Pupillary Response in an Auditory Rhythm Omissions Task in Parkinson´s Disease: A Pilot Study

When presented with short, rhythmical, musical excerpts, containing omitted beats which vary in saliency in terms of rhythmical patterns (contextual omission), and position (salience omissions), fMRI studies have shown a small effect depending on position of omission. Furthermore, when presented with auditory stimuli, a pupillary dilation response (PDR) is evoked, resulting in a pupillary peak dilation (PPD) sometime after stimulus onset. By utilizing and adapting an auditory beat-omission fMRI paradigm, to allow measurement of PDR and PPD, we used pupillometry data to investigate the effect of contextual omission (Simple vs Complex rhythm) and salience omission (O1 vs O2). We report data from a total of 25 participants, based on 45 datasets. The data were analyzed using four separate direct t-tests. We found that the omission has an effect on PPD, in that the most metrical salient omission (O1) results in a higher activation level compared to a less salient omission (O2), i.e., PPD was significantly higher in O1 simple rhythm omissions, and in O1 complex rhythm omissions, at an uncorrected threshold level.Masteroppgave i psykologiMAPSYK360INTL-HFINTL-PSYKINTL-SVINTL-MNINTL-MEDINTL-KMDMAPS-PSYKINTL-JU

Objective evaluation of Parkinson's disease bradykinesia

Bradykinesia is the fundamental motor feature of Parkinson’s disease - obligatory for diagnosis and central to monitoring. It is a complex clinicalsign that describes movements with slow speed, small amplitude, irregular rhythm, brief pauses and progressive decrements. Clinical ascertainment of the presence and severity of bradykinesia relies on subjective interpretation of these components, with considerable variability amongst clinicians, and this may contribute to diagnostic error and inaccurate monitoring in Parkinson’s disease. The primary aim of this thesis was to assess whether a novel non-invasive device could objectively measure bradykinesia and predict diagnostic classification of movement data from Parkinson’s disease patients and healthy controls. The second aim was to evaluate how objective measures of bradykinesia correlate with clinical measures of bradykinesia severity. The third aim was to investigate the characteristic kinematic features of bradykinesia. Forty-nine patients with Parkinson’s disease and 41 healthy controls were recruited in Leeds. They performed a repetitive finger-tapping task for 30 seconds whilst wearing small electromagnetic tracking sensors on their finger and thumb. Movement data was analysed using two different methods - statistical measures of the separable components of bradykinesia and a computer science technique called evolutionary algorithms. Validation data collected independently from 13 patients and nine healthy controls in San Francisco was used to assess whether the results generalised. The evolutionary algorithm technique was slightly superior at classifying the movement data into the correct diagnostic groups, especially for the mildest clinical grades of bradykinesia, and they generalised to the independent group data. The objective measures of finger tapping correlated well with clinical grades of bradykinesia severity. Detailed analysis of the data suggests that a defining feature of Parkinson’s disease bradykinesia called the sequence effect may be a physiological rather than a pathological phenomenon. The results inform the development of a device that may support clinical diagnosis and monitoring of Parkinson’s disease and also be used to investigate bradykinesia

Acoustic Changes during Passage Reading in Speakers with Parkinson\u27s Disease

Purpose: The purpose of this study was to evaluate speech changes in Parkinson’s disease (PD) while reading a passage, using both local (i.e., segment level) and global (i.e., utterance level) acoustic measures. Methods: 20 speakers participated in the study (10 PD, 10 neurologically healthy controls). The speakers were asked to read The Caterpillar passage in a conversational mode. A total of five acoustic measures were included (local: vowel duration, Euclidean distance between corner vowels and schwa; global: articulation rate, F0/intensity range). These acoustic measures were compared between two sentences located in the two positions within the paragraph, initial and final. Results: The findings indicated (1) overall speech differences between the two groups such as increased vowel duration and reduced vowel contrast and (2) speech differences between the beginning and end of the passage such as increased articulation rate toward the end. In addition, the results revealed that unlike control speakers, speakers with PD did not show a greater F0 and intensity range in the end compared to the beginning of the passage, which points a limited capability of prosody modulations in PD and its apparent pattern toward the end of passage reading. Discussion: Findings of this study support the notion that within- or across-task acoustic variation should be considered in speech sampling in clinical practice and research

A phenomenological study of partners of people with Parkinson\u27s disease who demonstrate communication changes

Parkinson\u27s disease is a common progressive neurological illness for which there is no known cure. While the cardinal signs are tremor, bradykinesia or slowness of movement, muscle rigidity and postural instability (Jahanshahi & Marsden, 1998, p.3) the patient may face an extended number of years experiencing all, or any combination of, the many other manifestations of the disease process. These manifestations include changes to various aspects of communication including loss of voice volume, diminished body language and loss of facial expression. All of these affect both verbal and non verbal communication. Given the progressive nature of Parkinson\u27s disease the patient may often require both physical and emotional support for many years. The long term partner or spouse often provides this care and support. There is a paucity of literature discussing the impact of communication changes or difficulties on the partner or spouse. Thus a study into the life experiences of the partners of people with Parkinson’s disease who demonstrate communication problems is needed. The aim of this study was to explore the experiences of partners of people with this neurological diagnosis and whose communication is affected. A phenomenological approach was utilised to explore the impact of communication changes on the partner of a person with Parkinson\u27s disease. Five participants took part in his study. Four of the participants responded to an advertisement placed in the Western Australian Parkinson’s Association newsletter. The remaining participant volunteered to be part of the study while she and her husband were on holiday in Perth, Western Australia from overseas. All of the participants were female and their husbands had been diagnosed with Parkinson\u27s disease for extended periods of time, ranging from five to fifteen years. In depth interviews were audio taped and transcribed verbatim. The data from these interviews were analysed using the method described by Colaizzi (1978). Data were described and interpreted and common themes were extrapolated and analysed. The three major themes emerging from the interviews were: The Partner/Carer Interface, Emotional Turmoil and Ways of Coping. The Partner/Carer Interface is made up of three sub themes, ‘life before diagnosis\u27\u27, the point of diagnosis and sharing the disease.\u27\u27 The second theme, Emotional Turmoil, includes the sub themes confronting the physical, \u27\u27the conditions always wins” and “social isolation”. The third theme addresses the skills necessary to cope with the future, or Ways of Coping. This theme encapsulates minor themes of \u27\u27knowing the beast , sharing the burden”, and finally preparing for the road ahead”. Based upon study findings recommendations are made in relation to care provision, patient education and community support. The need for further research has been identified, specifically into the diverse gender issues related to communication and the role of care giver. In addition the need for health professionals with an extensive knowledge base of this neurological condition has been identified as essential for quality nursing management

Navigating Occupation and Identity in Parkinson\u27s Disease: A Qualitative Exploration of Lived Experience

Evidence-based practice requires that health care providers interpret the best research evidence in the context of their clinical experience, while at the same time considering client knowledge and experiences. Although health care providers are becoming increasingly skilled at the evaluation of research evidence, client values and self-identified health issues are often neglected within the evidence-based practice process. Ignoring these key aspects of person-centered practice may lead to interventions that fail to target implications of a client’s disease that are important to occupational participation and quality of life. A focus on person-centeredness is particularly important in progressive neurodegenerative disorders such as Parkinson’s disease where there are no known curative treatments, and interventions must instead focus on symptom management. The purpose of this research therefore was to deepen the current understanding of the experience of life with Parkinson’s disease, and to use these understandings to inform health care practices for this group. Following a review of the lived experience literature, a primary study was conducted wherein six individuals with Parkinson’s disease were asked to take photographs and share verbal narrative accounts to illustrate their experience of living with Parkinson’s disease. Results highlight the interrelationship between occupation and identity, as many of the participants’ stories were interpreted as foregrounding the negotiation of occupation, and how such negotiation shaped their sense of identity. Overall, three major themes were identified: (1) Framing the meaning of Parkinson’s disease; (2) Negotiating engagement in occupation; (3) Being ready to accept changes that impact personal or social identity. These findings were used to make suggestions on how health care providers can enhance the level of person-centredness in their care

Doctor of Philosophy

dissertationThe purpose of this constructivist grounded theory study was to identify and examine challenges and strategies used by people with parkinsonism to maintain identity. These concerns were explored within the context of daily life, vital relationships, and familiar roles. The setting was three Midwestern states during historic winter weather conditions (2013-2014). Illness descriptions were obtained through medication logs and two scales: Hoehn and Yahr staging and activities of daily living. Qualitative data consisted of 62 in-depth interviews, photos, videos, fieldnotes, and memos. Twenty-five volunteers (10 female/15 male; ages 40-95) with self-reported Parkinson disease participated. Range of disease duration was 3 months to 30 years. Disease staging: I (n = 0), II (n = 0), III (n = 14), IV (n = 8), and V (n = 3). Stage III participants completed daily living activities at an independence level of 60 to 80%, while stage V participants ranged from 20 to 30%. Twenty-one participants used carbidopa-levodopa. Analytic coding procedures generated the theory of Preserving self. This clinically logical 5-staged theory represents social and psychological processes for maintaining identity while living with a life-limiting illness. The stages and transitions are: (1) Making sense of symptoms describes noticing and taking action prediagnosis. Transition: Finding out the diagnosis was shocking, but time-limited. (2) Turning points confronted abilities with demanding tasks and strong emotions. Transition: Unsettling reminders of losses were perpetual. (3) Dilemmas of identity are the difficulties relinquishing comfortable self-attributes. Transition: Sifting and sorting is a time of grieving, letting go, and considering new self-identities. (4) Reconnecting the self synthesizes former and current identities. Transition: Balancing risks and rewards compares a lost past with possible futures. (5) Envisioning a future demonstrates planning pragmatically with tunnel vision. iv Creative methods were developed for maintaining independence; abilities were frequently overestimated. An interesting finding was the use of self-adjusted carbidopa-levodopa beginning during Sifting and sorting continuing through Reconnecting the self. Medication was used as a social prosthesis to function normally, maintain valued relationships, and roles. People with parkinsonisim desperately seek normalcy. Recommendations include medication instruction to bridge wearing-off effects and sensory integrative activities as a self-reconnecting technique

Objective assessment of upper limb motor symptoms in Parkinson's Disease using body-worn sensors

MD ThesisBackground There is a need for an objective method of symptom assessment in Parkinson's disease (PD) to enable better treatment decisions and to aid evaluation of new treatments. Current assessment methods; patient-completed symptom diaries and clinical rating scales, have limitations. Accelerometers (sensors capable of capturing data on human movement) and analysis using artificial neural networks (ANNs) have shown potential as a method of motor symptom evaluation in PD. It is unknown whether symptom monitoring with body-worn sensors is acceptable to PD patients due to a lack of previous research. Methods 34 participants with PD wore bilateral wrist-worn accelerometers for 4 hours in a research facility (phase 1) and then for 7 days in their homes (phase 2) whilst also completing symptom diaries. An ANN designed to predict a patient’s motor status, was developed and trained based on accelerometer data during phase 2. ANN performance was evaluated (leave-one-out approach) against patient-completed symptom diaries during phase 2, and against clinician rating of disease state during phase 1 observations. Participants’ views regarding the sensors were obtained via a Likert-style questionnaire completed after each phase. Differences in responses between phases were assessed for using the Wilcoxon rank-sum test. Results ANN-derived values of the proportion of time in each disease state (phase 2), showed strong, significant correlations with values derived from patient-completed symptom diaries. ANN disease state recognition during phase 1 was sub-optimal. High concordance with sensors was seen. Prolonged wearing of the sensors did not adversely affect participants’ opinions on the wearability of the sensors, when compared to their responses following phase 1 Conclusions Accelerometers and ANNs produced results comparable to those of symptom diaries. Our findings suggest that long-term monitoring with wrist-worn sensors is acceptable to PD patients

Effects of Parkinson’s disease on motor asymmetry

Introduction: Persons with Parkinson’s disease (PD) experience changes cortically, subcortically and behaviorally. This dissertation examines the asymmetry of motor behavior to explore the role of asymmetry in persons with PD and its connection to clinical symptoms. Purpose: Project 1: To assess the hand asymmetry difference in young adults versus older adults. Project 2: To investigate the difference in hand asymmetry in older adults and persons with PD. Project 3: To explore the correlation between function and clinical symptoms of persons with PD. Methods: 55 right-handed participants [Young Adults (YA) = 20, Female = 10; Older Adults (OA) = 20, Female = 10; Persons with PD = 15, Female = 5] were recruited and performed motor tasks: Purdue Pegboard test, grip strength test, response task, thumb opposition task, tapping task, three variations of timed-up-and-go test (TUG), single leg stance task (SLS), Weight Distribution test and Limits of Stability test. The two-way ANOVA was conducted to examine a variance between YA and OA. A separate two-way ANOVA was conducted comparing variance between OA and persons with PD. The purpose was to explore asymmetries, characterized by a significant difference between groups’ left and right sides. Pearson’s correlation was implemented to examine connection of clinical symptoms and motor behavior. Statistics: IBM SPSS 24 software was used. Two 2-way ANOVAs with the between group factor of group (Young vs. Older in Project 1; Older vs. PD in project 2), and within group factor of hand (Right vs. Left in Study 1 & Study 2) were used to examine if age (or PD) changes hand asymmetry. Pearson’s correlation coefficient was used to determine correlations between Unified Parkinson’s Disease Rating Scale (UPDRS) and motor tasks in PD patients (Study 3). Results: Project 1: Results indicate asymmetry reduces with age in fine motor tasks containing speed, dexterity and strength components. Project 2: The basal ganglia dysfunction does not overall further exacerbate the reduced asymmetry with age. Project 3: Clinical symptoms of PD measured by the UPDRS are generally not associated with fine motor tasks of this study

The role of serotonergic and dopaminergic mechanisms and their interaction in Levodopa-induced dyskinesias

Long–term levodopa treatment in Parkinson’s disease (PD) is commonly associated with troublesome levodopa–induced dyskinesias (LIDs). Striatal serotonergic terminals amid the degenerating dopaminergic ones are proposed to play an important role in LIDs by taking up exogenous levodopa and releasing dopamine in an unregulated fashion. However, to date, the underlying mechanisms of LIDs are not fully understood. By using single photon emission computed tomography (SPECT) with 123I–Ioflupane and positron emission tomography (PET) with 11C–DASB and 11C–PE2I, the clinical studies conducted for this thesis aimed (a) to estimate the role of striatal dopamine transporter (DAT) availability in early PD as a prognostic marker for LIDs, (b) to explore whether striatal DAT availability changes over time are related to the appearance of LIDs, (c) to estimate the role of striatal serotonin-to-dopamine transporter (SERT–to–DAT) binding ratios to LIDs, and (d) to look for a relation between the changes in striatal SERT, DAT and SERT–to–DAT binding ratios over time and the appearance of LIDs. The main findings are as follows: (a) in early PD, striatal DAT availability alone does not predict the appearance of future LIDs, (b) at later stages, the occurrence of LIDs may be dependent on the magnitude of DAT decline in the putamen, (c) the SERT–to–DAT binding ratio in the putamen is increased in PD patients as compared to controls, and within PD, it is higher in patients with LIDs as compared to nondyskinetic patients, (d) as PD continues to progress, putaminal serotonergic terminals remain relatively unchanged in comparison to the dopaminergic ones and the aforementioned imbalance (as reflected by the binding ratio) increases over time. These findings provide fundamental insight in the pathophysiology of LIDs and have direct implications for further research towards novel therapeutics in PD dyskinesia.Open Acces

The Effects of Dance Therapy on Voice in Patients with Parkinson\u27s Disease in a Multicultural Population

Current literature suggests that dance therapy in individuals with Parkinson’s disease shows noticeable improvement in motor functions, for example gait and balance improvement. Additionally, patients with Parkinson’s disease who participate in dance therapy may perceive positive benefits on their quality of life. Therefore, it is believed that increases in core support and improvements in posture, as a result of dance therapy, will have effects on the voice in patients with PD. This thesis pulls from literature supporting treatment approaches in the field of speech-language pathology for voice patients with Parkinson’s disease. The aim of this study was to evaluate the benefits of dance therapy on voice in patients with Parkinson’s disease in a multicultural population. In this study, a quantitative design was employed to record patients’ perceptions of effects on their voice following dance therapy. Research findings reveal half of respondents observed improvements in their voice following dance therapy