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An integrated speech and physical therapy approach for Parkinson disease: Training Big and Loud
CM Fox, BG Farley, LO Ramig, & D McFarland

Recent findings in animal models of Parkinson Disease (PD) reveal that exercise favorably impacts behavioral characteristics of the disease and its neural substrates. These data suggest that exercise may modify disease progression and compels the need for exercise-based behavioral treatments in humans with PD. A well-established speech treatment (LSVT/Loud) incorporates principles of exercise and has been documented to be effective and long-lasting in people with PD. Principles of LSVT were recently applied to limb movement (Training Big) and were documented to be effective in the short term. These exercise-based protocols have been applied individually (minimal dual training) to apparently divergent motor systems (speech and limb). Recent evidence, however, suggests their may be distributed and perhaps interactive effects of exercise across motor behaviors. We take an initial step in verifying this hypothesis by evaluating the impact of a combined speech and physical therapy approach (training Big and Loud) that targets increased amplitude of speech and body movements simultaneously. Data from 8 subjects with PD reveal this integrated treatment strategy improved function in limb and speech motor tasks and dual task functioning. Findings will be discussed in relation to cross-system treatment interactions, principles of neuroplasticity and early behavioral intervention in PD.

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