Although the incidence of speech and voice disorders in individuals with PD is extremely high, only 3% to 4% receive speech treatment (112). One explanation for this is that carryover and long-term treatment outcomes have been disappointing and consequently the primary challenges in the treatment of hypokinetic dysarthria associated with PD. Clinicians have long been aware that when dysarthric PD patients are receiving direct stimulation, prodding, or feedback from the speech clinician or an external cue (113,114), they are likely to show a dramatic improvement in speech and voice production and overall intelligibility. However, maintaining these improvements without these external cues is extremely difficult for most of these individuals.
One explanation for the inability of individuals with PD to maximize and maintain treatment gains may be their deficits in internal cueing, vigilance, scaling amplitude of vocal output, and self-perception and self-regulation of vocal loudness and efforts (63,77). To maximize and maintain treatment effects, speech therapy of dysarthric PD patients should address these deficits. Ramig et al. (14,15) documented that improving amplitude of vocal output and sensory perception of vocal loudness and effort, as obtained via the LSVT® program, are key elements in successful speech treatment for individuals with PD. In addition, deficits in implicit or procedural learning (115) may underlie the challenges that individuals with PD have in maintaining long-term treatment effects and in learning to habituate newly acquired methods of speech production. Efforts to overcome these cognitive problems as part of treatment may also facilitate long-term outcome.
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