The Science and Practice of LSVT/LOUD: Neural Plasticity-Principled Approach to Treating Individuals with Parkinson Disease and Other Neurological Disorders

Cynthia M. Fox; Lorraine O. Ramig; Michelle R. Ciucci; Shimon Sapir; David H. McFarland; Becky G. Farley

doi:10.1055/s-2006-955118

Seminars in Speech and Language, Inhaltsverzeichnis

Semin Speech Lang 2006; 27(4): 283-299
DOI: 10.1055/s-2006-955118

The Science and Practice of LSVT/LOUD: Neural Plasticity-Principled Approach to Treating Individuals with Parkinson Disease and Other Neurological Disorders

Cynthia M. Fox¹ , Lorraine O. Ramig² , Michelle R. Ciucci³ , Shimon Sapir⁴ , David H. McFarland⁵ , Becky G. Farley⁶

¹Research Associate, National Center for Voice and Speech, Denver, CO Research Lecturer, Department of Neurology, University of Arizona, Tucson, Arizona
²Professor, Department of Speech, Language, Hearing Sciences, University of Colorado-Boulder; Senior Scientist, National Center for Voice and Speech, Denver Center for the Performing Arts, Denver, Colorado; Adjunct Professor, Columbia University, New York, New York; University of Colorado-Boulder, Boulder, Colorado
³Lecturer, University of Texas-Austin, and University of Colorado-Boulder, Boulder, Colorado
⁴Associate Professor, Department of Communication Sciences and Disorders, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel, Department of Communication Sciences and Disorders, Faculty of Social Welfare and Health Studies, University of Haifa, Mount Carmel, Haifa, Israel
⁵École d'orthophonie et d'audiologie et centre de recherche en sciences neurologiques, Faculté de médecine, Université de Montréal and School of Communication Sciences and Disorders and Center for Research on Language, Mind and the Brain, McGill University, University de Montréal, Montréal, Québec, Canada
⁶Assistant Research Professor, Department of Physiology, University of Arizona, Tucson, Arizona

Abstract

Our 15 years of research have generated the first short- and long-term efficacy data for speech treatment (Lee Silverman Voice Treatment; LSVT/LOUD) in Parkinson's disease. We have learned that training the single motor control parameter amplitude (vocal loudness) and recalibration of self-perception of vocal loudness are fundamental elements underlying treatment success. This training requires intensive, high-effort exercise combined with a single, functionally relevant target (loudness) taught across simple to complex speech tasks. We have documented that training vocal loudness results in distributed effects of improved articulation, facial expression, and swallowing. Furthermore, positive effects of LSVT/LOUD have been documented in disorders other than Parkinson's disease (stroke, cerebral palsy). The purpose of this article is to elucidate the potential of a single target in treatment to encourage cross-system improvements across seemingly diverse motor systems and to discuss key elements in mode of delivery of treatment that are consistent with principles of neural plasticity.

KEYWORDS

Parkinson's disease - neural plasticity - vocal loudness

Volltext

Referenzen

REFERENCES

1 Hartelius L, Svensson P. Speech and swallowing symptoms associated with Parkinson's disease and multiple sclerosis: a survey. Folia Phoniatr Logop. 1994; 46 9-17
2 Ho A, Iansek R, Marigliani C, Bradshaw J L, Gates S. Speech impairment in a large sample of people with Parkinson's disease. Behav Neurol. 1998; 11 131-137
3 Logemann J, Fisher H, Boshes B, Blonsky E. Frequency and concurrence of vocal tract dysfunctions in the speech of a large sample of Parkinson patients. J Speech Hear Disord. 1978; 43 47-57
4 Pitcairn T K, Clemie S, Gray J M, Pentland B. Non-verbal cues in the self-presentation of parkinsonian patients. Br J Clin Psychol. 1990; 29 177-184
5 Pitcairn T K, Clemie S, Gray J M, Pentland B. Non-verbal cues in the self-presentation of parkinsonian patients. Br J Clin Psychol. 1990; 29 177-184
6 Logemann J, Blonsky R, Boshes B. Dysphagia in parkinsonism. JAMA. 1975; 231 69-70
7 Koller W C, Tse W. Unmet medical needs in Parkinson's disease. Neurology. 2004; 62(Suppl 1) S1-S8
8 Krack P, Batir A, Van Blercom N et al.. Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med. 2003; 349(20) 1925-1934
9 Olanow C W, Jankovic J. Neuroprotective therapy in Parkinson's disease and motor complications: a search for a pathogenesis-targeted, disease-modifying strategy. Mov Disord. 2005; 20(Suppl 11) S3-10
10 Sapir S, Ramig L O, Countryman S, Fox C. Voice, speech, and swallowing disorders. In: Factor S, Weiner W Parkinson's Disease: Diagnosis and Clinical Management. 2nd ed. New York; Demos Medical Publishing 2006: 75-87
11 Wermuth L, Stenager E N, Stenager E, Boldsen J. Mortality in patients with Parkinson's disease. Acta Neurol Scand. 1995; 92 55-58
12 Tompkins P, Herman L. How many people in the U.S. have PD?. Parkinson's Information Exchange July 1998 Available at: http://www.parkinsons-information-exchange-network-online.com/parkmail3a/1998c/msg00789.html.Accessed March 20, 1999
13 Ramig L, Countryman S, Thompson L, Horii Y. Comparison of two forms of intensive speech treatment for Parkinson disease. J Speech Hear Res. 1995; 38 1232-1251
14 Ramig L O, Sapir S, Countryman S et al.. Intensive voice treatment (LSVT) for patients with Parkinson's disease: a 2 year follow up. J Neurol Neurosurg Psychiatry. 2001; 71 493-498
15 Ramig L O, Sapir S, Fox C, Countryman S. Changes in vocal loudness following intensive voice treatment (LSVT) in individuals with Parkinson's disease: a comparison with untreated patients and normal age-matched controls. Mov Disord. 2001; 16 79-83
16 Farley B G, Sherman S, Koshland G F. Shoulder muscle activity in Parkinson's disease during multijoint arm movements across a range of speeds. Exp Brain Res. 2004; 154 160-175
17 Hallett M, Khoshbin S. A physiological mechanism of bradykinesia. Brain. 1980; 103 301-314
18 Pfann K D, Buchman A S, Comella C L, Corcos D M. Control of movement distance in Parkinson's disease. Mov Disord. 2001; 16 1048-1065
19 Titze I. Vocal Fold Physiology: Frontiers in Basic Science. San Diego, CA; Singular 1993
20 Fisher B, Petzinger G, Nixon K et al.. Exercise-induced behavioral recovery and neuroplasticity in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned mouse basal ganglia. J Neurosci Res. 2004; 77 378-390
21 Liepert J, Miltner W, Bauder H et al.. Motor cortex plasticity during constraint-induced movement therapy in stroke patients. Neurosci Lett. 1998; 250 5-8
22 Cabrejo L, Auzou P, Ozsancak C, Hannequin D. Speech therapy of dysarthria in Parkinson's disease. Presse Med. 2003; 32 1745-1751
23 Dias A E, Barbosa E R, Coracini K, Maia F, Marcolin M A, Fregni F. Effects of repetitive transcranial magnetic stimulation on voice and speech in Parkinson's disease. Acta Neurol Scand. 2006; 113(2) 92-99
24 NICE .Parkinson's Disease: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care. London; Royal College of Physicians 2006
25 Pinto S, Ozsancak C, Tripoliti E, Thobois S, Limousin-Dowsey P, Auzou P. Treatments for dysarthria in Parkinson's disease. Lancet Neurol. 2004; 3 547-556
26 Ramig L O, Countryman S, O'Brien C, Hoehn M, Thompson L. Intensive speech treatment for patients with Parkinson's disease: Short and long term comparison of two techniques. Neurology. 1996; 47 1496-1504
27 Smith M, Ramig L O, Dromey C, Perez K, Samandari R. Intensive voice treatment in Parkinson's disease: laryngostroboscopic ﬁndings. J Voice. 1995; 9 453-459
28 Garren K, Brosovic G, Abaza M, Ramig L. Voice therapy and Parkinson disease: measures of vocal fold adduction. Paper presented at: the Voice Symposium June 2000 Philadelphia, PA;
29 Ramig L, Dromey C. Aerodynamic mechanisms underlying treatment-related changes in vocal intensity in patients with Parkinson disease. J Speech Hear Res. 1996; 39 798-807
30 Huber J, Stathopoulos E, Ramig L, Lancaster S. Respiratory function and variability in individuals with Parkinson disease: pre and post Lee Silverman Voice Treatment (LSVT^®). J Med Speech-Lang Pathol. 2003; 11 185-201
31 Ramig L, Sapir S, Baker K et al.. The “big picture” on the role of phonation in the treatment of individuals with motor speech disorders: or “What's up with loud?”. Paper presented at: the Tenth Biennial Conference on Motor Speech March 2000 San Antonio, TX;
32 Baumgartner C, Sapir S, Ramig L. Voice quality changes following phonatory-respiratory effort Treatment (LSVT^®) versus respiratory effort treatment for individuals with Parkinson disease. J Voice. 2001; 15 105-114
33 Countryman S, Hicks J, Ramig L, Smith M. Supraglottic hyperfunction in an individual with Parkinson disease: treatment outcome. Am J Speech Lang Pathol. 1996; 6 85-94
34 Dromey C, Ramig L, Johnson A. Phonatory and articulatory changes associated with increased vocal intensity in Parkinson disease: a case study. J Speech Hear Res. 1995; 38 751-763
35 Spielman J, Borod J, Ramig L. Effects of intensive voice treatment (LSVT) on facial expressiveness in Parkinson's disease: preliminary data. Cogn Behav Neurol. 2003; 16 177-188
36 El Sharkawi A, Ramig L, Logemann J et al.. Swallowing and voice effects of Lee Silverman Voice Treatment: a pilot study. J Neurol Neuropsychiatry Psychiatry. 2002; 72 31-36
37 Borod J, Koff E, Lorch M, Nicholas M. Channels of emotional communication in patients with unilateral brain damage. Arch Neurol. 1985; 42 345-348
38 Borod J, Welkowitz J, Alpert M et al.. Parameters of emotional processing in neuropsychiatric disorders: conceptual issues and a battery of tests. J Commun Disord. 1990; 23 247-271
39 Canino E, Borod J, Madigan N, Tabert M, Schmid J. The development of procedures for rating posed emotional expressions across facial, prosodic, and lexical channels. Percept Mot Skills. 1999; 89 57-71
40 Ross E, Mesulam M. Dominant language functions of the right hemisphere?. Arch Neurol. 1979; 36 144-148
41 Porges S. Orienting in a defensive world: mammalian modifications of our evolutionary heritage. A polyvagal theory. Psychophysiology. 1995; 32 301-318
42 Porges S. Emotion: an evolutionary by-product of the neural regulation of the autonomic nervous system. Ann N Y Acad Sci. 1997; 807 62-77
43 Zald D H, Pardo J V. The functional neuroanatomy of voluntary swallowing. Ann Neurol. 1999; 46(3) 281-286
44 Hamdy S, Mikulis D J, Crawley A et al.. Cortical activation during human volitional swallowing: an event-related fMRI study. Am J Physiol. 1999; 277(1 Pt 1) G219-G225
45 Liotti M, Ramig L O, Vogel D et al.. Hypophonia in Parkinson's disease. Neural correlates of voice treatment revealed by PET. Neurology. 2003; 60 432-440
46 Kleinow J, Smith A, Ramig L. Speech stability in idiopathic Parkinson disease: effects of rate and loudness manipulations. J Speech Lang Hear Res. 2001; 44 1041-1051
47 Dromey C, Ramig L. Intentional changes in sound pressure level and rate: their impact on measures of respiration, phonation, and articulation. J Speech Lang Hear Res. 1988; 41 1003-1018
48 Will L, Spielman J, Ramig L. Stimulated or trained loudness: is there a difference and does it matter?. Presented at: the Conference on Motor Speech Disorders March 2006 Austin, TX;
49 Schulman R. Articulatory dynamics of loud and normal speech. J Acoust Soc Am. 1989; 85 295-312
50 Narayana S, Vogel D, Brown S et al.. Mechanism of action of voice therapy in Parkinson's hypophonia-a PET study. Poster presented at: the 11th Annual Meeting of the Organization for Human Brain Mapping 2005 Toronto, Ontario, Canada;
51 Farley B G, Koshland G F. Training BIG to move faster: the application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson's disease. Exp Brain Res. 2005; 67 462-467
52 Fox C, Farley B, Ramig L. An integrated speech and physical therapy approach for Parkinson disease: Training Big and Loud. Abstract for paper presented at: the Biannual Conference on Motor Speech March 2006 Austin, TX;
53 Fox C M. Farley BG Learning Big and Loud™: an integrated rehabilitation approach to Parkinson's disease. Program No. 874.10, 2004 Abstract Viewer and Itinerary Planner. Washington, DC; Society for Neuroscience http://Available at: www.sfn.scholarone.com/itin2004
54 Fox C M, Farley B G, Ramig L O, McFarland D. An integrated rehabilitation approach to Parkinson's disease: learning big and loud. Mov Disord. 2005; 20 S127
55 Countryman S, Ramig L. Effects of intensive voice therapy on voice deficits associated with bilateral thalamotomy in Parkinson's disease: a case study. J Med Speech-Lang Pathol. 1993; 1 233-250
56 Countryman S, Ramig L, Pawlas A. Speech and voice deficits in Parkinsonian Plus syndromes: can they be treated?. J Med Speech Lang Pathol. 1994; 2 211-225
57 Sapir S, Spielman J, Countryman S et al.. Phonatory and articulatory changes in ataxic dysarthria following intensive voice therapy with the LSVT®: a single subject study. Am J Speech Lang Pathol. 2003; 12 387-399
58 Sapir S, Pawlas A, Ramig L, Seeley E, Fox C, Corboy J. Effects of intensive phonatory-respiratory treatment (LSVT) on voice in individuals with multiple sclerosis. J Med Speech Lang Pathol. 2001; 9(2) 35-45
59 Will L A, Fox C, Ramig L O. Intensive voice treatment for speech disorders following stroke. Poster presented at: the Motor Speech Disorders Conference 2002 Williamsburg, VA;
60 Ramig L, Gray S, Baker K et al.. The aging voice: a review, treatment data and familial and genetic perspectives. Folia Phoniatr Logop. 2001; 53(5) 252-265
61 Fox C. Intensive voice treatment for children with spastic cerebral palsy [Unpublished doctoral dissertation]. Tucson, AZ; University of Arizona 2002
62 Petska J, Halpern A, Ramig L, Robinson T. LSVT® and children with Down syndrome: a pilot study. Poster session presented at: the 13th Biennial Conference on Motor Speech March 2006 Austin, TX;
63 Allen G. Segmental timing control in speech production. J Phonetics. 1973; 1 219-237
64 Gandour J, Dechongkit S, Ponglorpisit S, Khunadorn F. Speech timing at the sentence level in Thai after unilateral brain damage. Brain Lang. 1994; 46 419-438
65 McClean M D, Tasko S M. Association of orofacial with laryngeal and respiratory motor output during speech. Exp Brain Res. 2002; 146 481-489
66 Smith A, McFarland D H, Weber C M. Interactions between speech and finger movements: an exploration of the dynamic pattern perspective. J Speech Hear Res. 1986; 29 471-480
67 Ackermann H, Wildgruber D, Daum I, Grodd W. Does the cerebellum contribute to cognitive aspects of speech production? A functional magnetic resonance imaging (fMRI) study in humans. Neurosci Lett. 1998; 247 187-190
68 Hirano S, Kojima H, Naito Y et al.. Cortical speech processing mechanisms while vocalizing visually presented languages. Neuroreport. 1996; 8 363-367
69 Ho A K, Iansek R, Bradshaw J L. Regulations of parkinsonian speech volume: the effect of interlocutor distance. J Neurol Neurosurg Psychiatry. 1999; 67 199-202
70 Ho A K, Bradshaw J L, Iansek T. Volume perception in parkinsonian speech. Mov Disord. 2000; 15 1125-1131
71 Jurgens U, Kirzinger A, von Cramon D. The effects of deep-reaching lesions in the cortical face area on phonation. A combined case report and experimental monkey study. Cortex. 1982; 18 125-130
72 Kitchen D M, Cheney D L, Seyfarth R M. Male chacma baboons (Papio hamadryas ursinus) discriminate loud call contests between rivals of different relative ranks. Anim Cogn. 2005; 8 1-6
73 Leinonen L, Laakso M L, Carlson S, Linnankoski I. Shared means and meanings in vocal expression of man and macaque. Logoped Phoniatr Vocol. 2003; 28 53-61
74 Tecumseh F W. The phonetic potential of nonhuman vocal tracts: comparative cineradiographic observations of vocalizing animals. Phonetica. 2000; 57 205-218
75 Ho A K, Iansek R, Bradshaw J L. Regulations of parkinsonian speech volume: the effect of interlocutor distance. J Neurol Neurosurg Psychiatry. 1999; 67 199-202
76 Ho A K, Bradshaw J L, Iansek R, Alfredson R. Speech volume regulation in Parkinson's disease: effects of implicit cues and explicit instructions. Neuropsychologia. 1999; 37 1453-1460
77 Jurgens U, von Cramon D. On the role of the anterior cingulate cortex in phonation: a case report. Brain Lang. 1982; 15 234-248
78 Meissner I, Sapir S, Kokmen E, Stein S D. The paramedian diencephalic syndrome: a dynamic phenomenon. Stroke. 1987; 18 380-385
79 Sapir S, Aronson A E. Clinician reliability in rating voice improvement after laryngeal nerve section for spastic dysphonia. Laryngoscope. 1985; 95 200-202
80 Seyfarth R M, Cheney D L. Meaning and emotion in animal vocalizations. Ann NY Acad Sci. 2003; 1000 32-55
81 Davis P, Zhang S, Winkworth A, Bandler R. Neural control of vocalization: respiratory and emotional influences. J Voice. 1996; 10 23-38
82 Jurgens U, Zwirner P. The role of the periaqueductal grey in limbic and neocortical vocal fold control. Neuroreport. 1996; 25 2921-2923
83 Larson C. The midbrain periaqueductal gray: a brainstem structure involved in vocalization. J Speech Hear Res. 1985; 28 241-249
84 MacLean P D, Newman J D. Role of midline frontolimbic cortex in production of the isolation call of squirrel monkeys. Brain Res. 1988; 450 111-123
85 Muller-Preuss P, Newnan J, Jurgens U. Anatomical and physiological evidence for a relationship between the “cingular” vocalization area and the auditory cortex in the squirrel monkey. Brain Res. 1980; 202 307-315
86 Ploog D. Phonation, emotion, cognition, with reference to the brain mechanisms involved. Ciba Found Symp. 1979; 69 79-98
87 West R A, Larson C R. Neurons of the anterior mesial cortex related to faciovocal activity in the awake monkey. J Neurophysiol. 1995; 74 1856-1869
88 Sapir S, Campbell C, Larson C. Effect of geniohyoid, cricothyroid, and sternothyroid muscle stimulation on voice fundamental frequency of electrically elicited phonation in rhesus macaque. Laryngoscope. 1981; 91 457-468
89 Cotman C W, Berchtold N C. Exercise: a behavioral intervention to enhance brain health and plasticity. Trends Neurosci. 2002; 25 295-301
90 Kleim J, Jones T, Schallert T. Motor enrichment and the induction of plasticity before or after brain injury. Neurochem Res. 2003; 11 1757-1769
91 Vaynman S, Gomez-Pinilla F. License to run: exercise impacts functional plasticity in the intact and injured central nervous system by using neurotrophins. Neurorehabil Neural Repair. 2005; 19 283-295
92 Cohen A D, Tillerson J L, Smith A D, Schallert T, Zigmond M J. Neuroprotective effects of prior limb use in 6-hydroxydopamine-treated rats: possible role of GDNF. J Neurochem. 2003; 85 299-305
93 Neeper S A, Gomez-Pinilla F, Choi J, Cotman C. Exercise and brain neurotrophins. Nature. 1995; 373 109
94 Ying Z, Roy R R, Edgerton R, Gomez-Pinilla F. Exercise restores levels of neurotrophins and synaptic plasticity following spinal cord injury. Exp Neurol. 2005; 193(2) 411-419
95 Kleim J, Jones T. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. Presented at: the Neurorehabilitation Workgroup Innovation and Evolution Workshop April 2005 Gainesville, FL;
96 Robichaud J A, Pfann K D, Vaillancourt D E, Comella C L, Corcos D M. Force control and disease severity in Parkinson's disease. Mov Disord. 2005; 20 441-450
97 Pisani A, Centonze D, Bernardi G, Calabresi P. Straital synaptic plasticity: implications for motor learning and Parkinson's disease. Mov Disord. 2005; 20(4) 395-402
98 Kleim J A, Hogg T M, VanderBerg P M, Cooper N R, Bruneau R, Remple M. Cortical synaptogenesis and motor map reorganization occur during late, but not early, phase of motor skill learning. J Neurosci. 2004; 24(3) 628-633
99 Ramig L O, Pawlas A, Countryman S. The Lee Silverman Voice Treatment (LSVT): A practical guide to treating the voice and speech disorders in Parkinson disease. Iowa City, IA; National Center for Voice and Speech 1995
100 Comery T A, Shar R, Greenough W T. Differential rearing alters spine density on medium-sized spiny neurons in the rat corpus striatum: evidence for association of morphological plasticity with early response gene expression. Neurobiol Learn Mem. 1995; 63 217-219
101 Kleim J A, Lussnig E, Schwarz E R, Comery T A, Greenough W T. Synaptogenesis and Fos expression in the motor cortex of the adult rat after motor skill learning. J Neurosci. 1996; 16 4529-4535
102 Plautz E J, Milliken G W, Nudo R J. Effects of repetitive motor training on movement representations in adult squirrel monkeys: role of use versus learning. Neurobiol Learn Mem. 2000; 74 27-55
103 Becker G, Mueller A, Braune S et al.. Early diagnosis of Parkinson's disease. J Neurol. 2002; 249(Suppl 3) 40-48
104 O'Shea S, Morris M E, Iansek R. Dual task interference during gait in people with Parkinson disease: effects of motor versus cognitive secondary tasks. Phys Ther. 2002; 82(9) 888-897
105 Fox C M, Morrison C E, Ramig L O, Sapir S. Current perspectives on the Lee Silverman Voice Treatment (LSVT) for people with idiopathic Parkinson's disease. Am J Speech Lang Pathol. 2002; 11 111-123
106 Alexander G E, Crutcher M D. Functional architecture of basal ganglia circuits: neural substrates of parallel processing. Trends Neurosci. 1990; 13 266-271
107 Graybiel A M. The basal ganglia and chunking of action repertoires. Neurobiol Learn Mem. 1998; 70 119-136
108 Jones T A, Chu C J, Grande L A, Gregory A D. Motor skills training enhances lesion-induced structural plasticity in the motor cortex of adult rats. J Neurosci. 1999; 19(22) 10153-10163
109 Tillerson J, Cohen A, Caudle M, Zigmond M, Schallert T, Miller G. Forced nonuse in unilateral parkinsonian rats exacerbates injury. J Neurosci. 2002; 22(15) 6790-6799
110 Fox C, Ramig L. Vocal sound pressure level and self-perception of speech and voice in men and women with idiopathic Parkinson disease. Am J Speech Lang Pathol. 1997; 6 85-94
111 Sapir S, Ramig L O, Hoyt P, Countryman S, O'Brien C, Hoehn M. Speech loudness and quality 12 months after intensive voice treatment (LSVT) for Parkinson's disease: a comparison with an alternative speech treatment. Folia Phoniatr Logop. 2002; 54 296-303
112 Byl N, Merzenich M M, Jenkins W M. A primate genesis model of focal dystonia and repetitive strain injury: I. Learning-induced dedifferentiation of the representation of the hand in the primary somatosensory cortex in adult monkeys. Neurology. 1996; 47 508-520
113 Lenz F A, Byl N N. Reorganization in the cutaneous core of the human thalamic principal somatic sensory nucleus (ventral caudal) in patients with dystonia. J Neurophysiol. 1999; 82 3204-3212
114 Byl N N, McKenzie A. Treatment effectiveness for patients with a history of repetitive hand use of and focal hand dystonia: a planned, prospective follow-up. J Hand Ther. 2000; 13 289-301
115 Brizard M, Carcenac C, Bemelmans A P, Feuerstein C, Mallet J, Savasta M. Functional reinnervation from remaining DA terminals induced by GDNF lentivirus in a rat model of early Parkinson's disease. Neurobiol Dis. 2006; 21(1) 90-101
116 Faherty C J, Shepherd K R, Herasimtschuk A. Environmental enrichment in adulthood eliminates neuronal death in experimental Parkinsonism. Brain Res Mol Brain Res. 2005; 134 170-179
117 Tillerson J, Cohen A, Philhower J, Miller G, Zigmond M, Schallert T. Forced limb-use effects on the behavioral and neurochemical effects of 6-hydroxydopamine. J Neurosci. 2001; 21(12) 4427-4435
118 Tillerson J L, Caudle W M, Reveron M E, Miller G W. Exercise induces behavioral recovery and attenuates neurochemical deficits in rodent models of Parkinson's disease. Neuroscience. 2003; 119 899-911
119 Bezard E, Gross C. Compensatory mechanisms in experimental and human Parkinsonism: Towards a dynamic approach. Prog Neurobiol. 1998; 55 93-116
120 Poulton N P, Muir G D. Treadmill training ameliorates dopamine loss but not behavioral deficits in hemi-Parkinsonian rats. Exp Neurol. 2005; 193 181-197
121 Taub E. Harnessing brain plasticity through behavioral techniques to produce new treatments in neurorehabilitation. Am Psychol. 2004; 59 692-704
122 Fisher B, Yip J. Physical Therapy for Individuals with Parkinson's Disease: A Paradigm Shift. Miami, FL; National Parkinson Foundation, Parkinson Report 2004: 10-13
123 Taub E, Lum P S, Hardin P, Mark B W, Uswatte G. AutoCITE: automated delivery of CI therapy with reduced effort by therapists. Stroke. 2005; 36 1301-1304
124 Halpern A E, Matos C, Ramig L O, Petska J, Spielman J. LSVTC-A PDA Supported Speech Treatment for Parkinson's disease. Poster presented at: the Annual American Speech-Language-Hearing Association Meeting 2004 Philadelphia, PA;
125 Halpern A, Matos C, Ramig L, Petska J, Spielman J, Bennett J. LSVTC- A PDA supported speech treatment for Parkinson's disease. Presented at: the 9th International Congress of Parkinson's Disease and Movement Disorders 2005 New Orleans, LA;
126 Halpern A, Cole R, Ramig L et al.. Virtual speech therapists-expanding the horizons of speech treatment for Parkinson's disease. Paper presented at: the Conference on Motor Speech March 2006
127 Brown R G, Marsden C D. Dual task performance and processing resources in normal subjects and patients with Parkinson's disease. Brain. 1991; 114 215-231
128 Theodoros D G, Constantinescu G, Russell T, Ward E C, Woolen R. A telerehabilitation application for treating disordered speech in Parkinson's disease. Paper presented at: The American Telemedicine Association Conference May 7-10, 2006

Lorraine O RamigPh.D. CCC-SLP

Department of Speech, Language, Hearing Sciences, University of Colorado, Boulder

Campus Box 409, Boulder, CO 80303

eMail: ramig@spot.colorado.edu