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Rehabilitation medicine
Research
Speech and communication in Parkinson’s disease: a cross-sectional exploratory study in the UK
  1. Maxwell S Barnish1,
  2. Simon M C Horton1,
  3. Zoe R Butterfint1,
  4. Allan B Clark2,
  5. Rachel A Atkinson3,
  6. Katherine H O Deane1
  1. 1 School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
  2. 2 Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
  3. 3 Adult Speech and Language Therapy Department, St Helier Hospital, Epsom and St Helier University Hospitals NHS Trust, London, UK
  1. Correspondence to Dr Maxwell S Barnish; barnish{at}cantab.net

Abstract

Objective To assess associations between cognitive status, intelligibility, acoustics and functional communication in PD.

Design Cross-sectional exploratory study of functional communication, including a within-participants experimental design for listener assessment.

Setting A major academic medical centre in the East of England, UK.

Participants Questionnaire data were assessed for 45 people with Parkinson’s disease (PD), who had self-reported speech or communication difficulties and did not have clinical dementia. Acoustic and listener analyses were conducted on read and conversational speech for 20 people with PD and 20 familiar conversation partner controls without speech, language or cognitive difficulties.

Main outcome measures Functional communication assessed by the Communicative Participation Item Bank (CPIB) and Communicative Effectiveness Survey (CES).

Results People with PD had lower intelligibility than controls for both the read (mean difference 13.7%, p=0.009) and conversational (mean difference 16.2%, p=0.04) sentences. Intensity and pause were statistically significant predictors of intelligibility in read sentences. Listeners were less accurate identifying the intended emotion in the speech of people with PD (14.8% point difference across conditions, p=0.02) and this was associated with worse speaker cognitive status (16.7% point difference, p=0.04). Cognitive status was a significant predictor of functional communication using CPIB (F=8.99, p=0.005, η2 = 0.15) but not CES. Intelligibility in conversation sentences was a statistically significant predictor of CPIB (F=4.96, p=0.04, η2 = 0.19) and CES (F=13.65, p=0.002, η2 = 0.43). Read sentence intelligibility was not a significant predictor of either outcome.

Conclusions Cognitive status was an important predictor of functional communication—the role of intelligibility was modest and limited to conversational and not read speech. Our results highlight the importance of focusing on functional communication as well as physical speech impairment in speech and language therapy (SLT) for PD. Our results could inform future trials of SLT techniques for PD.

  • parkinson-s disease
  • rehabilitation medicine
  • geruatric medicine

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-014642

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    Footnotes

    • Contributors MSB was the Chief Investigator and KHOD the primary academic supervisor. SMCH and RAA are registered speech and language therapies and are specialists in adult neurological disorders. The study was conceptualised and overseen by MSB, SMCH, ZRB and KHOD. Data were collected by MSB. Acoustic analysis was conducted by MSB and ZRB. Listener assessment was conducted by our panel of assessors supervised by MSB with advice from SMCH, ZRB and KHOD. Statistical analysis was overseen by ABC and conducted by MSB and ABC. The first draft of the manuscript was written by MSB. Data were initially interpreted by MSB and further interpretation provided by SMCH, ZRB, ABC, RAA and KHOD. All authors contributed academically and/or clinically valuable revisions to the manuscript. All authors approved the submission.

    • Funding We acknowledge funding from a UEA PhD studentship to MSB.

    • Competing interests None declared.

    • Patient consent No patient identifiable information in the manuscript.

    • Ethics approval Ethical approval for this study was granted by the National Research Ethics Service Committee East of England – Norfolk. All requisite local governance approvals were obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement We confirm that no additional data are available.