Date of Degree

9-2018

Document Type

Dissertation

Degree Name

Ph.D.

Program

Psychology

Advisor

Joan C. Borod

Committee Members

Justin Storbeck

Valentina Nikulina

Yvette Caro

Carolyn Pytte

Subject Categories

Biological Psychology | Other Rehabilitation and Therapy

Keywords

Parkinson's disease; Lee Silverman Voice Treatment; Facial Expression; Emotion; Predictors of Outcome; Rehabilitation

Abstract

Parkinson’s disease (PD) is a neurodegenerative disease associated with a wide range of motoric, cognitive, and behavioral symptoms. Impairments in facial mobility and emotional expressivity are common and can impair communication, in turn, affecting daily functioning and quality of life. Previous research suggests that the Lee Silverman Voice Treatment © (LSVT LOUD; Ramig et al., 2001, 2011) increases vocal loudness and facial expressivity in individuals with PD compared to PD and healthy controls. This study extends the literature by examining the effects of LSVT and an articulation-based control treatment (i.e., ARTIC) on multiple aspects of facial expressivity (i.e., emotional frequency [EF], emotional variability [EV], emotional intensity [EI], and social engagement [SE]) as well as non-emotional facial mobility (FM). Further, we examined whether demographic, clinical, cognitive, and affective variables predict facial expressivity and mobility improvement via LSVT.

Participants included 40 individuals with idiopathic PD (67.5% male) and 14 demographically-matched healthy controls (60% male). The PD participants were randomly assigned to one of the following conditions: the LSVT LOUD treatment group (n = 13), a control therapy (Articulation Treatment [ARTIC]; n = 14), or an Untreated Control Condition (n = 13). All posers (PDs & HCs) were video-taped, before and after treatment (for the LSVT & ARTIC PD groups) or at baseline and after a 4-5 week waiting period for (for the Untreated PDs [UPDs] & HCs), while producing emotional (Happy, Sad, & Angry) monologues from the New York Emotion Battery (Borod et al., 1998; Borod, Welkowitz, & Obler, 1992). The monologues were randomized and divided into 15-second segments, and evaluated by 18 naïve raters for 4 different aspects of facial emotional expression and facial mobility. Separate training sessions were held for each of the five facial rating variables (i.e., FM, EF, EV, EI, & SE), and interrater reliability was largely in the high range.

Findings revealed that PD posers displayed lower facial expressivity than HCs on three out of five variables, however, these effects were moderated by gender and emotion. In terms of gender, women were more expressive than men on all facial expression variables. Treatment results showed that individuals in the LSVT group showed significant improvements from pre- to post-treatment in facial expressivity for four out of the five variables examined (i.e., FM, EF, EV, & EI), however, for EV, this interaction was moderated by Gender, with significant increases from pre- to post-treatment for men but not for women in the LSVT group. There were no significant differences observed pre- to post-treatment for ARTIC or from baseline to 4-5 weeks later for the UPD and HC groups. In terms of predictive findings, demographic, clinical, cognitive, and affective variables did not predict facial improvement in LSVT participants, likely due to low power.

This study has multiple clinical and research implications. First, we examined facial expression through a multifactorial approach, involving mobility, expressivity, and social judgment of others, which has not been done in other studies with PD and which may provide a better understanding of the specific facial impairments in PD. Clinically, our treatment findings for LSVT are important to the rehabilitation therapy literature, because there are very few empirically-validated treatments targeting facial emotional expressivity and facial mobility in individuals with PD.

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