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Intensive Amplitude-specific Therapeutic Approaches for Parkinson's Disease: Toward a Neuroplasticity-principled Rehabilitation Model

Farley, Becky G. PT, PhD; Fox, Cynthia M. PhD, CCC-SLP; Ramig, Lorraine O. PhD, CCC-SLP; McFarland, David H. PhD, SLP

Topics in Geriatric Rehabilitation: April-June 2008 - Volume 24 - Issue 2 - p 99–114
doi: 10.1097/01.TGR.0000318898.87690.0d

Recent scientific advances in animal models of Parkinson disease suggest exercise is a legitimate disease-modifying therapeutic option that contributes to behavioral recovery and neurochemical sparing. These data challenge current rehabilitative assumptions and emphasize the need for neuroplasticity-principled exercise-based approaches to challenge the impaired system. We suggest one novel solution-–the intensive practice of amplitude-–a global motor control parameter. Training a single focus (amplitude) across (1) disciplines (physical, occupational, speech therapy), (2) tasks (transfers, activities of daily living, recreation), and (3) motor systems (speech, locomotion, reaching) may provide the complexity, difficulty, and repetition necessary for disease-modification in human Parkinson disease.

From the Department of Physiology, AHSC, University of Arizona, Tucson (Dr Farley); National Center for Voice and Speech, Denver, Colo, and Department of Neurology, University of Arizona, Tucson (Dr Fox); Department of Speech, Language, Hearing Sciences, University of Colorado–Boulder; National Center for Voice and Speech, Denver Center for the Performing Arts, Denver, Colo; and Columbia University, New York City, New York (Dr Ramig); École d'orthophonie et d'audiologie et centre de recherche en sciences neurologiques, Faculté de médecine, Université de Montréal and School of Communication Sciences and Disorders and Center for Research on Language, Mind and the Brain, McGill University (Dr McFarland).

Corresponding author: Becky G. Farley, PT, PhD, Department of Physiology, AHSC, University of Arizona, Tucson, AZ 85724 (e-mail:

This work was supported, in part, by funding from National Institute of Health Grant R21 NS043711 and R01 DC-01150. Special thanks to Gail Koshland for comments on the manuscript; Michelle Prior, Heather Spellman, and Kristan Leech for technical contributions; and to the subjects who participated in these studies.

© 2008 Lippincott Williams & Wilkins, Inc.