Emotional Prosody Treatment in Parkinson's
Condition: Parkinson Disease
MeSH terms: Parkinson Disease
Study type: Interventional

Summary: 
      This study investigates a treatment protocol which holds the potential to significantly
      improve communication and quality of life for individuals affected by Parkinson's disease
      (PD). Disorders of emotional communication are widely reported in PD and can negatively
      impact quality of life by increasing social isolation and decreasing independence.
      Individuals with emotional prosodic communication disorders are often perceived as depressed
      or unconcerned about others. This seeming negativity can cause difficulties in relationships,
      and increased feelings of stress and burden in caregivers which may result in earlier
      placement in an institutional care setting. This innovative treatment program could improve
      care for individuals with PD, as well as other individuals who may be affected by disorders
      of emotional prosodic communication (e.g., stroke or traumatic brain injury).
    

Detailed description: 
      Individuals with Parkinson's disease (PD) present with a variety of motor symptoms including
      resting tremor, difficulty initiating movement/slowed movements, and rigidity. While these
      motor signs and symptoms are the hallmark features, individuals with PD also often
      demonstrate changes in communication ability, with an estimated prevalence of 89 percent of
      all individuals with PD being affected. These disorders of communication have been reported
      by individuals with PD and their caregivers to be one of the most difficult aspects of living
      with this disorder.

      The most commonly diagnosed communicative disorder in PD is hypokinetic dysarthria which can
      result in changes in prosody, respiratory control, voice quality, and articulation. Of these,
      the disorders in prosody have been judged to be the most prominent deficit. Prosody includes
      the pitch, loudness, and rate with which speech utterances are produced and is used to
      communicate emotional connotation (e.g. angry versus sad). Impairments in speech prosody
      reduce the ability to communicate emotional feelings or intentions as well as reducing the
      intelligibility of the spoken message. While pharmacological treatments have been shown to be
      effective in improving motor function, these medications have not been shown to greatly
      mitigate speech production disorders including prosody, suggesting that therapies other than
      dopaminergic agents are needed to address prosody deficits in PD. Despite a negative impact
      on quality of life and reduced independence of individuals affected by emotional prosodic
      disorders, no published studies are available testing therapies to improve production of
      emotional prosody in PD.

      The primary goal of this proposal is to compare a treatment protocol shown to be effective in
      treating emotional prosodic deficit in stroke and TBI (Leon et al., 2005; Rosenbek et al.,
      2006) to a standard clinical treatment for prosody deficit that does not target the emotional
      aspect of the disorder in individuals with PD. The experimental treatment targets increased
      pitch and loudness variability, and control of speech rate, the core characteristics of
      prosodic insufficiency in PD, but with an emphasis on the emotional component of the
      disorder. The primary aims of the study are to determine treatment effect size by measuring
      the difference of the experimental protocol versus standard clinical care on prosodic deficit
      in individuals with PD via changes in acoustic and perceptual measures, as well as provide
      psychometric validation of test-retest reliability of the outcome measures.
    

Intervention name(s): Emotional prosodic treatment
Intervention type(s): Behavioral
Intervention description(s): The experimental treatment is consistent with the standard treatment in that it targets impairments in pitch/stress, loudness variability and control of speech rate, the core characteristics of prosodic insufficiency in PD (Darley, Aronson & Brown, 1969). However, the experimental treatment provides an innovative and targeted emphasis on the emotional component of the disorder. The production of emotional intonation in an utterance requires varying combinations of pitch/stress, loudness, and rate. Participants will receive clinician feedback as well as auditory and visual feedback on accuracy via the VisiPitch display.
Intervention model: Single Group Assignment
Intervention model description: Single group, pretest postest behavioral treatment design
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Prosody; Communication; Dysarthria