Advanced Technology and Tools for DBS Programming for Speech Functionality

DESCRIPTION (provided by applicant): Speech is a complex motor behavior often disrupted by neurological dysfunction. Parkinson's disease (PD) is one of the main disorders disrupting speech. Recently, deep brain stimulation (DBS) has proven to be effective for motor problems in patients with PD and other movement disorders. However, the effects of DBS on speech have not been consistently positive. Many difficulties arise from the subjective nature of speech evaluation and the multiple levels of monitoring a nd feedback (nonlinear dynamics, NLD) in the speech-production system. Programming can be slow and uncomfortable due to the large changes in settings needed to achieve immediately obvious changes in performance. NIH noted these issues in PA-07-395: In spi te of its clinical success, DBS technology and the associated surgical procedures have several limitations. For example, clinicians lack tools which combine anatomical, physiological, electrical, and behavioral data to optimize electrode placement and stim ulator programming. Improvement in some types of motor function, particularly speech, have not been as positive as others. When improvements in speech outcomes after DBS were noted, they were typically minimal and more variable than seen in akinesia, rigid ity, and dyskinesias. This project's goal is to develop an inexpensive portable device and software tools that will objectively analyze speech, to allow optimizing DBS electrode placement and settings for speech. This builds on objective, articulation-bas ed measures of speech and on NLD techniques. Phase 1 clearly showed that several articulation- and NLD-based measures distinguished among treatment states for peri-implant PD patients and that without suitable programming, many patients' speech may be subs tantially worsened. With programming, normal or near-normal values of these measures were reachable for most subjects. Phase-2 aims to: (a) expand on existing algorithms for automated speech processing; (b) validate measures specifically targeted for PD-re lated dysarthria; (c) link them to speaker intelligibility; (d) compare the device's sensitivity to clinicians; and (e) design and test the device with neurologist users. This device will enable neurologists to optimize DBS for speech quickly and efficient ly. Using this device during implantation could even enable adjusting the placement of the electrodes themselves by the neurosurgeon for improved programmability later. PUBLIC HEALTH RELEVANCE: This project will produce a handheld device to help Parkinson' s Disease patients with newly implanted deep-brain stimulators (DBS) achieve more functional outcomes more quickly, particularly for speech functionality. Moreover, the device may allow neurosurgeons to adjust the positioning of the electrodes in the opera ting room, to permit more functional placement for later optimization. Much of the device's value will apply as well to other motor disorders for which DBS is an approved therapy: epilepsy, dystonia, etc.