Steurer Hanna, Albrecht Franziska, Gustafsson Joakim Körner, Razi Adeel, Franzén Erika, Schalling Ellika
Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, 141 86 Huddinge, Stockholm, Sweden.
Research & Development Unit, Stockholms Sjukhem, 112 19 Stockholm, Sweden.
Brain Commun. 2024 Jul 12;6(4):fcae235. doi: 10.1093/braincomms/fcae235. eCollection 2024.
Speech, voice and communication changes are common in Parkinson's disease. HiCommunication is a novel group intervention for speech and communication in Parkinson's disease based on principles driving neuroplasticity. In a randomized controlled trial, 95 participants with Parkinson's disease were allocated to HiCommunication or an active control intervention. Acoustic analysis was performed pre-, post- and six months after intervention. Intention-to-treat analyses with missing values imputed in linear multilevel models and complimentary per-protocol analyses were performed. The proportion of participants with a clinically relevant increase in the primary outcome measure of voice sound level was calculated. Resting-state functional MRI was performed pre- and post-intervention. Spectral dynamic causal modelling and the parametric empirical Bayes methods were applied to resting-state functional MRI data to describe effective connectivity changes in a speech-motor-related network of brain regions. From pre- to post-intervention, there were significant group-by-time interaction effects for the measures voice sound level in text reading (unstandardized = 2.3, = 0.003), voice sound level in monologue (unstandardized = 2.1, = 0.009), Acoustic Voice Quality Index (unstandardized = 0.5, = 0.016) and Harmonics-to-Noise Ratio (unstandardized = 1.3, = 0.014) post-intervention. For 59% of the participants, the increase in voice sound level after HiCommunication was clinically relevant. There were no sustained effects at the six-month follow-up. In the effective connectivity analysis, there was a significant decrease in inhibitory self-connectivity in the left supplementary motor area and increased connectivity from the right supplementary motor area to the left paracentral gyrus after HiCommunication compared to after the active control intervention. In conclusion, the HiCommunication intervention showed promising effects on voice sound level and voice quality in people with Parkinson's disease, motivating investigations of barriers and facilitators for implementation of the intervention in healthcare settings. Resting-state brain effective connectivity was altered following the intervention in areas implicated, possibly due to reorganization in brain networks.
言语、嗓音和交流方面的变化在帕金森病中很常见。HiCommunication是一种基于神经可塑性原理的针对帕金森病言语和交流的新型团体干预措施。在一项随机对照试验中，95名帕金森病患者被分配到HiCommunication组或积极对照干预组。在干预前、干预后及干预后六个月进行声学分析。采用线性多水平模型对缺失值进行插补的意向性分析和补充的符合方案分析。计算主要结局指标嗓音声级有临床相关增加的参与者比例。在干预前和干预后进行静息态功能磁共振成像。将频谱动态因果模型和参数经验贝叶斯方法应用于静息态功能磁共振成像数据，以描述与言语运动相关的脑区网络中的有效连接变化。从干预前到干预后，在文本阅读中的嗓音声级（非标准化β = 2.3，P = 0.003）、独白中的嗓音声级（非标准化β = 2.1，P = 0.009）、声学嗓音质量指数（非标准化β = 0.5，P = 0.016）和谐波噪声比（非标准化β = 1.3，P = 0.014）等测量指标上存在显著的组×时间交互效应。对于59%的参与者，HiCommunication后嗓音声级的增加具有临床相关性。在六个月的随访中没有持续效应。在有效连接性分析中，与积极对照干预后相比，HiCommunication后左侧辅助运动区的抑制性自连接显著降低，右侧辅助运动区到左侧中央旁回的连接增加。总之，HiCommunication干预对帕金森病患者的嗓音声级和嗓音质量显示出有前景的效果，促使对在医疗环境中实施该干预的障碍和促进因素进行研究。干预后涉及的脑区静息态脑有效连接性发生改变，可能是由于脑网络的重组。
