JCPSLP Vol 18 No. 1Mar 2016

Prediction and Prognosis

www.speechpathologyaustralia.org.au

JCPSLP

Volume 18, Number 1 2016

Alexandra Callins

(top), Annie Hill

(centre), and

Deborah

Theodoros

Thisarticle

has been

peer-

reviewed

Keywords

credibility,

expectation

LSVT®LOUD

Parkinson’s

disease

speech-

language

pathology

rate (Duffy). The communication changes that present

in PD may directly impact upon social skills and cause

apprehension and embarrassment for people with PD

during social interactions (Miller, Noble, Jones, & Burn,

2006). Furthermore, communication deficits can place

limitations on participation in the family and society in

general and may impact upon an individual’s self-concept

(Miller et al., 2006).

The Lee Silverman Voice Treatment (LSVT

LOUD) is

an evidence-based treatment for hypokinetic dysarthria

associated with idiopathic PD (Fox, Ebersbach, Ramig, &

Sapir, 2012). Information on the efficacy of LSVT

LOUD

has been published extensively (Atkinson-Clement, Sadat

& Pinto, 2015; Ramig, Countryman, Thompson, & Horii,

1995; Ramig, Sapir, Countryman, et al., 2001; Ramig,

Sapir, Fox, & Countryman, 2001; Wight & Miller, 2015).

This program targets increased vocal loudness, increased

effort, sensory calibration of loudness and effort, and

self-cueing in order to improve speech intelligibility and

maintain improvements long-term (Fox et al., 2012). This

intensive program was developed around some of the

principles that promote activity-dependent neuroplasticity,

such as specificity, intensity, repetition, and saliency of

treatment tasks (Fox et al.). Enhanced speech intelligibility

can be expected due to increased loudness, increased

effort across the speech mechanism, resulting in greater

orofacial movements, tongue strength and mobility, and

more precise articulation (Ward, Theodoros, Murdoch, &

Silburn, 2000). Improvements in facial expression have also

been noted by Spielman, Borod, and Ramig (2003) and

some components of the oral and pharyngeal phases of

swallowing were observed by El Sharkawi et al. (2002).

It has been postulated that during some types of

rehabilitation, such as psychotherapy, a person’s response

to a treatment may be influenced by his or her expectations

and belief about the credibility of the treatment (Smeets et

al., 2008). Outcome expectancy is a person’s expectation

for a successful rehabilitation outcome, assuming he or she

makes the required effort (Geelen & Soons, 1996). It has

been suggested that most psychotherapies are inextricably

associated with the manipulation and adjustment of patient

expectations (Greenberg, Constantino, & Bruce, 2006).

The concept of treatment credibility is also important in the

rehabilitation process. Treatment credibility refers to how

believable, convincing, and logical the treatment seems to

the patient (Smeets et al., 2008).

The association between patient expectations and

credibility and their treatment outcomes has been

Research in the fields of psychotherapy and

rehabilitation has established an association

between ratings of treatment credibility and

patient expectations, and treatment

outcomes. However, little is known about the

relationship between credibility and

expectation and the outcomes of speech-

language pathology treatments. This study

aimed to examine the associations between

treatment credibility and patient expectations

and the outcomes for people with

Parkingson’s disease undergoing LSVT

LOUD

for hypokinetic dysarthria. The study also

sought to explore the influence of participant

variables on treatment credibility and patient

expectations. Forty-nine participants

completed a credibility and expectancy

questionnaire prior to treatment. The

treatment outcome measures included the

mean change pre- to post-treatment on the

total score of the Dysarthria Impact Profile

and vocal sound pressure level during a

monologue task. Correlation statistics

revealed only one fair correlation between

treatment credibility and the Dysarthria

Impact Profile total score change. The findings

support LSVT

LOUD as an efficacious

treatment for participants with hypokinetic

dysarthria as substantial improvements were

made to their speech, regardless of their

perceptions of treatment credibility,

expectations, and other participant factors.

arkinson’s disease (PD) is a neurodegenerative

disorder, characterised by resting tremor, rigidity,

bradykinesia, gait disturbance, and postural

instability (Olanow & Tatton, 1999). During the progression

of PD, hypokinetic dysarthria develops in up to 90% of

people (Duffy, 2005). The speech disorder is characterised

primarily by reduced volume, monotonous pitch and

loudness, a harsh and breathy vocal quality, imprecise

articulation, and, in some cases, disordered speech

Are patient expectations

and treatment credibility

related to outcomes from

LSVT

LOUD?

Alexandra Callins, Annie Hill, and Deborah Theodoros