An RCT of a telemedicine intervention for hypokinetic dysarthria in PD

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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.