***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Several previous studies have examined the health of carers , but they have usually focused on elderly subjects and have often not had representative control sample s. AIM To determine whether caring for a partner with Parkinson 's disease is associated with a worsening social , psychological and physical well-being than people with partners who do not suffer with Parkinson 's disease . METHOD One hundred and fifty-four carer spouses of subjects with Parkinson 's disease , and 124 non-carer spouses of r and omly selected population controls recruited from a national case-control study of early-onset Parkinson 's disease in the Republic of Irel and , between 1992 - 1994 , were studied . Outcome was measured along three dimensions : social functioning , assessed by the frequency of social contacts , outings and holidays ; psychological well-being , measured by the General Health Question naire ; and physical health , measured by the career 's use of medical services , medications and episodes of chronic illness . RESULTS Carer spouses were less likely to get out of the house once a week at least ( odds ratio 1.79 , 95 % confidence intervals 1.00 - 3.20 ) or to have had a holiday in the last year ( odds ratio 1.71 , 95 % confidence intervals 1.01 - 2.90 ) . Contact with friends and neighbours decreased with increasing care provision . For spouses providing a lot of care , there was an almost fivefold increase in psychiatric morbidity ( odds ratio 4.86 , 95 % confidence intervals 1.5 - 15.9 ) after adjusting for other variables . Most of the medical outcomes were less favourable among carers , but only the use of tranquilizers ( odds ratio 3.73 , 95 % confidence intervals 1.18 - 11.8 ) and episodes of chronic illness ( odds ratio 2.96 , 95 % confidence intervals 1.27 - 6.94 ) were significant . CONCLUSIONS Overall , career spouses have slightly worse social , psychological and physical profiles . For social outcomes , increasing care provision is associated with fewer contacts , outings and holidays . For psychological and physical measures , carers providing a lot of care experience worse health . These results have implication s for targeting appropriate interventions The aim of this study was to evaluate the effects of orofacial physiotherapeutic treatment ( OPT ) on the facial mobility of Parkinson 's disease ( PD ) sufferers . Sixteen participants with PD were allocated r and omly to either the Treatment group or the Control group . A short interview between the physiotherapist and each subject was videotaped , and 10 r and om frames of the videotape were selected to be used in the facial expression assessment . The quantification of facial expressions was achieved by using an objective microcomputer-based measurement system , based on a mathematical model of the face ( FACEM ) . A facial outline is obtained , as well as 12 facial measures , which represent distances between key facial l and marks . The facial assessment was performed on 3 separate occasions , that is , baseline ( pretreatment ) , posttreatment , and follow-up ( 4 weeks later ) . A repeated measures analysis of variance ( MANOVA ) revealed a significant main effect of Time and a significant interaction effect between Time and Group for the Mouth-Opening Measure , suggesting that after treatment , members of the Treatment group opened their mouths to a greater degree than members of the Control group . Within the Treatment group , significant differences between pretreatment and posttreatment scores ( MANOVA ) were found for Mouth-Opening Measure and Mid-Top-Lip Measure . Similarly , Mouth-Opening Measure , Mid-Top-Lip Measure , Lower-Lip Thickness Measure , Top Eyelid/Iris Intersect Measure and Lower Eyelid/Iris Intersect Measure were significant across time from baseline to follow-up in the Treatment group only . No significant differences were found on any of the facial measures during the same period for members of the Control group . These findings suggest that OPT can improve facial movement and that this benefit extends in time , beyond the period of OPT itself . Such an increase in facial mobility can be expected to modify the " Parkinsonian facies " and facilitate the display of facial expressions Respiratory symptoms are recognized as sequelae of motor dysfunction in idiopathic Parkinson 's disease ( IPD ) and these symptoms have the potential to cause problems with swallow , cough , voice and speech . Specifically , maneuvers that require rapid activation and coordination of upper airway and chest wall musculature become progressively impaired as motor dysfunction progresses during the natural course of the disease . This study reports on the maximum inspiratory and expiratory pressures produced by 28 participants ( average age 64 ) diagnosed with moderate to severe IPD ( average stage 2.5 with a range of 2.0 - 3.0 ) . All measures were collected during the " medication on " state . Outcomes of a specific respiratory muscle strength training technique for improving maximum expiratory pressure are reported for three of the patients in this study . Techniques that focus on strengthening the respiratory muscles in patients with IPD ( other than with low load breathing exercises ) , have not been previously reported . The results of this pilot study demonstrate that respiratory muscle weakness may be an important factor in the respiratory complications in IPD and that respiratory muscle strength training has the potential to improve expiratory muscle strength for this population . This improvement has the potential to positively impact high forced respiratory activities , such as forced breathing maneuvers , swallow , cough and speech functions that require greater magnitude and duration of expiration We studied the effect of clonazepam in a double-blind trial on 12 parkinsonian patients with hypokinetic dysarthria . Speech sample s were judged on 14 of the dimensions used in the Mayo Clinic dysarthria study . Of the 11 patients who completed the study , 10 showed improvement . The effective dosage of clonazepam was 0 . 25 to 0 . 5 mg/d with higher dosage than that less effective . Clonazepam has a definite role in the management of perkinsonian dysarthria A study was set up to judge the efficacy and long term effects of intensive speech therapy in patients with Parkinson 's Disease . A total of 22 patients entered the study but only 18 completed it . Twelve patients were r and omly allocated to a treatment group and participated in a two week intensive speech therapy programme . Ten patients were r and omly allocated to a control group and received no therapy . Six of the control group and all twelve of the treatment group patients were available for follow-up assessment s . It is concluded that a course of intensive speech therapy is of value to patients with speech and voice problems arising out of their Parkinson 's Disease and that the effects of speech therapy can be maintained for up to a period of three months at least 
    Output:
    
Some measures of speech monotoni city and articulation were investigated ; however , all these results were non-significant .
Although improvements in speech impairments were noted in these studies , due to the small number of patients examined , method ological flaws , and the possibility of publication bias , there is insufficient evidence to conclusively support or refute the efficacy of SLT for speech problems in Parkinson 's disease .