Feasibility and acceptability of Lee Silverman voice treatment in progressive ataxias

Communication difficulties have considerable impact on people with progressive ataxia, yet there are currently no evidence-based treatments. LSVT LOUD® focuses on the production of healthy vocal loudness whilst also improving breath support, vocal quality, loudness and articulation in participating patients. This study aimed to investigate whether Lee Silverman Voice Treatment (LSVT LOUD®) can improve communication effectiveness in these patients. We performed a rater-blinded, single-arm study investigating LSVT LOUD® treatment in a population of patients with progressive ataxia including Friedreich’s ataxia (n = 18), spinocerebellar ataxia type 6 (n = 1), idiopathic cerebellar ataxia (n = 1), and spastic paraplegia 7 (n = 1). Twenty-one patients were recruited to the study, with 19 completing treatment. Sessions were administered via Skype in the LSVT-X format, meaning two sessions per week over a period of 8 weeks. Assessments included two baseline and two post-treatment measures and focused on outcome measures covering aspects ranging from physiological function to impact and participation. Results indicate improvements in patient-perceived outcomes for 14 of the 19 participants, in both speech and psychosocial domains. Speech data furthermore demonstrate significant improvements in prolonged vowel duration, and voice quality measures. Intelligibility and naturalness evaluations showed no change post-treatment. Patients reported high acceptability of the treatment itself, as well as administration by Skype. This is the largest treatment study for people with progressive ataxia published to date. It provides an indication that LSVT LOUD® can have a positive impact on communication in this patient group and could form the basis for larger-scale trials

Feasibility and acceptability of Lee Silverman Voice Treatment for patients with hereditary ataxia

Objectives: This study aimed to assess the feasibility and acceptability of Lee Silverman Voice Treatment (LSVT) provided via Skype for patients with hereditary ataxia. Background: There are currently no evidence based speech treatments available for people with hereditary ataxia. As a result, these patients are often not offered treatment despite significant impact on communication related quality of life. This study investigated whether LSVT, a speech treatment focusing on increasing loudness, can improve communication in these speakers. Method: 20 patients were recruited to the study. An extended version of LSVT, consisting of 2 sessions a week over 8 weeks was provided via Skype. Two baseline (2 weeks apart) and two post-treatment measures (immediately following and 8 weeks after treatment) were collected. Materials included a range of speech tasks, questionnaires and a patient interview. Pre and post-treatment comparisons focused on acoustic and perceptual speech parameters, including voice quality, breath support, intelligibility and naturalness, as well as impact and communication participation. Results Results indicate improvements in breath support and in voice quality for sustained vowels and connected speech, both for acoustic and perceptual measures. Most of these improvements were maintained longer term. No changes were evident for intelligibility or naturalness, however, patient reported outcomes were positive for most participants, both in the speech and psychosocial domains. There were no negative reports with regard to fatigue, and the majority of patients preferred Skype delivery over face to face provision. Conclusion The study suggests, along with a recent pilot study by Vogel et al. (2019) that speech treatment can have a beneficial impact on communication in patients with hereditary ataxia and should therefore be provided by clinicians

Enhancing dysphonia clinic consultations through a focus on patients' expectations : streamlining and validation of a new tool (ACaPELa-R questionnaire)

ObjectiveThe Assessing and Caring for Patients' Expectations in Laryngology ('ACaPELa') questionnaire was developed to guide laryngology clinic consultations. This study aimed to audit its use, revise it depending on outcomes and validate it.MethodsThe questionnaire was completed by all new patients attending a laryngology clinic over one year. The questionnaire was refined and validated in a new cohort of patients over a six-month period.ResultsThirty-seven of 242 patients (15.3 per cent) incorrectly gave the same ranking to more than one question. Questions with similar content were collapsed to cover broader themes, and an outcome question was added, resulting in the five-item Assessing and Caring for Patients' Expectations in Laryngology - Revised ('ACaPELa-R') questionnaire. Using this revised questionnaire, there was a significant reduction in the number of same-ranked questions (4.4 vs 15.3 per cent; p = 0.003) and high patient satisfaction post-consultation (95.7 per cent).ConclusionThe Assessing and Caring for Patients' Expectations in Laryngology - Revised questionnaire makes patients' rank ordering of questions easier. It can be used to inform how different topics should be approached during the consultation and utilised for clinician self-audit

Mind-body and creative arts therapies for people with aphasia: a mixed-method systematic review

Background. In the context of aphasia rehabilitation there is a perceived need for interventions with a reduced linguistic demand targeting well-being. Mind-body and creative arts approaches are holistic and person-centred approaches, primarily relying on means other than verbal exchanges, and promoting self-regulation strategies. Aims. This mixed-method systematic review aimed to evaluate the availability, feasibility, and effectiveness of mind-body and creative arts therapies in promoting well-being for people with aphasia. Eight databases were searched using subject headings and key words. Full-text screening, critical appraisal and data extraction were conducted independently by two reviewers. A segregated synthesis approach was used (i.e. Revised Effect Direction Plot technique; Thematic Synthesis approach). Findings are presented in a narrative and visual form. Main Contribution. Twenty-two studies were included (Mind-body: n=11; Creative-arts: n=11). Heterogeneity of study design and quality, intervention type, procedures and dosage, outcomes, and level of offered communication support were identified. Improvements were noted across a wide range of well-being outcomes with more consistent positive results for anxiety and communication. 128 findings were extracted and synthetised in three broad themes: positive impact on self, empowering multifaceted experience, the relevance of needs-centred adjustments. Conclusion. Provisional findings about the benefits of mind-body and creative arts interventions on aspects of well-being for some individuals with aphasia were identified. However, findings are complex and need to be interpreted cautiously. Facilitators and barriers to these therapies are highlighted with related recommendations for practice. The review poses a demand for further research in the field, implementing rigorous methodology and aphasia-specific support to facilitate inclusion and engagement

Automatic detection of speech disorder in dysarthria using extended speech feature extraction and neural networks classification

This paper presents an automatic detection of Dysarthria, a motor speech disorder, using extended speech features called Centroid Formants. Centroid Formants are the weighted averages of the formants extracted from a speech signal. This involves extraction of the first four formants of a speech signal and averaging their weighted values. The weights are determined by the peak energies of the bands of frequency resonance, formants. The resulting weighted averages are called the Centroid Formants. In our proposed methodology, these centroid formants are used to automatically detect Dysarthric speech using neural network classification technique. The experimental results recorded after testing this algorithm are presented. The experimental data consists of 200 speech samples from 10 Dysarthric Speakers and 200 speech samples from 10 age-matched healthy speakers. The experimental results show a high performance using neural networks classification. A possible future research related to this work is the use of these extended features in speaker identification and recognition of disordered speech

Effects of acoustic features modifications on the perception of dysarthric speech - preliminary study (pitch, intensity and duration modifications)

Marking stress is important in conveying meaning and drawing listener’s attention to specific parts of a message. Extensive research has shown that healthy speakers mark stress using three main acoustic cues; pitch, intensity, and duration. The relationship between acoustic and perception cues is vital in the development of a computer-based tool that aids the therapists in providing effective treatment to people with Dysarthria. It is, therefore, important to investigate the acoustic cues deficiency in dysarthric speech and the potential compensatory techniques needed for effective treatment. In this paper, the relationship between acoustic and perceptive cues in dysarthric speech are investigated. This is achieved by modifying stress marked sentences from 10 speakers with Ataxic dysarthria. Each speaker produced 30 sentences using the 10 Subject-Verb-Object-Adjective (SVOA) structured sentences across three stress conditions. These stress conditions are stress on the initial (S), medial (O) and final (A) target words respectively. To effectively measure the deficiencies in Dysarthria speech, the acoustic features (pitch, intensity, and duration) are modified incrementally. The paper presents the techniques involved in the modification of these acoustic features. The effects of these modifications are analysed based on steps of 25% increments in pitch, intensity and duration. For robustness and validation, 50 untrained listeners participated in the listening experiment. The results and the relationship between acoustic modifications (what is measured) and perception (what is heard) in Dysarthric speech are discussed

Task based profiles of language impairment in Parkinson’s Disease

This study aimed to add to our understanding of language impairment in people with Parkinson's Disease (PwPD). Language difficulties are increasingly reported in PD. However, there are contradictory reports on how they relate to motor and cognitive impairment. In addition, the link between various language deficits or the same deficits across task modalities is not well understood. This lack of understanding impacts on clinicians’ ability to assess and effectively treat language impairment in PD. Our study therefore aimed to investigate language performance across a number of task structures and correlate this performance with cognitive skills, as well as motor and speech performance. The study included 22 German speaking PwPD and 22 matched healthy control participants. 18 participants in each group were cognitively healthy and four had mild cognitive impairment. They performed a number of executive function and language tasks of different complexity and structure. The linguistic investigation focused on grammatical accuracy and complexity, linguistic content as well as articulatory features. There were few cognitive differences between the two groups, with only set-shifting as an executive function being significantly reduced in PwPD, but grammatical error rate was higher in PwPD than in their healthy controls across all language tasks. This was linked to set shifting skills but only for the complex grammar condition, not for more naturalistic language tasks. Furthermore, there was no correlation of language performance across the task levels, i.e. error rates in the structured task did not predict naturalistic performance. Motor and dysarthria severity could not predict language impairment either. This study confirms the presence of language problems in PwPD in the absence of global cognitive impairment or only MCI, and at the same time establishes a task based relationship between the two skills. From a clinical perspective the data indicate that structured tests are unable to accurately predict naturalistic language performance, highlighting the need for functional assessments rather than relying on fast scoring structured tests, at least at early disease stages. In addition, the impact of the individual language difficulties needs to be explored to establish appropriate and effective treatment pathways

ClearSpeechTogether: a Rater Blinded, Single, Controlled Feasibility Study of Speech Intervention for People with Progressive Ataxia

BACKGROUND: Progressive ataxias frequently lead to speech disorders and consequently impact on communication participation and psychosocial wellbeing. Whilst recent studies demonstrate the potential for improvements in these areas, these treatments generally require intensive input which can reduce acceptability of the approach. A new model of care—ClearSpeechTogether—is proposed which maximises treatment intensity whilst minimising demands on clinician. This study aimed to establish feasibility and accessibility of this approach and at the same time determine the potential benefits and adverse effects on people with progressive ataxias. METHOD: This feasibility study targeted people with progressive ataxia and mild-moderate speech and gross motor impairment. ClearSpeechTogether consisted of four individual sessions over 2 weeks followed by 20 patient-led group sessions over 4 weeks. All sessions were provided online. Quantitative and qualitative data were collected for evaluation. RESULTS: Nine participants completed treatment. Feasibility and acceptability were high and no adverse effects were reported. Statistical tests found significantly reduced vocal strain, improved reading intelligibility and increased participation and confidence. Participant interviews highlighted the value of group support internalisation of speech strategies and psycho-social wellbeing. DISCUSSION: ClearSpeechTogether presented a feasible, acceptable intervention for a small cohort of people with progressive ataxia. It matched or exceeded the outcomes previously reported following individual therapy. Particularly notable was the fact that this could be achieved through patient led practice without the presence of a clinician. Pending confirmation of our results by larger, controlled trials, ClearSpeechTogether could represent an effective approach to manage speech problems in ataxia

Head and Neck Cancer Risk Calculator (HaNC-RC) - v.2. Adjustments and addition of symptoms and social history factors.

Objectives: Head and neck cancer (HNC) diagnosis through the 2-week wait, urgent suspicion of cancer (USOC) pathway has failed to increase early cancer detection rates in the UK. A head and neck cancer risk calculator (HaNC-RC) has previously been designed to aid referral of high-risk patients to USOC clinics (predictive power: 77%). Our aim was to refine the HaNC-RC to increase its prediction potential. Design: Following sample size calculation, prospective data collection and statistical analysis of referral criteria and outcomes. Setting: Large tertiary care cancer centre in Scotland. Participants: 3531 new patients seen in routine, urgent and USOC head and neck (HaN) clinics. Main outcome measures: Data collected were as follows: demographics, social history, presenting symptoms and signs and HNC diagnosis. Univariate and multivariate regression analysis were performed to identify significant predictors of HNC. Internal validation was performed using 1000 sample bootstrapping to estimate model diagnostics included the area under the receiver operator curve (AUC), sensitivity and specificity. Results: The updated version of the risk calculator (HaNC-RC v.2) includes age, gender, unintentional weight loss, smoking, alcohol, positive and negative symptoms and signs of HNC. It has achieved an AUC of 88.6% with two recommended triage referral cut-offs to USOC (cut-off: 7.1%; sensitivity: 85%, specificity: 78.3%) or urgent clinics (cut-off: 2.2%; sensitivity: 97.1%; specificity of 52.9%). This could redistribute cancer detection through USOC clinics from the current 60.9%–85.2%, without affecting total numbers seen in each clinical setting. Conclusions: The use of the HaNC-RC v.2 has a significant potential in both identifying patients at high risk of HNC early thought USOC clinics but also improving health service delivery practices by reducing the number of inappropriately urgent referrals

HEADS : UP Aphasia: co-creating a mindfulness-based course for stroke survivors with aphasia. Findings from a professional stakeholder survey

Background and aims: One third of stroke survivors lives with aphasia. Although anxiety and depression are common among people with aphasia (pwa), due to their complex communication needs these individuals are frequently excluded from therapeutic interventions with negative consequences on their mental health. HEADS: UP Aphasia is a Stroke Association-funded PhD research study which aims to co-create an aphasia-friendly version of HEADS: UP (Helping Ease Anxiety and Depression following Stroke; https://bit.ly/2QbB0cV), a stroke-specific adaptation of Kabat-Zinn's Mindfulness-based Stress Reduction (MBSR) course. Methods: The study was conducted online. In stage 3 of the research a social media strategy was used to recruit health professionals (HPs). Participants were invited to complete a 10-min bespoke questionnaire structured around the TIDieR checklist (Hoffmann et al., 2014) and delivered via RedCap. Questions focused on potential adjustments to be considered during subsequent co-creation/adaptation work. Closed questions were supplement by the option to 'comment'. Quantitative questionnaire data were analysed using descriptive statistics e.g. distribution and frequency; qualitative data using thematic analysis. Results: Twenty-eight HPs were recruited; n=25 professionals completed the survey (n=3 not completed). Key findings: delivery mode: 48% (n=12) 'blended'; setting: 68% (n=17) 'mix of 1:1 and group sessions'; session frequency: 44.4% (n=12) 'once weekly'. Explanatory comments helped identify potential facilitators and barriers e.g. group for peer support. Conclusions: The results offer a professional perspective of pwa's needs and priorities in the context of a complex psychosocial self-management intervention, and will guide the decision-making during subsequent HEADS: UP Aphasia co-development processes