An RCT of a telemedicine intervention for hypokinetic dysarthria in PD

项目背景/基本原理。绝大多数帕金森氏病(PD)患者会发展语言能力 减损(Ho等人，1999；Miller等人，2007；Schalling等人，2017)，其中大部分归类在一起 称为运动性构音障碍。运动性构音障碍的典型特征是韵律改变(例如， 降低响度和音调变化)、发音(例如，喘气或刺耳的声音)和发音(例如，不精确 辅音，集中元音)(Fox&Ramig，1997；Ho等人，1999；Hillenbrand&Houde，1996)。变化 演讲可能出现在PD的早期(Miller等人，2008；Rusz等人，2011；Skodda等人，2013)和进展 随时间推移的严重性(Skodda等人，2013年；Skodda等人，2009年；Skodda，Flasskamp等人，2011年)。此外，这样的 言语的改变会导致功能性交流和生活质量的显著下降(Miller等人，2006 &2007)。缓解帕金森病患者运动症状的药物和手术干预在很大程度上无效 有时甚至对言语有害。 项目目标。根据我们最近完成的退伍军人管理局尖顶项目的结果，我们建议进行一项 Pilot随机对照试验(RCT)对帕金森病患者运动性构音障碍的潜在评估 一种具有交互式自动语音反应的新型家庭运动干预的有效性 鼓励更高水平的语音表现的功能。我们假设介入治疗中的患者 计划将在6个月内提高语音清晰度和自我感知沟通能力，如 与健康教育计划中的患者进行比较。 项目方法。共有104名患有轻度至中度运动性构音障碍的社区退伍军人 将帕金森病患者随机分为运动干预组和健康教育对照组。我们将测试其效果 6个月时进行干预，观察结果、言语清晰度和自我感觉沟通能力。

Project Background/Rationale. The great majority of individuals with Parkinson's disease (PD) develop speech impairments (Ho et al., 1999; Miller et al., 2007; Schalling et al., 2017), most of which are grouped together and called hypokinetic dysarthria. Hypokinetic dysarthria is typically characterized by altered prosody (e.g., reduced loudness and pitch variation), phonation (e.g., breathy or harsh voice), and articulation (e.g., imprecise consonants, centralized vowels) (Fox & Ramig, 1997; Ho et al., 1999; Hillenbrand & Houde, 1996). Changes in speech may appear early in PD (Miller et al., 2008; Rusz et al., 2011; Skodda et al., 2013) and progress in severity over time (Skodda et al., 2013; Skodda et al., 2009; Skodda, Flasskamp et al., 2011). Further, such changes in speech lead to significant declines in functional communication and quality of life (Miller et al., 2006 & 2007). Pharmacological and surgical interventions that alleviate motor symptoms in PD are largely ineffective or sometimes even detrimental for speech. Project Objectives. Based on results from our recently completed VA SPiRE project, we propose to conduct a pilot randomized, controlled trial (RCT) in patients with hypokinetic dysarthria in PD to assess the potential effectiveness of a novel home-based exercise intervention with interactive automated speech response features that encourage a higher level of speech performance. We hypothesize that patients in the intervention program will improve in speech intelligibility and self-perceived communication ability over 6 months, as compared with patients in a health education program. Project Methods. A total of 104 community-dwelling veterans with hypokinetic dysarthria in mild-to-moderate PD will be randomized to the exercise intervention or to the health education control. We will test the effects of the intervention at 6 months for the outcomes speech intelligibility and self-perceived communication ability.