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Aktuelle Neurologie 2014; 41(05): 267-276
DOI: 10.1055/s-0034-1376952
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Dysarthrie bei der Parkinson-Krankheit – Phänomenologie, Pathophysiologie und therapeutische Ansätze

The Hypokinetic Dysarthria of Parkinson’s Disease – Phenomenology, Pathophysiology and Therapeutic Approaches
S. Skodda
1   Neurologie, Knappschaftskrankenhaus, Ruhr-Universität, Bochum
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Publication History

Publication Date:
18 June 2014 (online)

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Zusammenfassung

Bei der hypokinetischen Dysarthrie des idiopathischen Parkinson-Syndroms (IPS) handelt es sich um eine multidimensionale Störung, die bei der Mehrzahl der Patienten zu einer relevanten Kommunikationsstörung führen kann. Neben dem pathognomonischen Befund einer leisen, monotonen Sprechweise („monopitch and monoloudness“) kommt es in unterschiedlichem Ausmaß auch zu Beeinträchtigungen von Sprechatmung, Stimmbildung (Phonation), Aussprache (Artikulation) und Sprechgeschwindigkeit und -rhythmus. Während in frühen Erkrankungsstadien gewisse Aspekte der Dysarthrie auf dopaminerge Therapie ansprechen, sind insbesondere in weiter fortgeschrittenen Erkrankungsstadien die medikamentösen Therapiemaßnahmen meist wirkungslos. Die Tiefe Hirnstimulation/THS kann im Einzelfall eine gewisse Besserung distinkter Sprechmodalitäten wie Stimmqualität oder Lautstärke bewirken; bei einer Subgruppe von Patienten es kann aber auch zu einer relevanten Zunahme der Dysarthrie unter der THS kommen. Therapie der Wahl ist aktuell eine Stimm-/Sprechtherapie, die bereits frühzeitig vor einer relevanten Einschränkung der Kommunikationsfähigkeit initiiert werden sollte. Aktuell gibt es allerdings keine Daten darüber, welche Form der Logopädie zur Behandlung der hypokinetischen Dysarthrie besonders geeignet ist, wobei ein spezielles Verfahren mit Fokus auf einer Verbesserung der Lautstärke (LSVT®) sich zumindest in kleineren Studien als effektiv gezeigt hat. Zum aktuellen Zeitpunkt ist die hypokinetische Dysarthrie beim Morbus Parkinson eine therapeutische Herausforderung, die ein multidisziplinäres und auf die individuelle Symptomkonstellation des einzelnen Patienten angepasstes Therapiekonzept erfordert.

Abstract

The hypokinetic dysarthria of Parkinson’s ­disease (PD) is a multidimensional impairment which can induce a considerable communication disorder with relevant impact on quality of life in the majority of patients in the course of the disease. The typical pattern of Parkinsonian dysarthria consists of a reduction of loudness and intona­tion variability (“monopitch and monoloudness”) often in combination with alterations of speech respiration, phonation, articulation and temporal aspects of speech as speech rate and rhythm. Some aspects of hypokinetic dysarthria seem to respond to dopaminergic therapy especially in the early stages of disease, however, with advancing disease progression, pharmacological interventions become disappointing and typically cannot prevent the progressive impairment of overall speech intelligibility. Deep brain stimulation/DBS, although very effective as symptomatic therapy of motor impairment in advanced PD, has been reported to ameliorate some distinctive speech modalities in individual pa­tients; however, a subgroup of patients experience relevant deterioration of speech function under DBS. Up till now, speech/language therapy (SLT) is estimated as the gold standard in the treatment of Parkinsonian dysarthria, although none of the existing therapeutic SLT approaches have proven its effectiveness according to evidence-based medicine standards. The best documented SLT method is LSVT® which focusses on the amelioration of disturbed loudness of speech in PD. Therapy of dysarthria in PD is often challenging and ideally follows multidisciplinary therapeutic concepts adapted to the individual patient's needs.

Schlüsselwörter

idiopathisches Parkinson-Syndrom - hypokinetische Dysarthrie - dopaminerge Therapie - Tiefe Hirnstimulation - Stimm-/Sprechtherapie

Keywords

Parkinson’s disease - hypokinetic dysarthria - dopaminergic therapy - deep brain stimulation - speech therapy
 

  • Literatur

  • 1 Braak H, Del Tredici K, Rüb U et al. Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging 2003; 24: 197-211
    CrossrefPubMedGoogle Scholar
  • 2 Gaig C, Tolosa E. When does Parkinson’s disease begin?. Mov Disord 2009; 24 (Suppl. 02) S656-S664
    CrossrefPubMedGoogle Scholar
  • 3 Logemann JA, Fisher HB, Boshes B et al. Frequency and co-occurrence of vocal tract dysfunction in the speech of a large sample of parkinsonian patients. J Speech Hearing Disord 1978; 43: 47-57
    PubMedGoogle Scholar
  • 4 Ho A, Iansek R, Marigliani C et al. Speech impairment in a large sample of people with Parkinson’s disease. Behav Neurol 1998; 11: 131-137
    PubMedGoogle Scholar
  • 5 Parkinson J. An essay on the shaking palsy. In: J Neuropsychiatry Clin Neurosci 2002; 14: 223-236
    PubMedGoogle Scholar
  • 6 Darley FL, Aronson AE, Brown JR. Differential diagnostic patterns of dysarthria. J Speech Hear Res 1969; 12: 246-269
    CrossrefPubMedGoogle Scholar
  • 7 Darley FL, Aronson AE, Brown JR. Clusters of deviant speech dimensions in the dysarthrias. J Speech Hear Res 1969; 12: 462-496
    CrossrefPubMedGoogle Scholar
  • 8 Tjaden K, Wilding G. Effects of speaking tasks on intelligibility in Parkinson’s disease. Clin Linguist Phon 2011; 25: 155-168
    CrossrefPubMedGoogle Scholar
  • 9 Hovestadt A, Bogaard JM, Meerwaldt J et al. Pulmonary function in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1989; 52: 329-333
    CrossrefPubMedGoogle Scholar
  • 10 Huber JE, Spruill J. Respiratory function and variability in individuals with Parkinson’s disease: pre- and post-Lee Silverman Voice Treatment. J Med Speech Lang Pathol 2003; 11: 185-192
    PubMedGoogle Scholar
  • 11 Metter J, Hanson W. Clinical and acoustical variability in hypokinetic dysarthria. J Commun Disord 1986; 19: 347-366
    CrossrefPubMedGoogle Scholar
  • 12 Solomon NP, Hixon TJ. Speech Breathing in Parkinson’s disease. J Speech Hear Res 1983; 36: 294-310
    PubMedGoogle Scholar
  • 13 McClean MD, Beukelman DR, Yorkston KM. Speech-muscle visuomotor tracking in dysarthric and nonimpaired speakers. J Speech Hear Res 1987; 30: 276-282
    CrossrefPubMedGoogle Scholar
  • 14 Canter GJ. Speech characteristics of patients with Parkinson’s disease. I: Intensity, pitch, and duration. J Speech Hear Disord 1963; 28: 221-229
    CrossrefPubMedGoogle Scholar
  • 15 Canter GJ. Speech characteristics of patients with Parkinson’s disease: II. Physiological support for speech. J Speech Hear Disord 1965; 30: 44-49
    CrossrefPubMedGoogle Scholar
  • 16 Canter GJ. Speech characteristics of patients with Parkinson’s disease. III. Articulation, diadochokinesis, and overall speech adequacy. J Speech Hear Disord 1965; 30: 217-224
    CrossrefPubMedGoogle Scholar
  • 17 Hertrich I, Ackermann H. Gender-specific vocal dysfunction in Parkinson’s disease: Electroglottographic and acoustical analyses. An Oto Rhino Laryngol 1995; 104: 197-202
    PubMedGoogle Scholar
  • 18 Holmes RJ, Oates J, Phyland D et al. Voice characteristics in the progression of Parkinson’s disease. Int J Lang Commun Disord 2000; 35: 417-418
    PubMedGoogle Scholar
  • 19 Kent RD, Vorperian AK, Kent JF et al. Voice dysfunction in dysarthria: application of the Multi-Dimensional Voice Program. J Commun Disord 2003; 36: 281-306
    CrossrefPubMedGoogle Scholar
  • 20 Jimenez-Jimenez F, Gamboa J, Nieto A et al. Acoustic voice analysis in untreated patients with Parkinson’s disease. Parkinsonism Relat Disord 1997; 3: 111-116
    CrossrefPubMedGoogle Scholar
  • 21 Baker KK, Ramig LO, Luschei ES et al. Thyroarytenoid muscle activity associated with hypophonia in Parkinson’s disease and aging. Neurology 1998; 51: 1592-1598
    CrossrefPubMedGoogle Scholar
  • 22 Gallena S, Smith PJ, Zeffiro T et al. Effects of levodopa on laryngeal muscle activity for voice onset and offset in Parkinson’s disease. J Speech Lang Hear Res 2001; 44: 1284-1299
    CrossrefPubMedGoogle Scholar
  • 23 Hanson DG, Gerrat BR, Ward PH. Cinegraphic observations of laryngeal function in Parkinson’s disease. Laryngoscope 1984; 94: 348-353
    PubMedGoogle Scholar
  • 24 Perez KS, Ramig LO, Smith ME et al. The parkinson larynx: tremor and videoscopic findings. J Voice 1996; 10: 354-361
    CrossrefPubMedGoogle Scholar
  • 25 Forrest K, Weismer G, Turner GS. Kinematic acoustic and perceptual analyses of connected speech produced by parkinsonian and normal geriatric adults. J Acoust Soc Am 1989; 85: 2608-2622
    CrossrefPubMedGoogle Scholar
  • 26 Hunker C, Abbs J, Barlow S. The relationship between parkinsonian rigidity and hypokinesia in the orofacial system: a quantitative analysis. Neurology 1982; 2: 749-754
    PubMedGoogle Scholar
  • 27 Ackermann H, Konczak J, Hertrich I. The temporal control of repetitive articulatory movements in Parkinson’s disease. Brain Lang 1997; 57: 312-319
    PubMedGoogle Scholar
  • 28 Sapir S, Spielman JL, Ramig LO et al. Effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on vowel articulation in dysarthric individuals with idiopathic Parkinson disease: acoustic and perceptual findings. J Speech Lang Hear Res 2007; 50: 899-912
    CrossrefPubMedGoogle Scholar
  • 29 Skodda S, Visser W, Schlegel U. Vowel articulation in Parkinson’s disease. J Voice 2011; 25: 467-472
    CrossrefPubMedGoogle Scholar
  • 30 Skodda S, Visser W, Schlegel U. Gender-related patterns of dysprosody in Parkinson’s disease and correlation between speech variables and motor symptoms. J Voice 2011; 25: 76-82
    CrossrefPubMedGoogle Scholar
  • 31 Hirose H, Kiritani S, Sawashima M. Velocity of articulatory movements in normal and dysarthric subjects. Folia Phoniatr Logop 1982; 34: 210-215
    CrossrefPubMedGoogle Scholar
  • 32 Ludlow CL, Connor NP, Bassich CJ. Speech timing in Parkinson’s and Huntington’s disease. Brain Lang 1987; 32: 195-214
    CrossrefPubMedGoogle Scholar
  • 33 Netsell R, Daniel B, Celesia GG. Acceleration and weakness in parkinsonian dysarthria. J Speech Hear Disord 1975; 40: 170-178
    CrossrefPubMedGoogle Scholar
  • 34 De Letter M, Santens P, De Bodt M et al. Levodopa-induced alterations in speech rate in advanced Parkinson’s disease. Acta Neurol Belg 2006; 106: 19-22
    PubMedGoogle Scholar
  • 35 llles J, Metter EJ, Hanson WR et al. Parkinson’s disease: acoustic and linguistic considerations. Brain Lang 1988; 33: 146-160
    CrossrefPubMedGoogle Scholar
  • 36 Skodda S, Schlegel U. Speech rate and rhythm in Parkinson’s disease. Mov Disord 2008; 23: 985-992
    CrossrefPubMedGoogle Scholar
  • 37 Benke T, Butterworth B. Palilalia and repetitive speech: two case studies. Brain Lang 2001; 78: 62-81
    CrossrefPubMedGoogle Scholar
  • 38 Sapir S, Pawlas AA, Ramig LO et al. Voice and speech abnormalities in Parkinson disease: Relation to severity of motor impairment, duration of disease, medication, depression, gender, and age. J Med Speech Lang Pathol 2001; 9: 213-226
    PubMedGoogle Scholar
  • 39 Rusz J, Cmejla R, Ruzickova H et al. Quantitative acoustic measurements for characterization of speech and voice disorders in early untreated Parkinson’s disease. J Acoust Soc Am 2011; 129: 350-367
    CrossrefPubMedGoogle Scholar
  • 40 Ho AK, Iansek R, Bradshaw JL. Regulation of parkinsonian speech volume: the effect of interlocutor distance. J Neurol Neurosurg Psychiatry 1999; 67: 199-202
    CrossrefPubMedGoogle Scholar
  • 41 Skodda S, Grönheit W, Schlegel U. Impairment of vowel articulation as a possible marker of disease progression in Parkinson’s disease. PLoS One 2012; 7: e32132
    CrossrefPubMedGoogle Scholar
  • 42 Skodda S, Grönheit W, Mancinelli N et al. Progression of voice and speech impairment in the course of Parkinson’s disease: a longitudinal study. Parkinsons Dis 2013; 2013: 389195
    PubMedGoogle Scholar
  • 43 Skodda S, Flasskamp A, Schlegel U. Instability of syllable repetition as a marker of disease progression in Parkinson’s disease: a longitudinal study. Mov Disord 2011; 26: 59-64
    CrossrefPubMedGoogle Scholar
  • 44 Skodda S, Rinsche H, Schlegel U. Progression of dysprosody in Parkinson’s disease over time – a longitudinal study. Mov Disord 2009; 24: 716-722
    CrossrefPubMedGoogle Scholar
  • 45 Goberman A, Coelho C, Robb M. Phonatory characteristics of parkinsonian speech before and after morning medication: the ON and OFF states. J Commun Disord 2002; 35: 217-239
    CrossrefPubMedGoogle Scholar
  • 46 Skodda S, Visser W, Schlegel U. Gender-related patterns of dysprosody in Parkinson’s disease and correlation between speech variables and motor symptoms. J Voice 2010; 2011; 25: 76-82
    PubMedGoogle Scholar
  • 47 Rusz J, Cmejla R, Tykalova T et al. Imprecise vowel articulation as a potential early marker of Parkinson’s disease: effect of speaking task. J Acoust Soc Am 2013; 134: 2171-2181
    CrossrefPubMedGoogle Scholar
  • 48 Ackermann H, Ziegler W. Articulatory deficits in Parkinsonian dysarthria. J Neurol Neurosurg Psychiatry 1991; 54: 1093-1098
    CrossrefPubMedGoogle Scholar
  • 49 Caligiuri MP. The influence of speaking rate on articulatory hypokinesia in parkinsonian dysarthria. Brain Lang 1989; 36: 493-502
    CrossrefPubMedGoogle Scholar
  • 50 Ho AK, Iansek R, Bradshaw JL. Motor instability in Parkinsonian speech intensity. Neuropsychiatry Neuropsychol Behav Neurol 2001; 14: 109-116
    PubMedGoogle Scholar
  • 51 Konczak J, Ackermann H, Hertrich I et al. Control of repetitive lip and finger movements in Parkinson’s disease: influence of external timing signals and simultaneous execution on motor performance. Mov Disord 1997; 12: 665-676
    CrossrefPubMedGoogle Scholar
  • 52 Goberman AM, Elmer WE. Acoustic analysis of clear versus conversional speech in individuals with Parkinson’s disease. J Commun Disord 2005; 38: 215-230
    CrossrefPubMedGoogle Scholar
  • 53 Möbes J, Joppich G, Stiebritz F et al. Emotional speech in Parkinson’s disease. Mov Disord 2008; 23: 824-829
    CrossrefPubMedGoogle Scholar
  • 54 Oliveira RM, Gurd JM, Nixon P et al. Micrographia in Parkinson’s disease: The effect of providing external cues. J Neurol Neurosurg Psychiatry 1997; 63: 429-433
    CrossrefPubMedGoogle Scholar
  • 55 Rickards C, Cody FW. Proprioceptive control of wrist movements in Parkinson’s disease. Brain 1997; 120: 977-990
    CrossrefPubMedGoogle Scholar
  • 56 Sapir S, McClean M, Luschei E. Effects of frequency-modulated auditory tones on the voice fundamental frequency in humans. J Acoust Soc Am 1983; 73: 1070-1073
    CrossrefPubMedGoogle Scholar
  • 57 Caligiuri M, Abbs JH. Response properties of the perioral reflex in Parkinson’s disease. Exp Neurol 1987; 98: 563-572
    CrossrefPubMedGoogle Scholar
  • 58 Diamond SG, Schneider JS, Markham CH. Oral sensorimotor defects in people with Parkinson’s disease. Adv Neurol 1987; 45: 335-338
    PubMedGoogle Scholar
  • 59 Larson CR, Sun J, Hain TC. Effects of simultaneous perturbations of voice pitch and loudness feedback on voice F0 and amplitude control. Acoust Soc Am 2007; 121: 2862-2872
    CrossrefPubMedGoogle Scholar
  • 60 Schneider S, Diamond SG, Markham CH. Deficits in orofacial sensorimotor function in Parkinson’s disease. Ann Neurol 1986; 19: 275-282
    CrossrefPubMedGoogle Scholar
  • 61 Munhall K, MacDonald E, Byrne S. Talkers alter vowel production in response to real-time formant perturbation even when instructed not to compensate. J Acoust Soc Am 2009; 125: 384-390
    CrossrefPubMedGoogle Scholar
  • 62 Azulay JP, Mesure S, Blin O. Influence of visual cues on gait in Parkinson’s disease: contribution to attention or sensory dependence?. J Neurol Sci 2006; 248: 192-195
    CrossrefPubMedGoogle Scholar
  • 63 Morris ME, Iansek R, Matyas TA et al. Stride length regulation in Parkinson’s disease. Normalization strategies and underlying mechanisms. Brain 1996; 119: 551-568
    CrossrefPubMedGoogle Scholar
  • 64 Naravana S, Fox PT, Zhang W et al. Neural correlates of efficacy of voice therapy in Parkinson’s disease identified by performance-correlation analysis. Hum Brain Mapp 2010; 31: 222-236
    PubMedGoogle Scholar
  • 65 Sapir S, Ramig L, Hoyt P et al. Phonatory-respiratory effort (LSVT®) vs. respiratory effort treatment for hypokinetic dysarthria: comparing speech loudness and quality before and 12 months after treatment. Folia Phoniatr 2002; 54: 296-303
    CrossrefPubMedGoogle Scholar
  • 66 Rowe J, Stephan KE, Friston K et al. Attention to action in Parkinson’s disease: impaired effective connectivity among frontal cortical regions. Brain 2002; 125: 276-289
    CrossrefPubMedGoogle Scholar
  • 67 Nakano K, Zubick H, Tyler H. Speech defects of parkinsonian patients: Effects of levodopa therapy on speech intelligibility. Neurology 1973; 23: 865-870
    CrossrefPubMedGoogle Scholar
  • 68 Wolfe V, Garvin J, Bacon M et al. Speech change in Parkinson’s disease during treatment with l-dopa. J Commun Disord 1975; 8: 271-279
    CrossrefPubMedGoogle Scholar
  • 69 Azevedo LL, Cardoso F, Reis C. Acoustic analysis of prosody in females with Parkinson’s disease: effect of l-dopa. Arq Neuropsiquiatr 2003; 61: 995-998
    CrossrefPubMedGoogle Scholar
  • 70 De Letter M, Santens P, van Borsel J. The effect of levodopa on word intelligibility in Parkinson’s disease. J Commun Disord 2005; 38: 187-196
    CrossrefPubMedGoogle Scholar
  • 71 Rusz J, Cmeila R, Ruzickova H et al. Evaluation of speech impairment in early stages of Parkinson’s disease: a prospective study with the role of pharmacotherapy. J Neural Transm 2013; 120: 319-329
    CrossrefPubMedGoogle Scholar
  • 72 Benke T, Hohenstein C, Poewe W et al. Repetitive speech phenomena in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2000; 69: 319-324
    CrossrefPubMedGoogle Scholar
  • 73 De Letter M, Santens M, van Borsel J. The effect of levodopa on tongue strength and endurance in patients with Parkinson’s disease. Acta Neurol Belg 2003; 103: 35-38
    PubMedGoogle Scholar
  • 74 Gallena S, Smith PJ, Zeffiro T et al. Effects of levodopa on laryngeal muscle activity for voice onset and offset in Parkinson’s disease. J Speech Lang Hear Res 2001; 44: 1284-1299
    CrossrefPubMedGoogle Scholar
  • 75 Gentil M, Tournier CL, Perrin S et al. Effects of levodopa on finger and orofacial movements in Parkinson’s disease. Prog Neuropsychopharmacol Biol Psych 1998; 22: 1261-1274
    CrossrefPubMedGoogle Scholar
  • 76 Goberman AM, Blomgren M. Parkinsonian speech disfluencies: effects of L-dopa related fluctuations. J Fluency Disord 2003; 28: 55-70
    CrossrefPubMedGoogle Scholar
  • 77 Skodda S, Visser W, Schlegel U. Short- and long-term dopaminergic effects on dysarthria in early Parkinson’s disease. J Neural Transm 2010; 117: 197-205
    CrossrefPubMedGoogle Scholar
  • 78 Ho AK, Bradshaw JL, Iansek R. For better or worse: The effect of levodopa on speech in Parkinson’s disease. Mov Disord 2008; 23: 574-580
    CrossrefPubMedGoogle Scholar
  • 79 Kompoliti K, Wang QE, Goetz CG et al. Effects of central dopaminergic stimulation by apomorphine on speech in Parkinson’s disease. Neurology 2000; 54: 458-462
    CrossrefPubMedGoogle Scholar
  • 80 Schulz GM. The effects of speech therapy and pharmacological treatments on voice and speech in Parkinson’s disease: a review of the literature. Curr Med Chem 2002; 9: 1359-1366
    CrossrefPubMedGoogle Scholar
  • 81 Critchley EM. Speech disorders of Parkinsonism: a review. J Neurol Neurosurg Psychiatry 1981; 44: 751-758
    CrossrefPubMedGoogle Scholar
  • 82 Brumlik J, Canter G, De La Torre R et al. A critical analysis of the effects of trihexyphenidyl (artane) on the components of the Parkinsonian syndrome. J Nerv Ment Dis 1964; 138: 424-431
    CrossrefPubMedGoogle Scholar
  • 83 Shea BR, Drummond SS, Metzer WS et al. Effect on selegiline on speech performance in Parkinson’s disease. Folia Phoniatr (Basel) 1993; 45: 40-46
    CrossrefPubMedGoogle Scholar
  • 84 Steward C, Winfield L, Hunt A et al. Speech dysfunction in early Parkinson’s disease. Mov Disord 1995; 10: 562-565
    CrossrefPubMedGoogle Scholar
  • 85 Biary N, Pimental PA, Langenberg PW. A double-blind trial of clonazepam in the treatment of parkinsonian dysarthria. Neurology 1988; 38: 255-258
    CrossrefPubMedGoogle Scholar
  • 86 Dromey C, Kumar R, Lang AE et al. An investigation of the effects of subthalamic nucleus stimulation on acoustic measures of voice. Mov Disord 2000; 15: 1132-1138
    CrossrefPubMedGoogle Scholar
  • 87 Klostermann F, Ehlen F, Vesper J et al. Effects of subthalamic deep brain stimulation on dysarthrophonia in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2008; 79: 522-529
    CrossrefPubMedGoogle Scholar
  • 88 Tripoliti E, Zrinzo L, Martinez-Torres I et al. Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease. Neurology 2011; 76: 80-86
    CrossrefPubMedGoogle Scholar
  • 89 Deuschl G, Schade-Brittinger C, Krack P et al. for the German Parkinson Study Group, Neurostimulation Section . A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 2006; 355: 896-908
    CrossrefPubMedGoogle Scholar
  • 90 Pützer M, Barry WJ, Moringlane JR. Effect of bilateral stimulation of the subthalamic nucleus on different speech subsystems in patients with Parkinson’s disease. Clin Linguist Phon 2008; 22: 957-973
    CrossrefPubMedGoogle Scholar
  • 91 Tripoliti E, Zrinzo L, Martinez-Torres I et al. Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease. Neurology 2011; 76: 80-86
    CrossrefPubMedGoogle Scholar
  • 92 Skodda S, Grönheit W, Schlegel U et al. Effect of subthalamic stimulation on voice and speech in Parkinson’s disease: for the better or worse?. Front Neurol 2014; 4: 218
    PubMedGoogle Scholar
  • 93 Skodda S. Effect of deep brain stimulation on speech performance in Parkinson’s disease. Parkinsons Dis 2012; 850596
    PubMedGoogle Scholar
  • 94 Johansson L, Möller S, Olofsson K et al. Word-level intelligibility after caudal zona incerta stimulation for Parkinson’s disease. Acta Neurol Scand 2013; [Epub ahead of print]
    PubMedGoogle Scholar
  • 95 Pinto S, Ozsancak C, Tripoliti E et al. Treatments for dysarthria in Parkinson’s disease. Lancet Neurol 2004; 3: 547-556
    CrossrefPubMedGoogle Scholar
  • 96 Herd CP, Tomlinson CL, Deane KH et al. Comparison of speech and language therapy techniques for speech problems in Parkinson’s disease. Cochrane Database Syst Rev 2012; 15 CD002814
    PubMedGoogle Scholar
  • 97 Aronson AE. Clinical voice disorders. New York: Thieme-Stratton; 1990
    Google Scholar
  • 98 Adams SG. Hypokinetic dysarthria in Parkinson’s disease. In: McNeil MR. Hrsg Clinical management of sensorimotor speech disorders. New York: Thieme; 1997: 274-291
    Google Scholar
  • 99 Helm N. Management of palilalia with a pacing board. J Speech Hear Disord 1979; 44: 350-353
    CrossrefPubMedGoogle Scholar
  • 100 Shih LC, Piel J, Warren A et al. Singing in groups for Parkinson’s disease (SING-PD): a pilot study of group singing therapy for PD-related voice/speech disorders. Parkinsonism Relat Disord 2012; 18: 548-552
    CrossrefPubMedGoogle Scholar
  • 101 Downie AW, Low JM, Lindsay DD. Speech disorders in parkinsonism: usefulness of delayed auditory feedback in selected cases. Br J Disord Commun 1981; 16: 133-139
    PubMedGoogle Scholar
  • 102 Rubow R, Swift E. A microcomputer-based wearable biofeedback device to improve transfer of treatment in parkinsonian dysarthria. J Speech Hear Disord 1985; 50: 178-185
    CrossrefPubMedGoogle Scholar
  • 103 Stathopoulos ET, Huber JE, Richardson K et al. Increased vocal intensity due to the Lombard effect in speakers with Parkinson’s disease: Simultaneous laryngeal and respiratory strategies. J Commun Disord 2013; [Epub ahead of print]
    PubMedGoogle Scholar
  • 104 Ramig LO, Countryman L, Thompson L et al. Comparison of two forms of intensive speech treatment for Parkinson disease. J Speech Hear Res 1995; 38: 1232-1251
    CrossrefPubMedGoogle Scholar
  • 105 Ramig LO, Countryman S, O’Brien C et al. Intensive speech treatment for people with Parkinson’s disease: short and long term comparison of two techniques. Neurology 1996; 47: 1496-1504
    CrossrefPubMedGoogle Scholar
  • 106 Fox CM, Ramig LO, Ciucci MR et al. The science and practice of LSVT/LOUD: neural plasticity-principled approach to treating individuals with Parkinsons disease and other neurological disorders. Semin Speech Lang 2006; 27: 283-299
    Article in Thieme ConnectPubMedGoogle Scholar
  • 107 Howell S, Tripoliti E, Pring T. Delivering the Lee Silverman Voice Treatment (LSVT) by web camera: a feasibility study. Int J Lang Commun Disord 2009; 44: 287-300
    CrossrefPubMedGoogle Scholar
  • 108 Constantinescu G, Theodoros D, Russell T et al. Treating disordered speech and voice in Parkinson’s disease online: a randomized controlled non-inferiority trial. Int J Lang Commun Disord 2011; 46: 1-16
    PubMedGoogle Scholar
  • 109 Iansek R, Bradshaw JL, Phillips JG et al. Interaction of the basal ganglia and supplementary motor area in the elaboration of movements. In: Motor control and sensory motor integration: Issues and directions. Glencross DJ, Piek JP. Hrsg Elsevier Science BV; 1995: 37-59
    CrossrefGoogle Scholar
  • 110 Ghosh SS, Tourville SA, Guenther FH. A neuroimaging study of premotor lateralization and cerebellar involvement the in production of phonemes and syllables. J Speech Lang Hear Res 2008; 51: 1183-1202
    CrossrefPubMedGoogle Scholar
  • 111 Guenther FH, Ghosh SS, Tourville JA. Neural modelling and imaging of the cortical interactions underlying syllable production. Brain Lang 2006; 96: 280-301
    CrossrefPubMedGoogle Scholar
  • 112 Price CJ. The anatomy of language: a review of 100 fMRI studies ­published in 2009. Ann NY Acad Sci 2010; 1191: 62-88
    CrossrefPubMedGoogle Scholar
  • 113 Bohland JW, Guenther FH. A fMRI investigation of syllable sequence production. Neuroimage 2006; 32: 821-841
    CrossrefPubMedGoogle Scholar
  • 114 Brendel B, Hertrich I, Erb M et al. The contribution of mesiofrontal cortex to the preparation and execution of repetitive syllable productions: an fMRI study. Neuroimage 2010; 50: 1219-1230
    CrossrefPubMedGoogle Scholar
  • 115 Riecker A, Mathiak K, Wildgruber D et al. fMRI reveals two distinct cerebral networks subserving speech motor control. Neurology 2005; 22: 700-706
    PubMedGoogle Scholar
  • 116 Riecker A, Kassubek J, Gröschel W et al. The cerebral control of speech tempo: opposite relationship between speaking rate and BOLD signal changes at striatal and cerebellar structures. Neuroimage 2006; 29: 46-53
    CrossrefPubMedGoogle Scholar
  • 117 Christoffels IK, Formisano E, Schiller NO. Neural correlations of verbal feedback processing: an fMRI study employing overt speech. Hum Brain Mapp 2007; 28: 868-879
    CrossrefPubMedGoogle Scholar
  • 118 Grahn JA, Brett M. Impairment of beat-based rhythm discrimination in Parkinson’s disease. Cortex 2009; 45: 54-61
    CrossrefPubMedGoogle Scholar
  • 119 Grahn JA. The role of the basal ganglia in beat perception: neuroimaging and neuropsychological investigationa. Ann NY Acad Sci 2009; 1169: 35-45
    CrossrefPubMedGoogle Scholar
  • 120 Liotti M, Ramig LO, Vogel D et al. Hypophonia in Parkinson’s disease: neural correlates of voice treatment revealed by PET. Neurology 2003; 11: 432-440
    PubMedGoogle Scholar
  • 121 Pinto S, Thobois S, Costes N et al. Subthalamic nucleus stimulation and dysarthria in Parkinson’s disease: a PET study. Brain 2004; 127 (Pt 3) 602-615
    PubMedGoogle Scholar
  • 122 Sabatini U, Boulanouar K, Fabre N et al. Cortical motor reorganization in akinetic patients with Parkinson’s disease. Brain 2000; 123: 394-403
    CrossrefPubMedGoogle Scholar
  • 123 Samuel M, Ceballos-Baumann AO, Blin J et al. Evidence for lateral premotor and parietal overactivity in Parkinson’s disease during sequential and bimanual movements: A PET study. Brain 1997; 120: 963-976
    CrossrefPubMedGoogle Scholar
  • 124 Naravana S, Fox PT, Zhang W et al. Neural correlates of efficacy of voice therapy in Parkinson’s disease identified by performance-correlation analysis. Hum Brain Mapp 2010; 31: 222-236
    PubMedGoogle Scholar
  • 125 Arnold C, Gehrig J, Gispert S et al. Pathomechanisms and compensatory efforts related to Parkinsonian speech. Neuroimage Clin 2013; 4: 82-97
    PubMedGoogle Scholar