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3.417 The effects of pharmacological treatment on speech in Parkinson's disease
S184
Wednesday, 12 December 2007
the country and their comments were used to support and/or refine the recommendations. Results: The literature review revealed 5 systematic reviews and 4 randomized controlled trials reported in 9 articles. Recommendations based on these studies concerned a therapeutic strategy (i.e. Lee Silverman Voice Treatment) to diminish the impact of dysarthria in PD. Recommendations concerning interventions aimed at treating dysphagia or swallowing were based on consensus among expert SLT’s. The complete guideline includes 50 practice recommendations and a newly developed basic assessment form. Conclusion: This evidence-based guideline provides a basis for best practice by SLT’s treating PD-patients. Concurrently, it reveals that a serious amount of research needs to be done to provide more firm evidence for the efficacy of speech–language therapy in PD-patients.
Method: This pilot study analyzed 25 PD patients undergoung outpatient physical and occupational therapy with the MOVE test, and compared pre/post therapy scores with the FIM. The MOVE test incorporates 23 skills and tasks based on activity of daily living skills needed for the selfcare and safety of PD patients. Results: Sample t-test was used demonstrating the proportion of change was greater for MOVE over FIM (p < 0.001). Average change FIM 10.57% compared to MOVE 31.73%. Conclusion: MOVE is more sensitive for noting functional improvements with physical and occupational therapy for PD patients compared to the FIM.
3.415 Overview of current speech–language therapy for patients with Parkinson’s disease in the Netherlands
1 Gent,
J. Kalf1° , S. Does, I. van Eldik, K. Schepers, J. Wilmsen, B.R. Bloem, M. Munneke 1 Nijmegen, Netherlands
Objectives: 1. To evaluate perceptually the effects of levodopa on different aspects of speech: respiration, tongue force, intelligibility, prosody and speech rate. 2. To determine whether there is an evolution of objectively measured speech parameters along a levodopa drug cycle. Method: Conventional evaluations by means of visual analog scales were used for all perceptual studies. In the study of the levodopa drug cycle phonatory characteristics were analyzed using acoustic analysis (Praat) and aerodynamic measurements. Motor speech characteristics were determined with the Computerized Speech Lab. Results: In the on-condition significant improvement was found on intelligibility, Vital Capacity, Sustained Vowel Phonation, Phonation Quotient, tongue protrusion, pitch, loudness and speech rate. Sequential changes of speech parameters along the levodopa drug cycle can be demonstrated. There is considerable inter-individual variability as well as differences between individual speech characteristics. Conclusion: Pharmacological treatment results in improvement of speech, but not in normalization. We suggest to include in the linguistic diagnosis the search for an optimal therapeutic intervention time.
Objective: To provide an overview of the current speech–language therapy practice for patients with Parkinson’s disease (PD) in the Netherlands. Method: In March 2007 a questionnaire was sent to 506 speech– language therapists (SLT’s) working in private practices or in a clinical setting in 18 regions in the Netherlands. After one month a reminder was sent. Only SLT’s experienced with treating PD-patients were asked to complete the questionnaire providing detailed information about their current practice and competencies. Results: Two hundred and eighty SLT’s returned the questionnaires (55%) of whom 158 (56%) were familiar with assessment and treatment of PD-patients. The average number of patients yearly treated by speech therapists was 4, ranging from 0 to 23. The mean number of treatment sessions was 18.5 (range 1−63) and the number of sessions per month was 6 (range 1−19). The percentage of SLT’s who scored their competency in treating PD-patients as good or excellent was 31% in general, 26% for treating hypokinetic dysarthria, 27% for treating conversational problems, 45% for treating swallowing disorders and 20% for treating drooling. A total of 30% had followed a parkinson-specific course. Conclusion: Although speech and swallowing disorders are common disorders in PD, most SLT’s working with neurological patients only see a few PD-patients per year. Only a third of these SLT’s find their own competency good or excellent and up to 70% has not been specifically trained in treatment of PD-patients, stressing the need for improved education. In addition, the range and variance in treatment emphazises the need for an evidence-based guideline.
3.416 Improved sensitivity for functional assessment of Parkinson’s disease rehabilitation using the Mobility, Occupational & Vocational Examination (MOVE) test M. Jaffe1° Jolla, CA, USA
1 La
Objective: To develop a sensitive functional rehabilitation test for Parkinson’s disease (PD). Disease scales such as the Unified Parkinson’s disease Rating Scale (UPDRS) are useful as an index of disease severity. Disability scales are a tool used by the rehabilitation therapy team to measure the functional state of an individual with PD and an individual’s response to therapy. The Functional Independent Measure (FIM) disability scale has become the standard instrument used to document and monitor rehabilitation outcomes, however, it is not considered sensitive enough to detect subtle changes in functional ability. The Mobility, Occupational & Vocational Examination (MOVE) is a new functional test to objectively measure a PD patient’s level of skills and functional improvements.
3.417 The effects of pharmacological treatment on speech in Parkinson’s disease P. Santens1° , M. De Letter, G. Van Maele, M. De Bodt, J. Van Borsel Belgium
3.418 Osteoporosis in Parkinson’s disease: Comparative study with age-matched normal population S.-J. Chung1° , S.-R. Kim, D.-H. Kim, B.-J. Kim, J.-M. Koh, G.-S. Kim, M.-C. Lee 1 Seoul, Korea, Republic of Objective: To investigate the prevalence, risk factors, and clinical characteristics of osteoporosis in PD patients. Method: The study population consisted of 94 PD patients aged 55 years or older who consecutively visited the Parkinson Center of a university hospital between October 1, 2006 and June 30, 2007. Two hundred seventynine sex and age-matched normal controls, in whom BMD was measured at the same periods at the Health Promotion Center, were randomly allocated. Results: There were 40 males and 54 females in PD patients with an age range of 56 to 83 years (67.49±6.01 years). Mean PD duration was 30.4±32.7 months. After the correction of sex, age, weight and height, odds ratio (OR) for osteoporosis of PD patients was 2.7 (95% CI: 1.49 to 4.90, p = 0.001), with 7.9 (95% CI: 1.88 to 32.87, p = 0.005) in male PD patients and 2.3 (95% CI: 1.13 to 4.51, p = 0.021) in female PD patients. In male PD patients, serum homocysteine level was significantly higher than that of normal controls (p = 0.03). The serum levels of calcium, phosphorus, and total cholesterol were significantly decreased in male and female PD patients. The UPDRS II scores of PD patients showed correlation with BMD T-scores of lumbar spine (p = 0.063) and femur neck (p = 0.065). The UPDRS gait (item 29) subscore showed a tendency to correlate with BMD T-scores of lumbar spine (p = 0.088), and UPDRS walking (item 15) subscore had a tendency to correlate with BMD T-scores of femur neck (p = 0.088).
Wednesday, 12 December 2007
the country and their comments were used to support and/or refine the recommendations. Results: The literature review revealed 5 systematic reviews and 4 randomized controlled trials reported in 9 articles. Recommendations based on these studies concerned a therapeutic strategy (i.e. Lee Silverman Voice Treatment) to diminish the impact of dysarthria in PD. Recommendations concerning interventions aimed at treating dysphagia or swallowing were based on consensus among expert SLT’s. The complete guideline includes 50 practice recommendations and a newly developed basic assessment form. Conclusion: This evidence-based guideline provides a basis for best practice by SLT’s treating PD-patients. Concurrently, it reveals that a serious amount of research needs to be done to provide more firm evidence for the efficacy of speech–language therapy in PD-patients.
Method: This pilot study analyzed 25 PD patients undergoung outpatient physical and occupational therapy with the MOVE test, and compared pre/post therapy scores with the FIM. The MOVE test incorporates 23 skills and tasks based on activity of daily living skills needed for the selfcare and safety of PD patients. Results: Sample t-test was used demonstrating the proportion of change was greater for MOVE over FIM (p < 0.001). Average change FIM 10.57% compared to MOVE 31.73%. Conclusion: MOVE is more sensitive for noting functional improvements with physical and occupational therapy for PD patients compared to the FIM.
3.415 Overview of current speech–language therapy for patients with Parkinson’s disease in the Netherlands
1 Gent,
J. Kalf1° , S. Does, I. van Eldik, K. Schepers, J. Wilmsen, B.R. Bloem, M. Munneke 1 Nijmegen, Netherlands
Objectives: 1. To evaluate perceptually the effects of levodopa on different aspects of speech: respiration, tongue force, intelligibility, prosody and speech rate. 2. To determine whether there is an evolution of objectively measured speech parameters along a levodopa drug cycle. Method: Conventional evaluations by means of visual analog scales were used for all perceptual studies. In the study of the levodopa drug cycle phonatory characteristics were analyzed using acoustic analysis (Praat) and aerodynamic measurements. Motor speech characteristics were determined with the Computerized Speech Lab. Results: In the on-condition significant improvement was found on intelligibility, Vital Capacity, Sustained Vowel Phonation, Phonation Quotient, tongue protrusion, pitch, loudness and speech rate. Sequential changes of speech parameters along the levodopa drug cycle can be demonstrated. There is considerable inter-individual variability as well as differences between individual speech characteristics. Conclusion: Pharmacological treatment results in improvement of speech, but not in normalization. We suggest to include in the linguistic diagnosis the search for an optimal therapeutic intervention time.
Objective: To provide an overview of the current speech–language therapy practice for patients with Parkinson’s disease (PD) in the Netherlands. Method: In March 2007 a questionnaire was sent to 506 speech– language therapists (SLT’s) working in private practices or in a clinical setting in 18 regions in the Netherlands. After one month a reminder was sent. Only SLT’s experienced with treating PD-patients were asked to complete the questionnaire providing detailed information about their current practice and competencies. Results: Two hundred and eighty SLT’s returned the questionnaires (55%) of whom 158 (56%) were familiar with assessment and treatment of PD-patients. The average number of patients yearly treated by speech therapists was 4, ranging from 0 to 23. The mean number of treatment sessions was 18.5 (range 1−63) and the number of sessions per month was 6 (range 1−19). The percentage of SLT’s who scored their competency in treating PD-patients as good or excellent was 31% in general, 26% for treating hypokinetic dysarthria, 27% for treating conversational problems, 45% for treating swallowing disorders and 20% for treating drooling. A total of 30% had followed a parkinson-specific course. Conclusion: Although speech and swallowing disorders are common disorders in PD, most SLT’s working with neurological patients only see a few PD-patients per year. Only a third of these SLT’s find their own competency good or excellent and up to 70% has not been specifically trained in treatment of PD-patients, stressing the need for improved education. In addition, the range and variance in treatment emphazises the need for an evidence-based guideline.
3.416 Improved sensitivity for functional assessment of Parkinson’s disease rehabilitation using the Mobility, Occupational & Vocational Examination (MOVE) test M. Jaffe1° Jolla, CA, USA
1 La
Objective: To develop a sensitive functional rehabilitation test for Parkinson’s disease (PD). Disease scales such as the Unified Parkinson’s disease Rating Scale (UPDRS) are useful as an index of disease severity. Disability scales are a tool used by the rehabilitation therapy team to measure the functional state of an individual with PD and an individual’s response to therapy. The Functional Independent Measure (FIM) disability scale has become the standard instrument used to document and monitor rehabilitation outcomes, however, it is not considered sensitive enough to detect subtle changes in functional ability. The Mobility, Occupational & Vocational Examination (MOVE) is a new functional test to objectively measure a PD patient’s level of skills and functional improvements.
3.417 The effects of pharmacological treatment on speech in Parkinson’s disease P. Santens1° , M. De Letter, G. Van Maele, M. De Bodt, J. Van Borsel Belgium
3.418 Osteoporosis in Parkinson’s disease: Comparative study with age-matched normal population S.-J. Chung1° , S.-R. Kim, D.-H. Kim, B.-J. Kim, J.-M. Koh, G.-S. Kim, M.-C. Lee 1 Seoul, Korea, Republic of Objective: To investigate the prevalence, risk factors, and clinical characteristics of osteoporosis in PD patients. Method: The study population consisted of 94 PD patients aged 55 years or older who consecutively visited the Parkinson Center of a university hospital between October 1, 2006 and June 30, 2007. Two hundred seventynine sex and age-matched normal controls, in whom BMD was measured at the same periods at the Health Promotion Center, were randomly allocated. Results: There were 40 males and 54 females in PD patients with an age range of 56 to 83 years (67.49±6.01 years). Mean PD duration was 30.4±32.7 months. After the correction of sex, age, weight and height, odds ratio (OR) for osteoporosis of PD patients was 2.7 (95% CI: 1.49 to 4.90, p = 0.001), with 7.9 (95% CI: 1.88 to 32.87, p = 0.005) in male PD patients and 2.3 (95% CI: 1.13 to 4.51, p = 0.021) in female PD patients. In male PD patients, serum homocysteine level was significantly higher than that of normal controls (p = 0.03). The serum levels of calcium, phosphorus, and total cholesterol were significantly decreased in male and female PD patients. The UPDRS II scores of PD patients showed correlation with BMD T-scores of lumbar spine (p = 0.063) and femur neck (p = 0.065). The UPDRS gait (item 29) subscore showed a tendency to correlate with BMD T-scores of lumbar spine (p = 0.088), and UPDRS walking (item 15) subscore had a tendency to correlate with BMD T-scores of femur neck (p = 0.088).