PERIORAL BIOMECHANICS, KINEMATICS, AND ELECTROPHYSIOLOGY IN PARKINSON'S DISEASE

This investigation quantitatively characterized the orofacial biomechanics, labial kinematics, and associated electromyography (EMG) patterns in individuals with Parkinson's disease (PD) as a function of anti-PD medication state. Passive perioral stiffness, a clinical correlate of rigidity, was sampled using a face-referenced OroSTIFF system in 10 mildly diagnosed PD and 10 age/sex-matched control elderly. Labial movement amplitudes and velocities were evaluated using a 4-dimensional computerized motion capture system. Associated perioral EMG patterns were sampled to examine the characteristics of perioral muscles and compensatory muscular activation patterns during repetitive syllable productions. This study identified several trends that reflect various characteristics of perioral system differences between PD and control subjects: 1. The presence of high tonic EMG patterns after administration of dopaminergic treatment indicated an up-regulation of the central mechanism, which may serve to regulate orofacial postural control. 2. Multilevel regression modeling showed greater perioral stiffness in PD subjects, confirming the clinical correlate of rigidity in these patients. 3. Similar to the clinical symptoms in the upper and lower limb, a reduction of range of motion (hypokinesia) and velocity (bradykinesia) was evident in the PD orofacial system. Administration of dopaminergic treatment improved hypokinesia and bradykinesia. 4. A significant correlation was found between perioral stiffness and the range of labial movement, indicating these two symptoms may result in part from a common neural substrate. 5. As speech rate increased, PD speakers down-scaled movement amplitude and velocity compared to the control subjects, reflecting a compensatory mechanism to maintain target speech rates. 6. EMG from orbicularis oris inferior (OOIm) and depressor labii inferioris (DLIm) muscles revealed a limited range of muscle activation level in PD speakers, reflecting the underlying changes in motor unit firing behavior due to basal ganglia dysfunction. The results of this investigation provided a quantitative description of the perioral stiffness, labial kinematics, and EMG patterns in PD speakers. These findings indicate that perioral stiffness may provide clinicians a quantitative biomechanical correlate to medication response, movement aberrations, and EMG compensatory patterns in PD. The utilization of these objective assessments will be helpful in diagnosing, assessing, and monitoring the progression of PD to examine the efficacy of pharmacological, neurosurgical, and behavioral interventions

Perception on the Quality of Life, Communication and Life Satisfaction among Individuals with Parkison’s and Their Caregivers

BACKGROUND: Speech impairment, which reduces Quality of Life (QOL), frequently occurs in individuals with Parkinson’s disease (PD). As speaking is required for social interaction, speech impairment can reduce one’s life satisfaction. Although QOL has been well-studied in individuals with PD, the QOL of their caregivers has seldom been investigated. This study compared the QOL of individuals with PD and their caregivers. The relationships between QOL, self-rated speech scale, and life satisfaction level were examined.METHOD: A total of 20 individuals with PD and their caregivers completed the Parkinson’s disease Questionnaire-39 (PDQ-39) scale and the Life Satisfaction Scale (LSS). In addition, PD participants were asked to complete the Self-Rated Speech Scale (SRSS) to rate their speech intelligibility.RESULT: PD participants reported significantly lower QOL scores than their caregivers. However, there was no difference between the two groups on the social support and stigma dimensions, indicating that both groups reported similar levels of social support and stigma in their daily lives. A moderate significant correlation was observed between the LSS and PDQ-39 scores in the PD group, suggesting that life satisfaction could affect their QOL. Moreover, moderate correlation was found between the LSS and SRSS, showing that participants self-reported speech intelligibility has an impact on their life satisfaction.CONCLUSION: In general, individuals with PD showed lower QOL than their caregivers. Given that the SRSS, LSS and QOL are moderately correlated, identifying patients’ perception on their speech intelligibility and life satisfaction could help clinicians to better understand their patients’ needs when delivering speech therapy services.

Nonparticipatory Stiffness in the Male Perioral Complex

Purpose—The objective of this study was to extend previous published findings in the authors’ laboratory using a new automated technology to quantitatively characterize nonparticipatory perioral stiffness in healthy male adults. Method—Quantitative measures of perioral stiffness were sampled during a nonparticipatory task using a computer-controlled linear motor servo programmed to impose a series of tensile displacements over a span of approximately 24 mm at the oral angle in 20 healthy young male adults. Perioral electromyograms were simultaneously sampled to confirm nonparticipation or passive muscle state. Perioral stiffness, derived as a quotient from resultant force (ΔF) and oral span (ΔX), was modeled with regression techniques, and subsequently compared to previously reported perioral stiffness data for female adults. Results—Multilevel regression analysis revealed a significant quadratic relation between the perioral stiffness and interangle span; however, no significant difference was found between adult males and females. Conclusion—These normative measures will have application to future studies designed to objectively assess the effects of pathology (i.e., progressive neuromotor disease, traumatic brain insult) and intervention (pharmacologic, neurosurgical, and reconstructive surgery of the face [i.e., cleft lip, trauma, missile injuries]) on facial animation and speech kinematics

Nonparticipatory Stiffness in the Male Perioral Complex

Purpose—The objective of this study was to extend previous published findings in the authors’ laboratory using a new automated technology to quantitatively characterize nonparticipatory perioral stiffness in healthy male adults. Method—Quantitative measures of perioral stiffness were sampled during a nonparticipatory task using a computer-controlled linear motor servo programmed to impose a series of tensile displacements over a span of approximately 24 mm at the oral angle in 20 healthy young male adults. Perioral electromyograms were simultaneously sampled to confirm nonparticipation or passive muscle state. Perioral stiffness, derived as a quotient from resultant force (ΔF) and oral span (ΔX), was modeled with regression techniques, and subsequently compared to previously reported perioral stiffness data for female adults. Results—Multilevel regression analysis revealed a significant quadratic relation between the perioral stiffness and interangle span; however, no significant difference was found between adult males and females. Conclusion—These normative measures will have application to future studies designed to objectively assess the effects of pathology (i.e., progressive neuromotor disease, traumatic brain insult) and intervention (pharmacologic, neurosurgical, and reconstructive surgery of the face [i.e., cleft lip, trauma, missile injuries]) on facial animation and speech kinematics

OroSTIFF: Face-referenced measurement of perioral stiffness in health and disease

A new device and automated measurement technology known as OroSTIFF is described to characterize non-participatory perioral stiffness in healthy adults for eventual application to patients with orofacial movement disorders associated with neuromotor disease, traumatic injury, or congenital clefts of the upper lip. Previous studies of perioral biomechanics required head stabilization for extended periods of time during measurement which precluded sampling patients with involuntary body/head movements (dyskinesias), or pediatric subjects. The OroSTIFF device is face-referenced and avoids the complications associated with head-restraint. Supporting data of non-participatory perioral tissue stiffness using OroSTIFF are included from 10 male and 10 female healthy subjects. The OroSTIFF device incorporates a pneumatic glass air cylinder actuator instrumented for pressure, and an integrated subminiature displacement sensor to encode lip aperture. Perioral electromyograms were simultaneously sampled to confirm passive muscle state for the superior and inferior divisions of the orbicularis oris muscles. Perioral stiffness, derived as a quotient from resultant force (ΔF) and interangle span (ΔX), was modeled with multilevel regression techniques. Real-time calculation of the perioral stiffness function demonstrated a significant quadratic relation between imposed interangle stretch and resultant force. This stiffness growth function also differed significantly between males and females. This study demonstrates the OroSTIFF ‘proof-of-concept’ for cost-effective non-invasive stimulus generation and derivation of perioral stiffness in a group of healthy unrestrained adults, and a case study to illustrate the dosedependent effects of Levodopa on perioral stiffness in an individual with advanced Parkinson’s disease who exhibited marked dyskinesia and rigidity

Modification of Perioral Stiffness in Patients With Repaired Cleft Lip and Palate

Objective—To measure and compare the perioral stiffness among three groups of pediatric subjects: a group of patients with a repaired cleft lip (and palate) who had a secondary lip revision surgery (revision), another group of patients with repaired cleft lip (and palate) who did not have secondary surgery (nonrevision), and a group of noncleft “normal” patients (noncleft). Design—A parallel, three-group, nonrandomized clinical trial. Participants—A total of 16 patients with repaired cleft lip/palate who did not have lip revision, 13 patients with repaired cleft lip/palate who had lip revision surgery and were tested at 18 to 24 months postsurgery, and 27 noncleft patients. Analysis—Nonparticipatory perioral stiffness was sampled using a recently developed facereferenced measurement technology known as OroSTIFF. Perioral stiffness, derived as a quotient from resultant force and interangle lip span, was modeled with multilevel regression techniques. Real-time calculation of the perioral stiffness function demonstrated a significant quadratic relation between imposed interangle stretch and resultant force for each of the three groups. Results—This nonlinear stiffness growth function was significantly elevated in the nonrevision patients compared with the noncleft controls and is likely due to the presence of scar tissue in the upper lip; it was significantly lower among patients with cleft lip/palate who completed lip revision surgery. Conclusion—This study demonstrates the efficacy of applying an objective measurement to map differences in perioral tissue biomechanics among patients born with orofacial clefts

Modification of Perioral Stiffness in Patients With Repaired Cleft Lip and Palate

Objective—To measure and compare the perioral stiffness among three groups of pediatric subjects: a group of patients with a repaired cleft lip (and palate) who had a secondary lip revision surgery (revision), another group of patients with repaired cleft lip (and palate) who did not have secondary surgery (nonrevision), and a group of noncleft “normal” patients (noncleft). Design—A parallel, three-group, nonrandomized clinical trial. Participants—A total of 16 patients with repaired cleft lip/palate who did not have lip revision, 13 patients with repaired cleft lip/palate who had lip revision surgery and were tested at 18 to 24 months postsurgery, and 27 noncleft patients. Analysis—Nonparticipatory perioral stiffness was sampled using a recently developed facereferenced measurement technology known as OroSTIFF. Perioral stiffness, derived as a quotient from resultant force and interangle lip span, was modeled with multilevel regression techniques. Real-time calculation of the perioral stiffness function demonstrated a significant quadratic relation between imposed interangle stretch and resultant force for each of the three groups. Results—This nonlinear stiffness growth function was significantly elevated in the nonrevision patients compared with the noncleft controls and is likely due to the presence of scar tissue in the upper lip; it was significantly lower among patients with cleft lip/palate who completed lip revision surgery. Conclusion—This study demonstrates the efficacy of applying an objective measurement to map differences in perioral tissue biomechanics among patients born with orofacial clefts

A report of assessment tools for individuals with dysarthria

Introduction: The development of assessment tools for individuals with dysarthria has been reported in many clinical and empirical studies. Methodology: A literature review was based on online resources including Google Scholar, EBSCO, Medline, PubMed, and BIOMED Central articles and journals. Results and Conclusion: In this paper, we summarized the commonly used formal and informal assessment tools and explained the assessment procedure when managing clients with dysarthria. We aimed to share the current practice of speech-language pathologists together with the allied health service providers in the management of patients with dysarthri

Jun Dimerization Protein 2 Controls Senescence and Differentiation via Regulating Histone Modification

Transcription factor, Jun dimerization protein 2 (JDP2), binds directly to histones and DNAs and then inhibits the p300-mediated acetylation both of core histones and of reconstituted nucleosomes that contain JDP2 recognition DNA sequences. JDP2 plays a key role as a repressor of adipocyte differentiation by regulation of the expression of the gene C/EBPδ via inhibition of histone acetylation. Moreover, JDP2-deficient mouse embryonic fibroblasts (JDP2−/− MEFs) are resistant to replicative senescence. JDP2 inhibits the recruitment of polycomb repressive complexes (PRC1 and PRC2) to the promoter of the gene encoding p16Ink4a, resulting from the inhibition of methylation of lysine 27 of histone H3 (H3K27). Therefore, it seems that chromatin-remodeling factors, including the PRC complex controlled by JDP2, may be important players in the senescence program. The novel mechanisms that underline the action of JDP2 in inducing cellular senescence and suppressing adipocyte differentiation are reviewed

Characterizing employees with primary and secondary caregiving responsibilities: informal care provision in Malaysia

There is a need to determine the extent to which Malaysian employees reconcile both paid employment and informal care provision. We examined data from the Malaysia’s Healthiest Workplace via AIA Vitality Online Survey 2019 (N = 17,286). A multivariate multinomial regression was conducted to examine characteristics for the following groups: primary caregiver of a child or disabled child, primary caregiver of a disabled adult or elderly individual, primary caregiver for both children and elderly, as well as secondary caregivers. Respondent mean age ± SD was 34.76 ± 9.31, with 49.6% (n = 8573), identifying as either a primary or secondary caregiver to at least one child under 18 years, an elderly individual, or both. Males (n = 6957; 40.2%) had higher odds of being primary caregivers to children (OR 2.06; 95% CI 1.85–2.30), elderly (OR 1.24; 95% CI 1.09–1.41) and both children and elderly (OR 1.87; 95% CI 1.57–2.22). However, males were less likely to be secondary caregivers than females (OR 0.61; 95% CI 0.53–0.71). Our results highlight the differences in characteristics of employees engaged in informal care provision, and to a lesser degree, the extent to which mid-life individual employees are sandwiched into caring for children and/or the elderly