Introduktion: Parkinsons sjukdom (PS) är en neurodegenerativ sjukdom som påverkar rörelseförmåga, balans, gång och aktivitetsförmåga. Lee Silverman Voice Treatment BIG (LSVT BIG) har goda korttidseffekter men det saknas studier som beskriver personernas egna erfarenheter av att vidmakthålla fysisk träning och färdigheter efter att ha deltagit i LSVT BIG. Syfte: Syftet med studien var att utforska erfarenheter av att vidmakthålla fysisk träning och färdigheter hos personer med PS som deltagit i LSVT BIG.  Metod: Studien var av kvalitativ design med induktiv ansats. Semistrukturerade intervjuer genomfördes med 12 personer med PS som deltagit i LSVT BIG för minst tre månader sedan. De transkriberade intervjuerna analyserades med kvalitativ innehållsanalys enligt Graneheim och Lundman. Resultat: Analysen resulterade i temat tilltro och drivkraft att påverka funktion och sjukdomens progress. Det övergripande temat baserades på tre kategorier: upplägg som främjar egenträning, motivation att fortsätta träna och förstärkare av träning samt tre underkategorier per kategori. Resultatet beskriver betydelse av struktur på träningen, uppföljning och anpassning för att öka drivkraft och tilltro till att påverka funktion och progress av sjukdomen. Det ligger till grund för vidmakthållande av träning och färdigheter över tid.  Slutsats: Personer med PS som deltagit i LSVT BIG upplever att det är viktigt att upprätthålla motivation och individanpassa förstärkare av beteendet. Deras erfarenhet är att uppföljning och anpassning av träningen är nödvändig för att överbrygga hinder samt stärka tilltro och drivkraft att påverka symtom och progress av sjukdomen. Denna studie kan hjälpa fysioterapeuter och arbetsterapeuter eftersom personer med PS behöver stöd för att stärka resurser och överbrygga hinder gällande motivation, kontext och multisjuklighet. Framtida forskning behövs om långtidseffekter av LSVT BIG och ett beteendemedicinskt förhållningssätt kopplat till vidmakthållande av fysisk träning för personer med PS. / Introduction: Parkinson´s disease (PD) is a neurodegenerative disease that affects mobility, balance, ambulation and activity. Lee Silverman Voice Treatment BIG (LSVT BIG) has good short-term effects, but there are no studies describing people's own experiences of maintaining physical exercise and skills after participating in LSVT BIG. Aim: The aim of this study was to explore the experiences of maintaining physical exercise and skills in people with PD who participated in LSVT BIG. Method: The study was of qualitative design with inductive approach. The semistructured interviews were conducted with 12 people following a minimum of three months post participated in LSVT BIG. The transcribed interviews were analyzed with qualitative content analysis according to Graneheim and Lundman. Results: The analysis revealed in a theme 0f higher confidence and motivation to influence function and slowing the progression of the disorder. Three categories were identified to support the overall theme: arrangement that promote self training, motivation to continue physical exercise and enhancers of exercise, and three sub-categories per category. The results describe the importance of structure in exercise, follow-up and adjustment to increase motivation and confidence in being able to influence function and progression of the disorder. It forms the foundation for maintaining physical exercise and skills over time. Conclusion: The LVST BIG participants with PD felt the importance of motivation and individualized reinforcers of behaviour to maintain physical exercise and skills over time. In their experience, follow up and adaptation of the exercises is necessary in order to overcome barriers, give confidence and strengthen motivation to influence the symptoms and slow progression of the disorder. This study can help physiotherapist and occupational therapist as people with PD need support to strengthen their resources and overcome barriers regarding motivation, context and multi-illness. Long term effects of LSVT BIG and a behavioural medicine approach related to the maintenance and longevity of physical exercise for people with PD requires further research.

TITLE: Therapy of voice disorders AUTHOR: Michaela Horáková DEPARTMENT: Department of special education SUPERVISOR: Mgr. Miroslava Kotvová ABSTRACT: This diploma thesis deals with the voice disorders and their treatment options. The character of the thesis is mostly theoretical and the thesis is divided into four general parts. The first one elaborates the anatomy and physiology of the vocal tract as a basis for understanding mechanisms of voice pathology development, the second one is devoted to voice disorders and their categorization, and the third part deals with their therapy, as the czech literature reflects it. The last part of this thesis is dedicated to voice disorders therapy in the United States with a practical focus on therapeutical program Lee Silverman Voice Treatment (LSVT) widely used abroad during the treatment of voice disorders especially connected to Parkinson disease. The program is considered to be very effective and it is really popular outside of the Czech republic. LSVT is not well known in the Czech republic yet and there is actually only limited information devoted to this type of voice therapy. For this reason the thesis is based on analysis and comparison of the available foreign texts in order to inform the czech public about its theoretical basis, structure and system,...

Parkinson ’s disease (PD) is a progressive neurological disorder that affects one’s movement. As the disease develops, individuals begin to present with symptoms that include but are not limited to bradykinesia, rigidity, tremors, and hypokinetic dysarthria. These symptoms affect a person’s entire body, including his/her voice. The Lee Silverman Voice Treatment (LSVT) program for treating individuals with PD is supported by over twenty-five years of research. It is considered a safe, non-invasive method to improve vocal loudness and speech clarity in individuals with PD. However, simply because LSVT is effective in its current state, it does not mean that the protocol is the most efficient or effective it can be. One potential shortcoming of LSVT is that it does not provide patients with much, if any, visual feedback. We hypothesized that visual feedback would enable the client to more easily produce a voice characterized by increased loudness and vocal quality. The results of the study do not fully support this hypothesis. There was less variability in the client’s performance within each session during the experimental weeks the patients performance over the course of the week improved, this pattern was not observed during the non-experimental weeks. Additionally, the participant expressed preference for treatment days when the visual feedback was used, finding it helpful in more effectively regulating the volume of his voice.