1. Indiana CTSI ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH Indiana C linical and T ranslational S ciences I nstitute www.indianactsi.org Jessica E. Huber, Ph.D. Associate Professor Purdue University Device-Delivered Cueing to Treat Speech in Parkinson’s Disease

2. Indiana CTSI ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH Indiana C linical and T ranslational S ciences I nstitute www.indianactsi.org Parkinson’s Disease Progressive movement disorder in which there is a deficit in dopamine production Affects about 1.5 million people in the U.S. One of the most common degenerative diseases of neurological origin Has far reaching effects on the motor and cognitive systems, resulting in speech and language problems

3. Indiana CTSI ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH Indiana C linical and T ranslational S ciences I nstitute www.indianactsi.org Parkinson’s Disease 89% of people with Parkinson’s disease will develop voice problems 45% of people with Parkinson’s disease will develop articulation problems Perceptual features: –Reduced loudness (hypophonia) –Breathiness –Monotone (reduced pitch and loudness variation) –Disordered rate and short rushes of speech

4. Indiana CTSI ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH Indiana C linical and T ranslational S ciences I nstitute www.indianactsi.org Hypophonia Impacts intelligibility and impairs communication –Often communication partners are hearing impaired, exponentially increasing the effect of hypophonia on communication

5. Indiana CTSI ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH Indiana C linical and T ranslational S ciences I nstitute www.indianactsi.org PD: Self-Perception May not perceive their speech and voice problems as severely as their communication partners Individuals with PD may have difficulty appropriately perceiving their own loudness

6. Indiana CTSI ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH Indiana C linical and T ranslational S ciences I nstitute www.indianactsi.org PD: Medical Treatment Medical Treatment is usually pharmacological –L-dopa crosses blood-brain barrier to produce dopamine in the brain –Does not remediate speech symptoms well Deep Brain Stimulation is a common surgical treatment for later-stage patients –Helps tremor –Is often detrimental to speech, swallowing, and cognition

7. Indiana CTSI ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH Indiana C linical and T ranslational S ciences I nstitute www.indianactsi.org Proposed Therapy Effect We propose to use an device, which elicits the Lombard Effect –A “natural” external cue to increase loudness –Speakers naturally and automatically speak louder under conditions of background noise Our data demonstrate that using noise to cue increased loudness results in a greater increase in loudness in individuals with PD than seen in response to other types of cues to increase loudness

8. Indiana CTSI ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH Indiana C linical and T ranslational S ciences I nstitute www.indianactsi.org Purdue Research Device My laboratory is examining the use of a portable device which is designed to elicit a louder and clearer voice Voice activated device –An accelerometer is attached to the neck –The device turns on when individual begins to speak and off when they stop

9. Indiana CTSI ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH Indiana C linical and T ranslational S ciences I nstitute www.indianactsi.org Purdue Research Device Multi-talker babble plays in one ear while the patient speaks Uses open ear fitting Patient wears the device for 2-8 hours per day at times when s/he will be talking Automatically elicits clearer speech quality

10. Indiana CTSI ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH Indiana C linical and T ranslational S ciences I nstitute www.indianactsi.org Purdue Research Device Output loudness is controlled via an inset screw so researchers can access it, but not patients –Loudness maximum cannot exceed safe levels (85 dBA) Device tracks how much it was used in each 2-week period –Device is attached to a computer to download this information Has been designed with auto-on and off to save battery

11. Indiana CTSI ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH Indiana C linical and T ranslational S ciences I nstitute www.indianactsi.org Benefits of Purdue Device Use of an automatic response reduces the cognitive demand on the individual with PD Improved generalization – individuals will wear the device in daily communication contexts, so the intervention will become part of their daily living activities Will not require specially-trained clinicians –Any speech-language pathologist could work with the patient

12. Indiana CTSI ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH Indiana C linical and T ranslational S ciences I nstitute www.indianactsi.org Current Status We have 30 patients currently enrolled in the study Patients are demonstrating increases in vocal intensity (5-7 dB SPL) and speech clarity For some patients, voice and speech changes are present without the device after 8 weeks of therapy For some patients, even after 8 weeks of therapy, the device is needed for clear gains to be maintained Have seen continued effect for 6 months after therapy ends (but have not examined longer than 6 months) PreMid OffMid On

13. Indiana CTSI ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH Indiana C linical and T ranslational S ciences I nstitute www.indianactsi.org Plan for Future Development 1. Smaller and Wireless –Requires a different place to detect voice onset and offset –Requires smaller technology –Need to watch EMF due to DBS implants in many patients 2. Better programming controls 3. Larger size, multi-site study – full clinical trials 4. More commercial device