PDCOMM Pilot: Loudness measures Christina H Smith

Sponsors and funders

Pilot study 89 participants with PD were randomised in PD COMM Pilot 55 participants completed the loudness recordings 34 participants did not complete all the loudness recordings as they were part of PD COMM Pilot ‘light’ Data presented here is for the 55 ‘loudness recordings’ participants Randomisation: 19 NHS SLT, 16 LSVT LOUD®, and 20 control All 55 completed baseline assessments 3 participants in the LSVT LOUD® group did not complete assessments at 3 months 2 participants in the LSVT LOUD® group did not complete assessments at 6 months All participants in NHS and control group completed all assessments One participant withdrew as his carer wasn’t able to support the time commitment One participant withdrew due to poor health One participant was unable to complete the 3 month assessment due to poor health

Participants Baseline Characteristics LSVT smaller group some differences in baseline characteristics: LSVT had PD longer, taking more levodopa, slightly younger. *Tomlinson, Stowe, Patel, Rick, Gray and Clarke, 2010

Vocal Loudness Assessments Production of /a/ Reading a standardised passage Describing a composite line drawing

Details of assessments Production of /a/ Six trials to produce a sustained and loud /a/ Reading a standardised passage ‘The Rainbow passage’ The rainbow passage contains most of the phonemes of English. Description of composite line drawing ‘Cookie theft’ picture BDAE (Goodglass and Kaplan 1983) The picture is used as a prompt to elicit a sample of spontaneous speech.

Composite line drawing

Sound level meter CR: 260A Cirrus research

Mean Background Noise A computer is ≤ 40dB. Against this background noise conversational speech would be around 60dB.

Maximum loudness during sustained phonation /a/ A hoover is around 70dB and an alarm clock around 80dB. As you would expect loudness increases for the LSVT group after treatment, but it is notable that it remains at a similar level at the 6 month assessment point. Colours different on this slide!! Please use legend on each slide!!`

Duration of /a/ The participants in both the NHS and the LSVT group improved in there ability to sustain production of /a/ for longer than the control group. The LSVT continued with these gains upto 6 months while the NHS group flattened out. There were no changes in the control group. This may not be something that is directly treated in therapy and it may reflect improvement in respiratory function, improvement in vocal fold function, overall engagement, mood etc.

Mean loudness reading aloud 70-80 dB is a good volume. The LSVT group increase their loudness more than the other groups and sustain it better.

Mean loudness during spontaneous generated speech

Looking at the combined data

Combined participant data across tasks We can see here that the participants are able to attain slightly louder voice production in the simple /a/ task and there is a slight drop with the reading task and then a further drop with the spontaneous speech generation task. The hierarchy of these 3 tasks with regards cognitive load so this slight difference is not surprising. We can now look at this for each separate participant group.

Maximum loudness across task: LSVT participants Those receiving LSVT can be seen here with an increase in loudness for each task at 3 months with maintenance at 6 months.

Maximum loudness across tasks: NHS SLT participants The group receiving NHS therapy show no notable change in loudness

Maximum loudness across tasks: control participants And the control group, similar to the NHS show no change in loudness at the different time points.

Conclusions Preliminary data from this small group shows that providing therapy directed at increasing loudness results in an increase in loudness across tasks with different cognitive loads. The changes in loudness production for those who received therapy focussed on this outcome maintain the increased volume for up to six months, and possibly longer. The small changes seen in all three groups of participants for loudness is likely to be in part attributable to a ceiling effect with the participants having mild difficulties. The value of increasing volume needs to be examined in measures of intelligibility and comprehensibility.

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