Director: Kristie Spencer, Ph.D., CCC-SLP

We are interested in understanding the nature of neurogenic motor speech and cognitive disorders and how best to serve clients who experience these disorders.

Current projects include:

Speech impairment profiles in individuals with Parkinson’s disease  (Brown, Spencer, Friedlander)

It is common for individuals with Parkinson’s Disease (PD) to develop hypokinetic dysarthria, a speech impairment that can disrupt any or all subsystems of speech. Individuals with hypokinetic dysarthria can present with a variety of speech characteristics including a monotone voice, atypical pause patterns, impaired rate of speech, stuttering-like behaviors, and speech that is generally more difficult to understand.

It is also well established that distinct subtypes of PD exist. These subtypes are classified according to predominant motor symptoms (e.g., presence of tremor, posture or gait difficulties); as such, an individual with PD is often characterized as having either a tremor-dominant or non-tremor dominant subtype. Subtype dissociation is strongly supported in the literature, suggesting differences in disease patterns in the brain may underlie the differing motor symptom presentations. 

At present, it is unclear whether or how speech impairment characteristics align with PD motor subtypes. However, there is emerging research suggesting that differing speech profiles may relate to motor subtype. Examining speech impairment across PD subtypes may reveal patterns indicative of distinct speech profiles which would elevate our understanding of PD, aid in evaluation and management of the disease, and inform clinical and theoretical models of PD as well as hypokinetic dysarthria. Therefore, the purpose of the this study is to analyze speech impairment patterns and examine the association between these patterns and the well-established subtypes of PD.

Health-related quality of life in individuals with Parkinson's disease (Friedlander, Spencer, Brown)

Motor impairment, cognitive decline and speech impairment are prevalent consequences of PD and have been shown to impact health-related quality of life. However, it is unclear which domain exerts the most influence on self-perceived well-being. It is important to understand this question when educating people with PD and developing treatment plans and support strategies. Thus, the individual, collective and comparative influence of motor impairment, cognitive functioning and speech impairment will be examined to better understand their relationship to well-being in persons with PD. Specifically, this study is designed to assess the determinants of health-related quality of life in people with PD across four different sets of variables— demographic, cognitive ability, motor status, and speech intelligibility.

Using Smartphone Applications to Support Cognition in Individuals with Parkinson’s Disease: A Pilot Treatment Study (Cornell, Spencer, Sohlberg)

Cognitive impairment is a nonmotor symptom impacting a significant proportion of individuals with Parkinson Disease, even at the time of diagnosis, and is considered a risk factor for Parkinson’s Disease Dementia (PDD; Domellӧf, Ekman, Forsgren, & Elgh, 2015; Pedersen, Larsen, Tysnes, & Alves, 2017; Santangelo et al., 2015). Cognitive impairment not only negatively affects patients’ functional performance in instrumental activities of daily living and reduces participation in social and leisure activities, it also increases financial strain and caregiver burden (Jones et al., 2017; Lawson et al., 2014; Pirogovsky et al., 2014). Therefore, it is important in clinical practice to identify cognitive impairment in individuals with PD and determine intervention strategies that maintain or improve independence and quality of life, which in turn may reduce financial strain and caregiver burden. The purpose of this study is to examine the feasibility and impact of a hybrid (individual and small group) treatment study, designed to address the cognitive challenges of PD through the use of smartphones. The treatment program will focus on training voice commands to use two primary smartphone features: (i) reminders and (ii) the calendar function. Response to treatment will be measured via Goal Attainment Scaling (primary outcome measure) and measures of executive function, depression, and well-being (secondary outcome measures).

 

Recently completed:

An external aids treatment program for individuals with Parkinson Disease**  (Smasne, Spencer)

It is common for individuals with Parkinson’s Disease (PD) to experience changes to their cognitive functioning, even very early in the disease process. These changes often impact attention, memory, and executive functions (e.g., planning for the day, switching between tasks, etc.), and can reduce independence, increase caregiver strain, and make it difficult to accomplish everyday tasks. Several studies have attempted to address this issue by examining the effect of direct cognitive training in people with PD. Those studies often report successful outcomes, but the measures of success are predominantly formal paper-and-pencil or computerized tests. Little is known about whether improvement is seen in daily life, or with personally relevant goals. Also unknown is whether a different approach, namely one that provides compensatory cues to accomplish personal goals, would be beneficial.

There is a strong rationale for considering the compensatory cues route to support people with PD. Externally-provided compensatory cues, such as a daily schedule, an appointment reminder, or a checklist for a home project, are strategies that are commonplace for many people, with and without cognitive impairment. It is also well documented in the general literature on PD that “internal cues”, such as telling yourself to do a task a certain way, are often ineffective for people with PD. External cues, however, have been found to be very helpful for activities such as walking and writing. Yet there are no studies to date on using external cues to help alleviate the negative consequences of the cognitive changes experienced by many individuals with PD. Moreover, trainings focused on external cues have been proven successful for other clinical populations with cognitive impairment, such as people with traumatic brain injury or dementia.

This study was a novel, external cuing training program for a small group of individuals with Parkinson’s disease. Training goals were personally relevant to each participant and centered on daily life activities. The outcomes of training focused on the extent that the personal goals were met, and the participant’s and caregiver's perspective of well-being, elicited via questionnaires. Outcomes were measured immediately after the eight-week treatment, and 2 months post-training.

Positive training effects were demonstrated and maintained for the personalized primary outcome measure of Goal Attainment Scaling, with notable changes observed in secondary outcome measures. The untreated “control” goal remained unchanged.

 

Dysarthia Profiles in Hereditary Ataxia (Dawson, Spencer)

The dysarthrias associated with hereditary ataxias are poorly understood. Ataxic dysarthria, even in its purest form, can manifest in highly variable ways. This heterogeneity is magnified in the hereditary ataxias, which can present as a mixed dysarthria, often ataxic-spastic or ataxic-flaccid.

In an attempt to explain the widespread characteristics of ataxic dysarthria, two primary theories have emerged: (1) deviant speech characteristics cluster according to speech subsystem (Joanette & Dudley, 1980; Ebert et al., 1995) or (2) features of dysarthria are linked to patterns of instability or inflexibility (Hartelius et al., 2000; Spencer & France, 2016). Generally, the principle of instability would be associated with unusually increased variability, while the principle of inflexibility would be associated with speech symptoms that are abnormally invariant and equalized (see Table 1). This study tested these theories in adults with dysarthria from hereditary ataxia.

Research Questions

•Can speakers be classified into instability/inflexibility (or mixed presentation) subgroups based on Visual Analog Scale patterns?
•Can speakers be classified into subgroups based on presence/severity ratings across speech subsystems of articulation, phonation, respiration, and prosod

Speakers with dysarthria from hereditary ataxia were classified according to the instability/inflexibility hypothesis, similar to speakers with dysarthria from sporadic ataxia (Spencer & France, 2016). AMRs/SMRs were the most sensitive speech task. There was no apparent relationship between the instability/inflexibility profile and etiology, symptom duration, speaker age, or form of ataxia. However, there does appear to be a relationship to intelligibility level.