The aim of the present study was to explore four individuals' perspective of the way their speech and communication changed as a result of subthalamic nucleus deep brain stimulation treatment for Parkinson's disease. Interviews of two men and two women were analyzed using qualitative content analysis. Three themes emerged as a result of the analysis. The first theme included sub-themes describing both increased and unexpected communication difficulties such as a more vulnerable speech function, re-emerging stuttering and cognitive difficulties affecting communication. The second theme comprised strategies to improve communication, using different speech techniques and communicative support, as well as trying to achieve changes in medical and stimulation parameters. The third theme included descriptions of mixed feelings surrounding the surgery. Participants described the surgery as an unavoidable dramatic change, associated both with improved quality of life but also uncertainty and lack of information, particularly regarding speech and communication changes. Despite negative effects on speech, the individuals were generally very pleased with the surgical outcome. More information before surgery regarding possible side effects on speech, meeting with a previously treated patient and possibly voice and speech therapy before or after surgery are suggested to facilitate the adjustment to the new speech conditions. 1. Introduction Although subthalamic nucleus deep brain stimulation (STN-DBS) treatment for Parkinson’s disease (PD) has been reported to be an effective treatment for advanced motor symptoms of the limbs, such as tremor, rigidity, and bradykinesia, the effects on different speech parameters (phonation, articulation, speech rate) and intelligibility are equivocal [1–3]. Dysarthria was reported as a persistent adverse event in 5–70% of surgical cases reported by Romito and Albanese [2]. A recent study comparing 32 consecutive patients treated with STN-DBS with an optimally medicated control group [3] concluded that most patients exhibited reduced speech intelligibility, a negative change attributed to both medical and surgical factors. Other earlier studies have reported unaffected speech function [4] or improvements [5, 6]. In general, studies of speech effects show that phonatory and articulatory components measured separately are improved by STN-DBS [7–9]. However, speech intelligibility, which is more indicative of overall speech production, is often reduced [3]. The speech disorder associated with PD is well described [10, 11] mainly in terms
References
[1]
B. E. Murdoch, “Surgical approaches to treatment of Parkinson's disease: implications for speech function,” International Journal of Speech-Language Pathology, vol. 12, no. 5, pp. 375–384, 2010.
[2]
L. M. Romito and A. Albanese, “Dopaminergic therapy and subthalamic stimulation in Parkinson’s disease: a review of 5-year reports,” Journal of Neurology, vol. 257, pp. 298–304, 2010.
[3]
E. Tripoliti, L. Zrinzo, I. Martinez-Torres et al., “Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease,” Neurology, vol. 76, no. 1, pp. 80–86, 2011.
[4]
P. Krack, A. Batir, N. Van Blercom et al., “Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease,” New England Journal of Medicine, vol. 349, no. 20, pp. 1925–1934, 2003.
[5]
M. Gentil, P. Chauvin, S. Pinto, P. Pollak, and A. L. Benabid, “Effect of bilateral stimulation of the subthalamic nucleus on parkinsonian voice,” Brain and Language, vol. 78, no. 2, pp. 233–240, 2001.
[6]
M. Gentil, S. Pinto, P. Pollak, and A. L. Benabid, “Effect of bilateral stimulation of the subthalamic nucleus on parkinsonian dysarthria,” Brain and Language, vol. 85, no. 2, pp. 190–196, 2003.
[7]
S. Pinto, M. Gentil, P. Krack et al., “Changes induced by Levodopa and subthalamic nucleus stimulation on Parkinsonian speech,” Movement Disorders, vol. 20, no. 11, pp. 1507–1515, 2005.
[8]
E. Q. Wang, L. V. Metman, R. A. Bakay, et al., “Hemisphere-specific effects of subthalamic nucleus deep brain stimulation on speaking rate and articulatory accuracy of syllable repetitions in Parkinson’s disease,” Journal of Medical Speech-Language Pathology, vol. 14, no. 4, pp. 232–334, 2006.
[9]
L. D'Alatri, G. Paludetti, M. F. Contarino, S. Galla, M. R. Marchese, and A. R. Bentivoglio, “Effects of bilateral subthalamic nucleus stimulation and medication on Parkinsonian speech impairment,” Journal of Voice, vol. 22, no. 3, pp. 365–372, 2008.
[10]
S. G. Adams and A. Dykstra, “Hypokinetic dysarthria. I,” in Clinical Management of Sensorimotor Speech Disorders, M. McNeil, Ed., pp. 166–186, Theime Medical Publishers, New York, NY, USA, 2009.
[11]
K. M. Rosen, R. D. Kent, and J. R. Duffy, “Task-based profile of vocal intensity decline in parkinson's disease,” Folia Phoniatrica et Logopaedica, vol. 57, no. 1, pp. 28–37, 2005.
[12]
N. Miller, E. Noble, D. Jones, and D. Burn, “Life with communication changes in Parkinson's disease,” Age and Ageing, vol. 35, no. 3, pp. 235–239, 2006.
[13]
E. Frost, E. Tripoliti, M. I. Hariz, T. Pring, and P. Limousin, “Self-perception of speech changes in patients with Parkinson's disease following deep brain stimulation of the subthalamic nucleus,” International Journal of Speech-Language Pathology, vol. 12, no. 5, pp. 399–404, 2010.
[14]
B. H. Jacobson, A. Johnson, C. Grywalski et al., “The Voice Handicap Index (VHI): development and Validation,” American Journal of Speech-Language Pathology, vol. 6, no. 3, pp. 66–69, 1997.
[15]
J. W. Creswell, Qualitative Inquiry and Research Design: Choosing among Five Traditions, Sage, London, UK, 1998.
[16]
M. H. F. Grypdonck, “Qualitative health research in the era of evidence-based practice,” Qualitative Health Research, vol. 16, no. 10, pp. 1371–1385, 2006.
[17]
U. H. Graneheim and B. Lundman, “Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness,” Nurse Education Today, vol. 24, no. 2, pp. 105–112, 2004.
[18]
K. M. Yorkston, D. R. Beukelman, E. A. Strand, and M. Hakel, Management of Motor Speech Disorders in Children and Adults, PRO-ED, Austin, Tex, USA, 3rd edition, 2010.
[19]
L. Hartelius and P. Svensson, Dysartritest, Psykologiforlaget AB, Hagersten, Sweden, 1990.
[20]
M. Lillvik, E. Allemark, P. Karlstr？m, and L. Hartelius, “Intelligibility of dysarthric speech in words and sentences: development of a computerised assessment procedure in Swedish,” Logopedics Phoniatrics Vocology, vol. 24, no. 3, pp. 107–119, 1999.
[21]
P. Burnard, P. Gill, K. Stewart, E. Treasure, and B. Chadwick, “Analysing and presenting qualitative data,” British Dental Journal, vol. 204, no. 8, pp. 429–432, 2008.
[22]
P. Burnard, “A method of analysing interview transcripts in qualitative research,” Nurse Education Today, vol. 11, no. 6, pp. 461–466, 1991.
[23]
L. Burghaus, R. Hilker, A. Thiel et al., “Deep brain stimulation of the subthalamic nucleus reversibly deteriorates stuttering in advanced Parkinson's disease,” Journal of Neural Transmission, vol. 113, no. 5, pp. 625–631, 2006.
[24]
H. C. Walker, D. E. Phillips, D. B. Boswell et al., “Relief of acquired stuttering associated with Parkinson's disease by unilateral left subthalamic brain stimulation,” Journal of Speech, Language, and Hearing Research, vol. 52, no. 6, pp. 1652–1657, 2009.
[25]
N. Miller and L. Hartelius, “Acquired motor speech disorders,” in Impact of Communication Disability Across the Lifespan, K. Hilari and N. Botting, Eds., chapter 11, J & R Press, 2011.
[26]
G.-M. Hariz, T. Nakajima, P. Limousin et al., “Gender distribution of patients with Parkinson's disease treated with subthalamic deep brain stimulation; a review of the 2000–2009 literature,” Parkinsonism and Related Disorders, vol. 17, no. 3, pp. 146–149, 2011.
[27]
G. M. Hariz, M. Lindberg, M. I. Hariz, and A. T. Bergenheim, “Gender differences in disability and health-related quality of life in patients with Parkinson's disease treated with stereotactic surgery,” Acta Neurologica Scandinavica, vol. 108, no. 1, pp. 28–37, 2003.
[28]
L. M. Romito, F. M. Contarino, and A. Albanese, “Transient gender-related effects in Parkinson's disease patients with subthalamic stimulation,” Journal of Neurology, vol. 257, no. 4, pp. 603–608, 2010.
[29]
S. R. Montel and C. Bungener, “Coping and quality of life of patients with Parkinson disease who have undergone deep brain stimulation of the subthalamic nucleus,” Surgical Neurology, vol. 72, no. 2, pp. 105–110, 2009.
[30]
Y. S. Lincoln and E. G. Guba, Naturalistic Inquiry, Sage, Beverly Hills, Calif, USA, 1985.
[31]
J. M. Morse, et al., “Verification strategies for establishing reliability and validity in qualitative research,” International Journal of Qualitative Methods, vol. 1, no. 2, pp. 1–19, 2002.
[32]
S. Kvale, Den Kvalitativa Forskningsintervjun, Studentlitteratur, 1997.
[33]
J. M. Morse, “Validity by committee (editorial),” Qualitative Health Research, vol. 8, no. 4, pp. 443–445, 1998.
