n=14 in each group Sadagopan and Huber (2007)

14 Lee Silverman Treatment Program (LSVT LOUD) Intensive, 1 hour per day, 5 days per week, for 4 weeks Clinician instructs the patient to talk more loudly, to use high effort Clinician will work to help the patient with PD perceive their new louder voice as normal for them Practice 10 functional phrases the person uses in everyday life which are used to cue the person to talk louder everyday, outside of therapy Daily home practice is required

15 There is a large body of literature to support its use Improvements in voice and articulation and in intelligibility when the patients speak more loudly The effects can last 6 months to a year without additional therapy for some patients Sound Pressure Level (db) Pre-LSVT Post-LSVT subjects in each group Ramig, Countryman, Thompson, and Horii (1995)

16 Generalization to everyday activities is difficult for some patients Large body of literature has shown that external cues are more effective than internal ones for individuals with Parkinson s disease Because Parkinson s disease affects cognitive function, it is difficult for individuals with PD to remember to talk more loudly May not be appropriate for individuals who fatigue and may not be able to handle the intensive nature of the therapy Many people live too far from a trained, certified clinician

17 Set to 70% of the patient s maximum expiratory pressure or the highest level the patient can tolerate Patient completes: 5 breaths through the device, 5 times per day 5 days per week For 4-5 weeks EMST resistance setting is increased as the patient improves

18 Duration (seconds) Pre EMST Post EMST Compression Phase Duration Expiratory Rise Time Pitts, Bolster, Rosenbek, Troche, Okun, and Sapienza (2009), n = 10

19 Sound Pressure Level (db) Utterance Length (syll) Pre Post Pre Post Darling and Huber (in prep), n = 11

20 Device is set to elicit 3-5 db increase in SPL Patient wears the device each day (2-8 hours) during communicative situations Reads aloud for 30 min five days/week Noise amplitude from device is reset as patient improves

21 Sound Pressure Level (db) Utterance Length (syll) Pre Post Pre Post Huber et al (in prep), n = 38

22 15 of the 18 patients who did not significantly increase SPL had a significant change in speech rate Participants who changed rate had a shorter mean time since diagnosis than those who changed SPL and those who changed both rate and SPL Participants who increased SPL (with or without rate) had much longer durations of device use across the 8-week treatment period than those who did not show a change or who only changed rate Speech Rate (syll/sec) Pre Post Huber et al (in prep), n = 38

23 PD affects multiple domains of speech production There are several treatments which have demonstrated effectiveness LSVT LOUD EMST SpeechVive EMST affects cough, swallow, and speech which gives you multiple benefits from one treatment All three treatments work for some but not all patients. Need to consider multiple treatments when working with patients with PD.

Speech and Voice Impairments in Individuals with PD. Jessica E. Huber, Ph.D. Associate Professor Purdue University

Speech and Voice Impairments in Individuals with PD Jessica E. Huber, Ph.D. Associate Professor Purdue University jhuber@purdue.edu Parkinson s Disease Progressive disorder which affects about 1 million