An RCT of a telemedicine intervention for hypokinetic dysarthria in PD

项目背景/理由。绝大多数帕金森病（PD）患者会出现语言障碍。 损伤（Ho等人，1999;米勒等人，2007; Schalling等人，2017年），其中大部分都集中在一起 叫做运动减退性构音障碍运动功能减退性构音障碍的典型特征是韵律改变（例如， 降低的响度和音高变化），发声（例如，呼吸或刺耳的声音），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 言语障碍可能在PD早期出现（米勒等人，2008; Rusz等人，2011; Skodda等人，2013年）和进展情况 随着时间的严重性（Skodda等人，2013; Skodda等人，2009年; Skodda，Flasskamp等人，2011年）。此外，这种 言语的变化导致功能性交流和生活质量的显著下降（米勒等人，2006 和2007年）。减轻PD运动症状的药物和手术干预在很大程度上是无效的 有时甚至不利于言语。 项目目标。根据我们最近完成的VA SPiRE项目的结果，我们建议进行一项 在PD运动减退性构音障碍患者中进行的初步随机对照试验（RCT），以评估 一种新型基于家庭的运动干预与交互式自动语音应答的有效性 鼓励更高水平的语音性能的功能。我们假设参与干预的患者 计划将提高语言清晰度和自我感知的沟通能力超过6个月， 与健康教育项目中的患者相比。 项目方法。共有104名社区居住的退伍军人患有轻度至中度运动功能减退性构音障碍， 将PD随机分配至运动干预组或健康教育对照组。我们将测试 干预6个月后观察言语清晰度和自我感知沟通能力的变化。

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.