Heightened orofacial, manual, and gait variability in Parkinson's disease results from a general rhythmic impairment

Mobile version of the Battery for the Assessment of Auditory Sensorimotor and Timing Abilities (BAASTA): Implementation and adult norms

Timing and rhythm abilities are complex and multidimensional skills that are highly widespread in the general population. This complexity can be partly captured by the Battery for the Assessment of Auditory Sensorimotor and Timing Abilities (BAASTA). The battery, consisting of four perceptual and five sensorimotor tests (finger-tapping), has been used in healthy adults and in clinical populations (e.g., Parkinson's disease, ADHD, developmental dyslexia, stuttering), and shows sensitivity to individual differences and impairment. However, major limitations for the generalized use of this tool are the lack of reliable and standardized norms and of a version of the battery that can be used outside the lab. To circumvent these caveats, we put forward a new version of BAASTA on a tablet device capable of ensuring lab-equivalent measurements of timing and rhythm abilities. We present normative data obtained with this version of BAASTA from over 100 healthy adults between the ages of 18 and 87 years in a test-retest protocol. Moreover, we propose a new composite score to summarize beat-based rhythm capacities, the Beat Tracking Index (BTI), with close to excellent test-retest reliability. BTI derives from two BAASTA tests (beat alignment, paced tapping), and offers a swift and practical way of measuring rhythmic abilities when research imposes strong time constraints. This mobile BAASTA implementation is more inclusive and far-reaching, while opening new possibilities for reliable remote testing of rhythmic abilities by leveraging accessible and cost-efficient technologies.

Intergenerational choral singing to improve communication outcomes in Parkinson's disease: Development of a theoretical framework and an integrated measurement tool

Purpose: This study presented an initial step towards developing the evidence base for intergenerational choral singing as a communication-focussed rehabilitative approach for Parkinson's disease (PD).Method: A theoretical framework was established to conceptualise the rehabilitative effect of intergenerational choral singing on four domains of communication impairments - motor drive, timing mechanism, sensorimotor integration, higher-level cognitive and affective functions - as well as activity/participation, and quality of life. A computer-assisted multidimensional acoustic analysis was developed to objectively assess the targeted domains of communication impairments. Voice Handicap Index and the World Health Organization's Quality of Life assessment-abbreviated version were used to obtain patient-reported outcomes at the activity/participation and quality of life levels. As a proof of concept, a single subject with PD was recruited to participate in 9 weekly 1-h intergenerational choir rehearsals. The subject was assessed before, 1 week post, and 8 weeks post-choir.Result: Notable trends of improvement were observed in multiple domains of communication impairments at 1 week post-choir. Some improvements were maintained at 8 weeks post-choir. Patient-reported outcomes exhibited limited pre-post changes.Conclusion: This study provided the theoretical groundwork and an empirical measurement tool for future validation of intergenerational choral singing as a novel rehabilitation for PD.

Oromotor Nonverbal Performance and Speech Motor Control: Theory and Review of Empirical Evidence

This position paper offers a perspective on the long-standing debate concerning the role of oromotor, nonverbal gestures in understanding typical and disordered speech motor control secondary to neurological disease. Oromotor nonverbal tasks are employed routinely in clinical and research settings, but a coherent rationale for their use is needed. The use of oromotor nonverbal performance to diagnose disease or dysarthria type, versus specific aspects of speech production deficits that contribute to loss of speech intelligibility, is argued to be an important part of the debate. Framing these issues are two models of speech motor control, the Integrative Model (IM) and Task-Dependent Model (TDM), which yield contrasting predictions of the relationship between oromotor nonverbal performance and speech motor control. Theoretical and empirical literature on task specificity in limb, hand, and eye motor control is reviewed to demonstrate its relevance to speech motor control. The IM rejects task specificity in speech motor control, whereas the TDM is defined by it. The theoretical claim of the IM proponents that the TDM requires a special, dedicated neural mechanism for speech production is rejected. Based on theoretical and empirical information, the utility of oromotor nonverbal tasks as a window into speech motor control is questionable.

The effect of standing posture on amplitude and variability of postural tremor in Parkinson’s disease

INTRODUCTION

This study examined whether altering body position (i.e., sitting or standing) affected the dynamics of physiological tremor for healthy older adults and persons with Parkinson's disease (PD). It was also of interest to determine how consistent the tremor was for both groups as determined by examining changes in within-subject variability of tremor amplitude, regularity and frequency.

METHODS

Ten Parkinsonian participants (65.1±3.2 yrs.) and twelve elderly persons (71.2±2.6 yrs.) participated in this study. Tremor was collected from the index finger and hand segments using lightweight accelerometers during the performance of a bilateral pointing task. Persons performed the pointing task in a standing or sitting position.

RESULTS

As expected, the tremor for the PD persons was greater in magnitude (mean RMS, peak power), more regular (lower SampEn), and more inconsistent from trial-to-trial (increased intra-individual variability, IIV) than the tremor recorded for the elderly. Further, when assessed during standing, the magnitude of the tremor for all individuals (elderly and PD) was greater, more variable, and less complex compared to the tremor when assessed during the sitting posture. The only measure which did not change within each group was the frequency of the major tremor peak which remained consistent, showing no significant change between limbs or as a function of the posture adopted.

CONCLUSION

The findings revealed that tremor increased in amplitude and decreased in regularity for all individuals was assessed when standing compared to sitting. It is likely that these increases were task-related, reflecting the increased physical demands of performing the task when standing rather than being driven by specific age- or disease-related changes in the mechanisms underlying tremorgenesis. Further, the tremor for the PD individuals tended to be more variable from trial-by-trial in terms of both amplitude and regularity as compared to the elderly persons. Interestingly, the only tremor metric which showed no change within each group was the frequency of the major tremor peak which was consistent within both groups irrespective of the posture adopted.

Quality standards and recommendations for research in music and neuroplasticity

Research on how music influences brain plasticity has gained momentum in recent years. Considering, however, the nonuniform methodological standards implemented, the findings end up being nonreplicable and less generalizable. To address the need for a standardized baseline of research quality, we gathered all the studies in the music and neuroplasticity field in 2019 and appraised their methodological rigor systematically and critically. The aim was to provide a preliminary and, at the minimum, acceptable quality threshold-and, ipso facto, suggested recommendations-whereupon further discussion and development may take place. Quality appraisal was performed on 89 articles by three independent raters, following a standardized scoring system. The raters' scoring was cross-referenced following an inter-rater reliability measure, and further studied by performing multiple ratings comparisons and matrix analyses. The results for methodological quality were at a quite good level (quantitative articles: mean = 0.737, SD = 0.084; qualitative articles: mean = 0.677, SD = 0.144), following a moderate but statistically significant level of agreement between the raters (W = 0.44, χ² = 117.249, p = 0.020). We conclude that the standards for implementation and reporting are of high quality; however, certain improvements are needed to reach the stringent levels presumed for such an influential interdisciplinary scientific field.

Phoneme Representation and Articulatory Impairment: Insights from Adults with Comorbid Motor Coordination Disorder and Dyslexia

Phonemic processing skills are impaired both in children and adults with dyslexia. Since phoneme representation development is based on articulatory gestures, it is likely that these gestures influence oral reading-related skills as assessed through phonemic awareness tasks. In our study, fifty-two young dyslexic adults, with and without motor impairment, and fifty-nine skilled readers performed reading, phonemic awareness, and articulatory tasks. The two dyslexic groups exhibited slower articulatory rates than skilled readers and the comorbid dyslexic group presenting with an additional difficulty in respiratory control (reduced speech proportion and increased pause duration). Two versions of the phoneme awareness task (PAT) with pseudoword strings were administered: a classical version under time pressure and a delayed version in which access to phonemic representations and articulatory programs was facilitated. The two groups with dyslexia were outperformed by the control group in both versions. Although the two groups with dyslexia performed equally well on the classical PAT, the comorbid group performed significantly less efficiently on the delayed PAT, suggesting an additional contribution of articulatory impairment in the task for this group. Overall, our results suggest that impaired phoneme representations in dyslexia may be explained, at least partially, by articulatory deficits affecting access to them.

Intra-individual variability in cognitive performance predicts functional decline in Parkinson's disease

BACKGROUND

Cognitive deficits contribute to disability in Parkinson's disease (PD). Cognitive intra-individual variability (IIV) is associated with cognitive decline in age-related disorders, but IIV has not been related to functional ability in PD. We examined IIV in predicting functional ability in participants with PD.

METHODS

De-identified National Alzheimer's Coordinating Center data (N = 1,228) from baseline and follow-up visits included participants with PD propensity score matched to control participants at baseline on age (M = 72), education (M = 15), and gender (28% female). PD symptom duration averaged 6 years. Outcome measures included the Functional Ability Questionnaire (FAQ), overall test battery mean (OTBM) of ten cognitive variables, IIV calculated as the standard deviation of cognitive data for each participant, Geriatric Depression Scale (GDS), and Unified PD Rating Scale gait and posture items. Baseline FAQ status in the PD group was predicted using logistic regression with age, education, cognition, GDS, and motor function as predictors. We compared baseline characteristics of PD participants with and without functional impairment at follow up.

RESULTS

PD participants showed lower OTBM and greater IIV, GDS, and motor dysfunction than controls (p < .0001). Education, OTBM, IIV, GDS, and gait predicted functional status (77% overall classification; AUC = .84). PD participants with functional impairment at follow up showed significantly lower OTBM and greater IIV, GDS, and motor dysfunction at baseline (p < .001).

CONCLUSION

IIV independently predicts functional status in participants with PD while controlling for other variables. PD participants with functional impairment at follow up showed greater IIV than those without functional impairment at follow up.

Temporal malleability to auditory feedback perturbation is modulated by rhythmic abilities and auditory acuity

Auditory feedback perturbation studies have indicated a link between feedback and feedforward mechanisms in speech production when participants compensate for applied shifts. In spectral perturbation studies, speakers with a higher perceptual auditory acuity typically compensate more than individuals with lower acuity. However, the reaction to feedback perturbation is unlikely to be merely a matter of perceptual acuity but also affected by the prediction and production of precise motor action. This interplay between prediction, perception, and motor execution seems to be crucial for the timing of speech and non-speech motor actions. In this study, to examine the relationship between the responses to temporally perturbed auditory feedback and rhythmic abilities, we tested 45 adult speakers on the one hand with a temporal auditory feedback perturbation paradigm, and on the other hand with rhythm perception and production tasks. The perturbation tasks temporally stretched and compressed segments (onset + vowel or vowel + coda) in fluent speech in real-time. This technique sheds light on the temporal representation and the production flexibility of timing mechanisms in fluent speech with respect to the structure of the syllable. The perception tasks contained staircase paradigms capturing duration discrimination abilities and beat-alignment judgments. The rhythm production tasks consisted of finger tapping tasks taken from the BAASTA tapping battery and additional speech tapping tasks. We found that both auditory acuity and motor stability in finger tapping affected responses to temporal auditory feedback perturbation. In general, speakers with higher auditory acuity and higher motor variability compensated more. However, we observed a different weighting of auditory acuity and motor stability dependent on the prosodic structure of the perturbed sequence and the nature of the response as purely online or adaptive. These findings shed light on the interplay of phonological structure with feedback and feedforward integration for timing mechanisms in speech.

Rhythmic serious games as an inclusive tool for music-based interventions

Technologies, such as mobile devices or sets of connected sensors, provide new and engaging opportunities to devise music-based interventions. Among the different technological options, serious games offer a valuable alternative. Serious games can engage multisensory processes, creating a rich, rewarding, and motivating rehabilitation setting. Moreover, they can be targeted to specific musical features, such as pitch production or synchronization to a beat. Because serious games are typically low cost and enjoy wide access, they are inclusive tools perfectly suited for remote at-home interventions using music in various patient populations and environments. The focus of this article is in particular on the use of rhythmic serious games for training auditory-motor synchronization. After reviewing the existing rhythmic games, initial evidence from a recent proof-of-concept study in Parkinson's disease is provided. It is shown that rhythmic video games using finger tapping can be used with success as an at-home protocol, and bring about beneficial effects on motor performance in patients. The use and benefits of rhythmic serious games can extend beyond the rehabilitation of patients with movement disorders, such as to neurodevelopmental disorders, including dyslexia and autism spectrum disorder.

At-Home Training With a Rhythmic Video Game for Improving Orofacial, Manual, and Gait Abilities in Parkinson’s Disease: A Pilot Study

Rhythm disorders are consistently reported in Parkinson’s disease (PD). They manifest across motor domains, such as in orofacial (oral diadochokinesis), manual (finger tapping), and gait tasks. It is still unclear, however, whether these disorders are domain- and task-specific, or result from impaired common mechanisms supporting rhythm processing (general dysrhythmia). We tested the possibility that an at-home intervention delivered via a rhythmic video game on tablet improves motor performance across motor domains in PD. Patients with PD (n = 12) played at home a rhythmic video game (Rhythm Workers) on tablet, in which they finger-tapped to the beat of music, for 6 weeks. A control group (n = 11) played an active non-rhythmic video game (Tetris). A third group (n = 10) did not receive any intervention. We measured rhythmic abilities in orofacial, manual and gait motor domains, as well as rhythm perception, before and after the intervention. Patients who performed the rhythmic training improved their orofacial and manual rhythmic performance. This beneficial effect was linked to improved rhythm perception only following the rhythmic training period. We did not observe any improvement in rhythmic abilities in the other two groups. In this pilot study, we demonstrated that at-home intervention with a rhythmic video game using finger tapping can have beneficial effects on motor performance across different motor domains (manual and orofacial). This finding provides evidence of a general dysrhythmia in PD and paves the way to technology-driven interventions aiming at alleviating rhythm-related motor deficits in PD.

You got rhythm, or more: The multidimensionality of rhythmic abilities

Humans have a remarkable capacity for perceiving and producing rhythm. Rhythmic competence is often viewed as a single concept, with participants who perform more or less accurately on a single rhythm task. However, research is revealing numerous sub-processes and competencies involved in rhythm perception and production, which can be selectively impaired or enhanced. To investigate whether different patterns of performance emerge across tasks and individuals, we measured performance across a range of rhythm tasks from different test batteries. Distinct performance patterns could potentially reveal separable rhythmic competencies that may draw on distinct neural mechanisms. Participants completed nine rhythm perception and production tasks selected from the Battery for the Assessment of Auditory Sensorimotor and Timing Abilities (BAASTA), the Beat Alignment Test (BAT), the Beat-Based Advantage task (BBA), and two tasks from the Burgundy best Musical Aptitude Test (BbMAT). Principal component analyses revealed clear separation of task performance along three main dimensions: production, beat-based rhythm perception, and sequence memory-based rhythm perception. Hierarchical cluster analyses supported these results, revealing clusters of participants who performed selectively more or less accurately along different dimensions. The current results support the hypothesis of divergence of rhythmic skills. Based on these results, we provide guidelines towards a comprehensive testing of rhythm abilities, including at least three short tasks measuring: (1) rhythm production (e.g., tapping to metronome/music), (2) beat-based rhythm perception (e.g., BAT), and (3) sequence memory-based rhythm processing (e.g., BBA). Implications for underlying neural mechanisms, future research, and potential directions for rehabilitation and training programs are discussed.

Oral and Laryngeal Diadochokinesis Across the Life Span: A Scoping Review of Methods, Reference Data, and Clinical Applications

PURPOSE

The aim of this study was to conduct a scoping review of research on oral and laryngeal diadochokinesis (DDK) in children and adults, either typically developing/developed or with a clinical diagnosis.

METHOD

Searches were conducted with PubMed/MEDLINE, Google Scholar, CINAHL, and legacy sources in retrieved articles. Search terms included the following: DDK, alternating motion rate, maximum repetition rate, sequential motion rate, and syllable repetition rate.

RESULTS

Three hundred sixty articles were retrieved and included in the review. Data source tables for children and adults list the number and ages of study participants, DDK task, and language(s) spoken. Cross-sectional data for typically developing children and typically developed adults are compiled for the monosyllables /pʌ/, /tʌ/, and /kʌ/; the trisyllable /pʌtʌkʌ/; and laryngeal DDK. In addition, DDK results are summarized for 26 disorders or conditions.

DISCUSSION

A growing number of multidisciplinary reports on DDK affirm its role in clinical practice and research across the world. Atypical DDK is not a well-defined singular entity but rather a label for a collection of disturbances associated with diverse etiologies, including motoric, structural, sensory, and cognitive. The clinical value of DDK can be optimized by consideration of task parameters, analysis method, and population of interest.

Evaluating a Speech-Specific and a Computerized Step-Training-Specific Rhythmic Intervention in Parkinson's Disease: A Cross-Over, Multi-Arms Parallel Study

Background:

Recent studies suggest movements of speech and gait in patients with Parkinson's Disease (PD) are impaired by a common underlying rhythmic dysfunction. If this being the case, motor deficits in speech and gait should equally benefit from rhythmic interventions regardless of whether it is a speech-specific or step-training-specific approach.

Objective:

In this intervention trial, we studied the effects of two rhythmic interventions on speech and gait. These rhythmic intervention programs are similar in terms of intensity and frequency (i.e., 3x per week, 45 min-long sessions for 4 weeks in total), but differ regarding therapeutic approach (rhythmic speech vs. rhythmic balance-mobility training).

Methods:

This study is a cross-over, parallel multi-arms, single blind intervention trial, in which PD patients treated with rhythmic speech-language therapy (rSLT; N = 16), rhythmic balance-mobility training (rBMT; N = 10), or no therapy (NT; N = 18) were compared to healthy controls (HC; N = 17; matched by age, sex, and education: p > 0.82). Velocity and cadence in speech and gait were evaluated at baseline (BL), 4 weeks (4W-T1), and 6 months (6M-T2) and correlated.

Results:

Parameters in speech and gait (i.e., speaking and walking velocity, as well as speech rhythm with gait cadence) were positively correlated across groups (p < 0.01). Statistical analyses involved repeated measures ANOVA across groups and time, as well as independent and one-samples t-tests for within groups analyses. Statistical analyses were amplified using Reliable Change (RC) and Reliable Change Indexes (RCI) to calculate true clinically significant changes due to the treatment on a patient individual level. Rhythmic intervention groups improved across variables and time (total Mean Difference: 3.07 [SD 1.8]; 95% CI 0.2–11.36]) compared to the NT group, whose performance declined significantly at 6 months (p < 0.01). HC outperformed rBMT and NT groups across variables and time (p < 0.001); the rSLT performed similarly to HC at 4 weeks and 6 months in speech rhythm and respiration.

Conclusions:

Speech and gait deficits in PD may share a common mechanism in the underlying cortical circuits. Further, rSLT was more beneficial to dysrhythmic PD patients than rBMT, likely because of the nature of the rhythmic cue.

Speech Rhythm Variation in Early-Stage Parkinson's Disease: A Study on Different Speaking Tasks

Patients with Parkinson's disease (PD) usually reveal speech disorders and, among other symptoms, the alteration of speech rhythm. The purpose of this study is twofold: (1) to test the validity of two acoustic parameters-%V, vowel percentage and VtoV, the mean interval between two consecutive vowel onset points-for the identification of rhythm variation in early-stage PD speech and (2) to analyze the effect of PD on speech rhythm in two different speaking tasks: reading passage and monolog. A group of 20 patients with early-stage PD was involved in this study and compared with 20 age- and sex-matched healthy controls (HCs). The results of the acoustic analysis confirmed that %V is a useful cue for early-stage PD speech characterization, having significantly higher values in the production of patients with PD than the values in HC speech. A simple speaking task, such as the reading task, was found to be more effective than spontaneous speech in the detection of rhythmic variations.

The relation between falls risk and movement variability in Parkinson's disease

Falls are a major health concern for older adults with Parkinson's disease (PD). This study was designed to examine differences in falls risk and its relation to changes in the average and variability (i.e. intra-individual variability) of reaction time (RT), finger tapping, standing balance and walking between healthy older adults and persons with PD. Thirty-nine adults with PD (70.0 ± 8.1 years) and 29 healthy older adults (66.8 ± 10.4 years) participated in this study. Falls risk (using the physiological profile assessment), gait, RT, balance and tapping responses were assessed for all persons. Results demonstrated that individuals with PD exhibited a greater risk of falling coupled with a general slowing of motor function covering declines in walking, RT and finger tapping. In addition, the movement responses of the PD group were more variable than the healthy older adults. Correlation results revealed group differences with regards to the neuromotor measures which were significantly correlated with falls risk. For the PD group, gait measures were highly correlated with their falls risk while, for the healthy older adults, falls risk was linked to balance measures even though PD persons had increased sway. Overall, persons with PD were at greater falls risk, moved slower and with increased variability compared to the healthy older adults. Further, while there are some similarities between the two groups in terms of those measures related to falls risk, there were also several differences which highlight that persons with PD can have different risk factors for falling compared to healthy adults of similar age.

Disruptions of cortico-kinematic interactions in Parkinson's disease

The cortical role of the motor symptoms reflected by kinematic characteristics in Parkinson's disease (PD) is poorly understood. In this study, we aim to explore how PD affects cortico-kinematic interactions. Electroencephalographic (EEG) and kinematic data were recorded from seven healthy participants and eight participants diagnosed with PD during a set of self-paced finger tapping tasks. Event-related desynchronization (ERD) was compared between groups in the α (8-14 Hz), low-ß (14-20 Hz), and high-ß (20-35 Hz) frequency bands to investigate between-group differences in the cortical activities associated with movement. Average kinematic peak amplitudes and latencies were extracted alongside Sample Entropy (SaEn), a measure of signal complexity, as variables for comparison between groups. These variables were further correlated with average EEG power in each frequency band to establish within-group interactions between cortical motor functions and kinematic motor output. High ß-band power correlated with mean kinematic peak latency and signal complexity in the healthy group, while no correlation was found in the PD group. Also, the healthy group demonstrated stronger ERD in the broad ß-band than the PD participants. Our results suggest that cortical ß-band power in healthy populations is graded to finger tapping latency and complexity of movement, but this relationship is impaired in PD. These insights could help further enhance our understanding of the role of cortical ß-band oscillations in healthy movement and the possible disruption of that relationship in PD. These outcomes can provide further directions for treatment and therapeutic applications and potentially establish cortical biomarkers of Parkinson's disease.