Reduced vocal intensity (hypophonia) is a hallmark motor speech symptom of Parkinson’s disease (PD), and while the physiologic causes of motor speech changes in PD are not completely understood an impairment in accurate self-perception of speech has been identified as a common problem associated with PD causing many patients to have difficulty performing a task when reliant solely on an internal cue. With regards to speech production, many individuals with PD often overestimate their level of vocal intensity and when cued to speak at a more normal level of loudness (which many patients can do), they may insist: “this feels to loud,” I can’t talk this loud.” So standardized protocols for speech therapy treatment designed to address hypophonia often include vocal function exercises performed at a high level of vocal intensity in order toto improve strength and endurance for voice use.
But hypophonia is not a voice symptoms associated with Parkinson’s alone, many older adults report that they have difficulty projecting their voice adequately when in a noisy or high demand setting, and this is often due to a diagnosis of presbylarynx, or age related changes to voice. Physical deconditioning is often heard in the voice as vocal deconditioning.
Vocal function exercises designed to strengthen the voice must be performed at a high enough level of effort for an actual strength effect to take place. Just as we use weights or resistance bands to load the muscles of our arms and legs, making them work harder and grow, the same principle applies to the muscles used for voice. But, because I can’t attach weight to the larynx, vocal function exercise must place a demand or load on the the muscles causing them to work harder and get stronger.
When performing high effort vocal function exercises whether in speech therapy, at home by yourself during daily practice, or after discharge from speech therapy treatment, lack of accurate self-perception of loudness may impact independent speech and voice practice. Without feedback, individuals may not accurately judge the amount of effort required to perform vocal function exercises at a level of intensity that will provide a gain in strength and carryover to every day speech.
Can You Hear Me Now
The Hi-Volt® voice-on-light is a calibrated, voice-activated feedback tool that may help individuals with Parkinson’s or age related voice changes perform speech practice more efficiently on their own and help them feel the effort they need to use to generate a loud enough voice to obtain some strengthening effect and endurance for everyday conversation.
Frequently, the Hi-VOLT® it is introduced during speech therapy treatment, with a single cue: “speak loud enough to activate the light.” At home individuals can use the Hi-VOLT® during their speech practice, and, because the light is housed within a bracelet, they can also use it during physical therapy or in Rock Steady Boxing as an external cue for loudness when counting exercise reps. The Hi-VOLT was NOT designed for all day use but for those times you are performing vocal function exercises as a part of a daily exercise program.
Speech-Language Pathology Graduate student at Thiel College uses the Hi-VOLT with her patient while he does his Speak OUT!® warm-ups
Order a Hi-VOLT® here: https://voiceaerobicsdvd.com/product/hi-volt-voice-on-light-bracelet/
Augmented Feedback and Skill Learning
Feedback during exercise can come in many forms but it’s primarily used to guide performance to an intended outcome. Giving augmented feedback is a significant role for a speech or physical therapists when working with patients with Parkinson’s disease (PD), as these patients often under scale movements and voice. External feedback tools can be helpful to patients in and out of therapy, helping them re-calibrate to normal by seeing and feeling the effort associated with specific tasks such as walking and speaking.
Augmented feedback can save a learner time and energy in learning skills, and also add to information detected as well as information one cannot detect. External feedback helps a learner achieve a goal more quickly (guidance); influences the person’s perception of his/ her own ability in a skill (motivation); and improves the chance that the performer will repeat the performance (re-inforcement).
Does Hi-VOLT® Work?
Acoustic data for 98 PD patients was reviewed.Rounding up, the median loudness during a sustained phonation task without feedback was 74.0 dB SPL, and the median loudness when using the Hi-VOLT was 80.0 dB SPL. The increase in loudness that occurred when the patients used the Hi-VOLT is greater than would be expected by chance, and is therefore, statistically significant. The p-value of <0.001 indicates that there is less than a tenth of a percent chance that this increase in loudness occurred by chance, meaning that the difference is highly likely to be the result of using the Hi-VOLT®
Find out for yourself or for your patients. Add the Hi-VOLT® for PD audio of guided practice and strengthen your voice at home, in the car, or wherever you go!
Visit our website to learn more:https://voiceaerobicsdvd.com/
Watch our video:https://youtu.be/4HYlK2aHSycsi=_8CveCy9_RhT_TlB
My Mission: To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower. Mary Spremulli, MA, CCC-SLP * Voice Aerobics® A Whole Body Approach to Voice Practice* Certified End of Life Specialist Training (CEOLS) * FiTOUR® Group Exercise Instructor
Voice Aerobics the heART and Science of Voice Practice