The Effect of a Voice Treatment on Facial Expression in Parkinson’s Disease: Clinical and Demographic Predictors

Parkinson’s disease (PD) is a neurodegenerative disease associated with a wide range of motoric, cognitive, and behavioral symptoms. Impairments in facial mobility and emotional expressivity are common and can impair communication, in turn, affecting daily functioning and quality of life. Previous research suggests that the Lee Silverman Voice Treatment © (LSVT LOUD; Ramig et al., 2001, 2011) increases vocal loudness and facial expressivity in individuals with PD compared to PD and healthy controls. This study extends the literature by examining the effects of LSVT and an articulation-based control treatment (i.e., ARTIC) on multiple aspects of facial expressivity (i.e., emotional frequency [EF], emotional variability [EV], emotional intensity [EI], and social engagement [SE]) as well as non-emotional facial mobility (FM). Further, we examined whether demographic, clinical, cognitive, and affective variables predict facial expressivity and mobility improvement via LSVT. Participants included 40 individuals with idiopathic PD (67.5% male) and 14 demographically-matched healthy controls (60% male). The PD participants were randomly assigned to one of the following conditions: the LSVT LOUD treatment group (n = 13), a control therapy (Articulation Treatment [ARTIC]; n = 14), or an Untreated Control Condition (n = 13). All posers (PDs & HCs) were video-taped, before and after treatment (for the LSVT & ARTIC PD groups) or at baseline and after a 4-5 week waiting period for (for the Untreated PDs [UPDs] & HCs), while producing emotional (Happy, Sad, & Angry) monologues from the New York Emotion Battery (Borod et al., 1998; Borod, Welkowitz, & Obler, 1992). The monologues were randomized and divided into 15-second segments, and evaluated by 18 naïve raters for 4 different aspects of facial emotional expression and facial mobility. Separate training sessions were held for each of the five facial rating variables (i.e., FM, EF, EV, EI, & SE), and interrater reliability was largely in the high range. Findings revealed that PD posers displayed lower facial expressivity than HCs on three out of five variables, however, these effects were moderated by gender and emotion. In terms of gender, women were more expressive than men on all facial expression variables. Treatment results showed that individuals in the LSVT group showed significant improvements from pre- to post-treatment in facial expressivity for four out of the five variables examined (i.e., FM, EF, EV, & EI), however, for EV, this interaction was moderated by Gender, with significant increases from pre- to post-treatment for men but not for women in the LSVT group. There were no significant differences observed pre- to post-treatment for ARTIC or from baseline to 4-5 weeks later for the UPD and HC groups. In terms of predictive findings, demographic, clinical, cognitive, and affective variables did not predict facial improvement in LSVT participants, likely due to low power. This study has multiple clinical and research implications. First, we examined facial expression through a multifactorial approach, involving mobility, expressivity, and social judgment of others, which has not been done in other studies with PD and which may provide a better understanding of the specific facial impairments in PD. Clinically, our treatment findings for LSVT are important to the rehabilitation therapy literature, because there are very few empirically-validated treatments targeting facial emotional expressivity and facial mobility in individuals with PD

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

Models and Analysis of Vocal Emissions for Biomedical Applications

The MAVEBA Workshop proceedings, held on a biannual basis, collect the scientific papers presented both as oral and poster contributions, during the conference. The main subjects are: development of theoretical and mechanical models as an aid to the study of main phonatory dysfunctions, as well as the biomedical engineering methods for the analysis of voice signals and images, as a support to clinical diagnosis and classification of vocal pathologies

Models and Analysis of Vocal Emissions for Biomedical Applications

The MAVEBA Workshop proceedings, held on a biannual basis, collect the scientific papers presented both as oral and poster contributions, during the conference. The main subjects are: development of theoretical and mechanical models as an aid to the study of main phonatory dysfunctions, as well as the biomedical engineering methods for the analysis of voice signals and images, as a support to clinical diagnosis and classification of vocal pathologies

Developing a methodology for manipulating spontaneous blinks.

While blinking is necessary for ocular protection and lubrication, people blink much more than is necessary for routine ocular maintenance. These extra, spontaneous blinks are extremely difficult to manipulate and thus, have remained somewhat of a mystery. In order to determine the effects of spontaneous blinks, a methodology to manipulate them naturally must be created. The aim of this study was to develop such methodology using videos of animated speakers displaying high and low blink rates, and determine whether this influenced participant blink rates. It was expected that watching videos of a speaker's face would manipulate blink rate. It was also expected that participants would imitate the speaker's blink timing and blink immediately after the speaker blinks, called blink entrainment. Participants watched four videos, two featuring an animated speaker with a high blink rate, and two featuring the same animated speaker with a low blink rate. In between the speaker videos, participants completed ten trials of several variations of a lexical decision task. The speaker videos provided instructions on how to complete each of these tasks. A Wilcoxon signed-rank test showed that the differences between participant blink rates across the high blink rate and the low blink rate were significant (Z = -3.16, p = .002). Participants blinked more frequently while watching the high blink rate videos than when watching the low blink rate videos. A Wilcoxon signed-rank test also showed a significant difference between entrainment blinks and non-entrainment blinks in the high blink rate condition (Z = -3.65, p = .001), and the low blink rate condition (Z = -2.21, p = .027). These results indicate that a standardized methodology for manipulating spontaneous blinks is possible. With the use of the animated speaker videos, spontaneous blinks can be manipulated

Relationships between cognitive status, speech impairment and communicative participation in Parkinson’s disease

Aim: To assess the relationships between cognitive status, speech impairment and communicative participation in Parkinson’s disease. Introduction: Speech and communication difficulties, as well as cognitive impairment, are prevalent in Parkinson’s. The contributions of cognitive impairment and acoustic speech characteristics remain equivocal. Relationships between Impairment and Participation levels of the International Classification of Functioning, Disability and Health (ICF) have not been thoroughly investigated. Methods: 45 people with Parkinson’s and 29 familiar controls performed read, mood and conversational speech tasks as part of a multimethod investigation. Data analysis formed three main parts. Depression, cognition and communication were assessed using questionnaires. Phonetic analysis was used to produce an acoustic characterisation of speech. Listener assessment was used to assess conveyance of emotion and intelligibility. Qualitative Content Analysis was used to provide a participant’s insight into speech and communicative difficulties associated with Parkinson’s disease. Results: Cognitive status was significantly associated with certain read speech acoustic characteristics, emotional conveyance and communicative participation. No association was found with intelligibility or conversational speech acoustic characteristics. The only acoustic speech characteristics that predicted intelligibility were intensity and pause in the read speech condition. The contribution of intelligibility to communicative participation was modest. People with Parkinson’s disease reported a range of psychosocial, cognitive and physical factors affecting their speech and communication. Conclusions: I provide evidence for a role for cognitive status in emotional conveyance and communicative participation, but not necessarily general speech production, in Parkinson’s disease. I demonstrate that there may not be a strong relationship between ICF Impairment level speech measures and functional measures of communication. I also highlight the distinction between measures of communication at the ICF Activity and Participation levels. This study demonstrates that reduced participation in everyday communication in Parkinson’s disease appears to result from a complex interplay of physical, cognitive and psychosocial factors. Further research is required to apply these findings to contribute to future advances in speech and language therapy for Parkinson’s disease

Thin Slice Judgments in the Clinical Context

Clinicians make a variety of judgments about their clients, from judging personality traits to making diagnoses, and a variety of methods are available to do so, ranging from observations to structured interviews. A large body of work demonstrates that from a brief glimpse of another’s nonverbal behavior, a variety of traits and inner states can be accurately perceived. Additionally, from these thin slices of behavior, even future outcomes can be predicted with some accuracy. Certain clinical disorders such as Parkinson’s disease and facial paralysis disrupt nonverbal behavior and may impair clinicians’ ability to make accurate judgments. In certain contexts, personality disorders, anxiety, depression, suicide attempts and outcomes can be detected from others’ nonverbal behavior. Additionally, thin slices can predict psychological adjustment to divorce, bereavement, sexual abuse, and well-being throughout life. Thus, for certain traits and disorders, judgments from a thin slice could provide a complementary tool for the clinician’s toolbox.Keywords: person perception, psychological disorders, nonverbal behavior, accurac

Models and Analysis of Vocal Emissions for Biomedical Applications

The International Workshop on Models and Analysis of Vocal Emissions for Biomedical Applications (MAVEBA) came into being in 1999 from the particularly felt need of sharing know-how, objectives and results between areas that until then seemed quite distinct such as bioengineering, medicine and singing. MAVEBA deals with all aspects concerning the study of the human voice with applications ranging from the newborn to the adult and elderly. Over the years the initial issues have grown and spread also in other fields of research such as occupational voice disorders, neurology, rehabilitation, image and video analysis. MAVEBA takes place every two years in Firenze, Italy. This edition celebrates twenty-two years of uninterrupted and successful research in the field of voice analysis

Models and Analysis of Vocal Emissions for Biomedical Applications

The International Workshop on Models and Analysis of Vocal Emissions for Biomedical Applications (MAVEBA) came into being in 1999 from the particularly felt need of sharing know-how, objectives and results between areas that until then seemed quite distinct such as bioengineering, medicine and singing. MAVEBA deals with all aspects concerning the study of the human voice with applications ranging from the neonate to the adult and elderly. Over the years the initial issues have grown and spread also in other aspects of research such as occupational voice disorders, neurology, rehabilitation, image and video analysis. MAVEBA takes place every two years always in Firenze, Italy. This edition celebrates twenty years of uninterrupted and succesfully research in the field of voice analysis