Acknowledgements This research is funded by a grant from the Dunhill Medical Trust (R192/0511) and supported by the NIHR, through the Comprehensive Clinical Research Network and C. Sackley's NIHR Senior Investigator award. Contact: gillian.beaton@nhs.ggc.scot.nhs.uk PDCOMM _ www.birmingham.ac.uk/pdcomm Conclusion This single case study challenged our perceptions of patients considered ‘suitable’ for LSVT within our SLT team at NHS Great Glasgow & Clyde. Typically this client would not have been offered LSVT due to reported medical, social and contextual factors. Following an intensive course of LSVT, Scott achieved his therapy goal, demonstrated an increase in vocal volume at conversation level and a positive attitude change towards communication. Final report of PDCOMM Pilot findings are expected in 2015. Aim To examine the participation of one individual ‘Scott’ with challenging medical, social and contextual factors in intensive LSVT in the context of a pilot trial. Gillian Beaton, 1, Bridget St George 2 , Carl E Clarke,3,5, Francis Dowling 2, Smitaa Patel 2, Rebecca Woolley 2, Natalie Ives 2, Caroline Rick 2, Keith Wheatley 2, Christina Smith 4, Marian C. Brady 2, Catherine M Sackley 6. 1. NHS Greater Glasgow and Clyde, 2. Nursing, Midwifery and Allied Health Professions Research Unit, 3. University of Birmingham,, 4. University College London, 6. University of East Anglia, 5. Sandwell and West Birmingham Hospitals NHS Trust Introduction LSVT: Lee Silverman Voice Treatment (LSVT) is an intensive speech treatment offered to people with dysarthria associated with Parkinson’s Disease (PD) (1). In NHS Greater Glasgow and Clyde we offer patients LSVT if they (i) are able to attend 16 one hour treatment sessions over four weeks (supplemented by home-based exercises), (ii) are able to cope with the physical demands of attendance, (iii) appear motivated to change and (iv) have hypophonic dysarthria. PDCOMM: PDCOMM pilot is a UK-wide Dunhill Medical Trust funded randomised controlled trial (ISRCTN 75223808) which compares LSVT versus standard NHS treatment versus no SLT. Patients with idiopathic PD, presenting with self-reported voice or speech problems identified at neurology and movement disorder clinic appointments, were eligible for inclusion. Following Ethical and Research and Development approvals (11/WM/0343) PDCOMM Pilot commenced recruitment at NHS Greater Glasgow and Clyde in February 2013. A total of 89 participants were recruited to the national trial which closed to recruitment at the end of March 2014. Follow-up of participants is still ongoing and analysis of data is underway. Implementation at NHS Greater Glasgow & Clyde: During the course of PDCOMM we observed that participants randomised to receive LSVT did not always reflect those patients we would typically have offered LSVT within NHS contexts. Results Scott attended all 16 of the prescribed LSVT treatment sessions delivered by two SLTs. Due to shortness of breath, he did not always tolerate full 60 minute sessions recommended for LSVT. Length of sessions ranged from 30 minutes to 45 minutes. Across the 12 month period reductions in VHI, V-RQoL and PDQ39 scores were observed (Figs 1-3). At therapy end, Scott reported he had met his pre-treatment goal “ People no longer ask me to repeat”. Challenging clinical decisions relating to the provision of LSVT for people with Parkinson’s Disease: a single case study Method Participant Profile: Scott had a history of (i) angina and shortness of breath, (ii) depression, (iii) a pre-morbid dysarthria following closed head injury in 2006. He had no carer support at home or elsewhere. He faced significant transport challenges in attending clinic sessions requiring three bus journeys and ten minute walk to and from the hospital for each visit. Scott was motivated to attend for LSVT. His treatment goal was to reduce the number of repetition requests from conversation partners. Baseline Measures: Baseline measures for PDCOMM study were completed by the research nurse including Vocal Handicap Index (VHI) (2), Voice Related Quality Of Life Questionnaire (V-RQoL) (3) and Parkinson's Disease Questionnaire-39 (PDQ-39) (4). Randomisation: Following baseline measures, Scott was deemed eligible for participation in PDCOMM trial The research nurse contacted the trial office and Scott was randomised to receive LSVT. LSVT: At each LSVT session decibel ratings (sustained phonation, conversation and reading) were recorded by the SLTs using a Radioshak Sound Level Meter positioned 30cms from the mouth. Home therapy tasks were recommended at each session. Outcome measures: VHI, VRQOL and PDQ39 were captured at three, six and 12 months after randomisation. 0 20 40 60 80 100 120 Baseline 3 months 6 months 12 months VHI 0 5 10 15 20 25 30 35 40 45 50 Baseline 3 months 6 months 12 months VRQOL 0 20 40 60 80 100 120 140 160 Baseline 3 months 6 months 12 months PDQ 39 A patient receiving LSVT References 1. RAMIG L.O., ET AL. (2001) Changes in vocal loudness following intensive voice treatment (LSVT) in individuals with Parkinson's disease: a comparison with untreated patients and normal age-matched controls. Movement Disorders, 16, 79-83. 2. JACOBSON B.H., ET AL. (1997) The Voice Handicap Index (VHI): Development and Validation American Journal of Speech-Language Pathology, 6, 66-70. 3. HOGIKYAN N.D. & SETHURAMAN, G. (1999) Validation of an instrument to measure voicerelated quality of life (V-RQOL). Journal of Voice, 13, 557-69. 4.. PETO V, ET AL. (1998) PDQ-39: a review of the development, validation and application of a Parkinson's disease quality of life questionnaire and its associated measures. Journal of Neurology, 245 Suppl 1, S10-4. Fig 1 : VHI scores at baseline , 3 , 6 and 12 months. Fig 2 : V-RQoL scores at baseline , 3 , 6 and 12 months. Fig 3 : PDQ-39 scores at baseline , 3 , 6 and 12 months.