Association of intrapartum epidural analgesia and oxytocin exposure with offspring autism and neurodevelopment from the Japan Environment and Children's Study.

Parkinson's disease (PD) is a heterogeneous neurodegenerative disorder with motor and non-motor manifestations that extend to speech and communication. Hypophonia, reduced prosodic variation, voice quality disturbances, and articulatory imprecision are common and contribute to participation restrictions and decreased quality of life. Growing evidence indicates that targeted speech-language interventions can improve speech and voice symptoms and functional communication in people with PD, potentially through experience-dependent neuroplasticity mechanisms. Principles such as high intensity, repetition, specificity, salience, and progressive task challenge have been proposed to optimize treatment effects. Our group developed HiCommunication, a 10-week group intervention grounded in these principles and designed to progressively increase cognitive–communicative load while training louder, clearer speech. HiCommunication employs hierarchical training, integrates clinic-based group sessions with at-home practice, and aims to facilitate transfer from structured tasks to everyday communication. Feasibility work demonstrated high acceptability and adherence, and a subsequent randomized controlled trial (RCT) with blinded assessors indicated beneficial effects on speech and voice outcomes as well as effective connectivity changes in a speech-motor brain network relative to an active control. Despite encouraging group-level effects, substantial inter-individual variability is typical in PD. Differences in disease phenotype, medication, motor and cognitive status, and baseline speech characteristics can influence responsiveness. Consequently, even effective programs may show attenuated mean effects if subtypes respond differently. Identifying baseline features that characterize responders versus non-responders is therefore critical for precision rehabilitation—to optimize referral and tailor intervention content and progression.