Abstract
As part of ongoing research to investigate and document the efficacy of intensive voice therapy to improve functional communication in patients with idiopathic Parkinson's disease, forty-four patients were enrolled in a controlled, randomized, prospective study. Pre-to-post- treatment comparisons are presented here on twenty-two of those patients with usable laryngeal imaging data. Of the twenty-two patients, thirteen patients received intensive therapy aimed at increasing vocal and respiratory effort (VR), while nine received intensive therapy aimed at increasing respiratory effort (R) only. All patients had a pre-treatment evaluation which included two (but sometimes only one) voice recordings and an otolaryngologic examination with laryngostroboscopy. At the completion of four weeks of therapy (sixteen sessions) two voice recordings were made and laryngostroboscopy was again performed. The pre- and post- therapy videolaryngostroboscopy tapes were then randomized and reviewed by four expert judges. Raters' findings were then compared with vocal intensity measured before and after therapy. The VR therapy group showed pre-post improvements on laryngostroboscopic variables: less glottal incompetence and a decrease in supraglottal hyperfunction following therapy. No differences were observed in the R only group. The mean intensity increase in the VR therapy group was 12.5 dB, compared with a decrease of 1.9 dB in the R only group. These findings suggest that in patients with Parkinson's disease, intensive therapy focusing on phonatory effort improves adduction of the vocal folds as assessed by laryngostroboscopy. Differences in laryngeal function in these patients observed with fiberoptic laryngoscopy and rigid telescopic laryngoscopy are discussed.

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