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Marian C Brady - One of the best experts on this subject based on the ideXlab platform.
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a multicentre randomised controlled trial to compare the clinical and cost effectiveness of lee silverman voice treatment versus standard nhs speech and Language Therapy versus control in parkinson s disease a study protocol for a randomised controll
Trials, 2020Co-Authors: Catherine Sackley, Marian C Brady, Caroline Rick, Francis Dowling, Christopher R Burton, Pui Au, Gillian Beaton, Maria Caulfield, Sylvia Dickson, Max HughesAbstract:Background Parkinson’s disease (PD) affects approximately 145,519 people in the UK. Speech impairments are common with a reported prevalence of 68%, which increase physical and mental demands during conversation, reliance on family and/or carers, and the likelihood of social withdrawal reducing quality of life. In the UK, two approaches to Speech and Language Therapy (SLT) intervention are commonly available: National Health Service (NHS) SLT or Lee Silverman Voice Treatment (LSVT LOUD®). NHS SLT is tailored to the individuals’ needs per local practice typically consisting of six to eight weekly sessions; LSVT LOUD® comprises 16 sessions of individual treatment with home-based practice over 4 weeks. The evidence-base for their effectiveness is inconclusive. Methods/design PD COMM is a phase III, multicentre, three-arm, unblinded, randomised controlled trial. Five hundred and forty-six people with idiopathic PD, reporting speech or voice problems will be enrolled. We will exclude those with a diagnosis of dementia, laryngeal pathology or those who have received SLT for speech problems in the previous 2 years. Following informed consent and completion of baseline assessments, participants will be randomised in a 1:1:1 ratio to no-intervention control, NHS SLT or LSVT LOUD® via a central computer-generated programme, using a minimisation procedure with a random element, to ensure allocation concealment. Participants randomised to the intervention groups will start treatment within 4 (NHS SLT) or 7 (LSVT LOUD®) weeks of randomisation. Primary outcome: Voice Handicap Index (VHI) total score at 3 months. Secondary outcomes include: VHI subscales, Parkinson’s Disease Questionnaire-39; Questionnaire on Acquired Speech Disorders; EuroQol-5D-5 L; ICECAP-O; resource utilisation; adverse events and carer quality of life. Mixed-methods process and health economic evaluations will take place alongside the trial. Assessments will be completed before randomisation and at 3, 6 and 12 months after randomisation. The trial started in December 2015 and will run for 77 months. Recruitment will take place in approximately 42 sites around the UK. Discussion The trial will test the hypothesis that SLT is effective for the treatment of speech or voice problems in people with PD compared to no SLT. It will further test whether NHS SLT or LSVT LOUD® provide greater benefit and determine the cost-effectiveness of both interventions. Trial registration International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ID: 12421382. Registered on 18 April 2016.
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self managed computerised speech and Language Therapy for patients with chronic aphasia post stroke compared with usual care or attention control big cactus a multicentre single blinded randomised controlled trial
Lancet Neurology, 2019Co-Authors: Rebecca Palmer, Pam Enderby, Marian C Brady, Audrey Bowen, Munyaradzi Dimairo, Cindy Cooper, Nicholas Latimer, Steven A Julious, E J Cross, Abualbishr AlshreefAbstract:Summary Background Post-stroke aphasia might improve over many years with speech and Language Therapy; however speech and Language Therapy is often less readily available beyond a few months after stroke. We assessed self-managed computerised speech and Language Therapy (CSLT) as a means of providing more Therapy than patients can access through usual care alone. Methods In this pragmatic, superiority, three-arm, individually randomised, single-blind, parallel group trial, patients were recruited from 21 speech and Language Therapy departments in the UK. Participants were aged 18 years or older and had been diagnosed with aphasia post-stroke at least 4 months before randomisation; they were excluded if they had another premorbid speech and Language disorder caused by a neurological deficit other than stroke, required treatment in a Language other than English, or if they were currently using computer-based word-finding speech Therapy. Participants were randomly assigned (1:1:1) to either 6 months of usual care (usual care group), daily self-managed CSLT plus usual care (CSLT group), or attention control plus usual care (attention control group) with the use of computer-generated stratified blocked randomisation (randomly ordered blocks of sizes three and six, stratified by site and severity of word finding at baseline based on CAT Naming Objects test scores). Only the outcome assessors and trial statistician were masked to the treatment allocation. The speech and Language therapists who were doing the outcome assessments were different from those informing participants about which group they were assigned to and from those delivering all interventions. The statistician responsible for generating the randomisation schedule was separate from those doing the analysis. Co-primary outcomes were the change in ability to retrieve personally relevant words in a picture naming test (with 10% mean difference in change considered a priori as clinically meaningful) and the change in functional communication ability measured by masked ratings of video-recorded conversations, with the use of Therapy Outcome Measures (TOMs), between baseline and 6 months after randomisation (with a standardised mean difference in change of 0·45 considered a priori as clinically meaningful). Primary analysis was based on the modified intention-to-treat (mITT) population, which included randomly assigned patients who gave informed consent and excluded those without 6-month outcome measures. Safety analysis included all participants. This trial has been completed and was registered with the ISRCTN, number ISRCTN68798818. Findings From Oct 20, 2014, to Aug 18, 2016, 818 patients were assessed for eligibility, of which 278 (34%) participants were randomly assigned (101 [36%] to the usual care group; 97 [35%] to the CSLT group; 80 [29%] to the attention control group). 86 patients in the usual care group, 83 in the CSLT group, and 71 in the attention control group contributed to the mITT. Mean word finding improvements were 1·1% (SD 11·2) in the usual care group, 16·4% (15·3) in the CSLT group, and 2·4% (8·8) in the attention control group. Word finding improvement was 16·2% (95% CI 12·7 to 19·6; p Interpretation CSLT plus usual care resulted in a clinically significant improvement in personally relevant word finding but did not result in an improvement in conversation. Future studies should explore ways to generalise new vocabulary to conversation for patients with chronic aphasia post-stroke. Funding National Institute for Health Research, Tavistock Trust for Aphasia.
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release a protocol for a systematic review based individual participant data meta and network meta analysis of complex speech Language Therapy interventions for stroke related aphasia
Aphasiology, 2019Co-Authors: Marian C Brady, Myzoon Ali, Linda J Williams, Louise R Williams, Kathryn Vandenberg, Masahiro Abo, Frank Becker, Audrey Bowen, Caitlin Brandenburg, Caterina BreitensteinAbstract:Background: Speech and Language Therapy (SLT) benefits people with aphasia following stroke. Group level summary statistics from randomised controlled trials hinder exploration of highly complex SL...
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lee silverman voice treatment versus standard speech and Language Therapy versus control in parkinson s disease a pilot randomised controlled trial pd comm pilot
Pilot and Feasibility Studies, 2018Co-Authors: Catherine Sackley, Marian C Brady, Christina H Smith, Caroline Rick, Natalie Ives, Ramilla Patel, Francis Dowling, Smitaa Patel, Rebecca Woolley, Helen C RobertsAbstract:Speech-related problems are common in Parkinson’s disease (PD), but there is little evidence for the effectiveness of standard speech and Language Therapy (SLT) or Lee Silverman Voice Treatment (LSVT LOUD®). The PD COMM pilot was a three-arm, assessor-blinded, randomised controlled trial (RCT) of LSVT LOUD®, SLT and no intervention (1:1:1 ratio) to assess the feasibility and to inform the design of a full-scale RCT. Non-demented patients with idiopathic PD and speech problems and no SLT for speech problems in the past 2 years were eligible. LSVT LOUD® is a standardised regime (16 sessions over 4 weeks). SLT comprised individualised content per local practice (typically weekly sessions for 6–8 weeks). Outcomes included recruitment and retention, treatment adherence, and data completeness. Outcome data collected at baseline, 3, 6, and 12 months included patient-reported voice and quality of life measures, resource use, and assessor-rated speech recordings. Eighty-nine patients were randomised with 90% in the Therapy groups and 100% in the control group completing the trial. The response rate for Voice Handicap Index (VHI) in each arm was ≥ 90% at all time-points. VHI was highly correlated with the other speech-related outcome measures. There was a trend to improvement in VHI with LSVT LOUD® (difference at 3 months compared with control: − 12.5 points; 95% CI − 26.2, 1.2) and SLT (difference at 3 months compared with control: − 9.8 points; 95% CI − 23.2, 3.7) which needs to be confirmed in an adequately powered trial. Randomisation to a three-arm trial of speech Therapy including a no intervention control is feasible and acceptable. Compliance with both interventions was good. VHI and other patient-reported outcomes were relevant measures and provided data to inform the sample size for a substantive trial. International Standard Randomised Controlled Trial Number Register: ISRCTN75223808 . registered 22 March 2012.
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speech and Language Therapy for aphasia after stroke an updated systematic review and meta analyses
Stroke, 2016Co-Authors: Marian C Brady, Pam Enderby, Jon Godwin, Helen Kelly, Pauline CampbellAbstract:Aphasia significantly affects the individual, families, and communities. Timely, effective intervention is vital. Speech and Language Therapy (SLT) is a complex rehabilitation intervention targeting improvement in Language and communication abilities (verbal comprehension, spoken Language, reading, writing), activity, and participation. Therapy may vary in intervention regimen, theoretical approach, or delivery model. Our comprehensive updated review1 synthesized evidence of the effectiveness of SLT for aphasia after stroke found in randomized control trials compared with (1) no Therapy and (2) other SLT interventions. We searched a range of databases, including the Cochrane Stroke Group Trials Register, the Cochrane Central Register of Controlled Trials, Cochrane Library Databases, MEDLINE, EMBASE, CINAHL, AMED (Allied and Complementary Medicine Database), LLBA (Linguistics and Language Behaviour Abstracts), and SpeechBITE (Speech Pathology Database for Best Interventions and Treatment Efficacy) (all from inception to September 2015). We also searched …
Stephen J Fowler - One of the best experts on this subject based on the ideXlab platform.
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physioTherapy and speech and Language Therapy intervention for patients with refractory chronic cough a multicentre randomised control trial
Thorax, 2017Co-Authors: Sarah Chamberlain Mitchell, Rachel Garrod, Lynne Clark, Abdel Douiri, Sean M Parker, Jenny Ellis, Stephen J Fowler, Siobhan Ludlow, James H HullAbstract:Background PhysioTherapy, and speech and Language Therapy are emerging non-pharmacological treatments for refractory chronic cough. We aimed to investigate the efficacy of a physioTherapy, and speech and Language Therapy intervention (PSALTI) to improve health-related quality of life (HRQoL) and to reduce cough frequency in patients with refractory chronic cough. Methods In this multicentre randomised controlled trial, patients with refractory chronic cough were randomised to four weekly 1:1 sessions of either PSALTI consisting of education, laryngeal hygiene and hydration, cough suppression techniques, breathing exercises and psychoeducational counselling or control intervention consisting of healthy lifestyle advice. We assessed the change in HRQoL at week 4 with the Leicester Cough Questionnaire (LCQ). Secondary efficacy outcomes included 24-hour objective cough frequency (Leicester Cough Monitor) and cough reflex sensitivity. The primary analysis used an analysis of covariance adjusted for baseline measurements with the intention-to-treat population. This study was registered at UK Clinical Research Network (UKCRN ID 10678). Findings Between December 2011 and April 2014, we randomly assigned 75 participants who underwent baseline assessment (34 PSALTI and 41 controls). In the observed case analysis, HRQoL (LCQ) improved on average by 1.53 (95% CI 0.21 to 2.85) points more in PSALTI group than with control (p=0.024). Cough frequency decreased by 41% (95% CI 36% to 95%) in PSALTI group relative to control (p=0.030). The improvements within the PSALTI group were sustained up to 3 months. There was no significant difference between groups in the concentration of capsaicin causing five or more coughs. Interpretation Greater improvements in HRQoL and cough frequency were observed with PSALTI intervention. Our findings support the use of PSALTI for patients with refractory chronic cough. Trial registration number UKCRN ID 10678 and [ISRCTN 73039760][1]; Results. [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN73039760
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impact of respiratory speech and Language Therapy on symptoms in vocal cord dysfunction
European Respiratory Journal, 2016Co-Authors: Jemma Haines, Claire Slinger, Aashish Vyas, Stephen J FowlerAbstract:Introduction: Our specialist multidisciplinary Airways Service manages patients with vocal cord dysfunction (VCD), principally with respiratory speech and Language Therapy (rSLT). The VCDQ (Fowler 2015) is the first validated questionnaire for use in VCD, with 12 statements covering a broad range of impacts and symptoms. Aim: To determine the effect of treatment on each VCDQ statement and establish where rSLT has most impact. Methods: We included retrospective (Sept 2015 - Jan 2016) data from patients who had i) endoscopically diagnosed VCD; ii) completed rSLT treatment; and iii) pre & post VCDQ data. Results: Sixteen patients had full data sets. All patients reported clinical improvements. There was overall improvement in VCDQ from median (range) 46 (20-60) pre to 38 (12-50) post rSLT (Wilcoxon9s signed rank p=0.017). Of the 12 statements, items 10 (I am frustrated that my symptoms have not been understood correctly) and 12 (the attacks impact on my social life) improved the most [3.0 (1-5) to 1.0 (1-4), p=0.001] and [4.0 (1-5) to 3.0 (1-5), p=0.001 respectively]. Improvements in item 2 (I feel I can9t get breath past a certain point in my throat/upper chest because of restriction) and 3 (my breathlessness is usually worse when breathing in) were nearly statistically significant [4.0 (1-5) to 3.0 (1-5), p=0.062] and [4.0 (1-5) to 3.0 (1-5), p=0.077 respectively]. Conclusions: Management of VCD with rSLT is beneficial. This preliminary analysis suggests it has the most significant impact on psychosocial issues and may also have physical benefits for symptoms. We acknowledge larger numbers are required to guide future therapeutic refinements.
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patients perspective of physioTherapy speech and Language Therapy intervention psalti for refractory chronic cough secondary analysis
European Respiratory Journal, 2016Co-Authors: Sarah Chamberlain Mitchell, Rachel Garrod, Abdel Douiri, Sean M Parker, Jenny Ellis, Stephen J Fowler, Siobhan Ludlow, Lynne Clarke, James H HullAbstract:Introduction: PhysioTherapy, speech and Language Therapy intervention (PSALTI) reduces cough symptoms in patients with refractory chronic cough. We investigated the patients9 opinions and perspectives of the treatment and its acceptability. Methods: Participants who had undergone 4 weekly 1 to 1 sessions in the PSALTI RCT were asked to complete a paper survey anonymously on their opinions of the treatment at their 3month follow up. Count data was expressed as frequencies and percentages of the total number of responses. Results: Of the 22 participants who completed their 3month follow up, 16 participants completed the survey. The majority of participants reported a decrease in their cough frequency (81%, n=13)), cough intensity (63%, n=10) and their embarrassment felt due to their cough (50%, n=7). The majority of participants also reported an improvement in sleep (63%, n=10) and their ability to control their cough post treatment (63%, n=10). The treatment components of PSALTI that participants felt were most helpful were the laryngeal hygiene and hydration/cough distraction techniques sipping water (n=15), sucking sweets (n=12), hard swallow technique (n=11) and breathing exercises (n=9). The majority of participants felt within the RCT, the session lengths (87%, n=13), frequency (93%, n=13) and total number (100%, n=15) were 9just right9. When asked if the sessions could have been completed within a group rather than 1 to 1 79% reported 9no.9 Conclusion: These results give the first insight into the patients9 perspective of PSALTI and are very useful to consider when designing further studies and considering implementation into patient care.
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speech and Language Therapy for chronic cough and vocal cord dysfunction patient satisfaction with Therapy given face to face and via videocalls
European Respiratory Journal, 2015Co-Authors: Jemma Haines, Stephen J Fowler, Claire Slinger, Aashish Vyas, Siobhan LillieAbstract:Introduction: Our tertiary airways service offers specialist speech and Language Therapy (SLT) for vocal cord dysfunction and refractory chronic cough, face-to-face or via Skype™. Analysis of the Skype™ pilot suggested that the response to Therapy was equivalent to face-to-face.We have reviewed patient satisfaction with both methods. Methods: A tailored patient satisfaction questionnaire was sent to all patients discharged from respiratory SLT between January and June 2014. Patients were invited to complete the questionnaire anonymously and return by post in a pre-paid envelope. Results: Twenty-six of 61 questionnaires were returned (response rate 43%). Patient satisfaction was very favourable with 96% pleased with the overall service provided. Further, 96% were happy to have engaged with SLT as a treatment option and felt they had been given enough information about why they had been referred. We compared data from those receiving traditional clinician-facing appointments (n=18) with those having virtual consultations (n=8). Approximately a third found traditional clinic appointment times inconvenient compared to 0% over Skype™. Of the Skype™ cohort 100% patient satisfaction was reported for all questions compared with 84% from the traditional treatment delivery mode. Conclusions: Listening to patients9 views is essential to providing a patient -centred health service. Identifying such a favourable patient satisfaction response emphasises the importance of respiratory SLT. Based on the feedback received virtual SLT consultations are now routinely offered to patients who struggle to attend traditional clinic appointments.
Wolfdieter Heiss - One of the best experts on this subject based on the ideXlab platform.
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fv 13 the combination of repetitive transcranial magnetic stimulation rtms and Language Therapy enhances improvement of functional communication and linguistic skills in patients with subacute aphasia
Clinical Neurophysiology, 2016Co-Authors: Ilona Rubifessen, A Hartmann, Thomas Rommel, Wolfdieter HeissAbstract:Background and Objective Repetitive transcranial magnetic stimulation (rTMS) has shown encouraging effects on naming performance in the treatment of persons with chronic aphasia by means of inhibiting homologous Language areas and reactivating perilesional tissue ( Naeser et al., 2005 ). However, there are heterogeneous results about the combined impact of speech and Language Therapy (SLT) and rTMS in the subacute stage of aphasia and its effect on linguistic performance in Language assessments and functional communication ( Thiel et al., 2013 , Seniow et al., 2013 ). As few studies have dealt with the effect of rTMS on functional communication, the study aimed to determine to which extent rTMS combined with SLT improves functional communication and linguistic skills in patients with subacute aphasia. Methods Design and Participants: The randomized, blinded, sham-controlled study investigated the effect of a 10-day treatment period with inhibitory rTMS over the right inferior frontal gyrus versus sham stimulation in conjunction with SLT on Language recovery in 30 participants with subacute aphasia after stroke. Intervention: During treatment period, half of the participants received 10 sessions of 20 min 1 Hz-rTMS over the right inferior frontal gyrus (BA 45) and the other half was subjected to sham stimulation. Directly thereafter all the participants underwent 45 min of SLT. SLT aimed at recruiting left hemisphere perilesional areas by using tasks and Therapy methods which had been shown to activate predominantly left hemisphere structures in imaging studies ( Heim et al., 2008 ). Outcome Measures: Aachen Aphasia Test (AAT), Amsterdam-Nijmegen Everyday Language Test (ANELT), a naming screening and subscales of the Functional Independence Measure (FIM), all assessed the day before and the day after treatment period. Results The participants who received real rTMS significantly improved in all 10 measures of Language skills and functional communication whereas sham treated participants significantly improved only regarding 6/10 measures (P Conclusion The results show for the first time that linguistic skills as well as functional communication are bolstered by combining rTMS and behavioral Language Therapy in patients with subacute aphasia.
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add on effects of repetitive transcranial magnetic stimulation on subacute aphasia Therapy enhanced improvement of functional communication and basic linguistic skills a randomized controlled study
Archives of Physical Medicine and Rehabilitation, 2015Co-Authors: Ilona Rubifessen, A Hartmann, Walter Huber, Bruno Fimm, Thomas Rommel, Alexander Thiel, Wolfdieter HeissAbstract:Abstract Objective To determine to what extent repetitive transcranial magnetic stimulation (rTMS) combined with speech and Language Therapy improves functional communication and basic linguistic skills of individuals with subacute aphasia. Design Randomized, blinded, and sham-controlled study. Setting Neurologic rehabilitation hospital. Participants Participants (N=30) with subacute aphasia after stroke. Interventions During a 2-week treatment period, half of the participants received 10 sessions of 20-minute inhibitory 1-Hz rTMS over the right inferior frontal gyrus (Brodmann area 45), and the other half received sham stimulation. Directly thereafter, all the participants underwent 45 minutes of speech and Language Therapy. Main Outcome Measures Aachen Aphasia Test, Amsterdam-Nijmegen Everyday Language Test (ANELT), a naming screening, and subscales of the FIM, all assessed the day before and the day after treatment period. Results The participants who received real rTMS significantly improved with respect to all 10 measures of basic linguistic skills and functional communication, whereas sham-treated participants significantly improved in only 6 of 10 measures (paired t tests, P P ≤.05). Conclusions For the first time, this study has demonstrated that basic linguistic skills as well as functional communication are bolstered by combining rTMS and behavioral Language Therapy in patients with subacute aphasia.
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non invasive repeated therapeutic stimulation for aphasia recovery a multilingual multicenter aphasia trial
Journal of Stroke & Cerebrovascular Diseases, 2015Co-Authors: Alexander Thiel, A Hartmann, Sandra E Black, Elizabeth Rochon, Sylvain Lanthier, Joyce L Chen, George Mochizuki, Anna Zumbansen, Wolfdieter HeissAbstract:Noninvasive brain stimulation such as repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) has been used in case series and small randomized controlled trials to improve recovery from poststroke aphasia in combination with speech and Language Therapy. Results of these studies suggest possible clinical efficacy and an excellent safety profile. Therefore, a larger international multicenter proof-of-concept trial was launched, to directly compare the safety and efficacy of rTMS, tDCS, and sham stimulation as adjuvant Therapy to speech and Language Therapy in subacute poststroke aphasia. In the 4 participating centers, subacute stroke patients with aphasia are randomized between 5 and 30 days after ischemic stroke to either receive rTMS, tDCS, or sham stimulation in combination with a daily 45 minutes speech and Language Therapy session for 10 days. Efficacy is evaluated at 1 and 30 days after the last of the 10 treatment sessions using 3 outcome measures, validated in all participating Languages: Boston naming test, Token test, and verbal fluency test. Additionally, adverse events are recorded to prove safety. In this study, a total of 90 patients will be recruited, and data analysis will be completed in 2016. This is the first multilingual and multinational randomized and controlled trial in poststroke aphasia and if positive, will add an effective new strategy for early stage poststroke aphasia rehabilitation.
Catherine Sackley - One of the best experts on this subject based on the ideXlab platform.
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a multicentre randomised controlled trial to compare the clinical and cost effectiveness of lee silverman voice treatment versus standard nhs speech and Language Therapy versus control in parkinson s disease a study protocol for a randomised controll
Trials, 2020Co-Authors: Catherine Sackley, Marian C Brady, Caroline Rick, Francis Dowling, Christopher R Burton, Pui Au, Gillian Beaton, Maria Caulfield, Sylvia Dickson, Max HughesAbstract:Background Parkinson’s disease (PD) affects approximately 145,519 people in the UK. Speech impairments are common with a reported prevalence of 68%, which increase physical and mental demands during conversation, reliance on family and/or carers, and the likelihood of social withdrawal reducing quality of life. In the UK, two approaches to Speech and Language Therapy (SLT) intervention are commonly available: National Health Service (NHS) SLT or Lee Silverman Voice Treatment (LSVT LOUD®). NHS SLT is tailored to the individuals’ needs per local practice typically consisting of six to eight weekly sessions; LSVT LOUD® comprises 16 sessions of individual treatment with home-based practice over 4 weeks. The evidence-base for their effectiveness is inconclusive. Methods/design PD COMM is a phase III, multicentre, three-arm, unblinded, randomised controlled trial. Five hundred and forty-six people with idiopathic PD, reporting speech or voice problems will be enrolled. We will exclude those with a diagnosis of dementia, laryngeal pathology or those who have received SLT for speech problems in the previous 2 years. Following informed consent and completion of baseline assessments, participants will be randomised in a 1:1:1 ratio to no-intervention control, NHS SLT or LSVT LOUD® via a central computer-generated programme, using a minimisation procedure with a random element, to ensure allocation concealment. Participants randomised to the intervention groups will start treatment within 4 (NHS SLT) or 7 (LSVT LOUD®) weeks of randomisation. Primary outcome: Voice Handicap Index (VHI) total score at 3 months. Secondary outcomes include: VHI subscales, Parkinson’s Disease Questionnaire-39; Questionnaire on Acquired Speech Disorders; EuroQol-5D-5 L; ICECAP-O; resource utilisation; adverse events and carer quality of life. Mixed-methods process and health economic evaluations will take place alongside the trial. Assessments will be completed before randomisation and at 3, 6 and 12 months after randomisation. The trial started in December 2015 and will run for 77 months. Recruitment will take place in approximately 42 sites around the UK. Discussion The trial will test the hypothesis that SLT is effective for the treatment of speech or voice problems in people with PD compared to no SLT. It will further test whether NHS SLT or LSVT LOUD® provide greater benefit and determine the cost-effectiveness of both interventions. Trial registration International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ID: 12421382. Registered on 18 April 2016.
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lee silverman voice treatment versus standard speech and Language Therapy versus control in parkinson s disease a pilot randomised controlled trial pd comm pilot
Pilot and Feasibility Studies, 2018Co-Authors: Catherine Sackley, Marian C Brady, Christina H Smith, Caroline Rick, Natalie Ives, Ramilla Patel, Francis Dowling, Smitaa Patel, Rebecca Woolley, Helen C RobertsAbstract:Speech-related problems are common in Parkinson’s disease (PD), but there is little evidence for the effectiveness of standard speech and Language Therapy (SLT) or Lee Silverman Voice Treatment (LSVT LOUD®). The PD COMM pilot was a three-arm, assessor-blinded, randomised controlled trial (RCT) of LSVT LOUD®, SLT and no intervention (1:1:1 ratio) to assess the feasibility and to inform the design of a full-scale RCT. Non-demented patients with idiopathic PD and speech problems and no SLT for speech problems in the past 2 years were eligible. LSVT LOUD® is a standardised regime (16 sessions over 4 weeks). SLT comprised individualised content per local practice (typically weekly sessions for 6–8 weeks). Outcomes included recruitment and retention, treatment adherence, and data completeness. Outcome data collected at baseline, 3, 6, and 12 months included patient-reported voice and quality of life measures, resource use, and assessor-rated speech recordings. Eighty-nine patients were randomised with 90% in the Therapy groups and 100% in the control group completing the trial. The response rate for Voice Handicap Index (VHI) in each arm was ≥ 90% at all time-points. VHI was highly correlated with the other speech-related outcome measures. There was a trend to improvement in VHI with LSVT LOUD® (difference at 3 months compared with control: − 12.5 points; 95% CI − 26.2, 1.2) and SLT (difference at 3 months compared with control: − 9.8 points; 95% CI − 23.2, 3.7) which needs to be confirmed in an adequately powered trial. Randomisation to a three-arm trial of speech Therapy including a no intervention control is feasible and acceptable. Compliance with both interventions was good. VHI and other patient-reported outcomes were relevant measures and provided data to inform the sample size for a substantive trial. International Standard Randomised Controlled Trial Number Register: ISRCTN75223808 . registered 22 March 2012.
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subjective experiences of speech and Language Therapy in patients with parkinson s disease a pilot study
Rehabilitation Research and Practice, 2015Co-Authors: Laura Spurgeon, Carl E Clarke, Catherine SackleyAbstract:Purpose. Parkinson's disease can produce a range of speech-Language pathologies, which may require intervention. While evaluations of speech-Language Therapy have been undertaken, no work has been undertaken to capture patients' experiences of Therapy. This was the aim of the present study. Methods. Semistructured interviews, using themes derived from the literature, were conducted with nine Parkinson's disease patients, all of whom had undergone speech-Language Therapy. Participants' responses were analysed in accordance with Thematic Network Analysis. Results. Four themes emerged: emotional reactions (frustration, embarrassment, lack of confidence, disappointment, and anxiety); physical impact (fatigue, breathing and swallowing, and word production); practical aspects (cost of treatment, waiting times, and the actual clinical experience); and expectations about treatment (met versus unmet). Conclusions. While many benefits of speech-Language Therapy were reported, several negative issues emerged which could impact adversely on rehabilitation. Parkinson's disease is associated with a range of psychological and physical sequelae, such as fatigue and depression; recognising any individual experiences which could exacerbate the existing condition and incorporating these into treatment planning may improve rehabilitation outcomes.
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lee silverman voice treatment versus standard nhs speech and Language Therapy versus control in parkinson s disease pd comm pilot study protocol for a randomized controlled trial
Trials, 2014Co-Authors: Catherine Sackley, Marian C Brady, Christina H Smith, Caroline Rick, Natalie Ives, Ramilla Patel, Helen C Roberts, Francis Dowling, Sue Jowett, Keith WheatleyAbstract:Parkinson’s disease is a common movement disorder affecting approximately 127,000 people in the UK, with an estimated two thirds having speech-related problems. Currently there is no preferred approach to speech and Language Therapy within the NHS and there is little evidence for the effectiveness of standard NHS Therapy or Lee Silverman voice treatment. This trial aims to investigate the feasibility and acceptability of randomizing people with Parkinson’s disease-related speech or voice problems to Lee Silverman voice treatment or standard speech and Language Therapy compared to a no-intervention control. The PD COMM pilot is a three arm, assessor-blinded, randomized controlled trial. Randomization will be computer-generated with participants randomized at a ratio of 1:1:1. Participants randomized to intervention arms will be immediately referred to the appropriate speech and Language therapist. The target population are patients with a confirmed diagnosis of idiopathic Parkinson’s disease who have problems with their speech or voice. The Lee Silverman voice treatment intervention group will receive the standard regime of 16 sessions between 50 and 60 minutes in length over four weeks, with extra home practice. The standard speech and Language Therapy intervention group will receive a dose determined by patients’ individual needs, but not exceeding eight weeks of treatment. The control group will receive standard care with no speech and Language Therapy input for at least six months post-randomization. Outcomes will be assessed at baseline (pre-randomization) and post- randomization at three, six, and 12 months. The outcome measures include patient-reported voice measures, quality of life, resource use, and assessor-rated speech recordings. The recruitment aim is at least 60 participants over 21 months from 11 sites, equating to at least 20 participants in each arm of the trial. This trial is ongoing and recruitment commenced in May 2012. This study will provide information on the feasibility and acceptability of randomizing participants to different speech and Language therapies or control/deferred treatment. The findings relating to recruitment, treatment compliance, outcome measures, and effect size will inform a future phase III randomized controlled trial. International Standard Randomised Controlled Trial Number Register: ISRCTN75223808 registered 22 March 2012.
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speech and Language Therapy versus placebo or no intervention for speech problems in parkinson s disease
Cochrane Database of Systematic Reviews, 2012Co-Authors: Clare P Herd, Catherine Sackley, Claire L Tomlinson, Katherine H O Deane, Marian C Brady, Christina H Smith, Carl E ClarkeAbstract:Background Parkinson's disease patients commonly suffer from speech and vocal problems including dysarthric speech, reduced loudness and loss of articulation. These symptoms increase in frequency and intensity with progression of the disease). Speech and Language Therapy (SLT) aims to improve the intelligibility of speech with behavioural treatment techniques or instrumental aids. Objectives To compare the efficacy of speech and Language Therapy versus placebo or no intervention for speech and voice problems in patients with Parkinson's disease. Search methods Relevant trials were identified by electronic searches of numerous literature databases including MEDLINE, EMBASE, and CINAHL, as well as handsearching of relevant conference abstracts and examination of reference lists in identified studies and other reviews. The literature search included trials published prior to 11th April 2011. Selection criteria Only randomised controlled trials (RCT) of speech and Language Therapy versus placebo or no intervention were included. Data collection and analysis Data were abstracted independently by CH and CT and differences settled by discussion. Main results Three randomised controlled trials with a total of 63 participants were found comparing SLT with placebo for speech disorders in Parkinson's disease. Data were available from 41 participants in two trials. Vocal loudness for reading a passage increased by 6.3 dB (P = 0.0007) in one trial, and 11.0 dB (P = 0.0002) in another trial. An increase was also seen in both of these trials for monologue speaking of 5.4 dB (P = 0.002) and 11.0 dB (P = 0.0002), respectively. It is likely that these areclinically significant improvements. After six months, patients from the first trial were still showing a statistically significant increase of 4.5 dB (P = 0.0007) for reading and 3.5 dB for monologue speaking. Some measures of speech monotonicity and articulation were investigated; however, all these results were non-significant. Authors' conclusions Although improvements in speech impairments were noted in these studies, due to the small number of patients examined, methodological flaws, and the possibility of publication bias, there is insufficient evidence to conclusively support or refute the efficacy of SLT for speech problems in Parkinson's disease. A large well designed placebo-controlled RCT is needed to demonstrate SLT's effectiveness in Parkinson's disease. The trial should conform to CONSORT guidelines. Outcome measures with particular relevance to patients with Parkinson’s disease should be chosen and patients followed for at least six months to determine the duration of any improvement.
Christina H Smith - One of the best experts on this subject based on the ideXlab platform.
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lee silverman voice treatment versus standard speech and Language Therapy versus control in parkinson s disease a pilot randomised controlled trial pd comm pilot
Pilot and Feasibility Studies, 2018Co-Authors: Catherine Sackley, Marian C Brady, Christina H Smith, Caroline Rick, Natalie Ives, Ramilla Patel, Francis Dowling, Smitaa Patel, Rebecca Woolley, Helen C RobertsAbstract:Speech-related problems are common in Parkinson’s disease (PD), but there is little evidence for the effectiveness of standard speech and Language Therapy (SLT) or Lee Silverman Voice Treatment (LSVT LOUD®). The PD COMM pilot was a three-arm, assessor-blinded, randomised controlled trial (RCT) of LSVT LOUD®, SLT and no intervention (1:1:1 ratio) to assess the feasibility and to inform the design of a full-scale RCT. Non-demented patients with idiopathic PD and speech problems and no SLT for speech problems in the past 2 years were eligible. LSVT LOUD® is a standardised regime (16 sessions over 4 weeks). SLT comprised individualised content per local practice (typically weekly sessions for 6–8 weeks). Outcomes included recruitment and retention, treatment adherence, and data completeness. Outcome data collected at baseline, 3, 6, and 12 months included patient-reported voice and quality of life measures, resource use, and assessor-rated speech recordings. Eighty-nine patients were randomised with 90% in the Therapy groups and 100% in the control group completing the trial. The response rate for Voice Handicap Index (VHI) in each arm was ≥ 90% at all time-points. VHI was highly correlated with the other speech-related outcome measures. There was a trend to improvement in VHI with LSVT LOUD® (difference at 3 months compared with control: − 12.5 points; 95% CI − 26.2, 1.2) and SLT (difference at 3 months compared with control: − 9.8 points; 95% CI − 23.2, 3.7) which needs to be confirmed in an adequately powered trial. Randomisation to a three-arm trial of speech Therapy including a no intervention control is feasible and acceptable. Compliance with both interventions was good. VHI and other patient-reported outcomes were relevant measures and provided data to inform the sample size for a substantive trial. International Standard Randomised Controlled Trial Number Register: ISRCTN75223808 . registered 22 March 2012.
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lee silverman voice treatment versus standard nhs speech and Language Therapy versus control in parkinson s disease pd comm pilot study protocol for a randomized controlled trial
Trials, 2014Co-Authors: Catherine Sackley, Marian C Brady, Christina H Smith, Caroline Rick, Natalie Ives, Ramilla Patel, Helen C Roberts, Francis Dowling, Sue Jowett, Keith WheatleyAbstract:Parkinson’s disease is a common movement disorder affecting approximately 127,000 people in the UK, with an estimated two thirds having speech-related problems. Currently there is no preferred approach to speech and Language Therapy within the NHS and there is little evidence for the effectiveness of standard NHS Therapy or Lee Silverman voice treatment. This trial aims to investigate the feasibility and acceptability of randomizing people with Parkinson’s disease-related speech or voice problems to Lee Silverman voice treatment or standard speech and Language Therapy compared to a no-intervention control. The PD COMM pilot is a three arm, assessor-blinded, randomized controlled trial. Randomization will be computer-generated with participants randomized at a ratio of 1:1:1. Participants randomized to intervention arms will be immediately referred to the appropriate speech and Language therapist. The target population are patients with a confirmed diagnosis of idiopathic Parkinson’s disease who have problems with their speech or voice. The Lee Silverman voice treatment intervention group will receive the standard regime of 16 sessions between 50 and 60 minutes in length over four weeks, with extra home practice. The standard speech and Language Therapy intervention group will receive a dose determined by patients’ individual needs, but not exceeding eight weeks of treatment. The control group will receive standard care with no speech and Language Therapy input for at least six months post-randomization. Outcomes will be assessed at baseline (pre-randomization) and post- randomization at three, six, and 12 months. The outcome measures include patient-reported voice measures, quality of life, resource use, and assessor-rated speech recordings. The recruitment aim is at least 60 participants over 21 months from 11 sites, equating to at least 20 participants in each arm of the trial. This trial is ongoing and recruitment commenced in May 2012. This study will provide information on the feasibility and acceptability of randomizing participants to different speech and Language therapies or control/deferred treatment. The findings relating to recruitment, treatment compliance, outcome measures, and effect size will inform a future phase III randomized controlled trial. International Standard Randomised Controlled Trial Number Register: ISRCTN75223808 registered 22 March 2012.
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speech and Language Therapy versus placebo or no intervention for speech problems in parkinson s disease
Cochrane Database of Systematic Reviews, 2012Co-Authors: Clare P Herd, Catherine Sackley, Claire L Tomlinson, Katherine H O Deane, Marian C Brady, Christina H Smith, Carl E ClarkeAbstract:Background Parkinson's disease patients commonly suffer from speech and vocal problems including dysarthric speech, reduced loudness and loss of articulation. These symptoms increase in frequency and intensity with progression of the disease). Speech and Language Therapy (SLT) aims to improve the intelligibility of speech with behavioural treatment techniques or instrumental aids. Objectives To compare the efficacy of speech and Language Therapy versus placebo or no intervention for speech and voice problems in patients with Parkinson's disease. Search methods Relevant trials were identified by electronic searches of numerous literature databases including MEDLINE, EMBASE, and CINAHL, as well as handsearching of relevant conference abstracts and examination of reference lists in identified studies and other reviews. The literature search included trials published prior to 11th April 2011. Selection criteria Only randomised controlled trials (RCT) of speech and Language Therapy versus placebo or no intervention were included. Data collection and analysis Data were abstracted independently by CH and CT and differences settled by discussion. Main results Three randomised controlled trials with a total of 63 participants were found comparing SLT with placebo for speech disorders in Parkinson's disease. Data were available from 41 participants in two trials. Vocal loudness for reading a passage increased by 6.3 dB (P = 0.0007) in one trial, and 11.0 dB (P = 0.0002) in another trial. An increase was also seen in both of these trials for monologue speaking of 5.4 dB (P = 0.002) and 11.0 dB (P = 0.0002), respectively. It is likely that these areclinically significant improvements. After six months, patients from the first trial were still showing a statistically significant increase of 4.5 dB (P = 0.0007) for reading and 3.5 dB for monologue speaking. Some measures of speech monotonicity and articulation were investigated; however, all these results were non-significant. Authors' conclusions Although improvements in speech impairments were noted in these studies, due to the small number of patients examined, methodological flaws, and the possibility of publication bias, there is insufficient evidence to conclusively support or refute the efficacy of SLT for speech problems in Parkinson's disease. A large well designed placebo-controlled RCT is needed to demonstrate SLT's effectiveness in Parkinson's disease. The trial should conform to CONSORT guidelines. Outcome measures with particular relevance to patients with Parkinson’s disease should be chosen and patients followed for at least six months to determine the duration of any improvement.
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comparison of speech and Language Therapy techniques for speech problems in parkinson s disease
Cochrane Database of Systematic Reviews, 2012Co-Authors: Clare P Herd, Catherine Sackley, Claire L Tomlinson, Katherine H O Deane, Marian C Brady, Christina H Smith, Carl E ClarkeAbstract:Background Patients with Parkinson's disease commonly suffer from speech and voice difficulties such as impaired articulation and reduced loudness. Speech and Language Therapy (SLT) aims to improve the intelligibility of speech with behavioural treatment techniques or instrumental aids. Objectives To compare the efficacy and effectiveness of novel SLT techniques versus a standard SLT approach to treat Parkinsonian speech problems. Search methods We identified relevant, published prior to 11th April 2011, by electronic searches of numerous literature databases including CENTRAL, MEDLINE and CINAHL, as well as handsearching relevant conference abstracts and examining reference lists in identified studies and other reviews. Selection criteria Only randomised controlled trials (RCT) of one type of speech and Language Therapy versus another were included. Data collection and analysis Two review authors independently extracted data and resolved differences by discussion. Main results Six trials involving 159 patients satisfied the inclusion criteria. Data could not be analysed from one trial due to changes in patient numbers and from a second because the data provided were not in a usable format. All trials reported intelligibility measures but a statistically significant result was only reported for the diagnostic rhyme test used in the study of Lee Silverman Voice Treatment -LOUD (LSVT-LOUD) versus a modified version of this Therapy (LSVT-ARTIC). In this case a difference of 12.5 points (95% confidence interval (CI) -22.2 to -2.8; P = 0.01) between the mean changes in favour of the LSVT-LOUD group was reported for a speech sample overlaid with Babble noise; this difference was not reproduced for the two additional noise conditions under which the speech samples were assessed. LSVT-LOUD also outperformed LSVT-ARTIC and Respiration Therapy (RT) in improving loudness, with a difference in reading a sample text of 5.0 dB (95%CI -8.3 to -1.7; P = 0.003) and 5.5 dB (95% CI 3.4 to 7.7; P < 0.00001) respectively, and a difference in monologue speech of 2.9 dB (95% CI 0.6 to 5.2; P = 0.01) versus RT. Authors' conclusions Considering the small patient numbers in these trials, there is insufficient evidence to support or refute the efficacy of any form of SLT over another to treat speech problems in patients with Parkinson's disease.
