{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:23:23Z","timestamp":1747182203488,"version":"3.40.5"},"reference-count":59,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,6,19]],"date-time":"2024-06-19T00:00:00Z","timestamp":1718755200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp;amp; Comm Disor"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>SPEAK OUT! has been shown to enhance various aspects of voice such as intensity, prosody, voice quality and perception of voice. However, their impacts on expiration and communication effectiveness have not yet been evaluated. This study aimed to evaluate the effectiveness of the Hybrid SPEAK OUT! method on aerodynamic measurements and patient\u2010reported outcome measures (PROMs) in individuals with Parkinson's disease (PD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study included 157 participants with PD who underwent an intensive 8\u2010week multidisciplinary treatment program. The Hybrid SPEAK OUT! method consisted of three sessions per week, including two group sessions and one individual treatment session. Voice\u2010related aerodynamic measures included maximum phonation time (MPT), vocal cord function using the S\/Z ratio, and expiratory flow measures including peak\u00a0expiratory\u00a0flow (PEF) and peak cough flow (PCF). Two PROMs were included: the Hebrew version of the voice handicap index\u201010 and communication effectiveness questionnaire.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The results of 111 participants were analysed. MPT duration increased, PEF and PCF increased, and better scores were found in PROMs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These findings would appear to support the effectiveness of the Hybrid SPEAK OUT! methods improving function, activity and participation in individuals with PD. However, further research is needed.<\/jats:p><\/jats:sec><jats:sec><jats:title>WHAT THIS PAPER ADDS<\/jats:title><jats:sec><jats:title>What is already known on the subject<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Prior research has demonstrated the effectiveness of behavioral therapies, including the SPEAK OUT! program, in managing speech symptoms in individuals with Parkinson's disease (PD). These therapies have shown improvements in voice intensity, fundamental frequency, voice quality, and voice perception. However, the impact on aerodynamic measures, expiratory flow, and patient\u2010reported outcome measures has not been extensively studied.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What this paper adds to existing knowledge<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>This study adds to the existing knowledge by demonstrating that a Hybrid SPEAK OUT! approach, can lead to improvements in aerodynamic measures, including maximum phonation time (MPT), expiratory and cough peak flow. In terms of motor learning, we found that two non\u2010speech exhalation\u2010related tasks that were not directly trained improved following the intensive speech training protocol. Furthermore, it shows positive changes in patient\u2010reported outcome measures, with reduced voice\u2010related disability and improved communication efficiency.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What are the potential or actual clinical implications of this work?<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>The findings of this study have important clinical implications for the management of speech symptoms in individuals with PD. The Hybrid SPEAK OUT! program, which combines group and individual sessions, can effectively improve voice, aerodynamic measurements and patient\u2010reported outcome measures (PROMs), ultimately enhancing the overall quality of life for patients. These findings support the effectiveness of the Hybrid SPEAK OUT! methods for improving function, activity, and participation in individuals with PD.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><\/jats:sec>","DOI":"10.1111\/1460-6984.13077","type":"journal-article","created":{"date-parts":[[2024,6,19]],"date-time":"2024-06-19T10:19:08Z","timestamp":1718792348000},"page":"2217-2228","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hybrid SPEAK OUT! protocol improves aerodynamic measurements and PROMs in Parkinson's disease"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9212-820X","authenticated-orcid":false,"given":"Yarden","family":"Ashkenazi","sequence":"first","affiliation":[{"name":"Rehabilitation Center Ezra Lemarpe  Bnei\u2010Brak Israel"},{"name":"Rehabilitation Unit Tel\u2010Aviv Sourasky Medical Center  Tel\u2010Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nava","family":"Stainer","sequence":"additional","affiliation":[{"name":"Rehabilitation Center Ezra Lemarpe  Bnei\u2010Brak Israel"},{"name":"Loewenstein Rehabilitation Hospital  Raanana Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lyle","family":"Tadmor","sequence":"additional","affiliation":[{"name":"Rehabilitation Center Ezra Lemarpe  Bnei\u2010Brak Israel"},{"name":"Reuth Rehabilitation Hospital  Tel\u2010Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lilach","family":"Yaakov","sequence":"additional","affiliation":[{"name":"Rehabilitation Center Ezra Lemarpe  Bnei\u2010Brak Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inbal","family":"Friedman","sequence":"additional","affiliation":[{"name":"Rehabilitation Center Ezra Lemarpe  Bnei\u2010Brak Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roni","family":"Rips","sequence":"additional","affiliation":[{"name":"Rehabilitation Center Ezra Lemarpe  Bnei\u2010Brak Israel"},{"name":"Ben\u2010Yair Rehabilitation Center Clalit Health Services  Tel\u2010Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2490-1826","authenticated-orcid":false,"given":"Oshrat","family":"Sella Weiss","sequence":"additional","affiliation":[{"name":"Rehabilitation Center Ezra Lemarpe  Bnei\u2010Brak Israel"},{"name":"Schnaider Children's Medical Center  Petah Tikva Israel"},{"name":"Department of Communication Disorders University of Haifa  Haifa Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,6,19]]},"reference":[{"doi-asserted-by":"publisher","key":"e_1_2_10_2_1","DOI":"10.1016\/j.jvoice.2005.08.006"},{"doi-asserted-by":"publisher","key":"e_1_2_10_3_1","DOI":"10.1111\/1460\u20106984.12965"},{"doi-asserted-by":"publisher","key":"e_1_2_10_4_1","DOI":"10.1080\/14015439.2021.1958001"},{"doi-asserted-by":"publisher","key":"e_1_2_10_5_1","DOI":"10.1044\/2020_AJSLP\u201019\u201000024"},{"volume-title":"The co\u2010ordination and regulation of movements","year":"1967","author":"Bernstein N.","key":"e_1_2_10_6_1"},{"doi-asserted-by":"publisher","key":"e_1_2_10_7_1","DOI":"10.1159\/000488875"},{"doi-asserted-by":"publisher","key":"e_1_2_10_8_1","DOI":"10.1016\/j.rmed.2022.106740"},{"doi-asserted-by":"publisher","key":"e_1_2_10_9_1","DOI":"10.1044\/2019_pers"},{"key":"e_1_2_10_10_1","first-page":"523","volume-title":"The handbook of clinical linguistics","author":"Brockmann\u2010Bauser M.","year":"2024"},{"doi-asserted-by":"publisher","key":"e_1_2_10_11_1","DOI":"10.1590\/2317\u20101782\/20172017051"},{"doi-asserted-by":"publisher","key":"e_1_2_10_12_1","DOI":"10.1044\/1058-0360(2008\/07-0010)"},{"doi-asserted-by":"publisher","key":"e_1_2_10_13_1","DOI":"10.1183\/09031936.97.10020457"},{"volume-title":"Parkinson's disease and movement disorders. 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