PURPOSE:Mental ill-health is common after stroke. Stroke survivors with aphasia are at higher risk of depression and anxiety, but communication impairment makes identification challenging. This study investigates if, how, and by whom mental health is assessed in Swedish stroke care, and whether resources to assess mental health in stroke patients with aphasia are available. MATERIALS AND METHODS:A survey was distributed to healthcare professionals (HCP) in stroke care and rehabilitation across Sweden. 981 complete responses were included. RESULTS:HCP perceive mental ill-health as more common among patients with aphasia than among other stroke patients, but that their mental health is assessed less frequently. Assessment procedures are inconsistent. Physicians, psychologists, and social workers are viewed as responsible, but these professions are lacking in many rehabilitation settings and do not always work with patients with aphasia. HCPs attempt to adapt assessment procedures but report lacking aphasia-friendly material and competence in communication strategies. CONCLUSIONS:According to HCP, mental health is not assessed adequately, especially in patients with aphasia. More mental health professionals, greater competence in communication strategies, improved collaboration between professions, and access to aphasia-friendly assessment materials are important to improve mental health care for stroke patients with and without aphasia.

Abstract Background and aims Mental ill-health is common after stroke. Stroke survivors with aphasia are at higher risk of depression and anxiety, but communication impairment makes identification challenging. This study investigates if, how, and by whom mental health is assessed in Swedish stroke care, and whether adequate resources to assess mental health in stroke patients with aphasia are available. Methods An electronic survey was distributed to healthcare professionals (HCP) in stroke care and rehabilitation across Sweden. Results 981 respondents completed the entire survey and were included in the analysis. Mental health screening is relatively rare. HCP perceive mental ill-health as more common among patients with aphasia than among other stroke patients, but also that their mental health is assessed less frequently, with a risk that aphasia patients who need mental health support are not identified. Assessment procedures are inconsistent. Physicians, psychologists, and social workers are generally viewed as responsible for assessment of mental health, but these professions do not always work with patients with aphasia, and are lacking particularly in later phases of rehabilitation. HCPs attempt to adapt assessment procedures but report lacking aphasia-friendly material and competence in communication strategies. Conclusions According to HCP, mental health is not assessed adequately in stroke care, especially in patients with aphasia. More mental health professionals, increased competence in communication strategies, increased collaboration between professions, and access to aphasia-friendly assessment materials are important to improve mental health care for stroke patients with and without aphasia. Conflict of interest Camilla Olsson: Nothing to disclose. Ellika Schalling: Nothing to disclose.

BackgroundSpeech and voice symptoms are common in Parkinson's disease, yet predictors of response to behavioral speech interventions are unclear.ObjectivesTo identify predictors of responsiveness to a speech and communication group-intervention (HiCommunication) and contextualize findings against active controls.MethodsThis secondary analysis of a randomized controlled trial included intervention completers. Responders were defined for voice intensity (increase ≥2 decibels) and voice quality (Acoustic Voice Quality Index decrease ≥0.54). Nineteen baseline clinical, motor, cognitive, perceptual, and acoustic variables were entered into Random Forest classifiers. Primary models excluded the baseline value of the target domain; baseline-including variants were sensitivity analyses. Performance was evaluated using Cohen's kappa, precision, recall, and specificity; key predictors were examined using partial dependence.ResultsIn HiCommunication (n = 35), the primary voice intensity model showed moderate agreement (kappa = 0.57; precision = 0.79; recall = 0.90; specificity = 0.64). Higher baseline perceptual ratings of reduced loudness and overall speech deviation, as well as higher Acoustic Voice Quality Index values, were associated with a higher predicted probability of improvement in voice intensity, whereas higher levodopa equivalent daily dose was associated with a lower response probability; postural instability/gait difficulty or tremor-dominant motor phenotypes showed higher response probability than the indeterminate phenotype. Voice quality models were below chance without baseline Acoustic Voice Quality Index but reached kappa 0.38 when included. Active control models showed low performance.ConclusionsClinically accessible baseline measures predicted improvement in voice intensity following HiCommunication with moderate accuracy. Perceptual ratings may support expectation-setting and individualized planning of group-based speech intervention in Parkinson's disease, but findings require replication.ClinicalTrials.gov ID: NCT03213873, doi: 10.1177/1545968321999053Plain Language TitleWho benefits most from group-based speech and communication therapy in Parkinson's disease? This study explored whether simple clinical and speech measures collected before treatment can help predict which people with Parkinson's disease are most likely to improve their voice loudness after participating in an intensive group-based speech and communication program.

PurposeInvestigating how stroke healthcare professionals manage suicidality in stroke patients with and without aphasia.Materials and methodsA cross-sectional survey of 981 professionals in Sweden was conducted.ResultsNearly 60% of respondents had encountered suicidality in stroke patients without aphasia, while 40% had encountered it in patients with aphasia. SLPs were more likely to meet patients with aphasia and suicidality. Routine screening was rare, while 40% reported that suicidality was assessed when needed. Psychologists, physicians, and social workers were seen as responsible for assessments, with 13% of respondents feeling it was their responsibility to assess suicidality. Less than half of those felt competent to assess patients with aphasia. Aphasia was viewed as a barrier to assessment. Uncertainty was widespread regarding intervention, particularly in patients with aphasia, and there were concerns about the competence to handle such cases when referred to psychiatry. Free-text responses highlighted a perceived lack of competence, tools, and routine procedures for handling suicidality in aphasia, alongside calls for more mental health professionals and better interprofessional collaboration regarding suicidality in stroke rehabilitation.ConclusionsManagement of suicidality in stroke patients, particularly with aphasia, is surrounded by uncertainty. Greater competence in suicidality, aphasia-friendly communication, and improved interdisciplinary efforts are needed.

PURPOSE:This study aimed to explore and describe subjective experiences and feelings related to speech and communicative function for a group of individuals with Parkinson's disease (PD) and whether these changed after participation in HiCommunication, an intensive group intervention program focusing on speech and communication for individuals with PD. METHOD:Seven individuals who had completed the 10-week program participated in individual semistructured interviews that were transcribed and analyzed with content analysis. RESULTS:Eight subthemes grouped into three main themes emerged during the analysis, including communication challenges, insights from treatment, and practical considerations. CONCLUSION:The overarching theme, speech and communication training as a tool to respond to communication difficulties, describes that a group speech and communication treatment program, HiCommunication, may help individuals with PD form and implement strategies to maneuver negative emotional stress related to communication and decrease the risk of social isolation. SUPPLEMENTAL MATERIAL:https://doi.org/10.23641/asha.28556273.

BackgroundIntensive comprehensive rehabilitation is recommended as an effective way to improve speech and language in individuals with aphasia. However, there is limited research on patients' experiences, especially for modified Intensive Comprehensive Aphasia Programmes (mICAPs) in regular healthcare settings.AimThis study aimed to explore the acceptability, feasibility, and engagement of individuals with aphasia with and without co-occurring apraxia of speech (AOS), when participating in an mICAP in regular healthcare settings.Methods & ProceduresIn this multicentre intervention study across 13 Swedish clinics, quantitative data from 23 responses to questionnaires and qualitative data from semi structured interviews with five patients were analysed with a mixed method convergent design.Outcomes & ResultsQuantitative findings indicated high satisfaction with the mICAP. Patients found it effective, recommendable to others, and noted speech-language improvements. They felt involved in goal setting, were highly motivated, and expressed a need for more therapy. The timing of the mICAP is a previously overlooked aspect of participant experience, with a clear preference for the chronic phase, followed by the sub-acute phase. Challenges included tiredness, transportation, and time constraints. Five themes from the qualitative interviews were generated: (1) improvements in speech-language functions and daily activities; (2) the mICAP was enjoyable and effective, and the Speech-Language Pathologist (SLP) played an important role; (3) highly motivated for continued and more challenging rehab; (4) can be tiring at the start, but stamina improves; and (5) transportation and physical limitations can be barriers. Mixed-methods analysis revealed that qualitative data provided crucial nuances to the quantitative findings. Although the questionnaire respondents reported tiredness as a problem, the interviewed patients described an initial fatigue that was short-lived and replaced by increasing stamina. Similarly, although a preference for individual sessions was reported in the questionnaires, interview patients described the comprehensive format as more effective. And while goal setting involvement had high ratings in the questionnaires, interview responses indicated that both the goal setting process and the goals were unclear.ConclusionsParticipants with aphasia, with or without co-occurring AOS, found the mICAP acceptable and feasible when introduced across multiple sites in regular Swedish healthcare. They showed high engagement, described the mICAP as enjoyable and effective, and valued their contact with the SLP greatly. Although the intensive format can be initially tiring, the participants remained highly motivated for longer and even more demanding rehabilitation.

PURPOSE:HiCommunication is a group intervention for Parkinson's disease (PD) targeting speech and communication. This study investigated its effects on speech and voice using auditory-perceptual analyses, following previous evaluation with acoustic outcomes, and examined correlations between auditory-perceptual parameters and acoustic measures. METHODS:Ninety-five participants with mild-to-moderate PD were randomized to either HiCommunication or an active control intervention. Experienced speech and language pathologists rated 21 speech and voice parameters from recordings collected preintervention, postintervention, and at a 6-month follow-up. Intention-to-treat (ITT) analyses-where all participants are analyzed in their original groups regardless of adherence-used linear or Hurdle multilevel models with imputed missing values, complemented by per-protocol analyses. Correlation analyses examined the relationship between acoustic measures (voice sound level, Acoustic Voice Quality Index, and harmonics-to-noise ratio) and corresponding auditory-perceptual parameters. RESULTS:In the ITT analyses, loudness decay showed a significant group effect (b = 1.66, P = 0.032) and group-by-time interaction (b = 0.52, P = 0.034), confirmed in intervention completers. Additional group-by-time effects in completers were observed for imprecise articulation (b = 0.70, P = 0.016) and vocal fry (b = 0.58, P = 0.003). Weak-to-strong correlations were observed between auditory-perceptual and acoustic measures. CONCLUSION:The findings highlight the potential benefits of HiCommunication in improving loudness, articulation, and voice quality (ie, reduced vocal fry) in individuals with PD, particularly among completers of the intervention. However, effects on broader auditory-perceptual parameters of speech deviation were limited, and the perceptual ratings appeared less sensitive than acoustic measures in detecting subtle changes associated with mild hypokinetic dysarthria. These results underscore the value of combining auditory-perceptual and acoustic assessments in evaluating speech interventions and point to the need for strategies to support adherence and optimize outcomes. CLINICAL TRIAL REGISTRATION NUMBER:NCT03213873.

Parkinson’s disease (PD) is the second most common neurodegenerative disorder. Its prevalence is increasing. Many of the symptoms in PD affect communication. Several motor symptoms such as rigidity and bradykinesia have a direct effect on speech production. Non-motor symptoms such as fatigue and cognitive impairment may also have a negative impact on communication. Most individuals with PD experience communication problems as the disease progresses. Speech and voice symptoms in PD, and how they relate to neurophysiological changes caused by the disease, are described in this chapter. Differentiation between hypokinetic dysarthria, often observed in PD, and other types of dysarthria is discussed. A description of methods for assessment of speech and voice in PD and typical findings are also provided. Finally, different approaches to management of dysarthria and dysphonia in PD are described. This includes behavioral intervention methods, intervention programs, and communication-oriented strategies.

Speech, voice, and communication changes are common in Parkinson’s disease. HiCommunication is a novel group intervention for speech and communication in Parkinson’s disease based on principles driving neuroplasticity. In a randomised controlled trial, 95 participants with Parkinson’s disease were allocated to HiCommunication or an active control intervention. Acoustic analysis was performed pre-, post-, and six months after intervention. Intention-to-treat analyses with missing values imputed in linear multilevel models and complimentary per-protocol analyses were performed. The proportion of participants with a clinically relevant increase in the primary outcome measure of voice sound level was calculated. Resting-state functional MRI was performed pre- and post-intervention. Spectral dynamic causal modeling and the parametric empirical Bayes methods were applied to resting-state functional MRI data to describe effective connectivity changes in a speech-motor-related network of brain regions. From pre- to post intervention, there were significant group-by-time interaction effects for the measures voice sound level in text reading (unstandardised b = 2.3, p = 0.003), voice sound level in monologue (unstandardised b = 2.1, p = 0.009), Acoustic Voice Quality Index (unstandardised b = -0.5, p = 0.016), and Harmonics-to-Noise Ratio (unstandardised b = 1.3, p = 0.014) post-intervention. For 59% of the participants the increase in voice sound level after HiCommunication was clinically relevant. There were no sustained effects at the six-month follow-up. In the effective connectivity analysis, there was a significant decrease in inhibitory self-connectivity in the left supplementary motor area and increased connectivity from the right supplementary motor area to the left paracentral gyrus after HiCommunication compared to after the active control intervention. In conclusion, the HiCommunication intervention showed promising effects on voice sound level and voice quality in people with Parkinson’s disease, motivating investigations of barriers and facilitators for implementation of the intervention in healthcare settings. Resting-state brain effective connectivity was altered following the intervention in areas implicated, possibly due to reorganisation in brain networks.

Background: Intensive rehabilitation of aphasia is recommended in the national guidelines for stroke care, but is far from implemented in Swedish healthcare. Aim: To explore current practice and detect barriers and enablers for intensive aphasia rehabilitation among Speech Language Pathologists (SLPs) before they were enrolled in a national intervention study.Method: Thirty-six SLPs in 26 clinics answered a web-based questionnaire. Responses were processed using descriptive statistics and thematic analysis.Result: Treatment intensity, duration and delivery format varied widely, and two-thirds offered intensive rehabilitation rarely or never. Thematic analysis generated the following five barriers: understaffing, patient factors, teamwork/scheduling, prioritization, and accessibility, and three enablers: increased staffing, planned intervention programmes, and comprehensive delivery formats.Conclusions: Compliance with Swedish stroke guidelines for intensive aphasia rehabilitation is low, and the current practice varies widely between different clinics. Increasing SLPs in primary care and restructuring care by using planned and comprehensive intervention approaches are suggested to stimulate implementation.

Purpose: Research indicates that there is a tendency for females who stutter, more often than males, to use coping strategies that involve covering their stutter, for example, by avoiding situations that require verbal participation. The aim of the study is to increase knowledge about how covert stuttering develops and its impact on self-image and quality of life for women who stutter. Method: Eleven young women who stutter covertly were interviewed, and data were subjected to qualitative content analysis. Background information was obtained from the self-report instruments measuring the impact of stuttering on different aspects of life (Overall Assessment of the Speaker's Experiences of Stuttering) and degree of perceived social anxiety (Liebowitz Social Anxiety Scale, Self-Report). Results: Three main themes were identified: (a) managing stuttering, (b) personal aspects, and (c) stuttering as a phenomenon. Shame and a desire to fit in emerged as distinct motives for covering stuttering. The women described that stuttering controlled both life choices and everyday life. Development of self-image had been strongly negatively affected, resulting in social anxiety. The women expressed a particular vulnerability of being a woman who stutters, due to societal norms of female behavior and a lack of female role models who stutter. Conclusions: The choice of coping strategy was motivated by a desire to “be normal.” As a result, stuttering had come to dominate life and affect self-image and life choices. The study highlights the importance for clinicians to be alert to and aware of the fact that the experiences of women who stutter can lead them to develop coping strategies that have far-reaching negative consequences.

Purpose: We aimed to cross-sectionally describe the impact of stuttering on persons who stutter (PWS): children, adolescents, and young adults. Based on previous research on PWS and psychosocial health in the general population, we hypothesized that (a) the adverse impact of stuttering in PWS would be larger among adolescents than children and young adults and that (b) females, especially adolescent females, would report being more adversely impacted by their stuttering than males. Method: We pooled samples of Swedish PWS, obtaining 162 individuals (75 females and 87 males), aged 7–30 years. We measured the impact of stuttering using age-relevant versions of the Overall Assessment of the Speaker's Experience of Stuttering (OASES). The relationship between OASES score, age, and sex was described using a polynomial model with an interaction term between age and sex to allow for potential differences between females and males' age-related curves. Results: The average trends were that (a) the impact of stuttering was greater for the adolescents than for the children and young adults, and (b) females, especially adolescent females, were on average more impacted by their stuttering than males. Taking self-reported speech fluency into account did not change this pattern. Conclusions: In line with findings on psychosocial health, communication attitude, and self-esteem in the general population, the impact of stuttering seems to be particularly adverse among adolescents, especially female adolescents. Thus, clinicians need to be aware of the risk that young girls who stutter may develop a negative attitude to speech and communication, and this should also be communicated to caregivers and teachers. Supplemental Material: https://doi.org/10.23641/asha.21554877

Objective:The cerebral substrates of apraxia of speech (AOS) recovery remain unclear. Resting state fMRI post stroke can inform on altered functional connectivity (FC) within cortical language networks. Some initial studies report reduced FC between bilateral premotor cortices in patients with AOS, with lowest FC in patients with the most severe AOS. However, longitudinal FC studies in stroke are lacking. The aims of the present longitudinal study in early post stroke patients with AOS were (i) to compare connectivity strength in AOS patients to that in left hemisphere (LH) lesioned stroke patients without a speech-language impairment, (ii) to investigate the relation between FC and severity of AOS, aphasia and non-verbal oral apraxia (NVOA) and (iii) to investigate longitudinal changes in FC, from the subacute phase to the chronic phase to identify predictors of AOS recovery.Methods:Functional connectivity measures and comprehensive speech-language assessments were obtained at 4 weeks and 6 months after stroke in nine patients with AOS after a LH stroke and in six LH lesioned stroke patients without speech-language impairment. Functional connectivity was investigated in a network for speech production: inferior frontal gyrus (IFG), anterior insula (aINS), and ventral premotor cortex (vPMC), all bilaterally to investigate signs of adaptive or maladaptive changes in both hemispheres.Results:Interhemispheric vPMC connectivity was significantly reduced in patients with AOS compared to LH lesioned patients without speech-language impairment. At 6 months, the AOS severity was associated with interhemispheric aINS and vPMC connectivity. Longitudinal changes in FC were found in individuals, whereas no significant longitudinal change in FC was found at the group level. Degree of longitudinal AOS recovery was strongly associated with interhemispheric IFG connectivity strength at 4 weeks.Conclusion:Early interhemispheric IFG connectivity may be a strong predictor of AOS recovery. The results support the importance of interhemispheric vPMC connection in speech motor planning and severity of AOS and suggest that also bilateral aINS connectivity may have an impact on AOS severity. These findings need to be validated in larger cohorts.

Balance dysfunction is a disabling symptom in people with Parkinson’s disease (PD). Evidence suggests that exercise can improve balance performance and induce neuroplastic effects. We hypothesised that a 10-week balance intervention (HiBalance) would improve balance, other motor and cognitive symptoms, and alter task-evoked brain activity in people with PD. We performed a double-blind randomised controlled trial (RCT) where 95 participants with PD were randomised to either HiBalance ( n = 48) or a control group ( n = 47). We found no significant group by time effect on balance performance ( b = 0.4 95% CI [−1, 1.9], p = 0.57) or on our secondary outcomes, including the measures of task-evoked brain activity. The findings of this well-powered, double-blind RCT contrast previous studies of the HiBalance programme but are congruent with other double-blind RCTs of physical exercise in PD. The divergent results raise important questions on how to optimise physical exercise interventions for people with PD. Preregistration clinicaltrials.gov: NCT03213873.

PurposeAlterations in speech and voice are among the most common symptoms in Parkinson's disease (PD), often resulting in motor speech disorders such as hypokinetic dysarthria. We investigated dysarthria, verbal fluency, executive functions, and global cognitive function in relation to structural and resting-state brain changes in people with PD. MethodsParticipants with mild-moderate PD (n = 83) were recruited within a randomized controlled trial and divided into groups with varying degrees of dysarthria: no dysarthria (noDPD), mild dysarthria (mildDPD), moderate dysarthria (modDPD), and also combined mildDPD and modDPD into one group (totDPD). Voice sound level and dysphonia, verbal fluency, motor symptoms, executive functions, disease severity, global cognition, and neuroimaging were compared between groups. Gray matter volume and intensity of spontaneous brain activity were analyzed. Additionally, regressions between behavioral and neuroimaging data were performed. ResultsThe groups differed significantly in mean voice sound level, dysphonia, and motor symptom severity. Comparing different severity levels of dysarthria to noDPD, groups differed focally in resting-state activity, but not in brain structure. In totDPD, lower scores on semantic verbal fluency, a composite score of executive functions, and global cognition correlated with lower superior temporal gyrus volume. ConclusionThis study shows that severity of dysarthria may be related to underlying structural and resting-state brain alterations in PD as well as behavioral changes. Further, the superior temporal gyrus may play an important role in executive functions, language, and global cognition in people with PD and dysarthria.

Abstract Introduction Speech and communication problems are common in Parkinson's disease (PD) and can result in social withdrawal and reduced quality of life. Intervention may improve symptoms but transfer and maintenance remain challenging for many. Access to treatment may also be limited. Group intervention incorporating principles for experience‐dependent plasticity may address these challenges. The aim of this study was to develop and study feasibility aspects of a new intervention program for group training of speech and communication in people with PD. Materials & Methods Development and content of the program called HiCommunication is described. Core target areas are voice, articulation, word‐finding and memory. Five participants with mild‐moderate PD completed this feasibility trial. Attendance rate and possible adverse events as well as the participants' experiences were documented. A speech recording and dysarthria testing were completed to study feasibility of the assessment procedure and evaluate possible changes in voice sound level and intelligibility. Results Attendance rate was 89%. No adverse events occurred. Participants reported a positive experience and limited fatigue. Assessment was completed in approximately 30 min and was well tolerated. Four of five participants had an increased voice sound level during text‐reading postintervention and mean intelligibility improved. Conclusions Results indicate that HiCommunication is feasible for people with mild‐moderate PD. The program was appreciated and well tolerated. Positive outcomes regarding voice sound level and intelligibility were observed; however, the number of participants was very limited. The results motivate that effects of HiCommunication are further studied in a randomized controlled trial, which is ongoing.

Purpose: There is a recognized need for a reliable assessment instrument for apraxia of speech (AOS) diagnosis for post stroke patients. In 2014, Strand and colleagues reported high to excellent intraand interjudge reliability of the Apraxia of Speech Rating Scale (ASRS) in neurodegenerative speech and language disorders. Excellent interjudge reliability of the ASRS total score has also recently been reported in another study of individuals with chronic AOS after stroke, where the ratings were carried out by two experienced researchers not involved in the development of the instrument. However, it is still not fully determined whether the ASRS is a reliable instrument in assessment of patients in an early phase after stroke, where severe AOS is not uncommon. It is also not determined whether ASRS ratings can be performed reliably by practicing speech language pathologists (SLPs) without long common experience and joint training. This study therefore addresses these questions. Method: The ASRS was administered to thirty-six individuals in the first six months after stroke. The assessment procedures were video recorded. Ten of the recordings were selected for the reliability study, representative of patients typically seen at the actual inpatient ward with varying degrees of AOS severity. Five SLPs from different hospital departments participated as raters. The raters viewed each video and independently rated the presence and severity of AOS using the ASRS. To study intrajudge reliability, a rescoring was performed after a minimum of three weeks. Reliability was calculated using the intraclass correlation coefficient (ICC). Results: Intrajudge agreement for the ASRS total score varied from moderate to excellent (mean ICC = 0.69, 95 % CI [0.60, 0.77]) with most of the mean item level agreements within the categories 'moderate' or 'good. Interjudge reliability was poor for the ASRS total score (ICC = 0.42, 95 % CI [0.35, 0.50]). The item level results varied between moderate and poor, with lack of agreement on several items. Conclusions: For clinicians without expert knowledge of AOS and limited training using the ASRS, intraand interjudge reliability of the ASRS is not satisfactory. Also, since some items in the protocol require a certain level of speech production to target the diagnostic marker, findings indicate that the ASRS in its present design has limitations in assessment of severe AOS. As suggested by Strand and colleagues, video examples that illustrate the ASRS characteristics could be one helpful alternative to support clinician training. A minor revision of response definitions of the scale may improve the applicability of the ASRS in severe AOS.

Perceptual assessment is the basis for diagnosis and evaluation of treatment in speech-language pathology (SLP). Students need to practise assessment skills. A web-based platform with cases and expert feedback in cleft palate disorders was developed in national collaboration. The aim of the study was to evaluate the results of individual training on assessment skills in SLP students and their perception of e-learning. Forty-five students performed tests using a pre- and post-test set-up. Perceptual assessments were demonstrated and instructions provided during teacher-led activities in ongoing fully scheduled courses; students were then individually trained in their free time. Reference samples were available. A significant improvement was found in rating and phonetic transcriptions after training. Positive comments concerned accessibility and practice time.

ObjectivesThe purpose of this study was to assess the outcome following continuous tactile biofeedback of voice sound level administered, with a portable voice accumulator to individuals with Parkinson's disease (PD).MethodNine out of 16 participants with PD completed a 4-week intervention program where biofeedback of voice sound level was administered with the portable voice accumulator VoxLog during speech in daily life. The feedback, a tactile vibration signal from the device, was activated when the wearer used a voice sound level below an individually predetermined threshold level, reminding the wearer to increase voice sound level during speech. Voice use was registered in daily life with the VoxLog during the intervention period as well as during one baseline week, one follow-up week post intervention and 1 week 3 months post intervention. Self-to-other ratio (SOR), which is the difference between voice sound level and environmental noise, was studied in multiple noise ranges.ResultsA significant increase in SOR across all noise ranges of 2.28 dB (SD: 0.55) was seen for participants with scores above the cut-off for normal function (>26 points) on the cognitive screening test Montreal Cognitive Assessment (MoCA) (n = 5). No significant increase was seen for the group of participants with MoCA scores below 26 (n = 4). Forty-four percent ended their participation early, all which scored below 26 on MoCA (n = 7).ConclusionsBiofeedback administered in daily life regarding voice level may help individuals with PD to increase their voice sound level in relation to environmental noise in daily life, but only for a limited subset. Only participants with normal cognitive function as screened by MoCA improved their voice sound level in relation to environmental noise.