We awarded funds to three Graduate Students totaling $50,000 this past April at the Parkinson’s Medical Reception. The Graduate Student Research Program is part of a strategic initiative to encourage young scientists to enter the field of Parkinson’s research and to invest in research and training that offers promise for future work in the area of Parkinson’s. We were excited to award this year’s recipients: Thea Knowles, Olivia Samotus and Andrew Vo.
Researcher: Thea Knowles
Project Title: A Comparison of Voice Amplifiers and Personal Communication Systems in Individuals with Parkinson’s disease
The majority of individuals with Parkinson disease (PD) will develop speech impairments at some point during the course of the disease. One of the most prevalent and distinctive characteristics of the speech of people with PD is hypophonia, or an overall reduction in loudness that typically makes speech hard to understand across many different social contexts.
While there are behavioural interventions designed to help individuals with PD increase their speech loudness, these do not work for all individuals. The predominant criticism of these treatments is that improvements may not transfer beyond the clinical setting because of cognitive and sensorimotor deficits associated with PD. This may inhibit the incorporation of new speech strategies into habitual speech. An alternative to behavioural intervention is the use of amplification devices. These devices increase the loudness of the speech produced by the individual with PD rather than requiring them to speak at a higher volume. Though amplification devices provide a viable alternative, there are very few published studies that systematically examine their efficacy in PD.
The proposed study will compare the use of three different devices thought to bring benefit to people with hypophonia secondary to PD: 1) a portable wired voice amplifier; 2) a wireless voice amplifier; and 3) a wireless personal communication system. The first amplifier consists of a small portable speaker that can be worn on the waist belt of the individual with PD. Speech is amplified through a headset microphone attached via a cable to the speaker. The second amplifier also includes a headset microphone to be worn by the individual with PD, but the speech signal is transmitted wirelessly to a moderate-sized audio speaker located up to several metres away from the talker. The third unit is a personal communication device designed for two-way communication.
Personal communication devices have often been used in the past for individuals with hearing impairment, but have not yet been investigated for use in individuals with PD. Both the speaker and the listener wear small portable units. The speaker’s unit is wired to a headset microphone, and the listener’s unit is wired to headphones. The speech of the individual with PD is thus transmitted directly to the listener at a volume that allows them to be better heard.
The present study will examine the use of these three devices in twenty individuals with hypophonia and their caregivers over the course of four visits. The performance of these three devices will be compared using measures of speech intelligibility (understandability) in quiet and in noise, as well as through the use of patient and caregiver questionnaires and rating scales. Participants will be asked to take each device home for a week at a time, and to rate various aspects of each. Given the limited evidence that currently exists surrounding the use of amplification and personal communication devices in PD, it is anticipated that the results from the present study will provide important new information about patient preferences and the relative effectiveness of these devices.
Researcher: Olivia Samotus
Project Title: Investigating Spinal Cord Stimulation for Treating Gait Impairments in Advanced Parkinson’s Disease Patients
Axial symptoms, including gait and balance dysfunction, freezing of gait (FOG), and of speech, impair mobility and significantly reduce quality of life in patients living with Parkinson’s disease (PD). Benefits of dopaminergic therapy, such as levodopa, and deep brain stimulation are limited and unpredictable for such axial symptoms.
Spinal cord stimulation (SCS) may be a new therapeutic approach as SCS is simple, minimally invasive, and is a programmable out-patient treatment. Our pilot study followed five advanced PD patients over six months where we observed significant improvement in walking speed and stride lengths, reduced number of FOG episodes, and increased confidence in completing daily activities. The goal of this research project supported by Parkinson Society Southwestern Ontario is to investigate the therapeutic effect of SCS on gait including FOG in an additional 20 advanced PD patients.
We will assess changes in mobility using a gait carpet and a full-body motion capture suit to measure body locomotion during simple walking tasks before SCS surgery and up to one year after SCS surgery.
Researcher: Andrew Vo
Project Title: Evolution of Cognitive Symptoms and Effects of Dopamine Replacement Therapy in Parkinson’s disease: A Pharmacological MRI Investigation
Cognitive impairment is an undisputed, non-motor feature of Parkinson’s disease. Improved management of these symptoms in PD is a high priority. yet it remains a grossly unmet goal because of our poor current understanding of their pathophysiology.
Parkinson’s disease is marked by severe loss of brain cells that produce dopamine, an important chemical messenger involved in movement, cognition, behaviour and motivation. The brain region most affected by dopamine depletion is the striatum. Dopamine replacement therapy is prescribed to address this deficiency and normalize motor abnormalities in Parkinson’s disease. Whereas medication improves functions of more severely affected regions of striatum, it appears to worsen those of the less affected areas.
As Parkinson’s disease progresses, sources of dopamine further deteriorate and initially spared functions decline. The effects of medication on these impairments are not clear. Therefore, the aims of the proposed research are to 1) validate the brain regions underlying emerging cognitive deficits in Parkinson’s disease and 2) clarify the effects of dopaminergic therapy on these symptoms.
Patients at different stages of the disease will perform tests designed to assess cognitive abilities, first when on their dopaminergic medications and next when off medications, compared to healthy volunteers. Testing will be performed inside an fMRI scanner. FMRI is a safe and non-invasive imaging technique that allows us to look at the integrity of brain structure and function in individuals performing these tests.
The prevalence of Parkinson’s disease in the population is expected to rise given longer life expectancies, with more patients progressing into advanced disease stages, when cognitive impairment becomes the major source of disability. This research will significantly contribute to our understanding of cognitive decline in Parkinson’s disease and effectiveness of dopaminergic therapy in addressing these symptoms. This will translate into better-informed treatment strategies towards improved symptom management, ultimately improving quality of care and life for Parkinson’s disease patients.