Objective: This study aimed to evaluate the clinical relevance of effects on voice sound level (L_v) as well as brain connectivity using resting-state functional MRI (rsfMRI) following a novel speech and communication treatment for Parkinson’s disease (PD).

Background: The HiCommunication program for speech and communication in PD is based on principles driving neuroplasticity and has shown high compliance and acceptability [1] as well as positive results at a group level of the primary outcome measure L_v [2].

Method: Participants with PD (n=95) were recruited within a randomized controlled trial [3] and allocated to intervention with either HiCommunication or HiBalance (targeting balance and gait). Speech recordings and rsfMRI were performed pre and post intervention. Clopper Pearson exact 95% confidence intervals for the proportion of participants with a clinically relevant increase in L_v were calculated. Linear regression was used to test if L_v at baseline significantly predicted the change following HiCommunication. Complete rsfMRI data were available from 28 participants in the HiCommunication group. Spectral dynamic causal modeling [4] and the parametric empirical Bayes [5] methods were applied to describe effective connectivity changes in a speech related network [6].

Results: The percentage of participants with a clinically relevant increase in L_v after HiCommunication was 59%, CI [41%, 75%] and after HiBalance 13%, CI [4%, 28%]. It was found that L_v at baseline significantly predicted the change in L_v after HiCommunication (β = -0.332 p = 0.009). Pre HiCommunication an inhibitory effective connectivity from the right to the left supplementary motor area (SMA) was found. Further, the left SMA to the left paracentral gyrus showed inhibitory connectivity. Excitatory effective self-connectivity was found in the left SMA and paracentral gyrus. Post HiCommunication, the inhibitory effective connectivity from the right to the left SMA decreased and was the only effective connectivity found.

Conclusion: The results from this study suggest clinically relevant effects on L_v after HiCommunication. Notably, participants with a lower L_v at baseline showed a larger change in L_v following the intervention. Furthermore, resting-state connectivity was altered after the intervention. These changes could be a result of underlying compensatory effects but need further investigation.

References: [1] E. Schalling, H. Winkler, and E. Franzén, “HiCommunication as a novel speech and communication treatment for Parkinson’s disease: A feasibility study,” Brain and behavior, pp. e02150-e02150, 2021.
[2] M. Freidle et al., “Behavioural and neuroplastic effects of a double-blind randomised controlled balance exercise trial in people with Parkinson’s disease,” NPJ Parkinson’s Disease, vol. 8, no. 1, pp. 12-12, 2022.
[3] E. Franzén et al., “The EXPANd trial: effects of exercise and exploring neuroplastic changes in people with Parkinson’s disease: a study protocol for a double-blinded randomized controlled trial,” (in eng), BMC Neurol, vol. 19, no. 1, p. 280, Nov 12 2019.
[4] K. J. Friston, J. Kahan, B. Biswal, and A. Razi, “A DCM for resting state fMRI,” NeuroImage (Orlando, Fla.), vol. 94, no. 100, pp. 396-407, 2014.
[5] K. J. Friston et al., “Bayesian model reduction and empirical Bayes for group (DCM) studies,” NeuroImage (Orlando, Fla.), vol. 128, pp. 413-431, 2016.
[6] A. Baumann et al., “Neural Correlates of Hypokinetic Dysarthria and Mechanisms of Effective Voice Treatment in Parkinson Disease,” Neurorehabilitation and neural repair, vol. 32, no. 12, pp. 1055-1066, 2018.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-on-voice-sound-level-and-brain-connectivity-after-hicommunication-a-novel-speech-and-communication-treatment-for-parkinsons-disease/