PORTLAND, ORE. – A new device worn on one ear may help individuals with Parkinson’s disease to overcome speech deficits associated with the disease. When triggered by the wearer’s voice, the device, SpeechVive, provides a simulated room crowd noise or “babble” only when they are talking. Because it capitalizes on natural reflexes to this simulated background noise, improvement can occur independent of speech training.
Researchers led by Jessica Huber, PhD, a professor of speech, language, and hearing sciences at Purdue University in West Lafayette, Ind., investigated changes to speech after 3 months of daily use of the SpeechVive device by 16 individuals. The cohort had a mean age of 64.5 years (range: 56-78 years) and a mean disease duration of 8.1 years (range: 2-17 years). Six participants had previously had speech therapy (five with LSVT [Lee Silverman Voice Treatment] LOUD speech training exercises), and two had deep brain stimulation implants.
Dr. Jessica Huber
Similar to an earlier study of 39 participants, “We found a nice increase in loudness, that they just can wear the device, and they’re louder in their everyday communication,” Dr. Huber said in an interview during a poster session at the World Parkinson Congress. New to this study was a finding that the melody of speech was a little better, “so their questions are more like questions, and their statements are more like statements, so are the rising intonation on questions and the falling intonation on a statement.” Participants were also able to say more on one breath and to sound more natural with appropriate pauses because of the longer utterances.
After 3 months of use, participants as a group increased their sound pressure level (loudness) from 76.6 dB to 78.8 dB (a gain of 2.2 dB) from having the device OFF to ON. When it was then turned off, they had an intermediate sound pressure level of 77.7 dB (both P less than .0001 vs. pretest OFF). Intonation variability and intonation range also showed significant improvements for both statements and questions with the use of the device (all P less than or equal to .01). There were also improvements in a correct statement or question being produced, pausing patterns, and utterance length. No adverse events occurred in the study.
Dr. Huber said patients in the study were quite variable in their responses to SpeechVive for the different measures of speech. In general, she has found that about 75% of users get louder with the device, and some have clearer articulation or slower speech. Another 10%-15% have slower speech or better articulation without an increase in loudness.
A total of 50% of the users have a “carry-over” effect after using the device when they are not wearing it. “After about 8 weeks, they don’t need to keep wearing the device every day,” Dr. Huber noted. Others may wear it in the morning and have a lasting effect for the rest of the day, and some lose any benefit as soon as taking the device off. Not all patients reach a normal speech loudness, “but they’re going to get way better” than where they started, she said.
Available speech therapies
People with Parkinson’s disease (PD) often have reduced vocal loudness, increased speech rate, and slurred articulation. Available speech therapies have included adduction exercises, vocal function exercises, and LSVT LOUD speech training exercises. For some individuals with PD, these behavioral treatments may not carry over into daily life.
The SpeechVive consists of a piece placed into the ear canal and a piece that sits behind the ear, similar to a slightly larger version of a modern hearing aid. It is designed large enough that many patients, who have motor deficits, can don it themselves. Because it is on just one ear, users can hear other people talking and what is going on around them.
Dr. Huber noted several strengths of the device. First, it does not impose any cognitive load on the user because its effect is based on an automatic reflex. Second, little training is necessary. It is easy for the user to put on the device, and many of its beneficial effects occur as soon as it is activated. Third, compliance can be tracked using data stored by the device itself.
In a previous study, she saw that after using the device for 8 weeks, participants used more effective patterns with their respiratory and laryngeal mechanisms to produce louder speech. “It’s not like they’re working super hard after 8 weeks.” She thinks they are just not usually using their speech apparatus in the most efficient manner, and they become more efficient after using the device. They may also not sense how loud they are without it, so it helps patients “recalibrate” a sense of their own voices, something the LSVT LOUD training also does.
Jori Fleisher, MD, a movement disorders neurologist at the New York University Langone Medical Center, commented that the study shows an interesting approach to the common and difficult problem of hypophonia and dysphonia in people with Parkinson’s disease. “It can be very difficult to speak loud enough to be heard, and it often leads to people withdrawing socially and not speaking as much in conversation as they normally would,” she said. “LSVT LOUD works in practice when you’re actually doing the exercises, but often when people stop doing the exercises, their voice goes back toward their normal. So this is something that you can keep with you and sort of have constant prompting to overcome that tendency toward quieter voice. It has a lot of promise.”
She said she would like to see the data on compliance or adherence with using the device “because it seems like a great idea, but how much are people actually using it? ... Having more long-term follow-up to see whether this is something that people want to put into practice in their daily life would be very useful.” She also said she would like to see how long the carry-over effect lasts once people take off the device to be able to compare it with sessions of speech therapy or doing speech exercises.
SpeechVive is $2,495, which includes the device, a charger, and earpiece fittings. It is available only in the United States, but the company now has clearance to market it in Canada.
The research was funded by a grant from SpeechVive. Dr. Huber is the inventor of SpeechVive, has a patent on it, has a financial interest in the SpeechVive company, and sits on its board of directors. Dr. Fleisher reported having no financial conflicts.