Neurodegenerative dysarthria: Respiratory/phonatory (Perry et al., 2024)

Purpose: This systematic review represents an update to previous reviews of the literature addressing behavioral management of respiratory/phonatory dysfunction in individuals with dysarthria due to neurodegenerative disease.

Method: Multiple electronic database searches and hand searches of prominent speech-language pathology journals were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards.

Results: The search yielded 1,525 articles, from which 88 met inclusion criteria and were reviewed by two blinded co-investigators. A large range of therapeutic approaches have been added to the evidence base since the last review, including expiratory muscle strength training, singing, and computer- and device-driven programs, as well as a variety of treatment modalities, including teletherapy. Evidence for treatment in several different population groups—including cerebellar ataxia, myotonic dystrophy, autosomal recessive spastic ataxia of Charlevoix–Saguenay, Huntington’s disease, multiple system atrophy, and Lewy body dementia—were added to the current review. Synthesis of evidence quality provided strong evidence in support of only one behavioral intervention: Lee Silverman Voice Treatment Program (LSVT LOUD) in people with Parkinson’s disease. No other treatment approach or population included in this review demonstrated more than limited evidence, reflecting that these approaches/populations require urgent further examination.

Conclusion: Suggestions about where future research efforts could be significantly strengthened and how clinicians can apply research findings to their practice are provided.

S1: Databases, Keyword and Subject Headings used in Electronic Database Searches

S2: Parkinson’s disease: Study Design Details and Participant Characteristics for Lee Silverman Voice Treatment (LSVT LOUD®)/LSVT® Extended (LSVT-X®)/LSVT® Companion™ as Treatment Modalities

S2.1: Parkinson’s disease: PEDro Scores for Studies Describing Lee Silverman Voice Treatment LOUD® (LSVT LOUD®)/LSVT® Extended (LSVT-X)/LSVT® Companion™ as Interventions for Dysarthria

S2.2: Parkinson’s disease: Findings Summarizing the Benefit of Lee Silverman Voice Treatment LOUD® (LSVT LOUD®)/LSVT® Extended (LSVT-X)/LSVT® Companion™ on Vocal Intensity

S3: Parkinson’s disease: Study Design Details and Participant Characteristics for SPEAK OUT!® and The LOUD Crowd as Treatment Modalities

S3.1: Parkinson’s disease: PEDro Scores for Studies Describing SPEAK OUT!® and The LOUD Crowd as Interventions for Dysarthria

S4: Parkinson’s disease: Study Design Details and Participant Characteristics for Loud and Proud as a Treatment Modality

S4.1: Parkinson’s disease: PEDro Scores for Studies Describing Loud and Proud as Interventions for Dysarthria

S5: Parkinson’s disease: Study Design Details and Participant Characteristics for Pitch Limiting Voice Treatment (PVLT) as a Treatment Modality

S5.1: Parkinson’s disease: PEDro Scores for the Study Describing Pitch Limiting Voice Treatment (PVLT) as an Intervention for Dysarthria

S6: Parkinson’s disease: Study Design Details and Participant Characteristics for Music Therapy/Singing as a Treatment Modality

S6.1: Parkinson’s disease: PEDro Scores for Studies Describing Music Therapy/Singing as an Intervention for Dysarthria

S7: Parkinson’s disease: Study Design Details and Participant Characteristics for Verbal Cueing/Articulation Therapy/Speech Therapy as Treatment Modalities

S7.1: Parkinson’s disease: PEDro Scores for Studies Describing Verbal Cueing/Articulation Therapy/Speech Therapy as Interventions for Dysarthria

S8: Parkinson’s disease: Study Design Details and Participant Characteristics for Biofeedback as a Treatment Modality

S8.1: Parkinson’s disease: PEDro Scores for Studies Describing Biofeedback as an Intervention for Dysarthria

S9: Parkinson’s disease: Study Design Details and Participant Characteristics for Masking Noise/SpeechVive™ as a Treatment Modality

S9.1: Parkinson’s disease: PEDro Scores for Studies Describing Masking Noise/SpeechVive™ as an Intervention for Dysarthria

S10: Parkinson’s disease: Study Design Details and Participant Characteristics for Voice Therapy as a Treatment Modality

S10.1: Parkinson’s disease: PEDro Scores for Studies Describing Voice Therapy as an Intervention for Dysarthria

S11: Parkinson’s disease: Study Design Details and Participant Characteristics for Delayed Auditory Feedback/Frequency-Shifted Feedback as Treatment Modalities

S11.1: Parkinson’s disease: PEDro Scores for the Study Describing Delayed Auditory Feedback/Frequency-Shifted Feedback as Interventions for Dysarthria

S12: Parkinson’s disease: Study Design Details and Participant Characteristics for Expiratory Muscle Strength Training as a Treatment Modality

S12.1: Parkinson’s disease: PEDro Scores for the Study Describing Expiratory Muscle Strength Training as an Intervention for Dysarthria

S13: Parkinson’s disease: Study Design Details and Participant Characteristics for Group Dynamics/Coaching Strategies as a Treatment Modality

S13.1: Parkinson’s disease: PEDro Scores for the Study Describing Group Dynamics/Coaching Strategies as an Intervention for Dysarthria

S14: Progressive Supranuclear Palsy: Study Design Details and Participant Characteristics for LSVT LOUD® as a Treatment Modality

S14.1: Progressive Supranuclear Palsy: PEDro Scores for the Study Describing LSVT LOUD® as an Intervention for Dysarthria

S15: Progressive Supranuclear Palsy: Study Design Details and Participant Characteristics for Verbal Cueing as a Treatment Modality

S15.1: Progressive Supranuclear Palsy: PEDro Scores for the Study Describing Verbal Cueing as an Intervention for Dysarthria

S16: Progressive Supranuclear Palsy: Study Design Details and Participant Characteristics for Singing as a Treatment Modality

S16.1: Progressive Supranuclear Palsy: PEDro Scores for Studies Describing Singing as an Intervention for Dysarthria

S17: Multiple System Atrophy: Study Design Details and Participant Characteristics for Verbal Cueing as a Treatment Modality

S17.1: Multiple System Atrophy: PEDro Scores for the Study Describing Verbal Cueing as an Intervention for Dysarthria

S18: Multiple System Atrophy: Study Design Details and Participant Characteristics for Singing as a Treatment Modality

S18.1: Multiple System Atrophy: PEDro Scores for Studies Describing Singing as an Intervention for Dysarthria

S19: Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay: Study Design Details and Participant Characteristics for Melbourne Ataxia Speech Treatment as a Treatment Modality

S19.1: Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay: PEDro Scores for the Study Describing Melbourne Ataxia Speech Treatment as an Intervention for Dysarthria

S20: Cerebellar Ataxia: Study Design Details and Participant Characteristics for Lee Silverman Voice Treatment® – Extended Version as a Treatment Modality

S20.1: Cerebellar Ataxia: PEDro Scores for the Study Describing Lee Silverman Voice Treatment® – Extended Version as an Intervention for Dysarthria

S21: Huntington’s disease: Study Design Details and Participant Characteristics for Speech Therapy as a Treatment Modality

S21.1: Huntington’s disease: PEDro Scores for the Study Describing Speech Therapy as an Intervention for Dysarthria

S22: Lewy Body Dementia: Study Design Details and Participant Characteristics for Singing as a Treatment Modality

S22.1: Lewy Body Dementia: PEDro Scores for the Study Describing Singing as an Intervention for Dysarthria

S23: Multiple Sclerosis: Study Design Details and Participant Characteristics for Verbal Cueing as a Treatment Modality

S23.1: Multiple Sclerosis: PEDro Scores for Studies Describing Verbal Cueing as an Intervention for Dysarthria

S24: Multiple Sclerosis: Study Design Details and Participant Characteristics for Expiratory Muscle Strength Training as a Treatment Modality

S24.1: Multiple Sclerosis: PEDro Scores for the Study Describing Expiratory Muscle Strength Training as an Intervention for Dysarthria

S25: Multiple Sclerosis: Study Design Details and Participant Characteristics for Lee Silverman Voice Treatment® as a Treatment Modality

S25.1: Multiple Sclerosis: PEDro Scores for the Study Describing Lee Silverman Voice Treatment® as an Intervention for Dysarthria

S26: Myotonic Dystrophy: Study Design Details and Participant Characteristics for Speech Warming Up Exercises as a Treatment Modality

S26.1: Myotonic Dystrophy: PEDro Scores for the Study Describing Speech Warming Up Exercises as an Intervention for Dysarthria

Perry, S. E., Troche, M., Huber, J. E., Curtis, J., Kiefer, B., Sevitz, J., Dennard, Q., Borders, J., Browy, J. R., Dakin, A., Gonzalez, V., Chapman, J., Wu, T., Katz, L., & Britton, D. (2024). Behavioral management of respiratory/phonatory dysfunction for dysarthria associated with neurodegenerative disease: A systematic review. American Journal of Speech-Language Pathology, 33(2), 1069–1097. https://doi.org/10.1044/2023_AJSLP-23-00274