Group climate in the voice therapy of patients with Parkinson’s Disease

Diaféria, Giovana; Madazio, Glaucya; Pacheco, Claudia; Takaki, Patricia Barbarini; Behlau, Mara

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Sumário

Original Article • CoDAS 29 (4) • 2017 • https://doi.org/10.1590/2317-1782/20172017051 copy

Group climate in the voice therapy of patients with Parkinson’s Disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

To verify the impact that group dynamics and coaching strategies have on the PD patients voice, speech and communication, as well as the group climate.

Methods

16 individuals with mild to moderate dysarthria due to the PD were divided into two groups: the CG (8 patients), submitted to traditional therapy with 12 regular therapy sessions plus 4 additional support sessions; and the EG (8 patients), submitted to traditional therapy with 12 regular therapy sessions plus 4 sessions with group dynamics and coaching strategies. The Living with Dysarthria questionnaire (LwD), the self-evaluation of voice, speech and communication, and the perceptual-auditory analysis of the vocal quality were assess in 3 moments: pre-traditional therapy (pre); post-traditional therapy (post 1); and post support sessions/coaching strategies (post 2); in post 1 and post 2 moments, the Group Climate Questionnaire (GCQ) was also applied.

Results

CG and EG showed an improvement in the LwD from pre to post 1 and post 2 moments. Voice self-evaluation was better for the EG - when pre was compared with post 2 and when post 1 was compared with post 2 - ranging from regular to very good; both groups presented improvement in the communication self-evaluation. The perceptual-auditory evaluation of the vocal quality was better for the EG in the post 1 moment. No difference was found for the GCQ; however, the EG presented lower avoidance scores in post 2.

Conclusion

All patients showed improvement in the voice, speech and communication self-evaluation; EG showed lower avoidance scores, creating a more collaborative and propitious environment for speech therapy.

Keywords
Parkinson’s Disease; Self-assessment; Voice; Communication; Speech Therapy; Group Structure

	CONTROL GROUP	EXPERIMENTAL GROUP	P-VALUE
Age	73.5 ± 5.1	57.3 ± 16.7	0.035
H & Y Scale	2.7 ± 0.3	2.0 ± 0	0.32
Dysarthria	1.7 ± 0.4	1.5 ± 0.5	0.43
IQCODE	2.78 ± 0.4	2.85 ± 0.7	0.35

GROUP DYNAMICS
SESSION	DYNAMICS	DURATION	OBJECTIVE AND STRATEGIES
1^st	PERSONAL PRESENTATION	15 min	Encourage the personal presentation of the group members’ and the group leaders/therapists by choosing an object that would represent the individual expectations for the further group work.
1^st	CHALLENGES	30 min	Work to overcome challenges that occurred in the childhood, youth or adulthood life in order to strengthen the self-esteem and share moments of victory with the group. Coping work strategies.
2^nd	DAILY UPDATE	15 min	Redeem the insights that occurred during the past week after the first session.
2^nd	SELF-FEEDBACK	30 min	To identify positive, negative and knew behaviors that allowed improvement in the quality of life. These behaviors were presented out loud so that the group could validate, or not, the perception of each one.
3^rd	DAILY UPDATE	15 min	Redeem the insights that occurred during the past week.
3^rd	DESCRIPTION OF PERSONALITIES	30 min	To provide a moment of communication among the group members, in order to reinforce the new vocal pattern learned in the vocal therapy; also to evaluate aspects of communication, memory and linguistic. Work in partnership (2 persons): description of a known person previously defined and written on a paper on the patients back so that the other person would guess the chosen personality.
4^th	DAILY UPDATE	15 min	Redeem the insights that occurred during the past week.
4^th	AFFECTION	30 min	Manifestation of affection while sharing a box of chocolates.

Evaluation		Moment	Mean	Median	Standard Deviation	N	P-value
Evaluation		Moment	Mean	Median	Standard Deviation	N	Pre	Post 1	Three Moments
Voice Self-evaluation	CG	Pre	2.88	3	0.83	8	-	-	0.589
		Post 1	2.75	3	0.89	8	0.564	-
		Post 2	3.25	3	1.28	8	0.48	0.194
	EG	Pre	3	3	0.93	8	-	-	0.006
		Post 1	3	3	0.76	8	1	-
		Post 2	4	4	0.53	8	0.023	0.011
Communication Self-evaluation	CG	Pre	2.88	2.5	1.13	8	-	-	0.019
		Post 1	2.88	3	0.83	8	1	-
		Post 2	3.75	3.5	0.89	8	0.053	0.02
	EG	Pre	3.13	3.5	0.99	8	-	-	0.048
		Post 1	3.75	3.5	0.89	8	0.096	-
		Post 2	4.13	4	0.64	8	0.039	0.257
LwD	CG	Pre	2.32	2.56	0.94	8	-	-	0.005
		Post 1	3.57	3.75	1.14	8	0.012	-
		Post 2	3.17	3.24	1.12	8	0.03	0.263
	EG	Pre	1.98	2.03	1.1	8	-	-	0.093
		Post 1	2.93	3.26	1.1	8	0.036	-
		Post 2	2.84	2.69	1.04	8	0.017	0.575

Perceptual-Auditory Analysis	CG		EG		P-value
Perceptual-Auditory Analysis	N	%	N	%	P-value
Pre	3	18.80%	1	6.30%	0.285
Post 1	5	31.30%	11	68.80%	0.034
Post 2	8	50.00%	4	25.00%	0.144

Group Climate		Moment	Mean	Median	Standard Deviation	N	CI	P-value
Group Climate		Moment	Mean	Median	Standard Deviation	N	CI	Pre	Post 1	Three Moments
Engagement	CG	Pre	2.53	2.4	1.26	8	0.87	-	-	0.648
		Post 1	2.98	3	1.38	8	0.95	0.446	-
		Post 2	2.9	2.9	1.14	8	0.79	0.497	0.779
	EG	Pre	2.95	3.1	1.11	8	0.77	-	-	0.657
		Post 1	2.98	2.5	1.4	8	0.97	0.932	-
		Post 2	3.25	3.2	0.48	8	0.33	0.484	0.624
Avoidance	CG	Pre	2.75	2.5	1.28	8	0.89	-	-	0.657
		Post 1	3.04	2.83	1.39	8	0.96	0.136	-
		Post 2	2.67	2.67	1.37	8	0.95	0.799	0.526
	EG	Pre	2.83	3.17	1.14	8	0.79	-	-	0.166
		Post 1	2	2.17	1.1	8	0.76	0.128	-
		Post 2	1.96	2.17	0.58	8	0.4	0.028	0.799
Conflict	CG	Pre	0.97	1	0.49	8	0.34	-	-	0.587
		Post 1	0.91	0.63	1.06	8	0.73	0.888	-
		Post 2	0.78	0.75	0.77	8	0.54	0.528	0.753
	EG	Pre	0.78	0.63	0.59	8	0.41	-	-	0.066
		Post 1	0.59	0.5	0.53	8	0.37	0.528	-
		Post 2	0.44	0.13	0.56	8	0.39	0.091	0.344

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[1] Conflict of interests: nothing to declare.