Neural Correlates of Hypokinetic Dysarthria and Mechanisms of Effective Voice Treatment in Parkinson Disease

Baumann, Alexander; Nebel, Adelheid; Granert, Oliver; Giehl, Kathrin; Wolff, Stephan; Schmidt, W.F.; Baasch, Christin; Schmidt, Gerhard; Witt, Karsten; Deuschl, Günther; Hartwigsen, Gesa; Zeuner, Kirsten E.; Eimeren, Thilo van

doi:10.1177/1545968318812726

Cited by 39 publications

(39 citation statements)

References 55 publications

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“…Given previously reported hyperactivity in the speech motor networks in individuals with PD during speech production (Liotti et al, 2003;Pinto et al, 2004;Rektorova et al, 2007;Huang et al, 2016), one might predict a decrease of cortical brain activity that is accompanied by improved auditory-vocal integration. This is in contrast with increased cortical activity following LSVT LOUD observed in the present and previous studies (Narayana et al, 2010;Baumann et al, 2018). However, there is evidence showing that improved hypokinetic dysarthria by LSVT LOUD is accompanied by increased activation in the right DLPFC, anterior insula, and basal ganglia and decreased activation in the motor/premotor regions (Liotti et al, 2003).…”

Section: Potential Mechanisms Of Efficacy Of Lsvt Loudcontrasting

confidence: 98%

Neurobehavioral Effects of LSVT® LOUD on Auditory-Vocal Integration in Parkinson’s Disease: A Preliminary Study

Tan

Fan

et al. 2021

Front. Neurosci.

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Individuals with Parkinson’s disease (PD) are impaired in auditory-vocal integration, characterized by abnormal compensatory responses to auditory feedback errors during self-monitoring of vocal production. The present study examined whether auditory feedback control of vocal pitch production in PD can benefit from Lee Silverman voice treatment (LSVT® LOUD), a high effort, intensive speech treatment for hypokinetic dysarthria in PD. Before and immediately after LSVT LOUD, 12 individuals with PD were instructed to produce sustained vowel sounds while hearing their voice unexpectedly pitch-shifted by −200 cents. Their vocal responses and event-related potentials (ERPs) to pitch perturbations were measured to assess the treatment outcomes. A group of 12 healthy controls were one-to-one pair matched by age, sex, and language. Individuals with PD exhibited abnormally enhanced vocal and ERP P2 responses to pitch perturbations relative to healthy controls. Successful treatment with LSVT LOUD, however, led to significantly smaller and faster vocal compensations that were accompanied by significantly larger P2 responses. Moreover, improved vocal loudness during passage reading was significantly correlated with reduced vocal compensations for pitch perturbations. These preliminary findings provide the first neurobehavioral evidence for beneficial effects of LSVT LOUD on impaired auditory-vocal integration associated with PD, which may be related to improved laryngeal motor functions and a top-down modulation of the speech motor network by LSVT LOUD.

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Section: Potential Mechanisms Of Efficacy Of Lsvt Loudcontrasting

confidence: 98%

Neurobehavioral Effects of LSVT® LOUD on Auditory-Vocal Integration in Parkinson’s Disease: A Preliminary Study

Tan

Fan

et al. 2021

Front. Neurosci.

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“…The abovementioned correlations and increased activation in the ACC mostly involved the right-sided hemispheric regions. This accords well with the described right-sided functional brain reorganization due to the successful LSVT [14,15]. However, it seems that the increased engagement of these regions did not fully compensate for vocal muscle bradykinesia in our patients.…”

Section: Fmri Results: Reading Task-induced Activationssupporting

confidence: 92%

“…In PD, only a few functional imaging studies have explored the neural mechanisms of HD symptoms, with inconsistent results probably due to varied methodologies and patient populations [1]. In general, deficits in the basal ganglia and cerebellar activation and connectivity as well as altered functional connection of the STG have been described [8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Articulatory network reorganization in Parkinson's disease as assessed by multimodal MRI and acoustic measures

Klobušiaková

Mekyska

Brabenec

et al. 2021

Parkinsonism & Related Disorders

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Introduction: Hypokinetic dysarthria (HD) is common in Parkinson's disease (PD). Our objective was to evaluate articulatory networks and their reorganization due to PD pathology in individuals without overt speech impairment using a multimodal MRI protocol and acoustic analysis of speech. Methods: A total of 34 PD patients with no subjective HD complaints and 25 age-matched healthy controls (HC) underwent speech task recordings, structural MRI, and reading task-induced and resting-state fMRI. Grey matter probability maps, task-induced activations, and resting-state functional connectivity within the regions engaged in speech production (ROIs) were assessed and compared between groups. Correlation with acoustic parameters was also performed. Results: PD patients as compared Tto HC displayed temporal decreases in speech loudness which were related to BOLD signal increases in the right-sided regions of the dorsal language pathway/articulatory network. Among those regions, activation of the right anterior cingulate was increased in PD as compared to HC. We also found bilateral posterior superior temporal gyrus (STG) GM loss in PD as compared to HC that was strongly associated with diadochokinetic (DDK) irregularity in the PD group. Task-induced activations of the left STG were increased in PD as compared to HC and were related to the DDK rate control. Conclusions: The results provide insight into the neural correlates of speech production control and distinct articulatory network reorganization in PD apparent already in patients without subjective speech impairment.

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“…It is in response to this challenge that we must expand our research and investigative faculties to design new and more targeted studies, looking deeper into the patient population than symptomology and presentation alone. We now have the resources to investigate areas such as genetic predisposition, anatomic and functional differences on functional magnetic resonance imaging, and medical comorbidities in the case of vocal fold disorders (Baumann et al, 2018;Fisher et al, 2008;Lovett, 2014;Morgan et al, 2013;Shuster, 2003). It is with the creative use of these parameters that we can expand our understanding of the diseases we seek to treat and to further refine our treatments.…”

mentioning

confidence: 99%

“…Part of the inevitable change in approach that occurs with continued investigation is the addition of new technologies. Blood tests (e.g., Bridgemohan et al, 2019;Mohammadi et al, 2018;Sanz et al, 2012), biopsies (e.g., Hanshew et al, 2014;Thibeault et al, 2002), magnetic resonance imaging scans (e.g., Baumann et al, 2018;Kryshtopava et al, 2017), genetic testing (e.g., Duflo et al, 2006;Peng et al, 2018), and so forth provide different information than symptomology alone, and these technologies are becoming more and more widely used in speech pathology research. It is now an opportune time to expand our tool set to include more of the biologically based technologies for detection of disorderrelated differences at a protein and genome level.…”

mentioning

confidence: 99%

Research in Speech Science and Voice Disorders: The Promise of Modern Genetic Approaches in Improving Clinical Diagnosis and Treatment

Kimball

Sayce

2020

Perspect ASHA SIGs

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Much of the research in speech science and voice biology characterizes disorders through observations of functional behaviors, physiological measurements (e.g., videostroboscopy, subglottic pressure, noninvasive electroencephalography, acoustics, etc.), and outcome metrics. This body of research contributes to our understanding of disease presentation and informs clinical assessment and treatment paradigms. However, when existing treatments are not consistently effective in empirical testing, these techniques are limited in the information they can provide for revising clinical plans and improving patient outcomes. Investigation into gene mutations and protein and gene-level changes in speech science and voice disorders is starting to elucidate the pathophysiology underlying these conditions. In this article, we discuss the strengths and limitations of research relying on behavioral and functional assessment and treatment efficacy data in speech science and voice. We also provide a basic overview of modern genetic research approaches that may lend to greater mechanistic and etiological understanding of the disorders our patients face.

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Neural Correlates of Hypokinetic Dysarthria and Mechanisms of Effective Voice Treatment in Parkinson Disease

Abstract: Supplementary material for this article is available on the Neurorehabilitation & Neural Repair website along with the online version of the article.

Cited by 39 publications

References 55 publications

Neurobehavioral Effects of LSVT® LOUD on Auditory-Vocal Integration in Parkinson’s Disease: A Preliminary Study

Neurobehavioral Effects of LSVT® LOUD on Auditory-Vocal Integration in Parkinson’s Disease: A Preliminary Study

Articulatory network reorganization in Parkinson's disease as assessed by multimodal MRI and acoustic measures

Research in Speech Science and Voice Disorders: The Promise of Modern Genetic Approaches in Improving Clinical Diagnosis and Treatment

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