The Effects of Arts-Based Interventions on Vocal and Facial Expressiveness in People with Parkinson’s Disease (PD)

Patients with Parkinson’s Disease (PD) exhibit deficits in their ability to produce emotional facial expressions, referred to as the “Masked Face Syndrome” (Rinn, 1984) as well as deficits in vocal expressiveness (Gray & Tickle-Degnen, 2010). Facial mimicry, which refers to the automatic mimicking of others’ facial expressions, and perception of emotion in others’ facial expressions are also impaired in PD (Buxton, McDonald & Tippett, 2013; Livingstone et al., under review). Research in neurotypicals has found that disrupting facial mimicry leads to reduced ability to identify facial expressions (Oberman, Winkielman & Ramachandran, 2007). Rhythmic auditory stimulation, which is inherent to singing, has been shown to aid motor movements. For example, rhythmic cues can improve gait and speech fluency (Thaut, et al., 1996).

Question: Can facial mimicry be rehabilitated with intentional imitation of emotional expressions while singing?

Participants: 13 PD patients enrolled in Parkinson’s Choir; 13 PD patients enrolled in Dancing With Parkinson’s program

Buxton, S. L., McDonald, L., & Tippett, L. J. (2013). Impaired recognition of prosody

and subtle emotional facial expressions in Parkinson’s disease. Behavioural

Neuroscience, 127, 193–203.

Gray, H. M., & Tickle-Degnen, L. (2010 ) A Meta-Analysis of Performance on Emotion

Recognition Tasks in Parkinson’s Disease.Neuropsychology, 42, 176-191.

Livingstone, S. R., Vezer, E., McGarry, L. M., Lang, A. E., & Russo, F. A. (under

review). Why didn’t she return my smile? Deficits in the mimicry of facial

expressions in Parkinson’s disease. Neuropsychologia.

Oberman, L. M., Winkielman, P., & Ramachandran, V. S. (2007). Face to face:

Blocking facial mimicry can selectively impair recognition of emotional

expressions. Social Neuroscience, 2, 167-178.

Thaut, M. H. McIntosh, G. C., Rice, R. R., Miller, R.A., Rathbun, J., & Brault, J.M. (1996).

Rhythmic auditory stimulation in gait training for Parkinsonʼs disease patients.

Movement Disorders, 11, 193-200.

Rinn, W. E. (1984). The neuropsychology of Facial Expression. J Psychological Bulletin, 95, 52-

77.

Background Next Steps: Parkinson’s Choir

Methods

Results

Results from Background Research

Comparison to Dance

Implications

ReferencesPlacement of EMG electrodesRed = corrugator (frowning muscles) Green = zygomaticus (smiling muscles)

Domenica Fanelli1, Esztella Vezer1, Steven Livingstone1&2, Sean Hutchins3, & Frank A. Russo1&2

1Department of Psychology, Ryerson University, 2 Toronto Rehabilitation Institute, 3 The Royal Conservatory of Music

Measures: Taken at week 1, week 13 and 2-month follow-up:1. Facial mimicry: EMG recordings of facial muscles while observing videos of

expressed emotion (neutral, calm, happy, sad, angry, fearful, disgusted, surprised)2. Voluntary facial expressiveness: EMG recordings of facial muscles while

demonstrating best effort at happy, sad, angry and surprised expressions3. Emotion perception task: Participant identifies emotions in 42 videos of expressed

emotion (calm, happy, sad, angry, fearful, disgusted, surprised)4. Vocal quality: Participant is audio recorded while performing a range of vocal tasks:

• Fundamental frequency (FF) range: Say “ah” from lowest to highest note• Maximum amplitude: Say “ah” as loud as possible• Maximum vowel duration: Sustain “ah” for as long as possible• Mean FF/fluctuations in FF/mean amplitude/fluctuations in

amplitude/jitter/shimmer in normal speech: Reading of “Rainbow Passage”• Mean FF/fluctuations in FF/mean amplitude/fluctuations in

amplitude/jitter/shimmer in emotional speech: Talk about a happy day for 30 seconds

Choir Program Details: 13 one-hour weekly sessions involving vocal exercises and singing happy and sad songs (based on previously found areas of mimicry impairment) while imitating emotional expressions.

Hypotheses:

1.There will be a significant increase on all measures at week 13 and at the two-month follow up in the choir group

2.There will be no significant post-intervention increase on measures in the dance group

Once complete, this study will increase our understanding of the impact of arts-based interventions on aspects of emotional communication in PD, as well as clarify the role of rhythmic auditory stimulation. It is also hoped that positive results will promote the expansion of specialized choir programs for people with PD.

In a previous study, 13 PD patients (treatment group) underwent 13 weekly sessions of imitating videos of actors singing with a range of emotional expressions, while 13 further PD patients (control group) observed the videos without imitation across the same time period. Facial mimicry of both groups were measured using EMG at weeks 1 and 2, as well as at 2-month follow-up.