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> Dear list members,
>
> Those of you who have enjoyed the many contributions of Tom Riess to
> various PD topics may remember his SPEECH SURVEY a little over 2 years
> ago, also his experiments with Delayed Audio Feedback devices.
>
> Tom's information has been extremely helpful to my relative, another PD
> patient (55/20). Both gentlemen discovered, some years ago, their strong
> receptiveness to certain auditory stimulation; the effect is as an
> IMMEDIATE ENHANCEMENT IN SPEECH AND FINE MOTOR CONTROL;  for these two
> patients it works every time, there is no wearing off with time.
>
> What this effect IS NOT: not a miracle cure; not a sales pitch;  it is not
> gradual speech rehabilitation therapy, in which the organs relearn their
> function;  although rhythmic music may have a similar effect, this is not
> an emotional soothing trick
>
> What it probably IS: simply stated, the neural network in the brain
> appears to switch from one phase to another under certain circumstances
> (yet to be scientifically identified); the ON/OFF phase switches under
> L-dopa treatment are another example; another similar example is the
> famous kinesia paradoxa investigated and described by Dr. Oliver Sacks in
> the book and movie AWAKENINGS; it seems to only occur in a limited number
> or acoustically sensitive PD patients, after long-time dopamine
> replacement medication;  from a neurological and motor control point of
> view it is probably an important neural dynamic phenomenon.
>
> If you are interested and feel that it may help your impaired speech, then
> here is what you can do:
> *     first review the attachment
> *     next review in the Parkinsn List archives the some 25 relevant posts
> on this topic (late 1996 - early 1997, search keyword "speech")
> *     here is how to try out such a sensory feedback system: you may have
> a home audio system allowing you to talk into a microphone and feed right
> back to your ear; talk, talk, talk for at least 30 sec, the effect should
> be immediate; alternately go to your local electric guitar or music
> synthesizer/electronic keyboard store;  they probably have a sound room
> with a mike, speakers, and a Reverb/Delay unit; you may wish to vary the
> delay parameter;  note that a normal person would find such delayed voice
> feedback disturbing to his continued speech
>
> We would like to hear, by return e-mail, from any of you with a similar
> experience; for statistical purposes, we'd like to have a short note even
> from those of you with no noticeable effect. We'll gather and follow up on
> data supplied in the period aug.1 - sept.30.1999. If the response is
> significant enough, we may be able to interest a multi-disciplinary group
> of specialists to investigate the phenomenon;  this may provide tremendous
> help to some PD sufferers.
>
> Andrew Mera
> Seatlle, WA
>
> ----------------------------------
>
> Extract from a technical paper: Auditory stimulation of fine motor control
> in a Parkinson patient (in preparation)
>
> ...One significant therapeutic effect occurs... while listening to some
> favorite rhythmic music. Previously stiff fingers are immediately enabled
> to tap rhythm or write text; arms can wave, legs dance, moving lips
> verbalize. Certain tones, tempos and rhythms are preferable: reggae or
> classic rock (e.g. Don McLean's American Pie) are more effective than
> allegro Mozart or Beethoven; the difference could be the presence in
> electronically altered music of heavy base (low frequencies have a
> stronger effect on the body), or of vibrato and delay; offbeat rhythms in
> Latin tango and Greek bouzouki; but just a drum solo or metronome ticking
> won't do.
> When the music stops, the dexterity disappears, he quickly reverts to a
> hypokinetic state. His successive on/off phases, recorded on camera, are
> as impressive to a casual audience as neurosurgeons' demonstrations of a
> patient with/without electrical stimulator.
>
> Another experiment in assisted loud reading is also worth describing.
> Reciting is much easier with another person reading the text along. Rather
> than follow the other voice, he is entrained to lead by one or two words;
> when the other person stops, his own lips stop moving within a few seconds
> and his voice deteriorates into an inarticulate groan.
>
> Next he tried feeding his own voice back via a
> microphone-amplifier-earphone system: the stiff lips again are able to
> phonate, even to whistle a song. The effect is further enhanced upon
> including a reverberation and delay device (effect of a concert hall or
> echo chamber) into the audio loop. Other motor functions also come alive:
> finger dexterity, gait balance, facial expression.  The effect is
> strongest in a sound room with multiple speakers and subwoofer, the delay
> being just a few milliseconds. He and [Riess 1997] have experimented with
> several portable delayed audio feedback (DAF) devices: echo pedals used by
> electric guitarists, speech enhancement devices developed for stutter
> therapy. When the reverb is turned off, the effect is reduced; when the
> sound feedback is completely removed, the stiffness and pain come back
> stronger than before;  there appears to be no adaptive learning in the
> neural system, no lasting therapeutic effect. The audio device takes input
> sound at each frequency (say 262 Hz midrange C plus overtones) and
> modulates the output amplitude at 5-10 Hz, or delays it by up to 225 msec.
> By comparison ... the heart pulsation rate is around 1-2 Hz. Effectively,
> he has a portable device, which he turns on whenever he needs it. ..
>
> Many questions remain for additional study. Is the effect selective to
> individual motor functions, or does it address connected functions?  Are
> the most effective stimuli tied to certain physiological rhythms, such as
> pulse rate, breathing, tremors? One needs to also consider aperiodic,
> random, and impulsive neural processes...
>
>