Your client with Parkinson’s disease (PD) significantly improved their speech in the treatment room and the research lab following LSVT LOUD. Will these improvements be perceived by untrained listeners who are naïve to speech disorders and PD?
It is generally agreed that a most critical goal of all our speech treatment is that it makes an impact on our client’s speech in his/her ‘real world’ functional daily communication. However, we rarely study this ‘real world’ impact following treatment. Our typical focus is on measuring post-treatment improvements in the treatment room, in the research lab, and in reports by the client and family members of post-treatment changes.
These listeners ratings are all made by individuals who know the client, realize the client has PD, and are typically experienced in rating speech in PD. Furthermore, they are also aware that the client is participating in speech treatment.
It is uncommon to have the speech of our clients rated pre and post treatment by individuals who are untrained listeners, naïve to speech disorders and PD, plus are unknown to the client.
In many ways, speech ratings by such naive listeners would seem to be an ultimate test of the effectiveness of LSVT LOUD. Such ratings would evaluate whether LSVT LOUD made a positive, perceptible impact on our client’s ‘real world’ functional communication.
However, obtaining such ratings efficiently, and recruiting an adequate number of naive listeners is challenging and thus is infrequently part of routine pre to post treatment assessments of any treatment, including LSVT LOUD.
One approach to obtaining these important data is though crowdsourcing. Crowdsourcing is a procedure to recruit the general population to solve problems. It has had many applications in neuroscience, linguistics, behavioral psychology, as well as most recently, speech pathology.
Listeners are recruited online, sign up for a task with a known duration, no advanced knowledge or training is required and they are paid a fee after completion. They participate from their home computer independently.
In contrast, for typical speech rating tasks, listeners are generally required to have advanced knowledge about the task or disorder. Listeners travel to a research lab, are trained in the procedure and sit in a sound booth and provide their responses.
You can think of crowdsourcing somewhat like a zoom call, where many listeners from all across the US can participate, but each listener is at his/her home computer and independently rates speech stimuli online. One key advantage of crowdsourcing is the ease for listeners and thus the speed of recruiting naïve listeners.
The Research
Nightengale et al, 2019, carried out a proof-of-concept study of crowdsourcing and LSVT LOUD. Fourteen speakers with PD pre and post LSVT were rated by 36 untrained naïve listeners. The listeners heard two words pre and post LSVT LOUD and were asked to rate which one was ‘more clearly articulated’.
Post-treatment samples were rated statistically significantly ‘more clearly articulated’ 64.15%, compared to pre-treatment samples 35.85% (p<.05).
Nightengale et al (2019) concluded these results supported that the treatment related changes following LSVT LOUD were detectable by untrained, naïve listeners. They also concluded that these data supported the viability of crowdsourcing to obtain more functionally relevant measures of change following LSVT LOUD.
The second LSVT LOUD crowdsourcing study was led by McAllister, et al., 2023. This study reported a secondary outcome measure of a randomized controlled trial (Ramig et al, 2018). This study focused on 29 naïve listener ratings of voice quality in 65 clients with PD across pre, post, and 6 month follow up. Analysis revealed that LSVT LOUD ratings by naïve listeners showed a statistically significant increase post treatment (<.001), which was maintained above pre-treatment levels at follow up.
These findings support the use of crowdsourcing to evaluate changes in voice quality in PD following LSVT LOUD and document the positive impact of LSVT LOUD on ‘real world’ functional communication as rated by naïve listeners.
Considerations for Crowdsourcing
The combined findings of these two studies are of great significance because for the first time, outcome data on both articulation and voice quality demonstrated that untrained, naïve listeners can hear post-treatment improvements following LSVT LOUD. These findings tell us that LSVT LOUD makes a positive impact on the ‘real world’ functional communication outside of the treatment room and research lab. These are the first studies in the world of PD to demonstrate this. The crowdsourcing data are reliable and creative, and the team lead by McAllister has done a superb job of making this unique and valuable contribution to the literature.
To quote McAllister “We think crowdsourcing has exciting potential to make it easier for researchers to understand the real-world relevance of the treatment methods they study, and ultimately support better alignment of priorities between researchers, clinicians, and patients.”
Both studies review various considerations for enhancing crowdsourcing quality control including listeners having adequate technology and controlling background noise. They carefully review methodology for data collection to ensure high reliability and validity of data obtained by crowdsourcing. The hope of the authors for the future is that their methodology can be combined with advances in AI to enhance studies of treatment outcomes.
What Do These Studies Mean To You?
These two research studies help us answer this question: Will the post-treatment LSVT LOUD improvements you measure in your treatment room and in the research lab be perceived by untrained listeners who are naïve to speech disorders and PD?
Based on these research studies, the answer is yes!! You can have confidence that LSVT LOUD has a positive impact on real world communication in your client’s life.
Take Home Message
The LSVT LOUD protocol has been published (Ramig et al., 2018) and is being implemented in over 70 countries with positive outcomes.
Five Randomized Control Trials (RCTs), funded by the National Institutes of Health (NIH), have been published and support the short and long-term efficacy of LSVT LOUD.
As an expert certified LSVT LOUD clinician, you deliver all the elements of treatment (intensive dosage, high effort exercises to increase healthy vocal loudness, and improve quality with a critical focus on sensory calibration). Of great importance is that throughout your treatment, you always keep your “eye on the ball“ of generalization to ‘real world’ functional communication: an ultimate goal of all speech treatment!
You are making it happen!
Nightingale, C., Swartz, M., Ramig, L. O., & McAllister, T. (2020). Using crowdsourced listeners’ ratings to measure speech changes in hypokinetic dysarthria: A proof-of-concept study. American Journal of Speech-Language Pathology, 29(2), 873–882. Nightingale et al 2020 AJSLP
McAllister, T., Nightingale, C., Moya-Galé, G., Kawamura, A., & Ramig, L. O. (2023). Crowdsourced Perceptual Ratings of Voice Quality in People With Parkinson’s Disease Before and After Intensive Voice and Articulation Therapies: Secondary Outcome of a Randomized Controlled Trial. Journal of Speech, Language, and Hearing Research, 66(5), 1541–1562. McAllister et al 2023 JSHLR
Ramig, L. O., Halpern, A., Spielman, J., Fox, C., & Freeman, K. (2018). Speech treatment in Parkinson’s Disease: Randomized controlled trial (RCT). Movement Disorders, 33(11), 1777–1791. Ramig et al 2018 Movement Disorders
