IndianaCTSI HUB

Mary Yeaman, who has Parkinson's disease, says the first sign that her voice had begun to fade came during a day at the gym. Talking with a friend at Rock Steady Boxing, a special balance and strength training program for patients with Parkinson's disease in downtown Indianapolis, Yeaman was suddenly caught off guard not by an unexpected right jab but by the realization that another talker had been much louder, she says, and stolen her conversation partner's attention.

For many patients with Parkinson's disease, hypophonia, or "soft voice," is a serious but frequently overlooked problem. Physicians tend to focus on quelling physical ailments, such as tremors, while missing less obvious symptoms like loss of voice—even as those symptoms can make patients feel as though they're disappearing in plain sight. But now a device being developed by Jessica Huber, PhD, associate professor of speech, language and hearing sciences at Purdue University, with support from the Indiana Clinical and Translational Sciences Institute (CTSI), the National Institutes of Health (NIH) and collaborators at the Indiana University School of Medicine (IUSM), is helping patients like Yeaman raise their voice.

"Sometimes I would start crying, I would get so frustrated being left out of conversations," says Yeaman, whose voice nearly doubled in volume after four weeks on Huber's treatment.

"The other day people were talking, trying to interrupt me, and I said, 'I'm talking now, and you can all be quiet,'" she laughs. "They looked at me—and they stopped talking! Before, they would talk right over me; I felt like I didn't even exist."

The device, says Huber, works by piping background noise straight into patients' ears every time they speak—similar to the low murmur at a crowded cocktail party— prompting an unconscious psychological reaction known as the "Lombard Effect" that causes everyone, not just patients with Parkinson's disease, to speak louder. It includes a small plastic tube which sits inside the ear and a wire that affixes to the neck via a small adhesive patch, ensuring the noise only activates when a patient is speaking. The actual hardware is housed inside a small gray box, which patients can clip to their belts or wear about their neck on a lanyard.

In addition to social gatherings, Yeaman wears the device while running errands and working as a ticket taker at the Conseco Fieldhouse. Everyone's noticed the results, she says.

Huber tells similar stories about other clinical trial participants, many recruited through Joanne Wojcieszek, MD, an associate professor of clinical neurology at Indiana University. They arrive claiming their spouses are losing their hearing, she says, but soon discover it's their own voice that's grown quieter.

"I can't imagine living 50 years with someone and now not being able to talk to them," says Huber, noting that quiet or inarticulate speech is a major quality of life issue among many Parkinson's patients, particularly since so many of their communication partners are hearing impaired.

So far, she says about 30 patients have used the device, with the average user raising their intensity by about 5 decibels—a significant increase. Some even experience improvement after ceasing daily use. Participants are given the device for eight weeks and outcomes are recorded up to six months.

Support for the development of the device worn by Yeaman and other participants in Huber's clinical trial comes from the Indiana CTSI, which provided $10,000 for her to collaborate with several biomedical engineers on an advanced prototype. Primary support for the project comes from a $1.87 million grant from the NIH, as well as $225,000 from the American Recovery and Reinvestment Act. In addition, Huber received $18,900 from the Regenstrief Institute to investigate potential integration into the health care system.

Currently, Huber collects information on speech intensity, articulation and breath patterns, among other variables, using equipment such as a decibel meter and chest bands for measuring breathing patterns. The next step, she says, is to start gathering more information on patients' disease states, a project for which she has begun a collaboration with Elizabeth Zauber, MD, a neurologist at IUSM.

The ultimate goal is to develop an even smaller, more marketable device, similar to a standard hearing aid, she says, noting her greatest priority is making the device available to a wider patient population.

"Getting to know the patients was a big change in my research direction," says Huber, whose focus has shifted from lab bench to bedside. "Now what I really want to do is find new ways to help."