PARKINSON DISEASE (Disorder)NCT07905612
Singing Therapy for Rehabilitating Facial Mimicry in Parkinson's Disease: A Randomised Controlled Trial
A study testing Singing Imitation Therapy and Singing Observation Therapy in people with PARKINSON DISEASE (Disorder), run by Toronto Metropolitan University at 1 site in Canada.
Trial summary
Parkinson's disease can reduce facial expression and change the voice, making it harder to communicate emotions. This study examined whether practising facial and vocal imitation through speech and singing could improve facial expression and emotional communication in people with Parkinson's disease. Read more about this study
- Who is it for?
- Ages 50 to 75 yearsHealthy volunteers can take part
- Conditions the study is for
- PARKINSON DISEASE (Disorder)
- What is being tested?
- Singing Imitation Therapy and Singing Observation Therapy
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 48 participants
- Where
- 1 siteCanada
- Study dates
- 28 Jun 2013to 24 Oct 2014
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 50 to 75 years
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Participants with Parkinson's disease:
- Clinical diagnosis of idiopathic Parkinson's disease.
- Aged 50-75 years at enrolment.
- Parkinson's disease diagnosed at age 50 years or older.
- At least eight years of English-speaking experience.
- Provided written informed consent.
Show all 10Show fewer
- Caregiver participants:
- Informal caregiver of a participant enrolled in the Parkinson's disease treatment trial.
- Provided separate informed consent to participate in questionnaire assessments.
- No separate age eligibility criteria were specified for caregiver participants. The stated age range of 50-75 years applies only to participants with Parkinson's disease.
Who cannot join
- Secondary or acquired parkinsonism.
- Hoehn and Yahr stage greater than 4.
- Clinically significant depressive symptoms, defined as a Beck Depression Inventory (BDI) score greater than 19.
- Cognitive impairment, defined for screening as a Montreal Cognitive Assessment (MoCA) score below 21.
- Severe visual or auditory deficits.
- Concurrent participation in another treatment trial.
Trial locations and contacts
1 site in 1 country.
Canada1 site
SMART Lab, Toronto Metropolitan University
Toronto, Ontario, M5B2K3
About this study
Official title: A Novel Singing Therapy to Improve Communication of Facial and Vocal Emotion
Parkinson's disease can reduce facial expression and change the voice, making it harder to communicate emotions. This study examined whether practising facial and vocal imitation through speech and singing could improve facial expression and emotional communication in people with Parkinson's disease.
Participants were assigned by chance to one of two 13-week programs. In Singing Imitation Therapy, participants watched and listened to recordings of emotional speech and song and copied the facial and vocal expressions. In Singing Observation Therapy, participants watched and listened to the recordings without being instructed to copy them.
The main hypothesis was that imitation would lead to greater improvements in facial expression and automatic facial responses to other people's emotional expressions than observation alone.
Read the detailed description
Reduced spontaneous facial expression, or hypomimia, can affect emotional communication and social interaction in Parkinson's disease. Facial mimicry refers to subtle, automatic facial muscle responses that occur when observing another person's emotional expressions. The study investigated whether deliberate practice of emotional facial and vocal expression could improve this spontaneous responsiveness.
The intervention was based on the proposed relationship between perceiving emotional expressions and producing the associated facial and vocal movements. Repeated intentional imitation was hypothesized to strengthen facial motor responsiveness and support expressive function. The observation comparator was included to examine whether active imitation offered additional benefits beyond repeated exposure to emotional speech and song. The broader rationale was that improved expressive function might support emotional communication and well-being.
Additional audio and video recordings were collected for exploratory analyses of vocal production, facial movement, and facial-vocal coordination. Vocal assessments using LSVT assessment tasks were recorded at Week 1, Week 13, and two months after treatment completion. Therapy sessions were video-recorded weekly during Weeks 1-13.
The original protocol proposed exploratory analyses of vocal frequency and intensity, including their ranges; speech rate; voice perturbation measures, including jitter and shimmer; formant frequencies; and harmonics-to-noise ratio. Planned facial movement analyses included displacement, velocity, and acceleration, together with analyses of coordination between facial movement and vocal acoustics.
Further analysis of instructed facial imitation is proposed within the Singing Imitation Therapy group because the treatment groups performed different activities during therapy. These analyses would characterise imitation performance and changes within that group over time. Additional features and computational methods selected after trial completion will be distinguished from those specified in the original protocol.
The trial was completed before public registration. It was retrospectively registered on the Open Science Framework (OSF) on May 25, 2026. The OSF record documents the study design and a later plan for longitudinal treatment-effect analyses comparing Singing Imitation Therapy with Singing Observation Therapy. The present ClinicalTrials.gov record provides an additional retrospective registration of the same completed trial.
- Conditions
- PARKINSON DISEASE (Disorder)
- Being tested
- Singing Imitation Therapy, Singing Observation Therapy
- Keywords
- singing therapy, facial bradykinesia, motor rehabilitation, Parkinson's disease
- Medical subject headings
- Parkinson Disease
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Singing Imitation TherapyBehavioural
Participants received approximately 20-minute, therapist-delivered home sessions once weekly for 13 weeks. Sessions used 43-45 emotional speech and song videos, with metronome-supported song presented before speech. Each video was presented twice: participants observed the first presentation and synchronously imitated the actor's facial and vocal expression during the second. After each sequence, participants identified the emotion and rated its intensity on a 1-5 scale. Therapist feedback encouraged facial and vocal expressiveness. Participants received DVDs of song-with-metronome videos for weekly home practice using the same imitation instructions; practice completion was not formally monitored.
Singing Observation TherapyBehavioural
Participants received approximately 20-minute, therapist-delivered home sessions once weekly for 13 weeks, matched to the imitation intervention in structure and duration. Sessions used 43-45 emotional speech and song videos, with metronome-supported song presented before speech. Each video was presented twice. Participants watched and listened without instructed imitation, attending to the actor's facial and vocal emotion and its intensity. After each sequence, participants identified the emotion and rated its intensity on a 1-5 scale. Therapist feedback directed attention to the actor's voice or facial expression. Participants received DVDs of song-with-metronome videos for weekly home practice using the same observation instructions; practice completion was not formally monitored.
| Study group | Role | What they receive |
|---|---|---|
| Singing Imitation Therapy | Experimental | Participants received Singing Imitation Therapy, involving active imitation of emotional facial and vocal expressions presented in speech and song videos. Receives: Behavioral: Singing Imitation Therapy |
| Singing Observation Therapy | Active comparator | Participants received Singing Observation Therapy, involving observation of emotional speech and song videos without instructed facial or vocal imitation. Receives: Behavioral: Singing Observation Therapy |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in Standardized Facial Muscle Activity From Week 1 to Week 13
Change in standardized facial muscle activity from Week 1 to Week 13. Surface electromyography is recorded from the zygomaticus major, corrugator supercilii, and medial frontalis during emotional speech and song observation. Mean activity 1-4 seconds after stimulus onset is expressed as percentage change from a 2-second prestimulus baseline, then standardized within participant and muscle, then within participant across muscles. Both recordings at each visit are included. Activity is retained by muscle and stimulus emotion. Analyses assess overall responsiveness across emotional trials, excluding neutral/calm, and emotion-congruent responses: happy versus neutral/calm for zygomaticus; negative emotions (sad, angry, fearful, disgust) versus neutral/calm for corrugator; and surprise versus neutral/calm for frontalis. Values are unitless with no fixed limits; positive changes indicate increased activity.
Measured: Week 1 and Week 13 (end of treatment).
Change in Standardized Facial Muscle Activity From Week 1 to Two Months After Treatment
Change in standardized facial muscle activity from Week 1 to two months after treatment completion. Surface electromyography is recorded from the zygomaticus major, corrugator supercilii, and medial frontalis during emotional speech and song observation. Mean activity 1-4 seconds after stimulus onset is expressed as percentage change from a 2-second prestimulus baseline, then standardized within participant and muscle, then within participant across muscles. Both recordings at each visit are included. Activity is retained by muscle and stimulus emotion. Analyses assess overall responsiveness across emotional trials, excluding neutral/calm, and emotion-congruent responses: happy versus neutral/calm for zygomaticus; negative emotions (sad, angry, fearful, disgust) versus neutral/calm for corrugator; and surprise versus neutral/calm for frontalis. Values are unitless with no fixed limits; positive changes indicate increased activity.
Measured: Week 1 and two months after completion of the 13-week intervention.
Change in Modified MDS-UPDRS Part III Motor Examination Total Score From Week 1 to Week 13
Change from Week 1 to Week 13, calculated as the Week 13 value minus the Week 1 value. Motor impairment is assessed using Part III of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). The postural-stability item was not administered. The modified total comprises the remaining 32 ratings, each scored 0-4; eligible partially completed assessments are prorated to the 32-rating scale. Total scores range from 0 to 128, with higher scores indicating greater impairment. Change scores range from -128 to 128. Negative changes indicate reduced motor impairment.
Measured: Week 1 and Week 13 (end of treatment).
Change in Modified MDS-UPDRS Part III Motor Examination Total Score From Week 1 to Two Months After Treatment
Change from Week 1 to two months after treatment completion, calculated as the follow-up value minus the Week 1 value. Motor impairment is assessed using Part III of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). The postural-stability item was not administered. The modified total comprises the remaining 32 ratings, each scored 0-4; eligible partially completed assessments are prorated to the 32-rating scale. Total scores range from 0 to 128, with higher scores indicating greater impairment. Change scores range from -128 to 128. Negative changes indicate reduced motor impairment.
Measured: Week 1 and two months after completion of the 13-week intervention.
Change in MDS-UPDRS Part III Facial Expression Score From Week 1 to Week 13
Change from Week 1 to Week 13, calculated as the Week 13 value minus the Week 1 value. Facial expression is assessed using item 3.2 of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Part III. This clinician-rated item assesses reduced facial expression, including blinking, spontaneous smiling, and lower-face movement. Scores range from 0 to 4, with higher scores indicating greater impairment. Change scores range from -4 to 4. Negative changes indicate reduced facial-expression impairment.
Measured: Week 1 and Week 13 (end of treatment).
Change in MDS-UPDRS Part III Facial Expression Score From Week 1 to Two Months After Treatment
Change from Week 1 to two months after treatment completion, calculated as the follow-up value minus the Week 1 value. Facial expression is assessed using item 3.2 of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Part III. This clinician-rated item assesses reduced facial expression, including blinking, spontaneous smiling, and lower-face movement. Scores range from 0 to 4, with higher scores indicating greater impairment. Change scores range from -4 to 4. Negative changes indicate reduced facial-expression impairment.
Measured: Week 1 and two months after completion of the 13-week intervention.
Change in MDS-UPDRS Part III Speech Score From Week 1 to Week 13
Change from Week 1 to Week 13, calculated as the Week 13 value minus the Week 1 value. Speech is assessed using item 3.1 of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Part III. This clinician-rated item assesses speech volume, modulation, and clarity. Scores range from 0 to 4, with higher scores indicating greater speech impairment. Change scores range from -4 to 4. Negative changes indicate reduced speech impairment.
Measured: Week 1 and Week 13 (end of treatment).
Change in MDS-UPDRS Part III Speech Score From Week 1 to Two Months After Treatment
Change from Week 1 to two months after treatment completion, calculated as the follow-up value minus the Week 1 value. Speech is assessed using item 3.1 of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Part III. This clinician-rated item assesses speech volume, modulation, and clarity. Scores range from 0 to 4, with higher scores indicating greater speech impairment. Change scores range from -4 to 4. Negative changes indicate reduced speech impairment.
Measured: Week 1 and two months after completion of the 13-week intervention.
Secondary outcomes (12)
Emotion-Recognition Accuracy at Week 13
Emotion recognition is assessed during the audiovisual speech and song task. After each video, participants select the emotion portrayed. Neutral and calm are combined into a single category for both target emotions and participant responses before scoring. Each valid response is scored 1 if it matches the target category after this grouping and 0 otherwise. Accuracy is expressed as the percentage of correct responses, from 0% to 100%, with higher values indicating more accurate recognition. Responses from both recordings at the assessment visit are included.
Measured: Week 13 (end of treatment).
Emotion-Recognition Accuracy at Two Months After Treatment
Emotion recognition is assessed during the audiovisual speech and song task. After each video, participants select the emotion portrayed. Neutral and calm are combined into a single category for both target emotions and participant responses before scoring. Each valid response is scored 1 if it matches the target category after this grouping and 0 otherwise. Accuracy is expressed as the percentage of correct responses, from 0% to 100%, with higher values indicating more accurate recognition. Responses from both recordings at the assessment visit are included.
Measured: Two months after completion of the 13-week intervention.
Emotion-Recognition Response Time at Week 13
Response time for selecting the emotion portrayed in the audiovisual speech and song task, measured in seconds. Responses from both recordings at the assessment visit are included. Lower values indicate faster emotion-category responses. This measure is distinct from the response time for rating emotional intensity.
Measured: Week 13 (end of treatment).
Emotion-Recognition Response Time at Two Months After Treatment
Response time for selecting the emotion portrayed in the audiovisual speech and song task, measured in seconds. Responses from both recordings at the assessment visit are included. Lower values indicate faster emotion-category responses. This measure is distinct from the response time for rating emotional intensity.
Measured: Two months after completion of the 13-week intervention.
Happiness Measures Composite Score at Week 6
Subjective well-being is assessed using the Happiness Measures composite. The composite is calculated by averaging the general happiness rating, rescaled to 0-100, and the self-reported percentage of time feeling happy. Both component responses are required. Scores range from 0 to 100, with higher scores indicating greater happiness.
Measured: Week 6 (during treatment).
Happiness Measures Composite Score at Week 13
Subjective well-being is assessed using the Happiness Measures composite. The composite is calculated by averaging the general happiness rating, rescaled to 0-100, and the self-reported percentage of time feeling happy. Both component responses are required. Scores range from 0 to 100, with higher scores indicating greater happiness.
Measured: Week 13 (end of treatment).
Happiness Measures Composite Score at Two Months After Treatment
Subjective well-being is assessed using the Happiness Measures composite. The composite is calculated by averaging the general happiness rating, rescaled to 0-100, and the self-reported percentage of time feeling happy. Both component responses are required. Scores range from 0 to 100, with higher scores indicating greater happiness.
Measured: Two months after completion of the 13-week intervention.
PDQ-39 Summary Index at Week 6
Parkinson's disease-related quality of life is assessed using the 39-item Parkinson's Disease Questionnaire (PDQ-39). It covers mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort. Items are scored 0-4. Each domain is converted to a 0-100 score, and the Summary Index is the mean of the eight domain scores. Index scores range from 0 to 100, with higher scores indicating poorer quality of life.
Measured: Week 6 (during treatment).
PDQ-39 Summary Index at Week 13
Parkinson's disease-related quality of life is assessed using the 39-item Parkinson's Disease Questionnaire (PDQ-39). It covers mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort. Items are scored 0-4. Each domain is converted to a 0-100 score, and the Summary Index is the mean of the eight domain scores. Index scores range from 0 to 100, with higher scores indicating poorer quality of life.
Measured: Week 13 (end of treatment).
PDQ-39 Summary Index at Two Months After Treatment
Parkinson's disease-related quality of life is assessed using the 39-item Parkinson's Disease Questionnaire (PDQ-39). It covers mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort. Items are scored 0-4. Each domain is converted to a 0-100 score, and the Summary Index is the mean of the eight domain scores. Index scores range from 0 to 100, with higher scores indicating poorer quality of life.
Measured: Two months after completion of the 13-week intervention.
Emotion-Recognition Unbiased Hit Rate at Week 13
Emotion-recognition accuracy is adjusted for response bias using Wagner's unbiased hit rate (Hu). For each emotion, Hu is the proportion of presentations of that emotion correctly identified multiplied by the proportion of uses of that response label that are correct. Scores range from 0 to 1, with higher scores indicating better recognition after adjustment for response bias. Scores are retained by emotion.
Measured: Week 13 (end of treatment).
Emotion-Recognition Unbiased Hit Rate at Two Months After Treatment
Emotion-recognition accuracy is adjusted for response bias using Wagner's unbiased hit rate (Hu). For each emotion, Hu is the proportion of presentations of that emotion correctly identified multiplied by the proportion of uses of that response label that are correct. Scores range from 0 to 1, with higher scores indicating better recognition after adjustment for response bias. Scores are retained by emotion.
Measured: Two months after completion of the 13-week intervention.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Oct 2026
- Study start28 Jun 2013
- Primary completion24 Oct 2014
- Study completion24 Oct 2014
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for PARKINSON DISEASE (Disorder)Studies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Two-arm, parallel-group randomised controlled trial comparing Singing Imitation Therapy with Singing Observation Therapy, an active comparator. Twenty-eight participants with Parkinson's disease were allocated individually using a coin toss, with a target allocation ratio of 1:1 and a maximum of 14 participants per group. Once one group reached this maximum, subsequent participants were assigned to the other group. Allocation was not stratified. Twenty caregivers provided separate consent for questionnaire assessments; they were not independently randomised and did not receive a study intervention.
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 48 participants (actual)
Sponsor and investigators
- Lead sponsor
- Toronto Metropolitan University
- Sponsor type
- University, hospital or other
- Collaborators
- University Health Network, Toronto, University of Toronto, Parkinson Society Canada
- Responsible party
- Principal investigator, Frank Russo, Toronto Metropolitan University
- Investigators
- Frank A Russo, PhD, Principal investigator, Toronto Metropolitan University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07905612
- Sponsor's protocol ID
- 12-5515
- Other IDs
- 2012-22, 895-2021-1018, cds2z
- Status last verified
- Oct 2026
- First submitted
- 23 Oct 2026
- Last updated
- 29 Oct 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: De-identified individual participant data underlying the trial results reported in the publication will be shared. These will include processed facial surface electromyography (sEMG) data, behavioural task data, motor and cognitive assessment scores, and participant and caregiver questionnaire scores. The datasets will be accompanied by a data dictionary describing the variables and their coding, together with analysis scripts. Anonymised raw data underlying the reported analyses will also be available upon reasonable request, subject to a data-sharing agreement.
Publications
Livingstone SR, Vezer E, McGarry LM, Lang AE, Russo FA. Deficits in the Mimicry of Facial Expressions in Parkinson's Disease. Front Psychol. 2016 Jun 7;7:780. doi: 10.3389/fpsyg.2016.00780. eCollection 2016.
PubMed 27375505
Study at a glance
From the registry record, last updated by the sponsor on 29 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Novel Singing Therapy to Improve Communication of Facial and Vocal Emotion
- ClinicalTrials.gov ID
- NCT07905612
- Acronym / sponsor ID
- 12-5515
- Conditions
- PARKINSON DISEASE (Disorder)
- Keywords
- singing therapy, facial bradykinesia, motor rehabilitation, Parkinson's disease
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 48 participants (actual)
- Lead sponsor
- Toronto Metropolitan UniversityUniversity, hospital or other
- Collaborators
- University Health Network, Toronto, University of Toronto, Parkinson Society Canada
- Study start
- 28 Jun 2013 (actual)
- Primary completion
- 24 Oct 2014 (actual)
- Study completion
- 24 Oct 2014 (actual)
- First posted
- 29 Oct 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Parkinson's disease can reduce facial expression and change the voice, making it harder to communicate emotions. This study examined whether practising facial and vocal imitation through speech and singing could improve facial expression and emotional communication in people with Parkinson's disease.
Participants were assigned by chance to one of two 13-week programs. In Singing Imitation Therapy, participants watched and listened to recordings of emotional speech and song and copied the facial and vocal expressions. In Singing Observation Therapy, participants watched and listened to the recordings without being instructed to copy them.
The main hypothesis was that imitation would lead to greater improvements in facial expression and automatic facial responses to other people's emotional expressions than observation alone.
Detailed description
Reduced spontaneous facial expression, or hypomimia, can affect emotional communication and social interaction in Parkinson's disease. Facial mimicry refers to subtle, automatic facial muscle responses that occur when observing another person's emotional expressions. The study investigated whether deliberate practice of emotional facial and vocal expression could improve this spontaneous responsiveness.
The intervention was based on the proposed relationship between perceiving emotional expressions and producing the associated facial and vocal movements. Repeated intentional imitation was hypothesized to strengthen facial motor responsiveness and support expressive function. The observation comparator was included to examine whether active imitation offered additional benefits beyond repeated exposure to emotional speech and song. The broader rationale was that improved expressive function might support emotional communication and well-being.
Additional audio and video recordings were collected for exploratory analyses of vocal production, facial movement, and facial-vocal coordination. Vocal assessments using LSVT assessment tasks were recorded at Week 1, Week 13, and two months after treatment completion. Therapy sessions were video-recorded weekly during Weeks 1-13.
The original protocol proposed exploratory analyses of vocal frequency and intensity, including their ranges; speech rate; voice perturbation measures, including jitter and shimmer; formant frequencies; and harmonics-to-noise ratio. Planned facial movement analyses included displacement, velocity, and acceleration, together with analyses of coordination between facial movement and vocal acoustics.
Further analysis of instructed facial imitation is proposed within the Singing Imitation Therapy group because the treatment groups performed different activities during therapy. These analyses would characterise imitation performance and changes within that group over time. Additional features and computational methods selected after trial completion will be distinguished from those specified in the original protocol.
The trial was completed before public registration. It was retrospectively registered on the Open Science Framework (OSF) on May 25, 2026. The OSF record documents the study design and a later plan for longitudinal treatment-effect analyses comparing Singing Imitation Therapy with Singing Observation Therapy. The present ClinicalTrials.gov record provides an additional retrospective registration of the same completed trial.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 2
- Model description
- Two-arm, parallel-group randomised controlled trial comparing Singing Imitation Therapy with Singing Observation Therapy, an active comparator. Twenty-eight participants with Parkinson's disease were allocated individually using a coin toss, with a target allocation ratio of 1:1 and a maximum of 14 participants per group. Once one group reached this maximum, subsequent participants were assigned to the other group. Allocation was not stratified. Twenty caregivers provided separate consent for questionnaire assessments; they were not independently randomised and did not receive a study intervention.
| Arm | Type | Receives |
|---|---|---|
| Singing Imitation Therapy | Experimental | Behavioral: Singing Imitation TherapyParticipants received Singing Imitation Therapy, involving active imitation of emotional facial and vocal expressions presented in speech and song videos. |
| Singing Observation Therapy | Active comparator | Behavioral: Singing Observation TherapyParticipants received Singing Observation Therapy, involving observation of emotional speech and song videos without instructed facial or vocal imitation. |
Who may qualify
- Ages
- 50 to 75 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (10 listed)
- Clinical diagnosis of idiopathic Parkinson's disease.
- Aged 50-75 years at enrolment.
- Parkinson's disease diagnosed at age 50 years or older.
- At least eight years of English-speaking experience.
- Provided written informed consent.
Key exclusion criteria (6 listed)
- Secondary or acquired parkinsonism.
- Hoehn and Yahr stage greater than 4.
- Clinically significant depressive symptoms, defined as a Beck Depression Inventory (BDI) score greater than 19.
- Cognitive impairment, defined for screening as a Montreal Cognitive Assessment (MoCA) score below 21.
- Severe visual or auditory deficits.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Singing Imitation TherapyParticipants received approximately 20-minute, therapist-delivered home sessions once weekly for 13 weeks. Sessions used 43-45 emotional speech and song videos, with metronome-supported song presented before speech. Each video was presented twice: participants observed the first presentation and synchronously imitated the actor's facial and vocal expression during the second. After each sequence, participants identified the emotion and rated its intensity on a 1-5 scale. Therapist feedback encouraged facial and vocal expressiveness. Participants received DVDs of song-with-metronome videos for weekly home practice using the same imitation instructions; practice completion was not formally monitored. | Behavioural | Singing Imitation Therapy |
| Singing Observation TherapyParticipants received approximately 20-minute, therapist-delivered home sessions once weekly for 13 weeks, matched to the imitation intervention in structure and duration. Sessions used 43-45 emotional speech and song videos, with metronome-supported song presented before speech. Each video was presented twice. Participants watched and listened without instructed imitation, attending to the actor's facial and vocal emotion and its intensity. After each sequence, participants identified the emotion and rated its intensity on a 1-5 scale. Therapist feedback directed attention to the actor's voice or facial expression. Participants received DVDs of song-with-metronome videos for weekly home practice using the same observation instructions; practice completion was not formally monitored. | Behavioural | Singing Observation Therapy |
Primary outcome
Change in Standardized Facial Muscle Activity From Week 1 to Week 13
Time frame: Week 1 and Week 13 (end of treatment).
Change in standardized facial muscle activity from Week 1 to Week 13. Surface electromyography is recorded from the zygomaticus major, corrugator supercilii, and medial frontalis during emotional speech and song observation. Mean activity 1-4 seconds after stimulus onset is expressed as percentage change from a 2-second prestimulus baseline, then standardized within participant and muscle, then within participant across muscles. Both recordings at each visit are included. Activity is retained by muscle and stimulus emotion. Analyses assess overall responsiveness across emotional trials, excluding neutral/calm, and emotion-congruent responses: happy versus neutral/calm for zygomaticus; negative emotions (sad, angry, fearful, disgust) versus neutral/calm for corrugator; and surprise versus neutral/calm for frontalis. Values are unitless with no fixed limits; positive changes indicate increased activity.
Change in Standardized Facial Muscle Activity From Week 1 to Two Months After Treatment
Time frame: Week 1 and two months after completion of the 13-week intervention.
Change in standardized facial muscle activity from Week 1 to two months after treatment completion. Surface electromyography is recorded from the zygomaticus major, corrugator supercilii, and medial frontalis during emotional speech and song observation. Mean activity 1-4 seconds after stimulus onset is expressed as percentage change from a 2-second prestimulus baseline, then standardized within participant and muscle, then within participant across muscles. Both recordings at each visit are included. Activity is retained by muscle and stimulus emotion. Analyses assess overall responsiveness across emotional trials, excluding neutral/calm, and emotion-congruent responses: happy versus neutral/calm for zygomaticus; negative emotions (sad, angry, fearful, disgust) versus neutral/calm for corrugator; and surprise versus neutral/calm for frontalis. Values are unitless with no fixed limits; positive changes indicate increased activity.
Change in Modified MDS-UPDRS Part III Motor Examination Total Score From Week 1 to Week 13
Time frame: Week 1 and Week 13 (end of treatment).
Change from Week 1 to Week 13, calculated as the Week 13 value minus the Week 1 value. Motor impairment is assessed using Part III of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). The postural-stability item was not administered. The modified total comprises the remaining 32 ratings, each scored 0-4; eligible partially completed assessments are prorated to the 32-rating scale. Total scores range from 0 to 128, with higher scores indicating greater impairment. Change scores range from -128 to 128. Negative changes indicate reduced motor impairment.
Change in Modified MDS-UPDRS Part III Motor Examination Total Score From Week 1 to Two Months After Treatment
Time frame: Week 1 and two months after completion of the 13-week intervention.
Change from Week 1 to two months after treatment completion, calculated as the follow-up value minus the Week 1 value. Motor impairment is assessed using Part III of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). The postural-stability item was not administered. The modified total comprises the remaining 32 ratings, each scored 0-4; eligible partially completed assessments are prorated to the 32-rating scale. Total scores range from 0 to 128, with higher scores indicating greater impairment. Change scores range from -128 to 128. Negative changes indicate reduced motor impairment.
Change in MDS-UPDRS Part III Facial Expression Score From Week 1 to Week 13
Time frame: Week 1 and Week 13 (end of treatment).
Change from Week 1 to Week 13, calculated as the Week 13 value minus the Week 1 value. Facial expression is assessed using item 3.2 of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Part III. This clinician-rated item assesses reduced facial expression, including blinking, spontaneous smiling, and lower-face movement. Scores range from 0 to 4, with higher scores indicating greater impairment. Change scores range from -4 to 4. Negative changes indicate reduced facial-expression impairment.
Change in MDS-UPDRS Part III Facial Expression Score From Week 1 to Two Months After Treatment
Time frame: Week 1 and two months after completion of the 13-week intervention.
Change from Week 1 to two months after treatment completion, calculated as the follow-up value minus the Week 1 value. Facial expression is assessed using item 3.2 of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Part III. This clinician-rated item assesses reduced facial expression, including blinking, spontaneous smiling, and lower-face movement. Scores range from 0 to 4, with higher scores indicating greater impairment. Change scores range from -4 to 4. Negative changes indicate reduced facial-expression impairment.
Change in MDS-UPDRS Part III Speech Score From Week 1 to Week 13
Time frame: Week 1 and Week 13 (end of treatment).
Change from Week 1 to Week 13, calculated as the Week 13 value minus the Week 1 value. Speech is assessed using item 3.1 of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Part III. This clinician-rated item assesses speech volume, modulation, and clarity. Scores range from 0 to 4, with higher scores indicating greater speech impairment. Change scores range from -4 to 4. Negative changes indicate reduced speech impairment.
Change in MDS-UPDRS Part III Speech Score From Week 1 to Two Months After Treatment
Time frame: Week 1 and two months after completion of the 13-week intervention.
Change from Week 1 to two months after treatment completion, calculated as the follow-up value minus the Week 1 value. Speech is assessed using item 3.1 of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Part III. This clinician-rated item assesses speech volume, modulation, and clarity. Scores range from 0 to 4, with higher scores indicating greater speech impairment. Change scores range from -4 to 4. Negative changes indicate reduced speech impairment.
12 secondary outcomes
Emotion-Recognition Accuracy at Week 13
Time frame: Week 13 (end of treatment).
Emotion-Recognition Accuracy at Two Months After Treatment
Time frame: Two months after completion of the 13-week intervention.
Emotion-Recognition Response Time at Week 13
Time frame: Week 13 (end of treatment).
Emotion-Recognition Response Time at Two Months After Treatment
Time frame: Two months after completion of the 13-week intervention.
Happiness Measures Composite Score at Week 6
Time frame: Week 6 (during treatment).
Happiness Measures Composite Score at Week 13
Time frame: Week 13 (end of treatment).
Happiness Measures Composite Score at Two Months After Treatment
Time frame: Two months after completion of the 13-week intervention.
PDQ-39 Summary Index at Week 6
Time frame: Week 6 (during treatment).
PDQ-39 Summary Index at Week 13
Time frame: Week 13 (end of treatment).
PDQ-39 Summary Index at Two Months After Treatment
Time frame: Two months after completion of the 13-week intervention.
Emotion-Recognition Unbiased Hit Rate at Week 13
Time frame: Week 13 (end of treatment).
Emotion-Recognition Unbiased Hit Rate at Two Months After Treatment
Time frame: Two months after completion of the 13-week intervention.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 29 Oct 2026.
- Results publication: PubMed 27375505Livingstone SR, Vezer E, McGarry LM, Lang AE, Russo FA. Deficits in the Mimicry of Facial Expressions in Parkinson's Disease. Front Psychol. 2016 Jun 7;7:780. doi: 10.3389/fpsyg.2016.00780. eCollection 2016.
- Retrospective OSF registration and longitudinal statistical analysis plan, registered 25 May 2026.Link provided by the sponsor.
- OSF project containing the original study protocol and supporting documents. Files will become publicly available upon publication of the associated article.Link provided by the sponsor.
- Individual participant dataSharing planned: Yes. De-identified individual participant data underlying the trial results reported in the publication will be shared. These will include processed facial surface electromyography (sEMG) data, behavioural task data, motor and cognitive assessment scores, and participant and caregiver questionnaire scores. The datasets will be accompanied by a data dictionary describing the variables and their coding, together with analysis scripts. Anonymised raw data underlying the reported analyses will also be available upon reasonable request, subject to a data-sharing agreement.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Frank A Russo, PhD principal investigator
Toronto Metropolitan University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Singing Imitation Therapy and Singing Observation Therapy in people with PARKINSON DISEASE (Disorder), run by Toronto Metropolitan University at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 10 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 29 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in Standardized Facial Muscle Activity From Week 1 to Week 13 (time frame: Week 1 and Week 13 (end of treatment).). The study lists 8 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07905612, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Oct 2026.