title: Intensive voice treatment (LSVT®LOUD) for Parkinson's disease following deep brain stimulation of the subthalamic nucleus.
abstract: OBJECTIVE
  Intensive 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.
  
  
  METHODS
  Eight 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.
  
  
  RESULTS
  Both 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.
  
  
  CONCLUSIONS
  Results 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.
  
  
  OBJECTIVE
  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.
authors: National Center for Voice and Speech-Denver, An Affiliate of the University of Colorado, Boulder, Denver, CO 80204, USA. jennifer.spielman@colorado.edu
authors: Jennifer
authors: J
authors: Spielman
authors: Leslie
authors: L
authors: Mahler
authors: Angela
authors: A
authors: Halpern
authors: Phllip
authors: P
authors: Gilley
authors: Olga
authors: O
authors: Klepitskaya
authors: Lorraine
authors: L
authors: Ramig
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D013064:Speech Disorders / Q000209:etiology / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D016896:Treatment Outcome; D014834:Voice Training