Wight Sheila, Miller Nick
Newcastle upon Tyne NHS Foundation Hospitals Trust, Newcastle upon Tyne, UK.
Int J Lang Commun Disord. 2015 Mar-Apr;50(2):215-25. doi: 10.1111/1460-6984.12132. Epub 2014 Dec 3.
Speaking louder/more intensely represents a longstanding technique employed to manage voice and intelligibility changes in people with Parkinson's. This technique has been formalized into a treatment approach and marketed as the Lee Silverman Voice Treatment (LSVT®) programme. Evidence for its efficacy has been published. Studies to date are dominated by research facility reports from the original LSVT® group or closely associated groups. Evidence for the efficacy of LSVT® in routine clinical settings is lacking.
METHODS & PROCEDURES: We conducted an audit of outcomes for consecutive people with Parkinson's who were offered and completed LSVT® in a routine hospital outpatient setting. In- and exclusion criteria, assessment and treatment protocols followed precisely the methods stipulated by LSVT® Global. Additionally, participants completed the Voice Handicap Index (VHI) and 23 carers completed a visual analogue scale (VAS) for items relating to functional outcomes.
OUTCOMES & RESULTS: Group data (n = 33) revealed statistically significant increases in all objective and subjective measures at the end of treatment, though outcomes on the different measures revealed variable individual responses. Mean intensity increases on prolonged vowel were 9.3 dB post-treatment. Significant gains of mean 7.5 and 6.8 dB were maintained at 12 (n = 25) and 24 months (n = 15) respectively for those available for follow-up. Significant intensity gains occurred for reading post-therapy (mean = 8.5 dB), but changes reverted to statistically non-significant at 12 and 24 months. Intensity increase (mean = 8.5 dB) was significant for monologues post-therapy, but not at 12 and 24 months. Median VHI improvement was statistically significant post-therapy and at 12 months, but not at 24 months. Carer VAS ratings all improved significantly post-therapy; at 12 months only perceived loudness, strain, mumbling and intelligibility remained statistically significantly above baseline. No significant gains persisted to 24 months.
CONCLUSIONS & IMPLICATIONS: LSVT® was successful for most individuals in this study. Not all patients attained significant changes by the end of treatment. Few patients who achieved significant gain at the end of treatment maintained this at 12 or 24 months. Implications for maintenance, interpretation of results in a degenerative condition and implications for further research are discussed.
提高音量/更用力说话是一种长期以来用于管理帕金森病患者声音和清晰度变化的技巧。这种技巧已被规范化为一种治疗方法，并作为李·西尔弗曼嗓音治疗（LSVT®）计划进行推广。其疗效的证据已经发表。迄今为止的研究主要由最初的LSVT®团队或密切相关团队的研究机构报告主导。缺乏LSVT®在常规临床环境中疗效的证据。
我们对在一家常规医院门诊环境中接受并完成LSVT®治疗的帕金森病连续患者的治疗结果进行了审核。纳入和排除标准、评估和治疗方案严格遵循LSVT®全球组织规定的方法。此外，参与者完成了嗓音障碍指数（VHI），23名护理人员针对与功能结果相关的项目完成了视觉模拟量表（VAS）。
组数据（n = 33）显示，治疗结束时所有客观和主观测量指标均有统计学意义的增加，不过不同测量指标的结果显示个体反应存在差异。治疗后延长元音时的平均强度增加了9.3分贝。对于可进行随访的患者，在12个月（n = 25）和24个月（n = 15）时，平均分别保持了7.5分贝和6.8分贝的显著增加。治疗后阅读时强度有显著增加（平均 = 8.5分贝），但在12个月和24个月时变化恢复为无统计学意义。治疗后独白时强度增加（平均 = 8.5分贝），但在12个月和24个月时无此变化。VHI中位数在治疗后和12个月时有统计学意义的改善，但在24个月时没有。护理人员的VAS评分在治疗后均有显著改善；在12个月时，只有感知响度、紧张度、含糊不清和清晰度在统计学上仍显著高于基线水平。到24个月时没有持续的显著改善。
在本研究中，大多数个体的LSVT®治疗是成功的。并非所有患者在治疗结束时都有显著变化。在治疗结束时取得显著改善的患者中，很少有人在12个月或24个月时仍保持这一状态。讨论了维持治疗的意义、在退行性疾病中对结果的解读以及对进一步研究的启示。
