Blog Archives

Functional magnetic resonance imaging exploration of combined hand and speech movements in Parkinson’s disease

Among the repertoire of motor functions, although hand movement and speech production tasks have been investigated widely by functional neuroimaging, paradigms combining both movements have been studied less so. Such paradigms are of particular interest in Parkinson’s disease, in which patients have specific difficulties performing two movements simultaneously. In 9 unmedicated patients with Parkinson’s disease and 15 healthy control subjects, externally cued tasks (i.e., hand movement, speech production, and combined hand movement and speech production) were performed twice in a random order and functional magnetic resonance imaging detected cerebral activations, compared to the rest. F-statistics tested within-group (significant activations at P values < 0.05, familywise error corrected), between-group, and between-task comparisons (regional activations significant at P values 10 voxels). For control subjects, the combined task activations comprised the sum of those obtained during hand movement and speech production performed separately, reflecting the neural correlates of performing movements sharing similar programming modalities. In patients with Parkinson’s disease, only activations underlying hand movement were observed during the combined task. We interpreted this phenomenon as patients’ potential inability to recruit facilitatory activations while performing two movements simultaneously. This lost capacity could be related to a functional prioritization of one movement (i.e., hand movement), in comparison with the other (i.e., speech production). Our observation could also reflect the inability of patients with Parkinson’s disease to intrinsically engage the motor coordination necessary to perform a combined task. © 2011 Movement Disorder Society

from Movement Disorders

Feasibility of Group Voice Therapy, for Individuals with Parkinson’s Disease

Conclusions
Clinician and participant feedback indicated that it was feasible to execute most LSVT® tasks in a group format with some modifications. The preliminary outcome data indicate that the targeted behavior (voice dB and loudness) did change in the predicted direction as did several other measures. Future studies comparing outcomes of group intervention to the gold standard LSVT®, and exploring retention of treatment gains over time, are needed.

from the Journal of Communication Disorders

Intensive Voice Treatment (LSVT®LOUD) for Parkinson’s disease following Deep Brain Stimulation of the Subthalamic Nucleus

Conclusions
Results support LSVT LOUD for treating voice and speech in individuals with PD following STN-DBS surgery. However, modifications may be required to maintain functional improvements.

from the Journal of Communication Disorders

Linguistic Complexity, Speech Production, and Comprehension in Parkinson’s Disease: Behavioral and Physiological Indices

Conclusions: These findings provide a novel window into the speech deficits associated with PD by examining performance on longer, sentence-level utterances in contrast to earlier investigations of single-word or nonword productions. Speech motor control processes and language comprehension were adversely affected in the majority of our participants with mild to moderate PD compared to the control group. Finally, increased syntactic complexity and sentence length affected both the healthy aging and PD groups’ speech production performance at the behavioral and kinematic levels.

from the Journal of Speech, Language, and Hearing Research

Modulation of dysarthropneumophonia by low-frequency STN DBS in advanced Parkinson’s disease

Conclusions:
Chronic treatment with low-frequency STN DBS may have a beneficial impact on dysarthropneumophonia, even in advanced PD patients.

from Movement Disorders

Comparison of subthalamic nucleus deep brain stimulation and Duodopa in the treatment of advanced Parkinson’s disease

Conclusion:
STN-DBS and Duodopa showed a significant efficacy on motor symptoms, activities of daily living, and motor complications. The group of Duodopa-treated patients developed more procedure-related complications.

from Movement Disorders

Blind randomized controlled study of the efficacy of cognitive training in Parkinson’s disease

The aim of this study was to analyze the efficacy of a cognitive training program on cognitive performance and quality of life in nondemented Parkinson’s disease patients. Participants who met UK Brain Bank diagnosis criteria for Parkinson’s disease, with I–III Hoehn & Yahr, aged 50–80, and nondemented (Mini-Mental State Examination ≥ 23) were recruited. Patient’s cognitive performance and functional and quality-of-life measures were assessed with standardized neuropsychological tests and scales at baseline and after 4 weeks. Subjects were randomly and blindly allocated by age and premorbid intelligence (Vocabulary, Wechsler Adult Intelligence Scale-III) into 2 groups: an experimental group and a control group. The experimental group received 4 weeks of 3 weekly 45-minute sessions using multimedia software and paper-and-pencil cognitive exercises, and the control group received speech therapy. A total of 28 patients were analyzed. Compared with the control group participants (n = 12), the experimental group participants (n = 16) demonstrated improved performance in tests of attention, information processing speed, memory, visuospatial and visuoconstructive abilities, semantic verbal fluency, and executive functions. There were no observable benefits in self-reported quality of life or cognitive difficulties in activities of daily living. We concluded that intensive cognitive training may be a useful tool in the management of cognitive functions in Parkinson’s disease. © 2011 Movement Disorder Society

from Movement Disorders

Communication changes in Parkinson’s disease

This article offers an overview of changes to speech and voice that arise in PD and the impact these underlying changes have on speech naturalness, intelligibility and participation in social life. Assessment and treatment are not a focus, but lessons for these areas are drawn from the description of the nature of overall changes.

from Revista de Logopedia, Foniatría y Audiología

Silent saliva aspiration in Parkinson’s disease

Conclusion: Silent aspiration and laryngeal penetration of saliva are common features in PD patients with daily drooling. The presence of hypoesthesia of the laryngeal structures and the lack of protective reflexes in such patients may play a major role in the mechanisms of SLP/SA

from Movement Disorders

Intonation and Speech Rate in Parkinson’s Disease: General and Dynamic Aspects and Responsiveness to Levodopa Admission

Conclusions
In this large series of PD patients, previous findings of reduced F0SD in PD were confirmed. Additionally, this is the first analysis to show an increasing reduction of F0 variability in the course of reading mirroring abnormalities in the dynamical aspects of speech in PD. According to the results of the levodopa challenge, dopaminergic stimulation seems to ameliorate dynamic intonation changes over time, whereas overall intonation variability might be a PD symptom independent of dopaminergic control.

from the Journal of Voice

Instability of syllable repetition as a marker of disease progression in Parkinson’s disease: A longitudinal study

Parkinsonian speakers show a tendency to articulatory acceleration and have difficulties to keep the steady pace of repeated syllables. The aim of this study was to analyse the stability of motor speech performance based upon a syllable repetition paradigm during the course of disease to find a potential marker of disease progression in Parkinson’s disease (PD). 58 patients withPD and 35 controls were tested and re-tested after at least 12 months (mean: 33.40/range: 12–88). In the PD group, motor impairment was similar at first and second visit. Participants had to repeat the syllable /pa/ in a self chosen steady pace. Percental coefficient of variance (COV) of interval length was measured for description of pace stability throughout the performance. Percental pace acceleration (%PA) was based upon a comparison of the speed of syllable repetition in the first and second half of the task. Patients with PD showed a significant elevation of COV and %PA indicating an instability of syllable repetition and a tendency to pace acceleration in the course of performing. Furthermore, in the PD group, COV and %PA showed a significant deterioration from first to second examination. Instability of steady syllable repetition in PD shows characteristic changes during the course of the disease, but no correlation with general motor impairment. Therefore, the underlying mechanism may be independent from dopaminergic deficits. The potential role of impaired syllable repetition as a marker of non-dopaminergic disease progression in PD needs validation by further studies. © 2010 Movement Disorder Society

from Movement Disorders

Voice and Fluency Changes as a Function of Speech Task and Deep Brain Stimulation

These findings suggest that voice and fluency are differentially affected by DBS treatment and that task conditions, interacting with subcortical functionality, influence motor speech performance.

from the Journal of Speech, Language, and Hearing Research

Alteraciones neuropsicológicas y de la fluencia verbal en la Enfermedad de Parkinson / Neuropsychological impairment and verbal fluency deficits in Parkinson’s Disease

We can conclude, therefore, that the neuropsychological and language assessment in patients with Parkinson’s disease is an important issue to take into consideration as it may help in knowing the impairment pattern and also in improving the patients day to day functioning as well as it’s quality of life.

from Revista de Logopedia, Foniatría y Audiología

Intonation Contrast in Cantonese Speakers With Hypokinetic Dysarthria Associated With Parkinson’s Disease

Conclusion: These data contribute to the researchers’ understanding of intonation marking in speakers with PD, with specific application to the production and perception of intonation in a lexical tone language.

from the Journal of Speech, Language, and Hearing Research

The prevalence and patterns of pharyngoesophageal dysmotility in patients with early stage Parkinson’s disease

Dysphagia occurs in the majority of patients with Parkinson’s disease (PD) and is known to correlate with abnormalities of oropharyngeal function. The aim of this study was to evaluate pharyngoesophageal activity in patients with early-stage PD. Newly diagnosed PD patients with a symptom duration not exceeding 3 years were included. All PD patients were questioned about symptoms of dysphagia and underwent combined multichannel intraluminal impedance manometry and multiple rapid swallow tests. Fifty-four patients (22 men and 32 women, 67.1 ± 10.3 years) were enrolled. The duration of Parkinsonian motor symptoms was 11.5 ± 8.8 months, the Hoehn and Yahr stage was 1.6 ± 0.4, and the total Unified Parkinson’s Disease Rating Scale was 25.1 ± 18.6. Esophageal manometry in the liquid swallow and viscous swallow tests was abnormal in 22 (40.7%) and 31 (67.4%) patients, respectively. Although manometric abnormalities were more common in patients with more severe dysphagia symptoms, many patients with no or minimal symptoms also had manometric abnormalities. Repetitive deglutition significantly correlated with failed peristalsis and incomplete bolus transit. Abnormal responses to multiple rapid swallow tests were found in 33 out of 54 patients; 29 with incomplete inhibition (repetitive contraction) and 4 with failed peristalsis. These results suggest that the majority of patients with early-stage PD showed pharyngeal and esophageal dysfunction even before clinical manifestations of dysphagia, which may reflect selective involvement of either the brain stem or the esophageal myenteric plexus in early-stage PD. © 2010 Movement Disorder Society.

from Movement Disorders