Treating Speech Movement Hypokinesia in Parkinson's Disease: Does Movement Size Matter?

The Relationship Between Acoustic and Kinematic Vowel Space Areas With and Without Normalization for Speakers With and Without Dysarthria

PURPOSE

Few studies have reported on the vowel space area (VSA) in both acoustic and kinematic domains. This study examined acoustic and kinematic VSAs for speakers with and without dysarthria and evaluated effects of normalization on acoustic and kinematic VSAs and the relationship between these measures.

METHOD

Vowel data from 12 speakers with and without dysarthria, presenting with a range of speech abilities, were examined. The speakers included four speakers with Parkinson's disease (PD), four speakers with brain injury (BI), and four neurotypical (NT) speakers. Speech acoustic and kinematic data were acquired simultaneously using electromagnetic articulography during a passage reading task. Raw and normalized VSAs calculated from corner vowels /i/, /æ/, /ɑ/, and /u/ were evaluated. Normalization was achieved through z score transformations to the acoustic and kinematic data. The effect of normalization on variability within and across groups was evaluated. Regression analysis was used across speakers to assess the association between acoustic and kinematic VSAs for both raw and normalized data.

RESULTS

When evaluating the speakers as three different groups (i.e., PD, BI, and NT), normalization reduced the standard deviations within each group and changed the relative differences in average magnitude between groups. Regression analysis revealed a significant relationship between normalized, but not raw, acoustic and kinematic VSAs, after the exclusion of an outlier speaker.

CONCLUSIONS

Normalization reduces the variability across speakers, within groups, and changes average magnitudes affecting speaker group comparisons. Normalization also influences the correlation between acoustic and kinematic measures. Further investigation of the impact of normalization techniques upon acoustic and kinematic measures is warranted.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22669747.

Palatal Electrotactile Display Outperforms Visual Display in Tongue Motor learning

Incomplete tongue motor control is a common yet challenging issue among individuals with neurotraumas and neurological disorders. In development of the training protocols, multiple sensory modalities including visual, auditory, and tactile feedback have been employed. However, the effectiveness of each sensory modality in tongue motor learning is still in question. The object of this study was to test the effectiveness of visual and electrotactile assistance on tongue motor learning, respectively. Eight healthy subjects performed the tongue pointing task, in which they were visually instructed to touch the target on the palate by their tongue tip as accurately as possible. Each subject wore a custom-made dental retainer with 12 electrodes distributed over the palatal area. For visual training, 3×4 LED array on the computer screen, corresponding to the electrode layout, was turned on with different colors according to the tongue contact. For electrotactile training, electrical stimulation was applied to the tongue with frequencies depending on the distance between the tongue contact and the target, along with a small protrusion on the retainer as an indicator of the target. One baseline session, one training session, and three post-training sessions were conducted over four-day duration. Experimental result showed that the error was decreased after both visual and electrotactile trainings, from 3.56±0.11 (Mean±STE) to 1.27±0.16, and from 3.97±0.11 to 0.53±0.19, respectively. The result also showed that electrotactile training leads to stronger retention than visual training, as the improvement was retained as 62.68±1.81% after electrotactile training and 36.59±2.24% after visual training, at 3-day post training.

A Survey on Gamification for Health Rehabilitation Care: Applications, Opportunities, and Open Challenges

Research trends in gamification have shown a significant diversity in various areas of e-health, particularly in addressing the issues of rehabilitation and physical activity. Rehabilitation requires better engaging tools that help to increase the patient’s motivation and engagement in particular forms of rehabilitation training. Adopting gamification in rehabilitation offers different treatment and care environments when implementing rehabilitation training. As gamification is increasingly being explored in rehabilitation, one might not realize that using various techniques in gamified applications yields a different effect on gameplay. To date, varied gamification techniques have been utilized to provide useful experiences from the perspective of health applications. However, a limited number of surveys have investigated the gamification of rehabilitation and the use of suitable game techniques for rehabilitation in the literature. The objective of this paper is to examine and analyze the existing gamification techniques for rehabilitation applications. A classification of rehabilitation gamification is developed based on the rehabilitation gamifying requirements and the gamification characteristics that are commonly applied in rehabilitation applications. This classification is the main contribution of this paper. It provides insight for researchers and practitioners into suitable techniques to design and apply gamification with increased motivation and sustainable engagement for rehabilitation treatment and care. In addition, different game elements, selection blocks, and gamification techniques are identified for application in rehabilitation. In conclusion, several challenges and research opportunities are discussed to improve gamification deployment in rehabilitation in the future.

Interventions Involving Biofeedback to Improve Swallowing in People With Parkinson Disease and Dysphagia: A Systematic Review

OBJECTIVES

To examine the effectiveness of biofeedback used in the treatment of adults with Parkinson disease (PD) and dysphagia, define the factors associated with biofeedback treatment outcomes, and inform a theory to guide the implementation of biofeedback in future dysphagia interventions.

DATA SOURCES

A systematic review using a narrative synthesis approach of all published and unpublished studies were sought with no date or language restrictions. Ten electronic databases (EMBASE, PubMed, CINAHL, Web of Science, Scopus, Science Direct, AMED, The Cochrane Database of Systematic Reviews, ProQuest Dissertations and Theses A & I, Google Scholar) were searched from inception to April 2019. This search was updated in January 2020. The methodological quality of included studies was assessed using Downs and Black checklist.

STUDY SELECTION

Four studies were included. The methodological quality of the included studies was low with a high risk of bias. Data were analyzed narratively and descriptively. Despite the heterogeneity of the included studies, the findings suggest that interventions incorporating visual biofeedback may have positive effects on swallowing-related quality of life.

CONCLUSIONS

Based on these preliminary findings, we provide directions for further research and clinical interventions that incorporate an augmentative biofeedback component of swallowing interventions in people with PD. Future studies should be rigorously designed and set appropriate biofeedback treatment in terms of types, schedules, and timing.

Motor-cognitive approach and aerobic training: a synergism for rehabilitative intervention in Parkinson's disease

Parkinson's disease (PD) results in a complex deterioration of motor behavior. Effective pharmacological or surgical treatments addressing the whole spectrum of both motor and cognitive symptoms are lacking. The cumulative functional impairment may have devastating socio-economic consequences on both patients and caregivers. Comprehensive models of care based on multidisciplinary approaches may succeed in better addressing the overall complexity of PD. Neurorehabilitation is a highly promising non-pharmacological intervention for managing PD. The scientific rationale beyond rehabilitation and its practical applicability remain to be established. In the present perspective, we aim to discuss the current evidence supporting integrated motor-cognitive and aerobic rehabilitation approaches for patients with PD while suggesting a practical framework to optimize this intervention in the next future.