A type of speech therapy developed for Parkinson’s disease works better than standard NHS treatment, which is ineffective, a UK-wide trial has found.
The research, involving 40 NHS speech and language therapy centres, discovered that people given a course of Lee Silverman voice treatment saw improvements when compared to NHS speech and language therapy or no treatment at all.
The Lee Silverman technique – which is based on speaking more loudly – is not widely available in the UK and experts say a lack of funding and staff is to blame.
Parkinson’s can affect speech in several ways and many people with the condition speak quietly and in one tone.
Sometimes their speech can sound hoarse and lacks emotion. They may also slur words or mumble.
The Lee Silverman voice treatment works by helping people recognise that their voice is too quiet and trains them to speak more loudly.
The treatment, also known as LSVT LOUD, is intensive, with several sessions every week.
In the new study, published in the British Medical Journal (BMJ), 388 people with Parkinson’s or difficulty speaking were randomly split into three groups: Lee Silverman voice treatment, NHS speech and language or no therapy at all.
The Lee Silverman group had four, face-to-face or remote 50-minute sessions per week for four weeks.
These patients had to do exercises such as repeating “ah” for as long as possible and speaking in a clear, loud voice while repeating sentences.
People also had five to 10 minutes of homework on their treatment days and 15 minutes twice daily on non-treatment days.
In comparison, NHS speech and language therapy was delivered according to what was offered locally, with an average of one session every other week for 11 weeks.
The findings of the trial showed that Lee Silverman was much more effective at reducing the impact of voice problems on patients than no speech and language therapy or the NHS version.
In fact, NHS therapy showed no evidence of benefit compared to no speech and language therapy at all.
The trial, funded by the National Institute for Health and Care Research (NIHR), was led by experts from the Universities of Nottingham and Birmingham.
Professor Catherine Sackley, from NIHR Nottingham biomedical research centre, said: “The impact of speech and communication problems in people with Parkinson’s disease can cause them to feel stigmatised.
“It can stop them going out, stop them socialising, and stop them doing day-to-day tasks such as shopping, which can have a detrimental impact on their quality of life.
“This is the first study of its kind to look at the most effective treatment options.
“The results clearly show that, delivered in this way, the LSVT LOUD method is both effective and it can be cost-effective.
“The NHS method as it is currently delivered is not effective.”
The Royal College of Speech and Language Therapists’ chief executive, Steve Jamieson, said: “We welcome robust research that explores different speech and language therapy approaches and benefits people with communication needs.
“While some NHS speech and language therapy services currently provide Lee Silverman voice therapy, we know that many are unable to do so, due to funding restraints and ongoing speech and language therapy workforce issues.
“If people with communication difficulties associated with Parkinson’s and other medical conditions are to access the vital evidence-based speech and language therapy they need, we must have more investment in the profession.”
Rowan Wathes, associate director of policy and health strategy at Parkinson’s UK, welcomed the study, adding that speech therapists not only support people with their voice, but provide expertise on language and word finding, managing saliva and swallowing.
She said: “Although this new study provides interesting insights into the effectiveness of the very structured and specific LSVT programme, the findings should not be taken that LVST is the only way to treat voice problems in Parkinson’s.
“NHS speech and language therapy is variable across the UK and there is no consensus on what ‘standard’ therapy is.
“The important thing for people with Parkinson’s is for them to have timely access to therapy that is personalised to their needs and goals.”
People with Parkinson’s are lacking enough of the chemical dopamine in their brain, which can cause symptoms such as shaking, slowness of movement and muscle stiffness.
Around 153,000 people in the UK have Parkinson’s and it is the fastest growing neurological condition in the world.
