Researchers have proposed a set of voice exercise games to help speech quality in people with Parkinson’s disease, which licensed speech therapists found to be a generally feasible, promising approach. 

If adopted in speech therapy routines, the games could motivate patients to practice more often at home so that their voice better retains volume and clarity, the researchers suggested. 

The proposed approach, The BioVisualSpeech Serious Game with Voice Exercises for People with Parkinson’s Disease with Hypokinetic Dysarthria, was published in Studies in Health Technology and Informatics.  

Speech changes, including dysarthria or difficulty speaking, are common in Parkinson’s, affecting about 89 percent of those with the condition. Often, patients have hypokinetic dysarthria, characterised by a reduced voice intensity, problems articulating words, a hoarse voice, and a monotonous pitch. 

While these speech changes can affect a person’s social and professional life, only 3 to 4 percent of those with such alterations take part in speech therapy to improve their ability to communicate, the researchers reported. 

Additionally, the success of such therapies requires intensive training and participants’ willingness to practice regularly at home, for which the essential motivation can be challenging. 

A pair of researchers in Portugal proposed a game-based way of practicing voice exercises for Parkinson’s patients with hypokinetic dysarthria, designed to make and keep them motivated. 

“Our proposal is to combine therapy, technology, feedback, and fun to motivate patients to practice the voice exercises regularly and at home, and to give them the appropriate feedback that allows them to understand their performance,” the researchers wrote. 

Accessed as an app on a computer or mobile device and controlled by the user’s voice, the game involves three exercises commonly used in speech therapy and selected on the advice of speech therapists. Each has a particular focus on helping a person increase their vocal intensity, or ability to speak more loudly. 

With intensity first determined for each participant by a speech therapist, players are asked to sustain a vowel sound at a stable intensity, to sustain the same vowel sound while adding pitch variations, and to practice the use of functional phrases common to daily life routines. 

Each game’s goal is to get an onscreen character to move in a straight line toward a box holding a surprise, picking it up once reached. 

The character’s movement is controlled by the player’s voice, and it moves forward only if the voice is within the intensity range – and pitch, when relevant to the exercise – chosen by the therapist. Reaching the box unlocks new game features.  

Characters stop moving when vocal intensity is inadequate, and a player then has a few seconds to correct their voice before the game ends in failure. 

“In this way, the character’s movement provides intuitive visual feedback on the player’s vocal intensity,” the researchers wrote. 

Exercises can be adapted to meet an individual’s particular needs and abilities, and therapists can alter the game’s difficulty as a person improves. 

Additional features to help with motivation, the researchers noted, include a push notification reminder if the app has not been opened for more than a day. Points awarded when vocal intensity is maintained within the set range also allow players to accrue coins that can be used to unlock new characters or scenarios. 

Researchers asked six speech therapists, with between three and 37 years of experience working with Parkinson’s patients, to evaluate the game. Generally, the therapists found it to be a useful tool for keeping patients motivated both during therapy sessions and at the home. 

“The game can be a good option for patients to train without the presence of a [speech therapist], every day or consistently, however it has some features that may depend on the [therapist], such as microphone calibration and customisation,” the researchers wrote. “Thus, it would be required that the game is parameterised at a therapy session prior to being used at home.”  

The six therapists largely thought the game was appropriate for people with Parkinson’s and had potential to improve voice quality. 

According to the researchers, “the game fulfills its main objectives: (1) it motivates training, (2) it is suitable for home training provided there is an initially in-person session for customisation, (3) it gives intuitive visual feedback on the player’s voice performance and (4) it has potential to help improve voice performance.” 

 Voice training that can be done at the home also offers an alternative to the face-to-face appointments that can be difficult, the team added. 

 Sources: 

Original story by Lindsey Shapiro, PhD  

Published by Parkinson’s News Today