手术和药物管理的运动基础症状帕金森病已经取得了巨大的进展，在过去的几十年。然而，言语和声音症状的行为管理并没有得到同样的飞跃发展。尽管帕金森病相关的语言和声音症状普遍存在，但目前很少有循证治疗选择。面对良好的疗效数据，Lee Silverman语音治疗(LSVT LOUD)计划继续是语音治疗的黄金标准。LSVT LOUD训练病人在察觉到自己的声音是柔和的时候监测和调整他们的声音强度。因此，LSVT LOUD的成功部分取决于一个人在言语产生过程中自我监控和自我暗示(内部暗示)的能力。虽然LSVT LOUD促进了许多PD患者沟通的显著改善，但并非所有患者对治疗都有反应。据推测，潜在的感觉和认知因素可能会阻碍治疗结果。一种新的治疗语言和声音障碍的行为疗法最近被引入。这款小型入耳设备使用外部噪音提示来发出更大的声音。 While LSVT LOUD and the SpeechViveTM have both been shown to significantly increase sound pressure level (SPL) in patients with PD, the physiologic adjustments supporting these changes in SPL remain unclear. This is an important area of study for two reasons. First, both treatments are exercised-based programs, yet the physiologic changes associated with these treatments are not well understood. Second, there is evidence to suggest that the use of an external cue, such as the noise cue used in SpeechViveTM training, elicits more efficient respiratory patterns in neurologically-healthy and neurologically-involved patients, in comparison to self-initiated cueing strategies, such as those used in LSVT LOUD. This study proposes to compare the influence of cueing strategy on treatment outcomes by examining simultaneous respiratory-laryngeal adjustments before and after participation in LSVT LOUD (internal cueing) and SpeechViveTM (external cueing) training. It is important to study respiratory-laryngeal interactions because both of these subsystems contribute to vocal intensity regulation. In addition, exercise physiology studies have indicated that internal and external forms of cueing elicit different perceptions of physical and mental effort during exercise. It is important to understand the patients' level of perceived physical and mental effort, associated with each treatment program, as these variables can effect adherence to the treatment regime. In summary, the proposed study is intended to 1) fill a critical void in our understanding of respiratory-laryngeal adjustments used to support increased SPL under two evidence-based behavioral voice treatment programs, and 2) to better understand how patients' perceptions of physical and mental effort are shaped by each treatment paradigm. The information generated in this study could potentially lead to more efficient voice rehabilitation for persons with PD.