Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-10T14:10:36.722Z Has data issue: false hasContentIssue false

Effects of the Lee Silverman Voice Treatment (LSVT® LOUD) on Hypomimia in Parkinson's Disease

Published online by Cambridge University Press:  13 February 2014

Aleksey I. Dumer*
Affiliation:
Department of Psychology, Queens College of the City University of New York (CUNY), Flushing, New York Department of Psychology, The Graduate Center of CUNY, New York, New York
Harriet Oster
Affiliation:
The Paul McGhee Division, School of Continuing and Professional Studies, New York University, New York, New York
David McCabe
Affiliation:
Department of Psychology, Queens College of the City University of New York (CUNY), Flushing, New York Department of Psychology, The Graduate Center of CUNY, New York, New York
Laura A. Rabin
Affiliation:
Department of Psychology, The Graduate Center of CUNY, New York, New York Department of Psychology, Brooklyn College of CUNY, Brooklyn, New York
Jennifer L. Spielman
Affiliation:
The National Center for Voice and Speech, Denver, Colorado
Lorraine O. Ramig
Affiliation:
The National Center for Voice and Speech, Denver, Colorado Department of Speech, Language, and Hearing Sciences, University of Colorado at Boulder, Boulder, Colorado
Joan C. Borod
Affiliation:
Department of Psychology, Queens College of the City University of New York (CUNY), Flushing, New York Department of Psychology, The Graduate Center of CUNY, New York, New York Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
*
Correspondence and reprint requests to: Aleksey I. Dumer, Center for Enhanced Performance, United States Military Academy, West Point, New York 10996. E-mail: a.dumer@gmail.com

Abstract

Given associations between facial movement and voice, the potential of the Lee Silverman Voice Treatment (LSVT) to alleviate decreased facial expressivity, termed hypomimia, in Parkinson's disease (PD) was examined. Fifty-six participants—16 PD participants who underwent LSVT, 12 PD participants who underwent articulation treatment (ARTIC), 17 untreated PD participants, and 11 controls without PD—produced monologues about happy emotional experiences at pre- and post-treatment timepoints (“T1” and “T2,” respectively), 1 month apart. The groups of LSVT, ARTIC, and untreated PD participants were matched on demographic and health status variables. The frequency and variability of facial expressions (Frequency and Variability) observable on 1-min monologue videorecordings were measured using the Facial Action Coding System (FACS). At T1, the Frequency and Variability of participants with PD were significantly lower than those of controls. Frequency and Variability increases of LSVT participants from T1 to T2 were significantly greater than those of ARTIC or untreated participants. Whereas the Frequency and Variability of ARTIC participants at T2 were significantly lower than those of controls, LSVT participants did not significantly differ from controls on these variables at T2. The implications of these findings, which suggest that LSVT reduces parkinsonian hypomimia, for PD-related psychosocial problems are considered. (JINS, 2014, 20, 1–11)

Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aarsland, D., Påhlhagen, S., Ballard, C.G., Ehrt, U., Svenningsson, P. (2012). Depression in Parkinson disease – Epidemiology, mechanisms and management. Nature Reviews Neurology, 8, 3547.CrossRefGoogle Scholar
Beck, A.T., Steer, R.A., Brown, G.K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychology Corporation.Google Scholar
Benjamini, Y., Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society, 57(Series B), 289300.Google Scholar
Best, C., Taylor, N. (1966). The physiological basis of medical practice; A text in applied physiology (8th ed.). Baltimore, MD: Williams & Wilkins.Google Scholar
Bologna, M., Fabbrini, G., Marsili, L., Defazio, G., Thompson, P.D., Berardelli, A. (2012). Facial bradykinesia. Journal of Neurology, Neurosurgery, and Psychiatry, 0, 15. doi:10.1136/jnnp-2012-303993 Google Scholar
Borod, J.C., Tabert, M.H., Santschi, C., Strauss, E. (2000). Neuropsychological assessment of emotional processing in brain-damaged patients. In J. C. Borod (Ed.), The neuropsychology of emotion (pp. 80105). New York, NY: Oxford University Press.Google Scholar
Borod, J.C., Welkowitz, J., Obler, L.K. (1992). The New York Emotion Battery. Unpublished materials. New York, NY: Department of Neurology, Mount Sinai Medical Center.Google Scholar
Bowers, D., Miller, K., Bosch, W., Gokcay, D., Pedraza, O., Springer, U., Okun, M. (2006). Faces of emotion in Parkinson's disease: Micro-expressivity and bradykinesia during voluntary facial expressions. Journal of the International Neuropsychological Society, 12, 765773.CrossRefGoogle ScholarPubMed
Brozgold, A.Z., Borod, J.C., Martin, C.C., Pick, L.H., Alpert, M., Welkowitz, J. (1998). Social functioning and facial emotional expression in neurological and psychiatric disorders. Applied Neuropsychology, 5, 1523.CrossRefGoogle ScholarPubMed
Busso, C., Narayanan, S.S. (2007). Interrelation between speech and facial gestures in emotional utterances: A single subject study. IEEE Transactions on Audio, Speech, and Language Processing, 15, 23312347.CrossRefGoogle Scholar
Crum, R.M., Anthony, J.C., Bassett, S.S., Folstein, M.F. (1993). Population-based norms for the Mini–Mental State Examination by age and education level. The Journal of the American Medical Association, 269, 23862391.CrossRefGoogle Scholar
Desmurget, M., Grafton, S.T., Vindras, P., Gréa, H., Turner, R.S. (2004). The basal ganglia network mediates the planning of movement amplitude. European Journal of Neuroscience, 19, 28712880.CrossRefGoogle ScholarPubMed
Dromey, C., Ramig, L.O. (1998). Intentional changes in sound pressure level and rate: Their impact on measures of respiration, phonation, and articulation. Journal of Speech, Language, and Hearing Research, 41, 10031018.CrossRefGoogle ScholarPubMed
Ekman, P., Friesen, W.V. (1978). Facial action coding system: A technique for the measurement of facial movement. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Ekman, P., Friesen, W.V., Hager, J.C. (2002). Facial Action Coding System: Investigator's guide. Salt Lake City, UT: Research Nexus.Google Scholar
El Sharkawi, A., Ramig, L., Logemann, J., Pauloski, B., Rademaker, A., Smith, C., Werner, C. (2002). Swallowing and voice effects of Lee Silverman Voice Treatment: A pilot study. Journal of Neurology, Neurosurgery, and Psychiatry, 72, 3136.CrossRefGoogle Scholar
Elefant, C., Lotan, M., Baker, F.A., Skeie, G.O. (2012). Effects of music therapy on facial expression of individuals with Parkinson's disease: A pilot study. Musicae Scientiae, 16, 392400.CrossRefGoogle Scholar
Erceg-Hurn, D.M., Mirosevich, V.M. (2008). Modern robust statistical methods: An easy way to maximize the accuracy and power of your research. American Psychologist, 63, 591601.CrossRefGoogle ScholarPubMed
Folstein, M.F., Folstein, S.E., McHugh, P.R. (1975). “Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle ScholarPubMed
Fridlund, A.J., Ekman, P., Oster, H. (1987). Facial expressions of emotion. In A. Siegman & S. Feldstein (Eds.), Nonverbal behavior and communication (pp. 143224). Hillsdale, NJ: Erlbaum.Google Scholar
Frisina, P.G., Borod, J., Foldi, N.S., Tenenbaum, H.R. (2008). Depression in Parkinson's disease: Health risks, etiology, and treatment options. Neuropsychiatric Disease and Treatment, 4, 8191.Google ScholarPubMed
Glass, G.V., McGaw, B., Smith, M.L. (1981). Meta-analysis in social research. Beverly Hills, CA: SAGE Publications.Google Scholar
Hall, P. (1992). On the removal of skewness by transformation. Journal of the Royal Statistical Society, 54(Series B), 221228.Google Scholar
Hemmesch, A.R., Tickle-Degnen, L., Zebrowitz, L.A. (2009). The influence of facial masking and sex on older adults’ impressions of individuals with Parkinson's disease. Psychology and Aging, 24, 542549.CrossRefGoogle ScholarPubMed
Ho, A.K., Bradshaw, J.L., Iansek, R., Alfredson, R. (1999). Speech volume regulation in Parkinson's disease: Effects of implicit cues and explicit instructions. Neuropsychologia, 37, 14531460.CrossRefGoogle ScholarPubMed
Hoehn, M.M., Yahr, M.D. (1967). Parkinsonism: Onset, progression and mortality. Neurology, 17, 427442.CrossRefGoogle ScholarPubMed
Hopf, H.C., Muller-Forell, W., Hopf, N.J. (1992). Localization of emotional and volitional facial paresis. Neurology, 42, 19181923.CrossRefGoogle ScholarPubMed
Iwase, M., Ouchi, Y., Okada, H., Yokoyama, C., Nobezawa, S., Yoshikawa, E., Watanabe, Y. (2002). Neural substrates of human facial expression of pleasant emotion induced by comic films: A PET Study. Neuroimage, 17, 758768.CrossRefGoogle ScholarPubMed
Jürgens, U. (2002). Neural pathways underlying vocal control. Neuroscience and Biobehavioral Reviews, 26, 235258.CrossRefGoogle ScholarPubMed
Katsikitis, M., Pilowsky, I. (1988). A study of facial expression in Parkinson's disease using a novel microcomputer-based method. Journal of Neurology, Neurosurgery, and Psychiatry, 51, 362366.CrossRefGoogle ScholarPubMed
Katsikitis, M., Pilowsky, I. (1991). A controlled quantitative study of facial expression in Parkinson's disease and depression. The Journal of Nervous and Mental Disease, 179, 683688.CrossRefGoogle ScholarPubMed
Katsikitis, M., Pilowsky, I. (1996). A controlled study of facial mobility treatment in Parkinson's disease. Journal of Psychosomatic Research, 40, 387396.CrossRefGoogle ScholarPubMed
Kazandjian, S., Borod, J.C., Brickman, A.M. (2007). Facial expression during emotional monologues in unilateral stroke: An analysis of monologue segments. Applied Neuropsychology, 14, 235246.CrossRefGoogle ScholarPubMed
Kenward, M.G., Roger, J.H. (2009). An improved approximation to the precision of fixed effects from restricted maximum likelihood. Computational Statistics & Data Analysis, 53, 25832595.CrossRefGoogle Scholar
Keselman, H.J., Algina, J., Lix, L.M., Wilcox, R.R., Deering, K. (2008). A generally robust approach for testing hypotheses and setting confidence intervals for effect sizes. Psychological Methods, 13, 110129.CrossRefGoogle ScholarPubMed
Keselman, H.J., Othman, A.R., Wilcox, R.R., Fradette, K. (2004). The new and improved two-sample t test. Psychological Science, 15, 4751.CrossRefGoogle ScholarPubMed
Keselman, H.J., Wilcox, R.R., Othman, A.R., Fradette, K. (2002). Trimming, transforming statistics, and bootstrapping: Circumventing the biasing effects of heteroscedasticity and nonnormality. Journal of Modern Applied Statistical Methods, 1, 288309.CrossRefGoogle Scholar
Liotti, M., Ramig, L.O., Vogel, D., New, P., Cook, C.I., Ingham, R.J., Fox, P.T. (2003). Hypophonia in Parkinson's disease: Neural correlates of voice treatment revealed by PET. Neurology, 60, 432440.CrossRefGoogle ScholarPubMed
McClean, M.D., Tasko, S.M. (2002). Association of orofacial with laryngeal and respiratory motor output during speech. Experimental Brain Research, 146, 481489.CrossRefGoogle ScholarPubMed
Miller, N., Andrew, S., Noble, E., Walshe, M. (2011). Changing perceptions of self as a communicator in Parkinson's disease: A longitudinal follow-up study. Disability and Rehabilitation, 33, 204210.CrossRefGoogle ScholarPubMed
Miller, N., Noble, E., Jones, D., Burn, D. (2006). Life with communication changes in Parkinson's disease. Age and Ageing, 35, 235239.CrossRefGoogle ScholarPubMed
Monrad-Krohn, G.H. (1924). On the dissociation of voluntary and emotional innervation in facial paresis of central origin. Brain, 47, 2235.CrossRefGoogle Scholar
Monrad-Krohn, G.H. (1957). The third element of speech: Prosody in the neuro-psychiatric clinic. The Journal of Mental Science, 103, 326331.CrossRefGoogle ScholarPubMed
Montreys, C.R., Borod, J.C. (1998). A preliminary evaluation of emotional experience and expression following unilateral brain damage. International Journal of Neuroscience, 96, 269283.CrossRefGoogle ScholarPubMed
Narayana, S., Fox, P.T., Zhang, W., Franklin, C., Robin, D.A., Vogel, D., Ramig, L.O. (2010). Neural correlates of efficacy of voice therapy in Parkinson's disease identified by performance-correlation analysis. Human Brian Mapping, 31, 222236.CrossRefGoogle ScholarPubMed
Nijhof, G. (1995). Parkinson's disease as a problem of shame in public appearance. Sociology of Health & Illness, 17, 193205. doi:10.1111/1467-9566.ep10933386 CrossRefGoogle Scholar
Pentland, B., Gray, J.M., Riddle, W.J., Pitcairn, T.K. (1988). The effects of reduced non-verbal communication in Parkinson's disease. British Journal of Disorders of Communication, 23, 3134.CrossRefGoogle ScholarPubMed
Pentland, B., Pitcairn, T.K., Gray, J.M., Riddle, W.J. (1987). The effects of reduced expression in Parkinson's disease on impression formation by health professionals. Clinical Rehabilitation, 1, 307312.CrossRefGoogle Scholar
Pernet, C.R., Wilcox, R., Rousselet, G.A. (2013). Robust correlation analyses: False positive and power validation using a new open source Matlab toolbox. Frontiers in Psychology, 3, 118. doi:10.3389/fpsyg.2012.00606 CrossRefGoogle ScholarPubMed
Ramig, L.O., Countryman, S., Thompson, L.L., Horii, Y. (1995). Comparison of two forms of intensive speech treatment for Parkinson disease. Journal of Speech, Language, and Hearing Research, 38, 12321251.CrossRefGoogle ScholarPubMed
Ramig, L., Fox, C., Sapir, S. (2008). Speech treatment for Parkinson's disease. Expert Reviews in Neurotherapeutics, 8, 297309.CrossRefGoogle ScholarPubMed
Ramig, L., Sapir, S., Countryman, S., Pawlas, A., O'Brien, C., Hoehn, M., Thompson, L. (2001). Intensive voice treatment (LSVT) for patients with Parkinson's disease: A 2 year follow up. Journal of Neurology, Neurosurgery, and Psychiatry, 71, 493498.CrossRefGoogle ScholarPubMed
Rinn, W.E. (1984). The neuropsychology of facial expression: A review of the neurological and psychological mechanisms for producing facial expressions. Psychological Bulletin, 95, 5277.CrossRefGoogle ScholarPubMed
Sapir, S., Ramig, L.O., Fox, C.M. (2011). Intensive voice treatment in Parkinson's disease: Lee Silverman Voice Treatment. Expert Reviews in Neurotherapeutics, 11, 815830.CrossRefGoogle ScholarPubMed
Sapir, S., Spielman, J.L., Ramig, L.O., Story, B.H., Fox, C. (2007). Effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on vowel articulation in dysarthric individuals with idiopathic Parkinson disease: Acoustic and perceptual findings. Journal of Speech, Language, and Hearing Research, 50, 899912.CrossRefGoogle Scholar
Simons, G., Ellgring, H., Pasqualini, M.S. (2003). Disturbance of spontaneous and posed facial expressions in Parkinson's disease. Cognition and Emotion, 17, 759778.CrossRefGoogle Scholar
Simons, G., Pasqualini, M.C.S., Reddy, V., Wood, J. (2004). Emotional and nonemotional facial expressions in people with Parkinson's disease. Journal of the International Neuropsychological Society, 10, 521535.CrossRefGoogle ScholarPubMed
Smith, M.C., Smith, M.K., Ellgring, H. (1996). Spontaneous and posed facial expression in Parkinson's disease. Journal of the International Neuropsychological Society, 2, 383391.CrossRefGoogle ScholarPubMed
Spielman, J.L., Borod, J.C., Ramig, L.O. (2003). The effects of intensive voice treatment on facial expressiveness in Parkinson disease: Preliminary data. Cognitive and Behavioral Neurology, 16, 177188.CrossRefGoogle ScholarPubMed
Spielman, J. L., Dumer, A., Borod, J. C., Oster, J., Rabin, L. A., Halpern, A., Ramig, L. O. (2012, February). Impact of intensive treatment targeting loudness or articulation on facial and vocalexpression in Parkinson disease (PD). Paper presented at the 16th Biennial Conference on Motor Speech, Santa Rosa, CA.Google Scholar
Spielman, J., Mahler, L., Halpern, A., Gilley, P., Klepitskaya, O., Ramig, L. (2011). Intensive voice treatment (LSVT®LOUD) for Parkinson's disease following deep brain stimulation of the subthalamic nucleus. Journal of Communication Disorders, 44, 688700.CrossRefGoogle ScholarPubMed
Stanley-Hermanns, M., Engebretson, J. (2010). Sailing the stormy seas: The illness experience of persons with Parkinson's disease. The Qualitative Report, 15, 340369. Retrieved from http://www.nova.edu/ssss/QR/QR15-2/stanley-hermanns.pdf Google Scholar
Tickle-Degnen, L., Lyons, K.D. (2004). Practitioners’ impressions of patients with Parkinson's disease: The social ecology of the expressive mask. Social Science & Medicine, 58, 603614.CrossRefGoogle ScholarPubMed
Tickle-Degnen, L., Zebrowitz, L.A., Ma, H. (2011). Culture, gender and health care stigma: Practitioners’ response to facial masking experienced by people with Parkinson's disease. Social Science & Medicine, 73, 95102.CrossRefGoogle ScholarPubMed
Tripoliti, E., Strong, L., Hickey, F., Foltynie, T., Zrinzo, L., Candelario, J., Limousin, P. (2011). Treatment of dysarthria following subthalamic deep brain stimulation for Parkinson's disease. Movement Disorders, 26, 24342437.CrossRefGoogle ScholarPubMed
Vaillancourt, D.E., Yu, H., Mayka, M.A., Corcos, D.M. (2007). Role of the basal ganglia and frontal cortex in selecting and producing internally guided force pulses. Neuroimage, 36, 793803.CrossRefGoogle ScholarPubMed
Vallejo, G., Ato, M. (2012). Robust tests for multivariate factorial designs under heteroscedasticity. Behavior Research Methods, 44, 471489.CrossRefGoogle ScholarPubMed
Wilcox, R.R. (2012). Introduction to robust estimation and hypothesis testing (3rd ed.). Oxford, England: Academic Press.Google Scholar
Wild, B., Rodden, F.A., Grodd, W., Ruch, W. (2003). Neural correlates of laugher and humor. Brain, 126, 21212138.CrossRefGoogle Scholar