title: Neural correlates of efficacy of voice therapy in Parkinson's disease identified by performance-correlation analysis.
abstract: LSVT LOUD (Lee Silverman Voice Treatment) is efficacious in the treatment of speech disorders in idiopathic Parkinson's disease (IPD), particularly hypophonia. Functional imaging in patients with IPD has shown abnormalities in several speech regions and changes in these areas immediately following treatment. This study serves to extend the analysis by correlating changes of regional neural activity with the main behavioral change following treatment, namely, increased vocal intensity. Ten IPD participants with hypophonia were studied before and after LSVT LOUD. Cerebral blood flow during rest and reading conditions were measured by H(2)(15)O-positron emission tomography. Z-score images were generated by contrasting reading with rest conditions for pre- and post-LSVT LOUD sessions. Neuronal activity during reading in the pre- versus post-LSVT LOUD contrast was correlated with corresponding change in vocal intensity to generate correlation images. Behaviorally, vocal intensity for speech tasks increased significantly after LSVT LOUD. The contrast and correlation analyses indicate a treatment-dependent shift to the right hemisphere with modification in the speech motor regions as well as in prefrontal and temporal areas. We interpret the modification of activity in these regions to be a top-down effect of LSVT LOUD. The absence of an effect of LSVT LOUD on the basal ganglion supports this argument. Our findings indicate that the therapeutic effect of LSVT LOUD in IPD hypophonia results from a shift in cortical activity to the right hemisphere. These findings demonstrate that the short-term changes in the speech motor and multimodal integration areas can occur in a top-down manner.
authors.affiliation: Department of Radiology, Research Imaging Center, University of Texas Health Science Center at San Antonio, Texas 78229, USA. narayana@uthscsa.edu
authors.forename: Shalini
authors.initials: S
authors.lastname: Narayana
authors.forename: Peter T
authors.initials: PT
authors.lastname: Fox
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.forename: Crystal
authors.initials: C
authors.lastname: Franklin
authors.forename: Donald A
authors.initials: DA
authors.lastname: Robin
authors.forename: Deanie
authors.initials: D
authors.lastname: Vogel
authors.forename: Lorraine O
authors.initials: LO
authors.lastname: Ramig
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001931:Brain Mapping; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010104:Oxygen Radioisotopes; D010300:Parkinson Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D049268:Positron-Emission Tomography; D011932:Reading; D012146:Rest / Q000502:physiology; D013060:Speech / Q000502:physiology; D013064:Speech Disorders / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014834:Voice Training; D014867:Water
chemical_list: D010104:Oxygen Radioisotopes; D014867:Water