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Sullivan L, Martin E, Allison KM. Effects of SPEAK OUT! & LOUD Crowd on Functional Speech Measures in Parkinson's Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1930-1951. [PMID: 38838243 DOI: 10.1044/2024_ajslp-23-00321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE This study investigated the effects of the SPEAK OUT! & LOUD Crowd therapy program on speaking rate, percent pause time, intelligibility, naturalness, and communicative participation in individuals with Parkinson's disease (PD). METHOD Six adults with PD completed 12 individual SPEAK OUT! sessions across four consecutive weeks followed by group-based LOUD Crowd sessions for five consecutive weeks. Most therapy sessions were conducted via telehealth, with two participants completing the SPEAK OUT! portion in person. Speech samples were recorded at six time points: three baseline time points prior to SPEAK OUT!, two post-SPEAK OUT! time points, and one post-LOUD Crowd time point. Acoustic measures of speaking rate and percent pause time and listener ratings of speech intelligibility and naturalness were obtained for each time point. Participant self-ratings of communicative participation were also collected at pre- and posttreatment time points. RESULTS Results showed significant improvement in communicative participation scores at a group level following completion of the SPEAK OUT! & LOUD Crowd treatment program. Two participants showed a significant decrease in speaking rate and increase in percent pause time following treatment. Changes in intelligibility and naturalness were not statistically significant. CONCLUSIONS These findings provide preliminary support for the effectiveness of the SPEAK OUT! & LOUD Crowd treatment program in improving communicative participation for people with mild-to-moderate hypokinetic dysarthria secondary to PD. This study is also the first to demonstrate positive effects of this treatment program for people receiving the therapy via telehealth.
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Affiliation(s)
- Lauren Sullivan
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
| | - Elizabeth Martin
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
| | - Kristen M Allison
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
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Abumalloh RA, Nilashi M, Samad S, Ahmadi H, Alghamdi A, Alrizq M, Alyami S. Parkinson's disease diagnosis using deep learning: A bibliometric analysis and literature review. Ageing Res Rev 2024; 96:102285. [PMID: 38554785 DOI: 10.1016/j.arr.2024.102285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
Parkinson's Disease (PD) is a progressive neurodegenerative illness triggered by decreased dopamine secretion. Deep Learning (DL) has gained substantial attention in PD diagnosis research, with an increase in the number of published papers in this discipline. PD detection using DL has presented more promising outcomes as compared with common machine learning approaches. This article aims to conduct a bibliometric analysis and a literature review focusing on the prominent developments taking place in this area. To achieve the target of the study, we retrieved and analyzed the available research papers in the Scopus database. Following that, we conducted a bibliometric analysis to inspect the structure of keywords, authors, and countries in the surveyed studies by providing visual representations of the bibliometric data using VOSviewer software. The study also provides an in-depth review of the literature focusing on different indicators of PD, deployed approaches, and performance metrics. The outcomes indicate the firm development of PD diagnosis using DL approaches over time and a large diversity of studies worldwide. Additionally, the literature review presented a research gap in DL approaches related to incremental learning, particularly in relation to big data analysis.
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Affiliation(s)
- Rabab Ali Abumalloh
- Department of Computer Science and Engineering, Qatar University, Doha 2713, Qatar
| | - Mehrbakhsh Nilashi
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam; School of Computer Science, Duy Tan University, Da Nang, Vietnam; UCSI Graduate Business School, UCSI University, No. 1 Jalan Menara Gading, UCSI Heights, Cheras, Kuala Lumpur 56000, Malaysia; Centre for Global Sustainability Studies (CGSS), Universiti Sains Malaysia, Penang 11800, Malaysia.
| | - Sarminah Samad
- Faculty of Business, UNITAR International University, Tierra Crest, Jalan SS6/3, Petaling Jaya, Selangor 47301, Malaysia
| | - Hossein Ahmadi
- Centre for Health Technology, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Abdullah Alghamdi
- Information Systems Dept., College of Computer Science and Information Systems, Najran University, Najran, Saudi Arabia; AI Lab, Scientific and Engineering Research Center (SERC), Najran University, Najran, Saudi Arabia
| | - Mesfer Alrizq
- Information Systems Dept., College of Computer Science and Information Systems, Najran University, Najran, Saudi Arabia; AI Lab, Scientific and Engineering Research Center (SERC), Najran University, Najran, Saudi Arabia
| | - Sultan Alyami
- AI Lab, Scientific and Engineering Research Center (SERC), Najran University, Najran, Saudi Arabia; Computer Science Dept., College of Computer Science and Information Systems, Najran University, Najran, Saudi Arabia
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Mu L, Chen J, Li J, Nyirenda T, Hegland KW, Beach TG. Mechanisms of Swallowing, Speech and Voice Disorders in Parkinson's Disease: Literature Review with Our First Evidence for the Periperal Nervous System Involvement. Dysphagia 2024:10.1007/s00455-024-10693-3. [PMID: 38498201 DOI: 10.1007/s00455-024-10693-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024]
Abstract
The majority of patients with Parkinson's disease (PD) develop swallowing, speech, and voice (SSV) disorders. Importantly, swallowing difficulty or dysphagia and related aspiration are life-threatening conditions for PD patients. Although PD treatments have significant therapeutic effects on limb motor function, their effects on SSV disorders are less impressive. A large gap in our knowledge is that the mechanisms of SSV disorders in PD are poorly understood. PD was long considered to be a central nervous system disorder caused by the death of dopaminergic neurons in the basal ganglia. Aggregates of phosphorylated α-synuclein (PAS) underlie PD pathology. SSV disorders were thought to be caused by the same dopaminergic problem as those causing impaired limb movement; however, there is little evidence to support this. The pharynx, larynx, and tongue play a critical role in performing upper airway (UA) motor tasks and their dysfunction results in disordered SSV. This review aims to provide an overview on the neuromuscular organization patterns, functions of the UA structures, clinical features of SSV disorders, and gaps in knowledge regarding the pathophysiology underlying SSV disorders in PD, and evidence supporting the hypothesis that SSV disorders in PD could be associated, at least in part, with PAS damage to the peripheral nervous system controlling the UA structures. Determining the presence and distribution of PAS lesions in the pharynx, larynx, and tongue will facilitate the identification of peripheral therapeutic targets and set a foundation for the development of new therapies to treat SSV disorders in PD.
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Affiliation(s)
- Liancai Mu
- Upper Airway Reserch Laboratory, Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ, 07110, USA.
- Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ, 07110, USA.
| | - Jingming Chen
- Upper Airway Reserch Laboratory, Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ, 07110, USA
| | - Jing Li
- Upper Airway Reserch Laboratory, Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ, 07110, USA
| | - Themba Nyirenda
- Upper Airway Reserch Laboratory, Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ, 07110, USA
| | - Karen Wheeler Hegland
- Upper Airway Dysfunction Laboratory, M.A. Program in Communication Sciences & Disorders, Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, 1225 Center Dr., Gainesville, FL, 32611, USA
| | - Thomas G Beach
- Director of Neuroscience, Director of Brain and Body Donation Program, Banner Sun Health Research Institute, 10515 West Santa Fe Dr, Sun City, AZ, 85351, USA
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Sousa NMF, Diniz JDFG, Galvão AP, Brucki SMD. Cognitive profile of patients with and without speech impairment in Parkinson's disease. Dement Neuropsychol 2023; 17:e20220093. [PMID: 38028381 PMCID: PMC10666554 DOI: 10.1590/1980-5764-dn-2022-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 12/01/2023] Open
Abstract
Cognitive functions have been the subject of studies evaluating the pathophysiological mechanism of speech control. Objective To compare the groups of patients with and without speech disorders with cognitive assessment, demographic, and clinical data (disease duration, functionality, and motor symptoms). Methods Retrospective, cross-sectional study. Patients were evaluated using the Addenbrooke's Cognitive Examination III and neuropsychological tests. The following speech subsystems were analyzed: articulation, phonation, resonance, and prosody, through auditory-perceptual evaluation (based on the Protocol for the Evaluation of Acquired Speech Disorders in Individuals with Parkinson's Disease - PADAF Protocol tests), observing aspects of speech programming and execution. The patients were distributed into three subgroups (normal cognition, mild cognitive impairment, and dementia). After speech evaluation, they were divided into two subgroups (with and without speech disorders). Results A total of 150 patients participated in this study, 104 men and 46 women, 63.58 (8.81) years of age, 11.03 (4.00) years of schooling, 6.61 (4.69) years of disease progression, and with the highest proportion of individuals in stage I-II of the Hoehn & Yarh (H&Y) scale (86, or 57.33%). Statistically significant differences were observed between subgroups with and without speech alteration. Worse performance was verified in the Trail Making Test (TMT) TMT-Δ and a tendency of difference in the TMT-B of the subgroup with speech disorders, in addition to worse severity of motor symptoms (H&Y) and cognitive complaints. Conclusion Individuals with speech disorders brought more frequent cognitive complaints and impairment below expected in tests assessing executive functions. Future studies, with stratification by type of speech disorder, are necessary to contribute to and validate these results.
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Affiliation(s)
| | | | | | - Sonia Maria Dozzi Brucki
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
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Konnai R, Van Harn M, Silbergleit A. Conversational Vocal Intensity in Parkinson's Disease: Treatment and Environmental Comparisons. J Voice 2023; 37:707-715. [PMID: 34134903 DOI: 10.1016/j.jvoice.2021.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Vibrotactile Feedback (VF) using wearable devices is an emerging treatment option for hypophonia in Individuals with Parkinson's disease (IwPD). Studies evaluating the effectiveness of VF in improving conversational vocal intensity in real-life environment in IwPD are limited. OBJECTIVE To determine the effect of VF on conversational vocal intensity and compare vocal intensity between a) clinic and real-life environment b) VF and Lee Silverman Voice Treatment (LSVT LOUD®)vs. VF alone in IwPD using a portable voice monitor (VocaLog2). METHODS Eight individuals with hypophonia secondary to PD were randomly assigned to two treatment groups- VF and LSVT LOUD® (Group 1) and VF (Group 2). VF was provided using VocaLog2 device. Duration of treatment was 4 weeks for both groups. Vocal intensity was measured in the real-life environment at baseline, during treatment, and at one-month follow-up. Vocal intensity in clinic was obtained at baseline and one-month follow-up. Voice Handicap Index (VHI) questionnaire was administered at baseline and one-month follow-up. RESULTS There was no significant difference in conversational vocal intensity between a) clinic and real-life environment at any point of time b) baseline and follow up for both treatment groups c) the two treatment groups at baseline, during each of the 4 weeks of treatment and at follow up d) VHI baseline and one month follow up scores. CONCLUSION VF, including when combined with LSVT LOUD®, is limited in improving conversational vocal intensity in real-life in IwPD. The effects of frequency and duration of VF on conversational vocal intensity must be systematically investigated using large scale studies in IwPD.
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Affiliation(s)
- Ramya Konnai
- Department of Neurology, Henry Ford Health System, West Bloomfield, Michigan.
| | - Meredith Van Harn
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Alice Silbergleit
- Department of Neurology, Henry Ford Health System, West Bloomfield, Michigan
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Mohseni Z, Mohamadi R, Habibi SAH, Saffarian A, Abolghasemi J. Voice improvement following conventional speech therapy combined with singing intervention in people with Parkinson's disease: A three-arm randomised controlled trial. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:1752-1767. [PMID: 37282797 DOI: 10.1111/1460-6984.12900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/26/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Although speech and voice disorders are common in Parkinson's disease (PD), there is insufficient evidence to support the effectiveness of behavioural speech therapies in these patients. AIMS This study aimed to examine the effects of a new tele-rehabilitation program, a combining of conventional speech therapy and singing intervention, on voice deficits in patients with PD. METHODS & PROCEDURES This study was a three-armed, assessor-masked, randomised controlled trial. Thirty-three people with PD were randomly assigned to the combination therapy, conventional speech therapy, or singing intervention group. This study followed the Consolidated Standards of Reporting Trials guidelines for non-pharmacological treatment. Each patient participated in 12 tele-rehabilitation sessions over 4 weeks. The combination therapy group received speech and singing interventions simultaneously (respiratory, speech, voice, and singing exercises). Voice intensity as a primary outcome and the voice handicap index (VHI), maximum frequency range, jitter and shimmer as secondary outcomes were evaluated 1 week before the first intervention session, 1 week after the last intervention session and 3 months after the last evaluation. OUTCOMES & RESULTS The results of repeated measures analysis of variance showed a significant main effect of time on all outcomes in all three groups after treatment (p < 0.001). There was a significant group effect for voice intensity (p < 0.001), VHI (p < 0.001), maximum frequency range (p = 0.014) and shimmer (p = 0.001). The combination therapy group demonstrated a significant outperformance in the VHI and shimmer than the speech therapy (p = 0.038) and singing intervention (p < 0.001) groups. The results of this study also indicated that combination therapy group compared to singing intervention group had a larger effect on voice intensity (p < 0.001), shimmer (p < 0.001) and maximum frequency range (p = 0.048). CONCLUSIONS & IMPLICATION The results demonstrated that combining speech therapy with a singing intervention delivered through tele-rehabilitation might be more effective in improving voice problems in patients with PD. WHAT THIS PAPER ADDS What is already known on the subject Parkinson's disease (PD) is a neurological disorder that frequently causes disturbances in speech and voice, which negatively affect patients' quality of life. Although speech difficulties occur in 90% of patients with PD, evidence-based treatment options for speech and language problems in these patients are limited. Therefore, further studies are required to develop and assess evidence-based treatment programs. What this study adds The findings of this study showed that a combination therapy program including conventional speech therapy approaches and individual singing intervention provided through tele-rehabilitation may have a greater effect on the improvement of voice problems in people with PD compared to speech therapy and singing intervention alone. What are the clinical implications of this work? Tele-rehabilitation combination therapy is an inexpensive and enjoyable behavioural treatment. The advantages of this method are that it is easy to access, appropriate for many stages of voice problems in PD, requires no prior singing training, encourages voice health and self-management and maximises treatment resources available to people with PD. We believe that the results of this study can provide a new clinical basis for treatment of voice disorders in people with PD.
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Affiliation(s)
- Zeinab Mohseni
- Rehabilitation Research Center, Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Reyhane Mohamadi
- Rehabilitation Research Center, Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Amir Hasan Habibi
- Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Arezoo Saffarian
- Rehabilitation Research Center, Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Jamile Abolghasemi
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Sanchez-Luengos I, Lucas-Jiménez O, Ojeda N, Peña J, Gómez-Esteban JC, Gómez-Beldarrain MÁ, Vázquez-Picón R, Foncea-Beti N, Ibarretxe-Bilbao N. Predictors of health-related quality of life in Parkinson's disease: the impact of overlap between health-related quality of life and clinical measures. Qual Life Res 2022; 31:3241-3252. [PMID: 35842497 PMCID: PMC9546987 DOI: 10.1007/s11136-022-03187-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aimed to determine predictors of health-related quality of life (HRQoL) in Parkinson's disease (PD) and to explore their predictive value before and after controlling overlapping items between HRQoL and clinical variables. METHODS One hundred and eight PD patients underwent motor, anxiety, depression, apathy, fatigue, and neurocognition assessment. HRQoL was assessed by the Parkinson's Disease Questionnaire-39 (PDQ-39). In order to determine predictors of HRQoL in PD, stepwise multiple regression analyses were performed in two ways: before and after removing the emotional well-being dimension from PDQ-39 to control the overlap between depression and anxiety, and HRQoL. RESULTS HRQoL total index was predicted by anxiety, fatigue, motor symptoms, and depression, explaining 26.9%, 7.2%, 2.8%, and 1.9% of the variance. However, after removing overlapping items, HRQoL total index was predicted by fatigue (16.5%), anxiety (6.1%), motor symptoms (3.9%), and neurocognition (2.5%), but not depression. Regarding HRQoL dimensions, mobility and activities of daily living were predicted by fatigue (19.7% and 5%) and UPDRS-III (4% and 10.2%); emotional well-being by fatigue (7.9%); social support by anxiety (12.2%) and UPDRS-III (8.6%); communication by neurocognition (5.3%) and UPDRS-III (3.4%); cognition by anxiety (10.6%) and bodily discomfort by anxiety (23%) and fatigue (4.1%). CONCLUSION These findings showed the importance of identifying and controlling overlapping items of HRQoL and clinical measures to perform an accurate interpretation. HRQoL dimensions showed different predictors before and after controlling the overlap. Based on these results fatigue, anxiety, motor symptoms, and neurocognition, but not depression are the main predictors of HRQoL in PD patients.
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Affiliation(s)
| | - Olaia Lucas-Jiménez
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Natalia Ojeda
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Javier Peña
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | | | | | | | - Nerea Foncea-Beti
- Department of Neurology, Hospital of Galdakao, Galdakao-Usansolo, Spain
| | - Naroa Ibarretxe-Bilbao
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
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Kothare H, Roesler O, Burke W, Neumann M, Liscombe J, Exner A, Snyder S, Cornish A, Habberstad D, Pautler D, Suendermann-Oeft D, Huber J, Ramanarayanan V. Speech, Facial and Fine Motor Features for Conversation-Based Remote Assessment and Monitoring of Parkinson's Disease. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3464-3467. [PMID: 36086652 DOI: 10.1109/embc48229.2022.9871375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We present a cloud-based multimodal dialogue platform for the remote assessment and monitoring of speech, facial and fine motor function in Parkinson's Disease (PD) at scale, along with a preliminary investigation of the efficacy of the various metrics automatically extracted by the platform. 22 healthy controls and 38 people with Parkinson's Disease (pPD) were instructed to complete four interactive sessions, spaced a week apart, on the platform. Each session involved a battery of tasks designed to elicit speech, facial movements and finger movements. We find that speech, facial kinematic and finger movement dexterity metrics show statistically significant differences between controls and pPD. We further investigate the sensitivity, specificity, reliability and generalisability of these metrics. Our results offer encouraging evidence for the utility of automatically-extracted audiovisual analytics in remote mon-itoring of PD and other movement disorders.
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Chen CL, Lin CH, Su CS, Cheng HC, Chen LM, Cherng RJ. Evaluation of the Psychometric Properties of a Newly Developed Chinese Screening Tool for Speech Disorders in Patients With Parkinson's Disease. Eval Health Prof 2022; 46:127-134. [PMID: 35722661 DOI: 10.1177/01632787221108458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The study aimed to analyze the psychometric properties of a newly developed Chinese screening tool, the Chinese Version of the Speech Disorders in Parkinson's Disease Questionnaire (SDPD-C). The SDPD-C contains a 24-item questionnaire with four assessment domains. Overall, 93 patients with idiopathic Parkinson's disease (PD) (age 70.1 ± 8.9 years) and 76 healthy older adults (age 67.2 ± 8.1 years) participated in the psychometric analysis study. The internal consistency of the SDPD-C was .91 (four dimensions: .69-.85), and test-retest reliability was .91 (four dimensions: .85-.88). The SDPD-C was highly correlated with the Voice Handicap Index-10 and Movement Disorder Society-Unified Parkinson's Disease Rating Scale II 2.1 (r = .83 and .78, respectively). The SDPD-C scores also differed significantly between stages 1 and 4 of the Hoehn and Yahr Scale (p < .05). The area under the receiver operating characteristic curve was .955 (95% confidence interval, .927-.983; asymptotic significance p < .001), and the optimal cut-off score of this study was 36, with a sensitivity of .849 and specificity of .947. The results indicate that SDPD-C showed good reliability, validity, accuracy, and discrimination. It can be used as a screening tool for speech disorders in patients with PD.
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Affiliation(s)
- Chi-Lin Chen
- Institute of Allied Health Sciences, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan
| | - Ching-Huang Lin
- Section of Neurology, 38024Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | | | - Hsiang-Chun Cheng
- Department of Speech Language Pathology and Audiology, 34905HungKuang University, Taichung, Taiwan
| | - Li-Mei Chen
- Department of Foreign Languages and Literature, National Cheng Kung University, Tainan, Taiwan
| | - Rong-Ju Cherng
- Institute of Allied Health Sciences, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan
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Narayana S, Franklin C, Peterson E, Hunter EJ, Robin DA, Halpern A, Spielman J, Fox PT, Ramig LO. Immediate and long-term effects of speech treatment targets and intensive dosage on Parkinson's disease dysphonia and the speech motor network: Randomized controlled trial. Hum Brain Mapp 2022; 43:2328-2347. [PMID: 35141971 PMCID: PMC8996348 DOI: 10.1002/hbm.25790] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/16/2021] [Accepted: 01/07/2022] [Indexed: 11/07/2022] Open
Abstract
This study compared acoustic and neural changes accompanying two treatments matched for intensive dosage but having two different treatment targets (voice or articulation) to dissociate the effects of treatment target and intensive dosage in speech therapies. Nineteen participants with Parkinsonian dysphonia (11 F) were randomized to three groups: intensive treatment targeting voice (voice group, n = 6), targeting articulation (articulation group, n = 7), or an untreated group (no treatment, n = 6). The severity of dysphonia was assessed by the smoothed cepstral peak prominence (CPPS) and neuronal changes were evaluated by cerebral blood flow (CBF) recorded at baseline, posttreatment, and 7-month follow-up. Only the voice treatment resulted in significant posttreatment improvement in CPPS, which was maintained at 7 months. Following voice treatment, increased activity in left premotor and bilateral auditory cortices was observed at posttreatment, and in the left motor and auditory cortices at 7-month follow-up. Articulation treatment resulted in increased activity in bilateral premotor and left insular cortices that were sustained at a 7-month follow-up. Activation in the auditory cortices and a significant correlation between the CPPS and CBF in motor and auditory cortices was observed only in the voice group. The intensive dosage resulted in long-lasting behavioral and neural effects as the no-treatment group showed a progressive decrease in activity in areas of the speech motor network out to a 7-month follow-up. These results indicate that dysphonia and the speech motor network can be differentially modified by treatment targets, while intensive dosage contributes to long-lasting effects of speech treatments.
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Affiliation(s)
- Shalini Narayana
- Department of Pediatrics, Division of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Crystal Franklin
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA
| | | | - Eric J Hunter
- Department of Communicative Sciences and Disorders, Michigan State University, Lansing, Michigan, USA
| | - Donald A Robin
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, New Hampshire, USA
| | - Angela Halpern
- LSVT Global Inc, Tucson, Arizona, USA.,National Center for Voice and Speech and Department of Speech-Language and Hearing Sciences, University of Colorado-Boulder, Boulder, Colorado, USA
| | - Jennifer Spielman
- National Center for Voice and Speech and Department of Speech-Language and Hearing Sciences, University of Colorado-Boulder, Boulder, Colorado, USA.,Front Range Voice Care, Denver, Colorado, USA
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA.,Audie L. Murphy South Texas Veterans Administration Medical Center, San Antonio, Texas, USA
| | - Lorraine O Ramig
- LSVT Global Inc, Tucson, Arizona, USA.,National Center for Voice and Speech and Department of Speech-Language and Hearing Sciences, University of Colorado-Boulder, Boulder, Colorado, USA.,Columbia University, New York, New York, USA
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11
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Pfeifer KJ, Cook AJ, Yankulova JK, Mortimer BJP, Erickson-DiRenzo E, Dhall R, Montaser-Kouhsari L, Tass PA. Clinical Efficacy and Dosing of Vibrotactile Coordinated Reset Stimulation in Motor and Non-motor Symptoms of Parkinson's Disease: A Study Protocol. Front Neurol 2021; 12:758481. [PMID: 34867742 PMCID: PMC8636796 DOI: 10.3389/fneur.2021.758481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Enhanced neuronal synchronization of the subthalamic nucleus (STN) is commonly found in PD patients and corresponds to decreased motor ability. Coordinated reset (CR) was developed to decouple synchronized states causing long lasting desynchronization of neural networks. Vibrotactile CR stimulation (vCR) was developed as non-invasive therapeutic that delivers gentle vibrations to the fingertips. A previous study has shown that vCR can desynchronize abnormal brain rhythms within the sensorimotor cortex of PD patients, corresponding to sustained motor relief after 3 months of daily treatment. To further develop vCR, we created a protocol that has two phases. Study 1, a double blinded randomized sham-controlled study, is designed to address motor and non-motor symptoms, sensorimotor integration, and potential calibration methods. Study 2 examines dosing effects of vCR using a remote study design. In Study 1, we will perform a 7-month double-blind sham-controlled study including 30 PD patients randomly placed into an active vCR or inactive (sham) vCR condition. Patients will receive stimulation for 4 h a day in 2-h blocks for 6 months followed by a 1-month pause in stimulation to assess long lasting effects. Our primary outcome measure is the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III off medication after 6 months of treatment. Secondary measures include a freezing of gait (FOG) questionnaire, objective motor evaluations, sensorimotor electroencephalography (EEG) results, a vibratory temporal discrimination task (VTDT), non-motor symptom evaluations/tests such as sleep, smell, speech, quality of life measurements and Levodopa Equivalent Daily Dose (LEDD). Patients will be evaluated at baseline, 3, 6, and 7 months. In the second, unblinded study phase (Study 2), all patients will be given the option to receive active vCR stimulation at a reduced dose for an additional 6 months remotely. The remote MDS-UPDRS part III off medication will be our primary outcome measure. Secondary measures include sleep, quality of life, objective motor evaluations, FOG and LEDD. Patients will be evaluated in the same time periods as the first study. Results from this study will provide clinical efficacy of vCR and help validate our investigational vibrotactile device for the purpose of obtaining FDA clearance. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT04877015.
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Affiliation(s)
- Kristina J. Pfeifer
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Alex J. Cook
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Jessica K. Yankulova
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | | | - Elizabeth Erickson-DiRenzo
- Department of Otolarygology Head and Neck Surgery/Laryngology Division, Stanford University School of Medicine, Stanford, CA, United States
| | - Rohit Dhall
- Department of Neurology, Center for Neurodegenerative Disorders, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Leila Montaser-Kouhsari
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Peter A. Tass
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
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12
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Hoffmeister JD, Kelm-Nelson CA, Ciucci MR. Quantification of brainstem norepinephrine relative to vocal impairment and anxiety in the Pink1-/- rat model of Parkinson disease. Behav Brain Res 2021; 414:113514. [PMID: 34358571 PMCID: PMC8393386 DOI: 10.1016/j.bbr.2021.113514] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 12/31/2022]
Abstract
Vocal communication impairment and anxiety are co-occurring and interacting signs of Parkinson Disease (PD) that are common, poorly understood, and under-treated. Both vocal communication and anxiety are influenced by the noradrenergic system. In light of this shared neural substrate and considering that noradrenergic dysfunction is a defining characteristic of PD, tandem investigation of vocal impairment and anxiety in PD relative to noradrenergic mechanisms is likely to yield insights into the underlying disease-specific causes of these impairments. In order to address this gap in knowledge, we assessed vocal impairment and anxiety behavior relative to brainstem noradrenergic markers in a genetic rat model of early-onset PD (Pink1-/-) and wild type controls (WT). We hypothesized that 1) brainstem noradrenergic markers would be disrupted in Pink1-/-, and 2) brainstem noradrenergic markers would be associated with vocal acoustic changes and anxiety level. Rats underwent testing of ultrasonic vocalization and anxiety (elevated plus maze) at 4, 8, and 12 months of age. At 12 months, brainstem norepinephrine markers were quantified with immunohistochemistry. Results demonstrated that vocal impairment and anxiety were increased in Pink1-/- rats, and increased anxiety was associated with greater vocal deficit in this model of PD. Further, brainstem noradrenergic markers including TH and α1 adrenoreceptor immunoreactivity in the locus coeruleus, and β1 adrenoreceptor immunoreactivity in vagal nuclei differed by genotype, and were associated with vocalization and anxiety behavior. These findings demonstrate statistically significant relationships among vocal impairment, anxiety, and brainstem norepinephrine in the Pink1-/- rat model of PD.
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Affiliation(s)
- Jesse D Hoffmeister
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI, 53706, USA; Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792-7375, USA.
| | - Cynthia A Kelm-Nelson
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792-7375, USA.
| | - Michelle R Ciucci
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI, 53706, USA; Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792-7375, USA; Neuroscience Training Program, University of Wisconsin-Madison, 9531 WIMR II, 1111 Highland Avenue, Madison, WI, 53705, USA.
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13
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Krasko MN, Hoffmeister JD, Schaen-Heacock NE, Welsch JM, Kelm-Nelson CA, Ciucci MR. Rat Models of Vocal Deficits in Parkinson's Disease. Brain Sci 2021; 11:925. [PMID: 34356159 PMCID: PMC8303338 DOI: 10.3390/brainsci11070925] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/21/2022] Open
Abstract
Parkinson's disease (PD) is a progressive, degenerative disorder that affects 10 million people worldwide. More than 90% of individuals with PD develop hypokinetic dysarthria, a motor speech disorder that impairs vocal communication and quality of life. Despite the prevalence of vocal deficits in this population, very little is known about the pathological mechanisms underlying this aspect of disease. As such, effective treatment options are limited. Rat models have provided unique insights into the disease-specific mechanisms of vocal deficits in PD. This review summarizes recent studies investigating vocal deficits in 6-hydroxydopamine (6-OHDA), alpha-synuclein overexpression, DJ1-/-, and Pink1-/- rat models of PD. Model-specific changes to rat ultrasonic vocalization (USV), and the effects of exercise and pharmacologic interventions on USV production in these models are discussed.
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Affiliation(s)
- Maryann N. Krasko
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA; (M.N.K.); (J.D.H.); (N.E.S.-H.); (J.M.W.); (C.A.K.-N.)
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Jesse D. Hoffmeister
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA; (M.N.K.); (J.D.H.); (N.E.S.-H.); (J.M.W.); (C.A.K.-N.)
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Nicole E. Schaen-Heacock
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA; (M.N.K.); (J.D.H.); (N.E.S.-H.); (J.M.W.); (C.A.K.-N.)
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Jacob M. Welsch
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA; (M.N.K.); (J.D.H.); (N.E.S.-H.); (J.M.W.); (C.A.K.-N.)
| | - Cynthia A. Kelm-Nelson
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA; (M.N.K.); (J.D.H.); (N.E.S.-H.); (J.M.W.); (C.A.K.-N.)
| | - Michelle R. Ciucci
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA; (M.N.K.); (J.D.H.); (N.E.S.-H.); (J.M.W.); (C.A.K.-N.)
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI 53706, USA
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI 53705, USA
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Single Word Intelligibility of Individuals with Parkinson's Disease in Noise: Pre-Specified Secondary Outcome Variables from a Randomized Control Trial (RCT) Comparing Two Intensive Speech Treatments (LSVT LOUD vs. LSVT ARTIC). Brain Sci 2021; 11:brainsci11070857. [PMID: 34199093 PMCID: PMC8301858 DOI: 10.3390/brainsci11070857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022] Open
Abstract
The majority of people with Parkinson's disease (PD) experience both prosodic changes (reduced vocal volume, reduced pitch range) and articulatory changes (imprecise articulation) that often limit speech intelligibility and may contribute to significant declines in quality of life. We conducted a randomized control trial comparing two intensive treatments, voice (LSVT LOUD) or articulation (LSVT ARTIC) to assess single word intelligibility in the presence of background noise (babble and mall). Participants (64 PD and 20 Healthy) read words from the diagnostic rhyme test (DRT), an ANSI Standard for measuring intelligibility of speech, before and after one month (treatment or no treatment). Teams of trained listeners blindly rated the data. Speech intelligibility of words in the presence of both noise conditions improved in PD participants who had LSVT LOUD compared to the groups that had LSVT ARTIC or no treatment. Intensive speech treatment targeting prominent prosodic variables in LSVT LOUD had a positive effect on speech intelligibility at the single word level in PD.
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15
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Advances in Parkinson's Disease detection and assessment using voice and speech: A review of the articulatory and phonatory aspects. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102418] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Duffy O, Synnott J, McNaney R, Brito Zambrano P, Kernohan WG. Attitudes Toward the Use of Voice-Assisted Technologies Among People With Parkinson Disease: Findings From a Web-Based Survey. JMIR Rehabil Assist Technol 2021; 8:e23006. [PMID: 33704072 PMCID: PMC8082949 DOI: 10.2196/23006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/18/2020] [Accepted: 01/17/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Speech problems are common in people living with Parkinson disease (PD), limiting communication and ultimately affecting their quality of life. Voice-assisted technology in health and care settings has shown some potential in small-scale studies to address such problems, with a retrospective analysis of user reviews reporting anecdotal communication effects and promising usability features when using this technology for people with a range of disabilities. However, there is a need for research to establish users' perspectives on the potential contribution of voice-assisted technology for people with PD. OBJECTIVE This study aims to explore the attitudes toward the use of voice-assisted technology for people with PD. METHODS A survey was approved for dissemination by a national charity, Parkinson's UK, to be completed on the web by people living with the condition. The survey elicited respondent demographics, PD features, voice difficulties, digital skill capability, smart technology use, voice-assisted technology ownership and use, confidentiality, and privacy concerns. Data were analyzed using descriptive statistics and summative content analysis of free-text responses. RESULTS Of 290 participants, 79.0% (n=229) indicated that they or others had noticed changes in their speech or voice because of the symptoms of their condition. Digital skills and awareness were reported on 11 digital skills such as the ability to find a website you have visited before. Most participants (n=209, 72.1%) reported being able to perform at least 10 of these 11 tasks. Similarly, of 70.7% (n=205) participants who owned a voice-assisted device, most of them (166/205, 80.9%) used it regularly, with 31.3% (52/166) reporting that they used the technology specifically to address the needs associated with their PD. Of these 166 users, 54.8% (n=91) sometimes, rarely, or never had to repeat themselves when using the technology. When asked about speech changes since they started using it, 25% (27/108) of participants noticed having to repeat themselves less and 14.8% (16/108) perceived their speech to be clearer. Of the 290 respondents, 90.7% (n=263) were not concerned, or only slightly concerned, about privacy and confidentiality. CONCLUSIONS Having been added to the homes of Western society, domestic voice assist devices are now available to assist those with communication problems. People with PD reported a high digital capability, albeit those who responded to a web-based survey. Most people have embraced voice-assisted technology, find it helpful and usable, and some have found benefit to their speech. Speech and language therapists may have a virtual ally that is already in the patient's home to support future therapy provision.
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Affiliation(s)
- Orla Duffy
- School of Health Sciences, Faculty of Life and Health Sciences, Ulster University, Newtownabbey, United Kingdom
- Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, Newtownabbey, United Kingdom
| | - Jonathan Synnott
- School of Computing, Faculty of Computing, Engineering and the Built Environment, Ulster University, Newtownabbey, United Kingdom
| | - Roisin McNaney
- Department of Human Centered Computing, Faculty of Information Technology, Monash University, Clayton, Australia
| | - Paola Brito Zambrano
- School of Computer Science, Electrical and Electronic Engineering and Engineering Maths, Faculty of Engineering, University of Bristol, Bristol, United Kingdom
| | - W George Kernohan
- Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, Newtownabbey, United Kingdom
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17
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Mood and emotional disorders associated with parkinsonism, Huntington disease, and other movement disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:175-196. [PMID: 34389117 DOI: 10.1016/b978-0-12-822290-4.00015-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This chapter provides a review of mood, emotional disorders, and emotion processing deficits associated with diseases that cause movement disorders, including Parkinson's disease, Lewy body dementia, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, frontotemporal dementia with parkinsonism, Huntington's disease, essential tremor, dystonia, and tardive dyskinesia. For each disorder, a clinical description of the common signs and symptoms, disease progression, and epidemiology is provided. Then the mood and emotional disorders associated with each of these diseases are described and discussed in terms of clinical presentation, incidence, prevalence, and alterations in quality of life. Alterations of emotion communication, such as affective speech prosody and facial emotional expression, associated with these disorders are also discussed. In addition, if applicable, deficits in gestural and lexical/verbal emotion are reviewed. Throughout the chapter, the relationships among mood and emotional disorders, alterations of emotional experiences, social communication, and quality of life, as well as treatment, are emphasized.
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18
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Bryans LA, Palmer AD, Anderson S, Schindler J, Graville DJ. The impact of Lee Silverman Voice Treatment (LSVT LOUD®) on voice, communication, and participation: Findings from a prospective, longitudinal study. JOURNAL OF COMMUNICATION DISORDERS 2021; 89:106031. [PMID: 33259945 DOI: 10.1016/j.jcomdis.2020.106031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Lee Silverman Voice Treatment (LSVT LOUD®), an intensive 4-week program of voice therapy, is regarded as the most well-researched, efficacious treatment for hypokinetic dysarthria in individuals with Parkinson's disease (PD). Although numerous studies have published acoustic and perceptual findings, there is comparatively little information about the impact of LSVT LOUD® on functional communication outcomes. METHODS This prospective, longitudinal study investigated the impact of treatment on daily communication in 25 individuals with PD. Three validated communication measures (the Voice Handicap Index, the Communicative Effectiveness Scale, and the Communicative Participation Item Bank) were given before and after treatment and again 4-8 weeks and 3-6 months following treatment. Communication partners were also asked to rate communication effectiveness at all four timepoints. RESULTS Significant improvements were found for all three self-reported scales which remained above baseline across all post-treatment timepoints. In addition, self-reported communicative effectiveness was significantly correlated with the assessments of communication partners. Particular benefits were reported for more complex communicative activities such as asking questions, giving detailed information, communicating in noisy situations, and speaking in groups. CONCLUSIONS Overall, the findings suggested that LSVT LOUD® promotes an increased sense of personal control over the communication difficulties resulting from PD by decreasing voice handicap and improving communication effectiveness and communicative participation. For individuals with PD, LSVT LOUD® may reduce the risk of social isolation by improving communication and facilitating social participation. LEARNING OUTCOMES As a result of this activity, the participant will be able to (1) describe the impact of PD on voice and communication, (2) discuss how these characteristics may be associated with more global measures of functional communication and particularly communicative participation, (3) explain which aspects of functional communication were affected by LSVT LOUD® as assessed by study participants and their communication partners.
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Affiliation(s)
- Linda A Bryans
- NW Center for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Rd., Portland, OR, 97239, USA.
| | - Andrew D Palmer
- NW Center for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Rd., Portland, OR, 97239, USA.
| | - Shannon Anderson
- Dept. of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - Joshua Schindler
- NW Center for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Rd., Portland, OR, 97239, USA.
| | - Donna J Graville
- NW Center for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Rd., Portland, OR, 97239, USA.
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19
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Chiu SY, Tsuboi T, Hegland KW, Herndon NE, Shukla AW, Patterson A, Almeida L, Foote KD, Okun MS, Ramirez-Zamora A. Dysarthria and Speech Intelligibility Following Parkinson’s Disease Globus Pallidus Internus Deep Brain Stimulation. JOURNAL OF PARKINSONS DISEASE 2020; 10:1493-1502. [DOI: 10.3233/jpd-202246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Although earlier studies reported variable speech changes following subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson’s disease (PD) patients, the effects of globus pallidus internus (GPi) DBS on speech performance in PD remain largely unknown. Objective: We aimed to characterize speech changes following PD GPi-DBS. Methods: We retrospectively analyzed clinical and speech outcomes of 25 PD patients treated with bilateral GPi-DBS at a single center. Outcome measures included the Unified Parkinson’s Disease Rating Scale (UPDRS), speech subsystem domains (respiratory, laryngeal, resonance, orofacial, rate, prosody, rhythm, and naturalness), and overall speech intelligibility. Scores at baseline were compared with those at 6 months, 1 year, and the longest clinical follow-up available. Results: In the off-medication state, activities of daily living and motor function based on UPDRS II and III significantly improved postoperatively. We observed unique patterns of speech changes in patients with PD following GPi-DBS in the short- (n = 25) and longer-term (n = 8) follow-up periods. Velopharyngeal (resonance), laryngeal components, and prosody worsened after bilateral GPi-DBS (p < 0.015). Speech intelligibility did not worsen after GPi-DBS in the short-term, but there was a trend to deteriorate at long-term follow-up (e.g., one year and beyond). We observed worsening of hypokinetic dysarthria in individual patients. Also, a minority of patients developed stuttering, spastic dysarthria, or ataxic dysarthria. Conclusion: Bilateral GPi-DBS worsened several modalities of parkinsonian speech without compromising overall speech intelligibility. GPi-DBS can potentially worsen or induce hypokinetic dysarthria, stuttering, spastic dysarthria, or ataxic dysarthria. GPi-DBS may have different and variable effects on speech function when compared to STN-DBS.
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Affiliation(s)
- Shannon Y. Chiu
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Takashi Tsuboi
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Karen W. Hegland
- UF Health Rehab Center at the Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | - Nicole E. Herndon
- UF Health Rehab Center at the Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Addie Patterson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Leonardo Almeida
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kelly D. Foote
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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Yuan F, Guo X, Wei X, Xie F, Zheng J, Huang Y, Huang Z, Chang Z, Li H, Guo Y, Chen J, Guo J, Tang B, Deng B, Wang Q. Lee Silverman Voice Treatment for dysarthria in patients with Parkinson's disease: a systematic review and meta-analysis. Eur J Neurol 2020; 27:1957-1970. [PMID: 32539227 DOI: 10.1111/ene.14399] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/04/2020] [Indexed: 02/06/2023]
Abstract
Approximately 89% of patients with Parkinson's disease (PD) suffer from dysarthria. Lee Silverman Voice Treatment (LSVT), a behavioral therapy, aims to improve speech and voice functions. The objective was to assess the effectiveness of LSVT compared with other/no speech interventions for dysarthria in patients with PD. Electronic databases, including PubMed, Embase and the Cochrane Library, were searched. The publication date of all included studies was before 6 March 2020. Only randomized controlled trials (RCTs) that evaluated the LSVT intervention compared with other/no speech intervention were considered. The data obtained from the included studies were described and the mean differences were calculated. Eight RCTs were included in this meta-analysis comparing LSVT with other/no speech interventions. In the comparison of LSVT versus no intervention, vocal intensity for sustained 'Ah' phonation, reading the 'Rainbow passage', monologue and describing a picture increased by 8.87, 4.34, 3.25 and 3.31 dB, respectively, after 1 month of therapy. Compared with the respiratory therapy group, the LSVT group also showed significant improvement in vocal intensity for sustained 'Ah' phonation, reading the 'Rainbow passage' and monologue immediately after treatment (13.39, 6.66 and 3.19 dB). Positive improvement still existed after 24 months. There was no difference in the therapeutic effect between face-to-face and online LSVT. The effectiveness of LSVT for dysarthria in patients with PD was verified in these trials. However, future RCTs with sufficient participants are essential to evaluate the effectiveness of LSVT for dysarthria.
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Affiliation(s)
- F Yuan
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - X Guo
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - X Wei
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - F Xie
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - J Zheng
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Y Huang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Z Huang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Z Chang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - H Li
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Y Guo
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - J Chen
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - J Guo
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, China
| | - B Tang
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, China
| | - B Deng
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Q Wang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
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21
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Levy ES, Moya-Galé G, Chang YHM, Freeman K, Forrest K, Brin MF, Ramig LA. The effects of intensive speech treatment on intelligibility in Parkinson's disease: A randomised controlled trial. EClinicalMedicine 2020; 24:100429. [PMID: 32639484 PMCID: PMC7327886 DOI: 10.1016/j.eclinm.2020.100429] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND More than 6,000,000 individuals worldwide are diagnosed with Parkinson's disease (PD). Nearly 90% develop speech signs that may substantially impair their speech intelligibility, resulting in losses in their communication and quality of life. Benefits of intensive speech treatment have been documented for a range of speech signs. However, the critical question of whether speech is more intelligible after treatment has not been investigated in a randomised controlled trial (RCT). We hypothesised that intensive speech treatment would improve speech intelligibility in PD. METHOD Sixty-four patients with hypokinetic dysarthria secondary to PD participated in this single-centre, parallel arm, statistically-powered RCT. Reporting follows CONSORT guidelines for non-pharmacological treatment. Patients were recruited from US clinics and randomised using a statistician-derived minimisation algorithm, to intensive speech treatment (16 1-hour sessions/1 month) targeting voice (voice group) or targeting articulation (articulation group) or to an untreated group (no treatment group). Speech treatments were delivered by speech clinicians who specialised in treating patients with PD. Trial design minimised bias and supported equipoise. For intelligibility assessment, blinded listeners (n = 117) orthographically transcribed 57 patients' recorded, self-generated narrative speech samples, randomly presented in multi-talker babble noise. Listeners were American-English speakers, ages 18-35 years, with normal hearing. The primary outcome was baseline (pre-treatment) to post-treatment change in transcription accuracy (TA), recognised as the most objective measure of intelligibility. TA was defined as the percentage of words transcribed correctly. Listeners, data collectors, and data managers were blinded to treatment conditions and groups. Reliability was evaluated using intraclass correlation coefficients and differences amongst groups were evaluated by mixed-effects models, in accordance with the intention-to-treat approach.This trial was registered with ClinicalTrials.gov Identifier: NCT00123084. FINDINGS Between June 23, 2016 and August 14, 2017, blinded listeners transcribed baseline and post-treatment speech samples for intelligibility assessment of 57 patients in the voice (n = 19), articulation (n = 19) and no treatment (n = 19) groups. Between-group differences (d) in changes from baseline to post-treatment in TA indicated significantly greater increases following treatment targeting voice than treatment targeting articulation (d = 26·2%, 95% CI 1·5 - 51·0; p = 0·04; ES=1·0). Differences between TA changes in the treatment targeting voice and in the no treatment group were significant (d = 42·8%, 95% CI 22·4 - 63·2; p = 0·0002; ES=1·8). Differences between TA changes in the treatment targeting articulation and in the no treatment group were not significant (d = 16·5%, 95% CI -6·1 - 39·2; p = 0·147; ES=0·9). INTERPRETATION These findings provide the first RCT evidence that intensive speech treatment targeting voice improves speech intelligibility in PD. Thus, this evidence-based treatment may positively impact health-related quality of life for patients with PD globally when it is included in patient management. FUNDING
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Affiliation(s)
- Erika S. Levy
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| | - Gemma Moya-Galé
- Department of Communication Sciences and Disorders, Long Island University, Brooklyn, NY, United States
| | - Young Hwa M. Chang
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| | - Katherine Freeman
- Department of Biomedical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Karen Forrest
- Department of Speech and Hearing Sciences, Indiana University, Bloomington, IN, United States
| | - Mitchell F. Brin
- Department of Neurology, University of California, Irvine, Allergan LLC, Irvine, CA, United States
- Research and Development, Allergan, an AbbVie Company, Irvine, CA, United States
| | - Lorraine A. Ramig
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
- National Center for Voice and Speech, Denver, CO, United States
- Department of Speech-Language and Hearing Sciences, University of Colorado, Boulder, CO, United States
- LSVT Global, Inc., Tucson, AZ, United States
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Sackley CM, Rick C, Au P, Brady MC, Beaton G, Burton C, Caulfield M, Dickson S, Dowling F, Hughes M, Ives N, Jowett S, Masterson-Algar P, Nicoll A, Patel S, Smith CH, Woolley R, Clarke CE. A multicentre, randomised controlled trial to compare the clinical and cost-effectiveness of Lee Silverman Voice Treatment versus standard NHS Speech and Language Therapy versus control in Parkinson's disease: a study protocol for a randomised controlled trial. Trials 2020; 21:436. [PMID: 32460885 PMCID: PMC7251680 DOI: 10.1186/s13063-020-04354-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/27/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) affects approximately 145,519 people in the UK. Speech impairments are common with a reported prevalence of 68%, which increase physical and mental demands during conversation, reliance on family and/or carers, and the likelihood of social withdrawal reducing quality of life. In the UK, two approaches to Speech and Language Therapy (SLT) intervention are commonly available: National Health Service (NHS) SLT or Lee Silverman Voice Treatment (LSVT LOUD®). NHS SLT is tailored to the individuals' needs per local practice typically consisting of six to eight weekly sessions; LSVT LOUD® comprises 16 sessions of individual treatment with home-based practice over 4 weeks. The evidence-base for their effectiveness is inconclusive. METHODS/DESIGN PD COMM is a phase III, multicentre, three-arm, unblinded, randomised controlled trial. Five hundred and forty-six people with idiopathic PD, reporting speech or voice problems will be enrolled. We will exclude those with a diagnosis of dementia, laryngeal pathology or those who have received SLT for speech problems in the previous 2 years. Following informed consent and completion of baseline assessments, participants will be randomised in a 1:1:1 ratio to no-intervention control, NHS SLT or LSVT LOUD® via a central computer-generated programme, using a minimisation procedure with a random element, to ensure allocation concealment. Participants randomised to the intervention groups will start treatment within 4 (NHS SLT) or 7 (LSVT LOUD®) weeks of randomisation. PRIMARY OUTCOME Voice Handicap Index (VHI) total score at 3 months. Secondary outcomes include: VHI subscales, Parkinson's Disease Questionnaire-39; Questionnaire on Acquired Speech Disorders; EuroQol-5D-5 L; ICECAP-O; resource utilisation; adverse events and carer quality of life. Mixed-methods process and health economic evaluations will take place alongside the trial. Assessments will be completed before randomisation and at 3, 6 and 12 months after randomisation. The trial started in December 2015 and will run for 77 months. Recruitment will take place in approximately 42 sites around the UK. DISCUSSION The trial will test the hypothesis that SLT is effective for the treatment of speech or voice problems in people with PD compared to no SLT. It will further test whether NHS SLT or LSVT LOUD® provide greater benefit and determine the cost-effectiveness of both interventions. TRIAL REGISTRATION International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ID: 12421382. Registered on 18 April 2016.
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Affiliation(s)
- C. M. Sackley
- Population Health Sciences, Addison House, King’s College London, Guy’s Campus, London, SE1 1UL UK
- School of Health Science, University of Nottingham, QMC, Nottingham, NG7 2HA UK
| | - C. Rick
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - P. Au
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - M. C. Brady
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0BA UK
| | - G. Beaton
- Queen Elizabeth Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - C. Burton
- School of Allied and Public Health Professions, Canterbury Christ church University, Canterbury, CT1 1QU UK
| | - M. Caulfield
- Bangor Institute for Health and Medical Research, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - S. Dickson
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0BA UK
| | - F. Dowling
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ UK
| | - M. Hughes
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - N. Ives
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - S. Jowett
- Health Economics, University of Birmingham, Birmingham,, B15 2TT UK
| | - P. Masterson-Algar
- Bangor Institute for Health and Medical Research, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - A. Nicoll
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0BA UK
| | - S. Patel
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - C. H. Smith
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
| | - R. Woolley
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - C. E. Clarke
- Institute for Applied Health Research, University of Birmingham, Birmingham, B15 2TT UK
- Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham,, B18 7QH UK
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23
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Tracy JM, Özkanca Y, Atkins DC, Hosseini Ghomi R. Investigating voice as a biomarker: Deep phenotyping methods for early detection of Parkinson's disease. J Biomed Inform 2019; 104:103362. [PMID: 31866434 DOI: 10.1016/j.jbi.2019.103362] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Abstract
Voice technology has grown tremendously in recent years and using voice as a biomarker has also been gaining evidence. We demonstrate the potential of voice in serving as a deep phenotype for Parkinson's Disease (PD), the second most common neurodegenerative disorder worldwide, by presenting methodology for voice signal processing for clinical analysis. Detection of PD symptoms typically requires an exam by a movement disorder specialist and can be hard to access and inconsistent in findings. A vocal digital biomarker could supplement the cumbersome existing manual exam by detecting and quantifying symptoms to guide treatment. Specifically, vocal biomarkers of PD are a potentially effective method of assessing symptoms and severity in daily life, which is the focus of the current research. We analyzed a database of PD patient and non-PD subjects containing voice recordings that were used to extract paralinguistic features, which served as inputs to machine learning models to predict PD severity. The results are presented here and the limitations are discussed given the nature of the recordings. We note that our methodology only advances biomarker research and is not cleared for clinical use. Specifically, we demonstrate that conventional machine learning models applied to voice signals can be used to differentiate participants with PD who exhibit little to no symptoms from healthy controls. This work highlights the potential of voice to be used for early detection of PD and indicates that voice may serve as a deep phenotype for PD, enabling precision medicine by improving the speed, accuracy, accessibility, and cost of PD management.
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Affiliation(s)
- John M Tracy
- Member of DigiPsych Lab, University of Washington, Seattle, WA, USA
| | - Yasin Özkanca
- Electrical & Electronics Engineering, Ozyegin University, Istanbul, Turkey
| | - David C Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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24
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Presotto M, Rieder CRDM, Olchik MR. Validação de conteúdo e confiabilidade do Protocolo de Avaliação dos Distúrbios Adquiridos de Fala em Indivíduos com Doença de Parkinson (PADAF). Codas 2019; 31:e20180230. [DOI: 10.1590/2317-1782/20192018230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/31/2019] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Elaborar e realizar a validação de conteúdo, assim como verificar a confiabilidade entre examinador do Protocolo de Avaliação dos Distúrbios Adquiridos de Fala em Indivíduos com Doença de Parkinson (PADAF). Método O estudo foi realizado em três etapas. Na primeira, foi elaborado o protocolo e validado seu conteúdo mediante análise de sete especialistas. Na segunda, aplicou-se o instrumento em 25 indivíduos com doença de Parkinson (DP) idiopática. Na terceira e última etapa, verificou-se a confiabilidade entre-examinador. Resultados A versão final do PADAF foi composta de 32 itens que avaliam a respiração, a fonação, a ressonância, a articulação e a prosódia. Mostrou-se válido, com índice de validade de conteúdo (IVC) bem acima daquele estabelecido na literatura e com perfeita concordância na verificação da confiabilidade entre examinador. Conclusão O PADAF para indivíduos com DP foi desenvolvido e teve seu conteúdo validado com perfeita confiabilidade do instrumento.
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Affiliation(s)
| | - Carlos Roberto de Mello Rieder
- Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre, Brasil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil
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25
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Cullen KP, Grant LM, Kelm-Nelson CA, Brauer AFL, Bickelhaupt LB, Russell JA, Ciucci MR. Pink1 -/- Rats Show Early-Onset Swallowing Deficits and Correlative Brainstem Pathology. Dysphagia 2018; 33:749-758. [PMID: 29713896 PMCID: PMC6207473 DOI: 10.1007/s00455-018-9896-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/16/2018] [Indexed: 02/06/2023]
Abstract
Parkinson disease (PD) compromises oropharyngeal swallowing, which negatively affects quality of life and contributes to aspiration pneumonia. Dysphagia often begins early in the disease process, and does not improve with standard therapies. As a result, swallowing deficits are undertreated in the PD population. The Pink1 -/- rat is used to model PD, and demonstrates widespread brainstem neuropathology in combination with early-onset sensorimotor dysfunction; however, to date, swallowing behaviors have not been evaluated. To test the hypothesis that Pink1 -/- rats demonstrate early-onset differences in swallowing, we analyzed within-subject oropharyngeal swallowing using videofluoroscopy. Pink1 -/- and wildtype (WT) controls at 4 (Pink1 -/- n = 16, WT = 16) and 8 (Pink1 -/- n = 12, WT = 12) months of age were tested. The average and maximum bolus size was significantly increased in Pink1 -/- rats at both 4 and 8 months. Bolus average velocity was increased at 8 months for all animals; yet, Pink1 -/- animals had significantly increased velocities compared to WT at 8 months. The data show a significant reduction in mastication rate for Pink1 -/- rats at 8 months suggesting the onset of oromotor dysfunction begins at this time point. Relationships among swallowing variables and neuropathological findings, such as increased alpha-synuclein protein in the nucleus ambiguus and reductions in noradrenergic cells in the locus coeruleus in the Pink1 -/- rats, were determined. The presence of early oropharyngeal swallowing deficits and relationships to brainstem pathology in Pink1-/- rat models of PD indicate that this may be a useful model of early swallowing deficits and their mechanisms. These findings suggest clinical implications for early detection and management of dysphagia in PD.
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Affiliation(s)
- Kaylee P Cullen
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, 53706, USA
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, 1300 University Avenue, 483 Medical Sciences Center, Madison, WI, 53706, USA
| | - Laura M Grant
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, 53706, USA
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, 1300 University Avenue, 483 Medical Sciences Center, Madison, WI, 53706, USA
| | - Cynthia A Kelm-Nelson
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, 1300 University Avenue, 483 Medical Sciences Center, Madison, WI, 53706, USA.
| | - Alexander F L Brauer
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, 1300 University Avenue, 483 Medical Sciences Center, Madison, WI, 53706, USA
| | - Luke B Bickelhaupt
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - John A Russell
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Michelle R Ciucci
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, 53706, USA
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, 1300 University Avenue, 483 Medical Sciences Center, Madison, WI, 53706, USA
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, 53706, USA
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26
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Baumann A, Nebel A, Granert O, Giehl K, Wolff S, Schmidt W, Baasch C, Schmidt G, Witt K, Deuschl G, Hartwigsen G, Zeuner KE, van Eimeren T. Neural Correlates of Hypokinetic Dysarthria and Mechanisms of Effective Voice Treatment in Parkinson Disease. Neurorehabil Neural Repair 2018; 32:1055-1066. [DOI: 10.1177/1545968318812726] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Hypokinetic dysarthria is highly prevalent in idiopathic Parkinson disease (PD), and effectiveness of high-intensity voice treatment is well established. However, the neural correlates remain largely unknown. Objective. We aimed to specify cerebral pathophysiology of hypokinetic dysarthria and treatment-induced changes using functional magnetic resonance imaging (fMRI). Methods. We used fMRI to investigate healthy controls (HCs) and patients with idiopathic PD–associated dysarthria before and after treatment according to the Lee Silverman Voice Treatment LOUD (LSVT). During fMRI, participants covertly read sentences with normal (eg, conversation in a quiet room) or high (eg, shouting on a windy beach) intensity. In addition, we tested LSVT effects on intelligibility and different speech features (intensity, pitch, articulation). Results. LSVT effectively improved intelligibility, articulation, and pitch in patients. Covert high-intensity speech compared with covert normal-intensity speech led to increased activation of mainly secondary motor areas and bilateral superior and medial temporal regions. Prior to LSVT, patients showed less activity in several speech-associated areas compared with HCs. As a neural correlate of effective LSVT, increased right-sided superior temporal activity correlated with improved intelligibility. Conclusion. This is the first brain imaging study using a covert speech paradigm in PD, which revealed cortical hypoactivation as correlate of hypokinetic dysarthria. Furthermore, cortical correlates of effective LSVT treatment colocalized with the neuronal network, showing increased activation during high- versus normal-intensity speech generation.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Karsten Witt
- Carl von Ossietzky University Oldenburg, Germany
| | | | - Gesa Hartwigsen
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | | | - Thilo van Eimeren
- University Hospital of Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
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Ramig L, Halpern A, Spielman J, Fox C, Freeman K. Speech treatment in Parkinson's disease: Randomized controlled trial (RCT). Mov Disord 2018; 33:1777-1791. [PMID: 30264896 PMCID: PMC6261685 DOI: 10.1002/mds.27460] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/07/2018] [Accepted: 05/22/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND As many as 89% of people with Parkinson's disease (PD) develop speech disorders. OBJECTIVES This randomized controlled trial evaluated two speech treatments for PD matched in intensive dosage and high-effort mode of delivery, differing in subsystem target: voice (respiratory-laryngeal) versus articulation (orofacial-articulatory). METHODS PD participants were randomized to 1-month LSVT LOUD (voice), LSVT ARTIC (articulation), or UNTXPD (untreated) groups. Speech clinicians specializing in PD delivered treatment. Primary outcome was sound pressure level (SPL) in reading and spontaneous speech, and secondary outcome was participant-reported Modified Communication Effectiveness Index (CETI-M), evaluated at baseline, 1, and 7 months. Healthy controls were matched by age and sex. RESULTS At baseline, the combined PD group (n = 64) was significantly worse than healthy controls (n = 20) for SPL (P < 0.05) and CETI-M (P = 0.0001). At 1 and 7 months, SPL between-group comparisons showed greater improvements for LSVT LOUD (n = 22) than LSVT ARTIC (n = 20; P < 0.05) and UNTXPD (n = 22; P < 0.05). Sound pressure level differences between LSVT ARTIC and UNTXPD at 1 and 7 months were not significant (P > 0.05). For CETI-M, between-group comparisons showed greater improvements for LSVT LOUD and LSVT ARTIC than UNTXPD at 1 month (P = 0.02; P = 0.02). At 7 months, CETI-M between-group differences were not significant (P = 0.08). Within-group CETI-M improvements for LSVT LOUD were maintained through 7 months (P = 0.0011). CONCLUSIONS LSVT LOUD showed greater improvements than both LSVT ARTIC and UNTXPD for SPL at 1 and 7 months. For CETI-M, both LSVT LOUD and LSVT ARTIC improved at 1 month relative to UNTXPD. Only LSVT LOUD maintained CETI-M improvements at 7 months. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Lorraine Ramig
- University of Colorado‐BoulderBoulderColoradoUSA
- National Center for Voice and Speech‐DenverDenverColoradoUSA
- Columbia University‐New York CityNew YorkNew YorkUSA
- LSVT Global, Inc.‐TucsonTucsonArizonaUSA
| | - Angela Halpern
- University of Colorado‐BoulderBoulderColoradoUSA
- National Center for Voice and Speech‐DenverDenverColoradoUSA
- LSVT Global, Inc.‐TucsonTucsonArizonaUSA
| | - Jennifer Spielman
- University of Colorado‐BoulderBoulderColoradoUSA
- National Center for Voice and Speech‐DenverDenverColoradoUSA
| | - Cynthia Fox
- National Center for Voice and Speech‐DenverDenverColoradoUSA
- LSVT Global, Inc.‐TucsonTucsonArizonaUSA
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Dashtipour K, Tafreshi A, Lee J, Crawley B. Speech disorders in Parkinson's disease: pathophysiology, medical management and surgical approaches. Neurodegener Dis Manag 2018; 8:337-348. [DOI: 10.2217/nmt-2018-0021] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The prevalence of speech disorders among individuals with Parkinson's disease (PD) has been reported to be as high as 89%. Speech impairment in PD results from a combination of motor and nonmotor deficits. The production of speech depends upon the coordination of various motor activities: respiration, phonation, articulation, resonance and prosody. A speech disorder is defined as impairment in any of its inter-related components. Despite the high prevalence of speech disorders in PD, only 3–4% receive speech treatment. Treatment modalities include pharmacological intervention, speech therapy, surgery, deep brain stimulation and vocal fold augmentation. Although management of Parkinsonian dysarthria is clinically challenging, speech treatment in PD should be part of a multidisciplinary approach to patient care in this disease.
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Affiliation(s)
- Khashayar Dashtipour
- Department of Neurology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Ali Tafreshi
- Department of Neurology, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jessica Lee
- Department of Neurology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Brianna Crawley
- Department of Otolaryngology, Loma Linda University School of Medicine, Loma Linda, CA, USA
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29
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Manes JL, Tjaden K, Parrish T, Simuni T, Roberts A, Greenlee JD, Corcos DM, Kurani AS. Altered resting-state functional connectivity of the putamen and internal globus pallidus is related to speech impairment in Parkinson's disease. Brain Behav 2018; 8:e01073. [PMID: 30047249 PMCID: PMC6160640 DOI: 10.1002/brb3.1073] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/19/2018] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Speech impairment in Parkinson's disease (PD) is pervasive, with life-impacting consequences. Yet, little is known about how functional connections between the basal ganglia and cortex relate to PD speech impairment (PDSI). Whole-brain resting-state connectivity analyses of basal ganglia nuclei can expand the understanding of PDSI pathophysiology. METHODS Resting-state data from 89 right-handed subjects were downloaded from the Parkinson's Progression Markers Initiative database. Subjects included 12 older healthy controls ("OHC"), 42 PD patients without speech impairment ("PDN"), and 35 PD subjects with speech impairment ("PDSI"). Subjects were assigned to PDN and PDSI groups based on the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III speech item scores ("0" vs. "1-4"). Whole-brain functional connectivity was calculated for four basal ganglia seeds in each hemisphere: putamen, caudate, external globus pallidus (GPe), and internal globus pallidus (GPi). For each seed region, group-averaged connectivity maps were compared among OHC, PDN, and PDSI groups using a multivariate ANCOVA controlling for the effects of age and sex. Subsequent planned pairwise t-tests were performed to determine differences between the three groups using a voxel-wise threshold of p < 0.001 and cluster-extent threshold of 272 mm3 (FWE<0.05). RESULTS In comparison with OHCs, both PDN and PDSI groups demonstrated significant differences in cortical connectivity with bilateral putamen, bilateral GPe, and right caudate. Compared to the PDN group, the PDSI subjects demonstrated significant differences in cortical connectivity with left putamen and left GPi. PDSI subjects had lower connectivity between the left putamen and left superior temporal gyrus compared to PDN. In addition, PDSI subjects had greater connectivity between left GPi and three cortical regions: left dorsal premotor/laryngeal motor cortex, left angular gyrus, and right angular gyrus. CONCLUSIONS The present findings suggest that speech impairment in PD is associated with altered cortical connectivity with left putamen and left GPi.
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Affiliation(s)
- Jordan L. Manes
- Department of Physical Therapy and Human Movement SciencesNorthwestern UniversityChicagoIllinois
| | - Kris Tjaden
- Department of Communication Disorders and SciencesUniversity at BuffaloBuffaloNew York
| | - Todd Parrish
- Department of RadiologyNorthwestern UniversityChicagoIllinois
| | - Tanya Simuni
- Ken and Ruth Davee Department of NeurologyNorthwestern UniversityChicagoIllinois
- The Parkinson's Disease and Movement Disorders ClinicNorthwestern UniversityChicagoIllinois
| | - Angela Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and DisordersNorthwestern UniversityEvanstonIllinois
| | | | - Daniel M. Corcos
- Department of Physical Therapy and Human Movement SciencesNorthwestern UniversityChicagoIllinois
| | - Ajay S. Kurani
- Department of RadiologyNorthwestern UniversityChicagoIllinois
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Grant LM, Barth KJ, Muslu C, Kelm-Nelson CA, Bakshi VP, Ciucci MR. Noradrenergic receptor modulation influences the acoustic parameters of pro-social rat ultrasonic vocalizations. Behav Neurosci 2018; 132:269-283. [PMID: 29985007 PMCID: PMC6062469 DOI: 10.1037/bne0000258] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Rats produce high rates of ultrasonic vocalizations (USVs) in social situations; these vocalizations are influenced by multiple neurotransmitter systems. Norepinephrine (NE) plays a significant role in vocalization biology; however, the contribution of NE to normal, prosocial vocal control has not been well established in the rat. To address this, we used NE adrenoceptor agonists (Cirazoline, Clonidine) and antagonists (Prozasin, Atipamezole, Propranolol) to quantify the contribution of specific alpha-1, alpha-2, and beta NE receptors to USV parameters in male Long Evans rats during seminaturalistic calling. We found that multiple USV acoustic variables (intensity, bandwidth, duration, peak frequency, and call profile) are modified by alterations in NE signaling. Very generally, agents that increased NE neurotransmission (Atipamezole) or activated alpha-1 receptors (Cirazoline), led to an increase in intensity and duration, respectively. Agents that decreased NE neurotransmission (Clonidine) or blocked alpha-1 receptors (Prazosin) reduced call rate, intensity, and bandwidth. However, the beta-receptor antagonist, Propranolol, was associated with increased call rate, duration, and intensity. Limb motor behaviors were largely unaffected by any drug, with the exception of Clonidine. Higher doses of Clonidine significantly reduced gross motor, grooming, and feeding behavior. These results confirm the involvement of NE transmission in vocal control in the rat, and suggest that this USV model is useful for studying the neuropharmacology of behavioral measures that may have implications for disease states, such as Parkinson's disease. (PsycINFO Database Record
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Investigating the effect of STN-DBS stimulation and different frequency settings on the acoustic-articulatory features of vowels. Neurol Sci 2018; 39:1683-1689. [PMID: 29938340 DOI: 10.1007/s10072-018-3479-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is the second most frequent progressive neuro-degenerative disorder. In addition to motor symptoms, nonmotor symptoms and voice and speech disorders can also develop in 90% of PD patients. The aim of our study was to investigate the effects of DBS and different DBS frequencies on speech acoustics of vowels in PD patients. METHODS The study included 16 patients who underwent STN-DBS surgery due to PD. The voice recordings for the vowels including [a], [e], [i], and [o] were performed at frequencies including 230, 130, 90, and 60 Hz and off-stimulation. The voice recordings were gathered and evaluated by the Praat software, and the effects on the first (F1), second (F2), and third formant (F3) frequencies were analyzed. RESULTS A significant difference was found for the F1 value of the vowel [a] at 130 Hz compared to off-stimulation. However, no significant difference was found between the three formant frequencies with regard to the stimulation frequencies and off-stimulation. In addition, though not statistically significant, stimulation at 60 and 230 Hz led to several differences in the formant frequencies of other three vowels. CONCLUSION Our results indicated that STN-DBS stimulation at 130 Hz had a significant positive effect on articulation of [a] compared to off-stimulation. Although there is not any statistical significant stimulation at 60 and 230 Hz may also have an effect on the articulation of [e], [i], and [o] but this effect needs to be investigated in future studies with higher numbers of participants.
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Li H, Li G, Liu G, Zhang Y. Liuzijue Qigong vs traditional breathing training for patients with post-stroke dysarthria complicated with abnormal respiratory control: study protocol of a single center randomized controlled trial. Trials 2018; 19:335. [PMID: 29941037 PMCID: PMC6019506 DOI: 10.1186/s13063-018-2734-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 06/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke-induced dysarthria is caused by muscle weakness, sacral or muscular dystonia, and incoordination of the articulatory organ formed by organic lesions caused by cerebral vascular obstruction or sudden bursting of blood vessels in the brain, which may cause abnormal breathing patterns, pronunciation, resonance, rhythm, and unclear articulation. The Six Character Formula, or Liuzijue qigong (LQG), is an essential part of Chinese traditional exercises and focuses on breathing-speech synchronization. The purpose of the present study was to compare the effects of LQG with traditional breathing training (combined with basic articulation training in both groups) in patients with post-stroke dysarthria. METHODS/DESIGN The proposed study will be a single-center randomized controlled trial. A total of 100 patients, with a modified Frenchay Dysarthria Assessment (FDA) dysarthria assessment score < 27 and with a FDA speech breathing level ≥ b will be randomly divided into study (LQG, n = 50) and control (conventional breathing training, n = 50) groups. Basic articulation training will be conducted once a day, five times a week for 3 weeks. Data collection will be conducted at baseline, 1 week, and 2 weeks post-treatment initiation and after completion of the treatment (3 weeks). Comprehensive analyses will be conducted to measure and compare any differences in speech breathing dysfunction levels, comprehensive evaluation of dysarthria, maximum phonation time (MPT), maximal counting ability, signal-noise (S/Z) ratio, and loudness scales between the study and control groups. DISCUSSION This trial will provide evidence about the effectiveness of LQG for improvement of speech breathing function and speech ability in patients with post-stroke dysarthria complicated with abnormal breathing. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-INR-16010215. Registered 21 December 2016.
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Affiliation(s)
- Hongli Li
- Department of Rehabilitation, the Central Hospital of Xuhui District, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China
| | - Gaiyan Li
- Department of Rehabilitation, the Central Hospital of Xuhui District, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China
| | - Gongliang Liu
- Department of Rehabilitation, the Central Hospital of Xuhui District, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China
| | - Ying Zhang
- Department of Rehabilitation, the Central Hospital of Xuhui District, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China.
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Lechien JR, Blecic S, Ghosez Y, Huet K, Harmegnies B, Saussez S. Voice Quality and Orofacial Strength as Outcome of Levodopa Effectiveness in Patients with Early Idiopathic Parkinson Disease: A Preliminary Report. J Voice 2018; 33:716-720. [PMID: 29724466 DOI: 10.1016/j.jvoice.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Sixty to 90% of patients with idiopathic Parkinson disease (IPD) developed early dysphonia and subtle speech impairment, which is usually related to orofacial muscular dysfunctions. The aim of this preliminary study is to assess the usefulness of voice quality and orofacial strength (involved in speech) as outcome of levodopa challenge test used for the IPD diagnosis. MATERIAL AND METHODS A total of 20 patients with early IPD were recruited and evaluated for clinical findings (Hoehn and Yahr scale), voice handicap index, maximal phonation time, phonation quotient, percent jitter, percent shimmer, noise-to-harmonic ratio, and orofacial muscular strength (Iowa Oral Performance Instrument) at baseline, throughout the levodopa challenge test and after therapeutic stabilization. RESULTS The intake of a standardized dose of levodopa (levodopa challenge test) significantly improved phonation quotient and percent shimmer. We did not find similar improvement after medical stabilization of patients (based on levodopa medication) despite an improvement of Hoehn and Yahr mean score. The intake of levodopa significantly improved cheeks and lips strength involved in speech quality both along the challenge test and after the therapeutic stabilization. CONCLUSIONS These preliminary findings support a differential impact of levodopa on voice and speech functions in early diagnosed IPD and a mismatch between the clinical examination, orofacial strength, and voice quality improvements once the patient is medically stabilized.
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Affiliation(s)
- Jérôme R Lechien
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Baudour, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.
| | - Serge Blecic
- Department of Neurology, EpiCURA Hospital, Baudour, Belgium
| | - Yves Ghosez
- Department of Anesthesiology, EpiCURA Hospital, Baudour, Belgium
| | - Kathy Huet
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Bernard Harmegnies
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Sven Saussez
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, RHMS Baudour, EpiCURA Hospital, Baudour, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium
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Kelm-Nelson CA, Trevino MA, Ciucci MR. Quantitative Analysis of Catecholamines in the Pink1 -/- Rat Model of Early-onset Parkinson's Disease. Neuroscience 2018; 379:126-141. [PMID: 29496635 DOI: 10.1016/j.neuroscience.2018.02.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 02/14/2018] [Accepted: 02/17/2018] [Indexed: 10/17/2022]
Abstract
Parkinson's disease (PD) related to homozygous mutations in the Pink1 gene is associated with nigrostriatal dopamine depletion and a wide range of sensorimotor deficits. In humans and animal models of PD, not all sensorimotor deficits are levodopa-responsive. We hypothesized that the underlying mechanisms of locomotion, limb control, and vocal communication behavior include other pathologies. Here, Pink1 -/- rats were treated with an oral dose of levodopa and limb motor and vocal communication behaviors were measured. Levodopa significantly improved some aspects of locomotion but did not improve ultrasonic vocalization intensity or frequency. Catecholamine concentrations in the striatum (SR), substantia nigra (SN), and locus coeruleus (LC) were analyzed to test the hypothesis that behavioral deficits would correlate to altered protein levels. There were no differences in dopamine concentrations in the SR and SN of Pink1 -/- animals compared to wild-type controls. There was a significant increase in norepinephrine concentration in the SN of Pink1 -/- animals. Moreover, an observed decrease in norepinephrine concentrations in the LC is consistent with the hypothesis that early-stage PD includes noradrenergic loss in the brainstem, and is congruent with a significant increase in catechol-O-methyltransferase expression in the LC of Pink1 -/- animals. Pearson's correlations showed that increases in time to traverse a tapered balance beam are significantly associated with reductions in striatal dopamine. Ultrasonic vocalization complexity was positively correlated with LC norepinephrine concentrations. These data support the evolving hypothesis that differences in neural substrates and early-onset noradrenergic mechanisms in the brainstem may contribute to pathogenesis in the Pink1 -/- rat.
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Affiliation(s)
- Cynthia A Kelm-Nelson
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, USA.
| | - Michael A Trevino
- Department of Psychology, University of Illinois-Urbana Champaign, Urbana-Champaign, IL, USA.
| | - Michelle R Ciucci
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, USA; Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA; Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA.
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Kelm-Nelson CA, Brauer AFL, Barth KJ, Lake JM, Sinnen MLK, Stehula FJ, Muslu C, Marongiu R, Kaplitt MG, Ciucci MR. Characterization of early-onset motor deficits in the Pink1-/- mouse model of Parkinson disease. Brain Res 2018; 1680:1-12. [PMID: 29229503 PMCID: PMC5767140 DOI: 10.1016/j.brainres.2017.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/09/2017] [Accepted: 12/04/2017] [Indexed: 01/07/2023]
Abstract
In Parkinson disease (PD), a complex neurodegenerative disorder that affects nearly 10 million people worldwide, motor skills are significantly impaired. However, onset and progression of motor deficits and the neural correlates of these deficits are poorly understood. We used a genetic mouse model of PD (Pink1-/-), with phenotypic similarities to human PD, to investigate the manifestation of early-onset sensorimotor deficits. We hypothesized this mouse model would show early vocalization and gross motor dysfunction that would be progressive in nature. Pink1-/- mice, compared to wild type (WT) controls, were evaluated at 2, 3, 4, 5, and 6 months of age. To quantify deficit progression, ultrasonic vocalizations and spontaneous locomotor activity (cylinder test and pole test) were analyzed. Although somewhat variable, in general, Pink1-/- mice produced significantly more simple calls with reduced intensity as well as a larger percentage of cycle calls compared to WT counterparts. However, there were no significant differences in duration, bandwidth, or peak frequency for any of the ultrasonic call types between genotypes. Pink1-/- mice showed a significant impairment in limb motor skills with fewer hindlimb steps, forelimb steps, and rears and lands in the cylinder test compared to WT. Additionally, Pink1-/- mice took significantly longer to turn and traverse during the pole test. Immunohistochemical staining showed no significant difference in the number of tyrosine hydroxylase (TH) positive cells in the substantia nigra or density of TH staining in the striatum between genotypes. These data suggest the Pink1-/- mouse model may be instrumental in defining early motor biomarkers of PD in the absence of nigrostriatal dopamine loss.
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Affiliation(s)
- Cynthia A Kelm-Nelson
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, USA.
| | - Alexander F L Brauer
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, USA
| | - Kelsey J Barth
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, USA
| | - Jacob M Lake
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, USA
| | - Mackenzie L K Sinnen
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA
| | - Forrest J Stehula
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, USA; Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Cagla Muslu
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA
| | - Roberta Marongiu
- Laboratory of Molecular Neurosurgery, Department of Neurological Surgery Weill Cornell Medicine, New York, NY, USA
| | - Michael G Kaplitt
- Laboratory of Molecular Neurosurgery, Department of Neurological Surgery Weill Cornell Medicine, New York, NY, USA
| | - Michelle R Ciucci
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, USA; Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA; Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA
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Sackley CM, Smith CH, Rick CE, Brady MC, Ives N, Patel S, Woolley R, Dowling F, Patel R, Roberts H, Jowett S, Wheatley K, Kelly D, Sands G, Clarke CE. Lee Silverman Voice Treatment versus standard speech and language therapy versus control in Parkinson's disease: a pilot randomised controlled trial (PD COMM pilot). Pilot Feasibility Stud 2018; 4:30. [PMID: 29344405 PMCID: PMC5763537 DOI: 10.1186/s40814-017-0222-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 12/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Speech-related problems are common in Parkinson's disease (PD), but there is little evidence for the effectiveness of standard speech and language therapy (SLT) or Lee Silverman Voice Treatment (LSVT LOUD®). METHODS The PD COMM pilot was a three-arm, assessor-blinded, randomised controlled trial (RCT) of LSVT LOUD®, SLT and no intervention (1:1:1 ratio) to assess the feasibility and to inform the design of a full-scale RCT. Non-demented patients with idiopathic PD and speech problems and no SLT for speech problems in the past 2 years were eligible. LSVT LOUD® is a standardised regime (16 sessions over 4 weeks). SLT comprised individualised content per local practice (typically weekly sessions for 6-8 weeks). Outcomes included recruitment and retention, treatment adherence, and data completeness. Outcome data collected at baseline, 3, 6, and 12 months included patient-reported voice and quality of life measures, resource use, and assessor-rated speech recordings. RESULTS Eighty-nine patients were randomised with 90% in the therapy groups and 100% in the control group completing the trial. The response rate for Voice Handicap Index (VHI) in each arm was ≥ 90% at all time-points. VHI was highly correlated with the other speech-related outcome measures. There was a trend to improvement in VHI with LSVT LOUD® (difference at 3 months compared with control: - 12.5 points; 95% CI - 26.2, 1.2) and SLT (difference at 3 months compared with control: - 9.8 points; 95% CI - 23.2, 3.7) which needs to be confirmed in an adequately powered trial. CONCLUSION Randomisation to a three-arm trial of speech therapy including a no intervention control is feasible and acceptable. Compliance with both interventions was good. VHI and other patient-reported outcomes were relevant measures and provided data to inform the sample size for a substantive trial. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number Register: ISRCTN75223808. registered 22 March 2012.
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Affiliation(s)
| | - Christina H. Smith
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
| | - Caroline E. Rick
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Marian C. Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Smitaa Patel
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Francis Dowling
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Ramilla Patel
- Parkinson’s UK West Midlands Regional Branch, London, UK
| | - Helen Roberts
- Faculty of Medicine, University of Southampton, London, UK
| | - Sue Jowett
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Debbie Kelly
- School of Rehabilitation Sciences, University of East Anglia, Norwich, UK
| | - Gina Sands
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Carl E. Clarke
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Neurology, Clinical Neurology City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH UK
| | - on behalf of the PD COMM Pilot Collaborative Group
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
- Parkinson’s UK West Midlands Regional Branch, London, UK
- Faculty of Medicine, University of Southampton, London, UK
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
- School of Rehabilitation Sciences, University of East Anglia, Norwich, UK
- Department of Neurology, Clinical Neurology City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH UK
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Kearney E, Giles R, Haworth B, Faloutsos P, Baljko M, Yunusova Y. Sentence-Level Movements in Parkinson's Disease: Loud, Clear, and Slow Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:3426-3440. [PMID: 29209727 DOI: 10.1044/2017_jslhr-s-17-0075] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 08/19/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE To further understand the effect of Parkinson's disease (PD) on articulatory movements in speech and to expand our knowledge of therapeutic treatment strategies, this study examined movements of the jaw, tongue blade, and tongue dorsum during sentence production with respect to speech intelligibility and compared the effect of varying speaking styles on these articulatory movements. METHOD Twenty-one speakers with PD and 20 healthy controls produced 3 sentences under normal, loud, clear, and slow speaking conditions. Speech intelligibility was rated for each speaker. A 3-dimensional electromagnetic articulograph tracked movements of the articulators. Measures included articulatory working spaces, ranges along the first principal component, average speeds, and sentence durations. RESULTS Speakers with PD demonstrated significantly smaller jaw movements as well as shorter than normal sentence durations. Between-speaker variation in movement size of the jaw, tongue blade, and tongue dorsum was associated with speech intelligibility. Analysis of speaking conditions revealed similar patterns of change in movement measures across groups and articulators: larger than normal movement sizes and faster speeds for loud speech, increased movement sizes for clear speech, and larger than normal movement sizes and slower speeds for slow speech. CONCLUSIONS Sentence-level measures of articulatory movements are sensitive to both disease-related changes in PD and speaking-style manipulations.
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Affiliation(s)
- Elaine Kearney
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Renuka Giles
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Brandon Haworth
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Electrical Engineering and Computer Science, York University, Toronto, Ontario, Canada
| | - Petros Faloutsos
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Electrical Engineering and Computer Science, York University, Toronto, Ontario, Canada
| | - Melanie Baljko
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Electrical Engineering and Computer Science, York University, Toronto, Ontario, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Biological Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
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Pawlukowska W, Szylińska A, Kotlęga D, Rotter I, Nowacki P. Differences between Subjective and Objective Assessment of Speech Deficiency in Parkinson Disease. J Voice 2017; 32:715-722. [PMID: 29122413 DOI: 10.1016/j.jvoice.2017.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study aims to establish the frequency at which patients with Parkinson disease subjectively assess the intensity of their speech disorders, factors that the patients believe determine the severity of their vocal impairment, and how their subjective self-assessment of vocal impairment by means of the Voice Handicap Index compares with the objective evaluation of the performance of the articulatory organs by means of Frenchay Dysarthria Assessment. MATERIALS AND METHODS The methods used Voice Handicap Index, Frenchay Dysarthria Assessment, and the Hoehn and Yahr scale. RESULTS Positive correlation was found between the subjective assessment of the performance of the speech organs and the impaired differentiation of lip movements and tongue sideways movements, impaired saliva control, dysfunction of the soft palate, and the pitch. Negative correlation was found between the subjective assessment of the severity of speech disorder, breathing at rest, and sentence comprehension. CONCLUSIONS Although we observed correlation between the subjective perception of certain speech disorders of patients with Parkinson disease and the objective assessment carried out by means of the Frenchay Dysarthria Assessment scale, the subjects did not believe the disorders had a significant impact on the quality of speech. Negative results of an examination do not necessarily reflect the subjective perception of the decline in the functioning of the articulatory organs. It should be assumed that lack of correlation between the subjective perception measured using Voice Handicap Index and the objective Frenchay Dysarthria-based assessment of the performance of the articulatory organs may result from a good adaptation to the progressive changes.
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Affiliation(s)
- Wioletta Pawlukowska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Clinic of Neurology, Pomeranian Medical University, Szczecin, Poland.
| | - Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, Szczecin, Poland; Department of Neurology, District Hospital, Głogów, Poland
| | - Dariusz Kotlęga
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | - Iwona Rotter
- Department of Neurology, District Hospital, Głogów, Poland; Department of Neurology, District Hospital, Głogów, Poland
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Martel-Sauvageau V, Tjaden K. Vocalic transitions as markers of speech acoustic changes with STN-DBS in Parkinson's Disease. JOURNAL OF COMMUNICATION DISORDERS 2017; 70:1-11. [PMID: 29032347 PMCID: PMC6048951 DOI: 10.1016/j.jcomdis.2017.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 09/15/2017] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Deep Brain Stimulation of the subthalamic nucleus (STN-DBS) effectively treats cardinal symptoms of idiopathic Parkinson's disease (PD) that cannot be satisfactorily managed with medication. Research is equivocal regarding speech changes associated with STN-DBS. This study investigated the impact of STN-DBS on vocalic transitions and the relationship to intelligibility. METHODS Eight Quebec-French speakers with PD and eight healthy controls participated. The slope of the second formant frequency (F2 slope) for glides was obtained. Locus equations (LEs) were calculated to capture vocalic transitions in consonant-vowel sequences. A visual analog scale was used to obtain judgments of intelligibility. Measures for the PD group were obtained both On and Off stimulation. RESULTS F2 slopes and LEs differed among groups, but there were no systematic differences for On versus Off STN-DBS. On an individual level, participants with PD exhibited heterogeneous changes with DBS stimulation. Intelligibility was significantly correlated with F2 slope. CONCLUSION F2 slope appears to be sensitive to articulatory impairment in PD and could be used in clinical settings to distinguish these speakers from healthy controls. However, acoustic metrics failed to identify systematic change with STN-DBS. The heterogeneity of results, as well as the clinical relevance of acoustic metrics are discussed.
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Affiliation(s)
- Vincent Martel-Sauvageau
- Centre interdisciplinaire de recherche en réadaptation et en intégration sociale (CIRRIS), Canada.
| | - Kris Tjaden
- Dept. of Communicative Disorders & Sciences, University at Buffalo, Canada
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Contribution of language studies to the understanding of cognitive impairment and its progression over time in Parkinson’s disease. Neurosci Biobehav Rev 2017; 80:657-672. [DOI: 10.1016/j.neubiorev.2017.07.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/28/2017] [Accepted: 07/27/2017] [Indexed: 11/24/2022]
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Sörös P, Doñamayor N, Wittke C, Al-Khaled M, Brüggemann N, Münte TF. Increase in Beta-Band Activity during Preparation for Overt Speech in Patients with Parkinson's Disease. Front Hum Neurosci 2017; 11:371. [PMID: 28790903 PMCID: PMC5522874 DOI: 10.3389/fnhum.2017.00371] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 07/03/2017] [Indexed: 12/25/2022] Open
Abstract
Speech impairment is a frequent and often serious symptom of Parkinson's disease (PD), characterized by a disorder of phonation, articulation and prosody. While research on the pathogenesis of the prominent limb motor symptoms has made considerable progress in recent years, the pathophysiology of PD speech impairment is still incompletely understood. To investigate the neural correlates of speech production in PD, EEG was recorded in 14 non-demented patients with idiopathic PD and preserved verbal fluency on regular dopaminergic medication (8 women; mean age ± SD: 69.5 ± 8.0 years). The control group consisted of 15 healthy age-matched individuals (7 women; age: 69.7 ± 7.0 years). All participants performed a visually-cued, overt speech production task; required utterances were papapa and pataka. During the preparatory phase of speech production, in a time window of 200-400 ms after presentation of the visual cue, β-power was significantly increased in PD patients compared to healthy controls. Previous research has shown that the physiological decrease of β-power preceding limb movement onset is delayed and smaller in PD patients off medication and normalizes under dopaminergic treatment. By contrast, our study demonstrates that β-power during preparation for speech production is higher in patients on dopaminergic therapy than controls. Thus, our results suggest that the mechanisms that regulate β-activity preceding limb movement and speech production differ in PD. The pathophysiological role of this increase in β-power during speech preparation needs to be determined.
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Affiliation(s)
- Peter Sörös
- Department of Neurology, University of LübeckLübeck, Germany
- Psychiatry and Psychotherapy, School of Medicine and Health Sciences, University Hospital Karl-Jaspers-Klinik, University of OldenburgOldenburg, Germany
- Neuroimaging Unit, University of OldenburgOldenburg, Germany
- Research Center Neurosensory Science, University of OldenburgOldenburg, Germany
| | - Nuria Doñamayor
- Department of Neurology, University of LübeckLübeck, Germany
- Department of Psychiatry, University of CambridgeCambridge, United Kingdom
| | | | | | | | - Thomas F. Münte
- Department of Neurology, University of LübeckLübeck, Germany
- Institute of Psychology II, University of LübeckLübeck, Germany
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Abstract
Systemic lupus erythematosus (SLE) is a chronic disease characterized by progressive tissue damage. In recent decades, novel treatments have greatly extended the life span of SLE patients. This creates a high demand for identifying the overarching symptoms associated with SLE and developing therapies that improve their life quality under chronic care. We hypothesized that SLE patients would present dysphonic symptoms. Given that voice disorders can reduce life quality, identifying a potential SLE-related dysphonia could be relevant for the appraisal and management of this disease. We measured objective vocal parameters and perceived vocal quality with the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale in SLE patients and compared them to matched healthy controls. SLE patients also filled a questionnaire reporting perceived vocal deficits. SLE patients had significantly lower vocal intensity and harmonics to noise ratio, as well as increased jitter and shimmer. All subjective parameters of the GRBAS scale were significantly abnormal in SLE patients. Additionally, the vast majority of SLE patients (29/36) reported at least one perceived vocal deficit, with the most prevalent deficits being vocal fatigue (19/36) and hoarseness (17/36). Self-reported voice deficits were highly correlated with altered GRBAS scores. Additionally, tissue damage scores in different organ systems correlated with dysphonic symptoms, suggesting that some features of SLE-related dysphonia are due to tissue damage. Our results show that a large fraction of SLE patients suffers from perceivable dysphonia and may benefit from voice therapy in order to improve quality of life.
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Speech disorders in Parkinson’s disease: early diagnostics and effects of medication and brain stimulation. J Neural Transm (Vienna) 2017; 124:303-334. [PMID: 28101650 DOI: 10.1007/s00702-017-1676-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/04/2017] [Indexed: 01/31/2023]
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Novotný M, Rusz J, Čmejla R, Růžičková H, Klempíř J, Růžička E. Hypernasality associated with basal ganglia dysfunction: evidence from Parkinson's disease and Huntington's disease. PeerJ 2016; 4:e2530. [PMID: 27703866 PMCID: PMC5047145 DOI: 10.7717/peerj.2530] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/04/2016] [Indexed: 11/20/2022] Open
Abstract
Background Although increased nasality can originate from basal ganglia dysfunction, data regarding hypernasality in Parkinson’s disease (PD) and Huntington’s disease (HD) are very sparse. The aim of the current study was to analyze acoustic and perceptual correlates of velopharyngeal seal closure in 37 PD and 37 HD participants in comparison to 37 healthy control speakers. Methods Acoustical analysis was based on sustained phonation of the vowel /i/ and perceptual analysis was based on monologue. Perceptual analysis was performed by 10 raters using The Great Ormond Street Speech Assessment ’98. Acoustic parameters related to changes in a 1/3-octave band centered on 1 kHz were proposed to reflect nasality level and behavior through utterance. Results Perceptual analysis showed the occurrence of mild to moderate hypernasality in 65% of PD, 89% of HD and 22% of control speakers. Based on acoustic analyses, 27% of PD, 54% of HD and 19% of control speakers showed an increased occurrence of hypernasality. In addition, 78% of HD patients demonstrated a high occurrence of intermittent hypernasality. Further results indicated relationships between the acoustic parameter representing fluctuation of nasality and perceptual assessment (r = 0.51, p < 0.001) as well as the Unified Huntington Disease Rating Scale chorea composite subscore (r = 0.42, p = 0.01). Conclusions In conclusion the acoustic assessment showed that abnormal nasality was not a common feature of PD, whereas patients with HD manifested intermittent hypernasality associated with chorea.
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Affiliation(s)
- Michal Novotný
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague , Prague , CZ , Czech Republic
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, CZ, Czech Republic; Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague, Prague, CZ, Czech Republic
| | - Roman Čmejla
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague , Prague , CZ , Czech Republic
| | - Hana Růžičková
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague , Prague , CZ , Czech Republic
| | - Jiří Klempíř
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague, Prague, CZ, Czech Republic; Institute of Anatomy, First Faculty of Medicine, Charles University in Prague, Prague, CZ, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague , Prague , CZ , Czech Republic
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Motor symptoms in Parkinson’s disease: A unified framework. Neurosci Biobehav Rev 2016; 68:727-740. [DOI: 10.1016/j.neubiorev.2016.07.010] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 07/11/2016] [Indexed: 01/18/2023]
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Abstract
Parkinson's disease is a major source of neurologic morbidity. A majority of patients with Parkinson's disease complain of problems with voice, speech, and swallowing. Treatments for these problems center on the improvement of vocal fold adduction through either speech therapy or vocal fold augmentation. No prior study has looked at laryngeal improvement after neurologic surgery, specifically deep brain stimulation, performed to treat Parkinson's disease. The goal of this study was to establish a baseline of laryngeal findings in patients who are considering deep brain stimulation. Fifteen patients underwent physical examination with videostroboscopy and fiberoptic endoscopic evaluation of swallowing before deep brain stimulation. In addition, they were asked to self-report voice handicap. Eighty-seven percent of patients demonstrated significant vocal fold bowing. All patients had some degree of pharyngeal residue of solids noted on evaluation of swallowing. All but one patient had a significant self-reported voice handicap. These findings are reviewed and established as a baseline for further study.
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Affiliation(s)
- Joel H Blumin
- Penn Center for Voice, Pennsylvania Hospital, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19107, USA
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Theodoros DG, Hill AJ, Russell TG. Clinical and Quality of Life Outcomes of Speech Treatment for Parkinson's Disease Delivered to the Home Via Telerehabilitation: A Noninferiority Randomized Controlled Trial. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 25:214-232. [PMID: 27145396 DOI: 10.1044/2015_ajslp-15-0005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 11/30/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE This study investigated the noninferiority and validity of an intensive speech treatment for people with Parkinson's disease (PD) delivered via telerehabilitation to the home. The effect of location on online delivery was also investigated. METHOD In this single-blinded, randomized controlled noninferiority trial, 31 participants with dysarthria associated with PD from a metropolitan area were randomly assigned to either face-to-face or online Lee Silverman Voice Treatment (LSVT LOUD). A cohort of 21 participants from nonmetropolitan areas was also recruited and treated online. Outcomes were assessed using acoustic, perceptual, and quality of life measures. RESULTS Noninferiority of online treatment was confirmed through comparable clinical and quality of life outcomes for the metropolitan online and face-to-face treatment groups. Significant improvements posttreatment were achieved for several acoustic, perceptual, and quality of life measures across the groups. No significant effect of online treatment location was identified. CONCLUSIONS Clinical and quality of life outcomes supported the noninferiority and validity of online delivery of intensive speech treatment to people with PD in the home. Future research should address the implementation of online treatment in a clinical service, cost analyses, and potentially technology-enabled clinical pathways for people with PD in order to maintain optimal communication and quality of life.
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Effects of dopaminergic replacement therapy on motor speech disorders in Parkinson’s disease: longitudinal follow-up study on previously untreated patients. J Neural Transm (Vienna) 2016; 123:379-87. [DOI: 10.1007/s00702-016-1515-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
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Costa FPD, Diaféria G, Behlau M. Aspectos comunicativos e enfrentamento da disfonia em pacientes com doença de Parkinson. Codas 2016; 28:46-52. [DOI: 10.1590/2317-1782/20162015054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/16/2015] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Investigar as estratégias de enfrentamento utilizadas por indivíduos com doença de Parkinson (DP), os sintomas vocais mais relatados, os problemas de comunicação mais presentes e a relação entre o tipo de enfrentamento, os sintomas vocais e os aspectos comunicativos. Métodos: Participaram 73 indivíduos, 33 do grupo experimental, com diagnóstico de DP e apresentando desvio vocal, e 40 do grupo controle (GC), saudáveis, sem desvio vocal. Eles foram submetidos aos seguintes procedimentos: aplicação do Protocolo de Estratégias de Enfrentamento das Disfonias (PEEDBR), da Escala de Sintomas Vocais (ESV) e do Questionário Vivendo com Disartria (VcD). Resultados: O grupo experimental (GE) apresentou desvios em todos os protocolos: PEEDBR, sendo a estratégia de enfrentamento mais utilizada a de "Autocontrole", ESV, com o domínio prevalente "Limitação", e VcD, com alteração em todas as seções. O PEEDBR apresentou correlação regular com a ESV e o VcD. Já entre o Questionário VcD e a ESV, verificouse relação direta entre o escore total do VcD e o escore total e o domínio emocional da ESV. Conclusão: Pacientes com DP usam todos os tipos de estratégias de enfrentamento, principalmente "Autocontrole". Eles possuem grande quantidade de sinais e sintomas vocais, e "Limitação" foi o domínio mais predominante. Há presença de dificuldades em todos os aspectos que abrangem sua comunicação. Quanto maior a ocorrência de sinais e sintomas vocais, mais o paciente refere ser difícil viver com a disartria, particularmente quando há desvios no domínio emocional.
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Affiliation(s)
| | - Giovana Diaféria
- Universidade Federal de São Paulo, Brazil; Centro de Estudos da Voz, Brasil; Associação Brasil Parkinson, Brasil
| | - Mara Behlau
- Universidade Federal de São Paulo, Brazil; Centro de Estudos da Voz, Brasil
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Articulatory Changes in Vowel Production following STN DBS and Levodopa Intake in Parkinson's Disease. PARKINSONS DISEASE 2015; 2015:382320. [PMID: 26558134 PMCID: PMC4617696 DOI: 10.1155/2015/382320] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/24/2015] [Accepted: 09/14/2015] [Indexed: 11/22/2022]
Abstract
Purpose. To investigate the impact of deep brain stimulation of the subthalamic nucleus (STN DBS) and levodopa intake on vowel articulation in dysarthric speakers with Parkinson's disease (PD). Methods. Vowel articulation was assessed in seven Quebec French speakers diagnosed with idiopathic PD who underwent STN DBS. Assessments were conducted on- and off-medication, first prior to surgery and then 1 year later. All recordings were made on-stimulation. Vowel articulation was measured using acoustic vowel space and formant centralization ratio. Results. Compared to the period before surgery, vowel articulation was reduced after surgery when patients were off-medication, while it was better on-medication. The impact of levodopa intake on vowel articulation changed with STN DBS: before surgery, levodopa impaired articulation, while it no longer had a negative effect after surgery. Conclusions. These results indicate that while STN DBS could lead to a direct deterioration in articulation, it may indirectly improve it by reducing the levodopa dose required to manage motor symptoms. These findings suggest that, with respect to speech production, STN DBS and levodopa intake cannot be investigated separately because the two are intrinsically linked. Along with motor symptoms, speech production should be considered when optimizing therapeutic management of patients with PD.
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