Data_Sheet_1_Evaluating a Speech-Specific and a Computerized Step-Training-Specific Rhythmic Intervention in Parkinson's Disease: A Cross-Over, Multi-Arms Parallel Study.docx

Background:Recent studies suggest movements of speech and gait in patients with Parkinson's Disease (PD) are impaired by a common underlying rhythmic dysfunction. If this being the case, motor deficits in speech and gait should equally benefit from rhythmic interventions regardless of whether it is a speech-specific or step-training-specific approach.
Objective:In this intervention trial, we studied the effects of two rhythmic interventions on speech and gait. These rhythmic intervention programs are similar in terms of intensity and frequency (i.e., 3x per week, 45 min-long sessions for 4 weeks in total), but differ regarding therapeutic approach (rhythmic speech vs. rhythmic balance-mobility training).
Methods:This study is a cross-over, parallel multi-arms, single blind intervention trial, in which PD patients treated with rhythmic speech-language therapy (rSLT; N = 16), rhythmic balance-mobility training (rBMT; N = 10), or no therapy (NT; N = 18) were compared to healthy controls (HC; N = 17; matched by age, sex, and education: p > 0.82). Velocity and cadence in speech and gait were evaluated at baseline (BL), 4 weeks (4W-T1), and 6 months (6M-T2) and correlated.
Results:Parameters in speech and gait (i.e., speaking and walking velocity, as well as speech rhythm with gait cadence) were positively correlated across groups (p < 0.01). Statistical analyses involved repeated measures ANOVA across groups and time, as well as independent and one-samples t-tests for within groups analyses. Statistical analyses were amplified using Reliable Change (RC) and Reliable Change Indexes (RCI) to calculate true clinically significant changes due to the treatment on a patient individual level. Rhythmic intervention groups improved across variables and time (total Mean Difference: 3.07 [SD 1.8]; 95% CI 0.2–11.36]) compared to the NT group, whose performance declined significantly at 6 months (p < 0.01). HC outperformed rBMT and NT groups across variables and time (p < 0.001); the rSLT performed similarly to HC at 4 weeks and 6 months in speech rhythm and respiration.
Conclusions:Speech and gait deficits in PD may share a common mechanism in the underlying cortical circuits. Further, rSLT was more beneficial to dysrhythmic PD patients than rBMT, likely because of the nature of the rhythmic cue.

研究背景：近期研究表明，帕金森病（Parkinson's Disease，PD）患者的言语与运动步态均存在功能受损，其共同病理机制为节律功能障碍。若该假说成立，则无论采用言语特异性抑或步态训练特异性的干预方案，言语与运动步态相关的运动障碍均应能从节律干预中获得同等程度的获益。
研究目的：本项干预试验旨在评估两种节律干预方案对帕金森病患者言语与步态的影响。两种节律干预方案在强度与频率上保持一致（即每周3次，每次45分钟，总疗程为4周），但治疗思路存在差异：分别为节律性言语训练与节律性平衡-活动训练。
研究方法：本研究为交叉设计、平行多组单盲干预试验。研究共纳入三组帕金森病患者：接受节律性言语语言疗法（rhythmic speech-language therapy，rSLT，n=16）、节律性平衡-活动训练（rhythmic balance-mobility training，rBMT，n=10）以及无治疗组（no therapy，NT，n=18），并以按年龄、性别、教育程度匹配的健康对照组（healthy controls，HC，n=17，p>0.82）作为参照。分别于基线（baseline，BL）、4周随访点（4W-T1）与6个月随访点（6M-T2）对受试者的言语与步态的速度及节律进行评估，并开展相关性分析。
研究结果：各组受试者的言语与步态参数（即言语与步行速度、言语节律与步态步频）均呈显著正相关（p<0.01）。统计分析方法包括：组间与时间点的重复测量方差分析，以及用于组内分析的独立样本t检验与单样本t检验。本研究同时采用可靠变化（Reliable Change，RC）与可靠变化指数（Reliable Change Indexes，RCI）进行补充分析，以在患者个体水平上计算由治疗带来的真正具有临床意义的变化。与无治疗组相比，节律干预组在各变量与时间点上均获得显著改善（总平均差值：3.07[SD=1.8]；95%置信区间：0.2~11.36），而无治疗组的表现于6个月时出现显著下降（p<0.01）。健康对照组在各变量与时间点上的表现均优于节律性平衡-活动训练组与无治疗组（p<0.001）；节律性言语语言疗法组在4周与6个月时的言语节律与呼吸指标上表现与健康对照组相当。
研究结论：帕金森病患者的言语与步态障碍可能共享皮层环路层面的共同病理机制。此外，节律性言语语言疗法对节律紊乱的帕金森病患者的获益优于节律性平衡-活动训练，这可能与节律线索的作用特性相关。