Towards Personalized Synthesized Voices for Individuals with Vocal Disabilities: Voice Banking and Reconstruction

When individuals lose the ability to produce their own speech, due to degenerative diseases such as motor neurone disease (MND) or Parkinson’s, they lose not only a functional means of communication but also a display of their individual and group identity. In order to build personalized synthetic voices, attempts have been made to capture the voice before it is lost, using a process known as voice banking. But, for some patients, the speech deterioration frequently coincides or quickly follows diagnosis. Using HMM-based speech synthesis, it is now possible to build personalized synthetic voices with minimal data recordings and even disordered speech. The power of this approach is that it is possible to use the patient’s recordings to adapt existing voice models pre-trained on many speakers. When the speech has begun to deteriorate, the adapted voice model can be further modified in order to compensate for the disordered characteristics found in the patient’s speech. The University of Edinburgh has initiated a project for voice banking and reconstruction based on this speech synthesis technology. At the current stage of the project, more than fifteen patients with MND have already been recorded and five of them have been delivered a reconstructed voice. In this paper, we present an overview of the project as well as subjective assessments of the reconstructed voices and feedback from patients and their families

Palliative care for people with dementia living at home: a systematic review of interventions

Background: The European Association for Palliative Care White Paper defined optimal palliative care in dementia based on evidence and expert consensus. Yet, we know little on how to achieve this for people with dementia living and dying at home. Aims: To examine evidence on home palliative care interventions in dementia, in terms of their effectiveness on end-of-life care outcomes, factors influencing implementation, the extent to which they address the European Association for Palliative Care palliative care domains and evidence gaps. Design: A systematic review of home palliative care interventions in dementia. Data sources: The review adhered to the PRISMA guidelines and the protocol was registered with PROSPERO (CRD42018093607). We searched four electronic databases up to April 2018 (PubMed, Scopus, Cochrane library and CINAHL) and conducted lateral searches. Results: We retrieved eight relevant studies, none of which was of high quality. The evidence, albeit of generally weak quality, showed the potential benefits of the interventions in improving end-of-life care outcomes, for example, behavioural disturbances. The interventions most commonly focused on optimal symptom management, continuity of care and psychosocial support. Other European Association for Palliative Care domains identified as important in palliative care for people with dementia, for example, prognostication of dying or avoidance of burdensome interventions were under-reported. No direct evidence on facilitators and barriers to implementation was found. Conclusions: The review highlights the paucity of high-quality dementia-specific research in this area and recommends key areas for future work, for example, the need for process evaluation to identify facilitators and barriers to implementing interventions.Peer reviewedFinal Published versio

Systemic infections after acute stroke

After an acute stroke, systemic infection can complicate the recovery process and lead to a worse clinical outcome, including a higher risk of mortality. Post-stroke infection (PSI) is responsible for the majority of the mortality occurring between 1 week and 1 month after stroke, peaking towards the end of the second week. The effects of PSI on longer-term outcome and other aspects of recovery, such as cognition, mood and quality of life, are largely unknown. The cerebrovascular event itself may result in a systemic immunosuppressed state, hence lowering the threshold for subsequent systemic bacterial infections. Although there have been advances in the basic understanding of the pathophysiological mechanisms of PSI, clinical studies have not provided any clear guidelines on the best methods of managing or preventing PSI. This article provides a review of the current knowledge of the phenomenon of PSI and the possible future developments in the understanding and treatment of PSI

Behavioural and psychological symptoms in dementia and the challenges for family carers: systematic review

Background: Tailored psychosocial interventions can help families to manage behavioural and psychological symptoms in dementia (BPSD), but carer responses to their relative's behaviours contribute to the success of support programmes. Aims: To understand why some family carers have difficulty in dealing with BPSD, in order to improve the quality of personalised care that is offered. Method: A systematic review and meta-ethnographic synthesis was conducted of high-quality quantitative and qualitative studies between 1980 and 2012. Results: We identified 25 high-quality studies and two main reasons for behaviours being reported as challenging by family carers: changes in communication and relationships, resulting in ‘feeling bereft’; and perceptions of transgressions against social norms associated with ‘misunderstandings about behaviour’ in the relative with dementia. The underlying belief that their relative had lost, or would inevitably lose, their identity to dementia was a fundamental reason why family carers experienced behaviour as challenging. Conclusions: Family carers' perceptions of BPSD as challenging are associated with a sense of a declining relationship, transgressions against social norms and underlying beliefs that people with dementia inevitably lose their ‘personhood’. Interventions for the management of challenging behaviour in family settings should acknowledge unmet psychological need in family carers

Assessment scales in stroke: clinimetric and clinical considerations

As stroke care has developed, there has been a need to robustly assess the efficacy of interventions both at the level of the individual stroke survivor and in the context of clinical trials. To describe stroke-survivor recovery meaningfully, more sophisticated measures are required than simple dichotomous end points, such as mortality or stroke recurrence. As stroke is an exemplar disabling long-term condition, measures of function are well suited as outcome assessment. In this review, we will describe functional assessment scales in stroke, concentrating on three of the more commonly used tools: the National Institutes of Health Stroke Scale, the modified Rankin Scale, and the Barthel Index. We will discuss the strengths, limitations, and application of these scales and use the scales to highlight important properties that are relevant to all assessment tools. We will frame much of this discussion in the context of "clinimetric" analysis. As they are increasingly used to inform stroke-survivor assessments, we will also discuss some of the commonly used quality-of-life measures. A recurring theme when considering functional assessment is that no tool suits all situations. Clinicians and researchers should chose their assessment tool based on the question of interest and the evidence base around clinimetric properties

Personalising synthetic voices for individuals with severe speech impairment.

Speech technology can help individuals with speech disorders to interact more easily. Many individuals with severe speech impairment, due to conditions such as Parkinson's disease or motor neurone disease, use voice output communication aids (VOCAs), which have synthesised or pre-recorded voice output. This voice output effectively becomes the voice of the individual and should therefore represent the user accurately. Currently available personalisation of speech synthesis techniques require a large amount of data input, which is difficult to produce for individuals with severe speech impairment. These techniques also do not provide a solution for those individuals whose voices have begun to show the effects of dysarthria. The thesis shows that Hidden Markov Model (HMM)-based speech synthesis is a promising approach for 'voice banking' for individuals before their condition causes deterioration of the speech and once deterioration has begun. Data input requirements for building personalised voices with this technique using human listener judgement evaluation is investigated. It shows that 100 sentences is the minimum required to build a significantly different voice from an average voice model and show some resemblance to the target speaker. This amount depends on the speaker and the average model used. A neural network analysis trained on extracted acoustic features revealed that spectral features had the most influence for predicting human listener judgements of similarity of synthesised speech to a target speaker. Accuracy of prediction significantly improves if other acoustic features are introduced and combined non-linearly. These results were used to inform the reconstruction of personalised synthetic voices for speakers whose voices had begun to show the effects of their conditions. Using HMM-based synthesis, personalised synthetic voices were built using dysarthric speech showing similarity to target speakers without recreating the impairment in the synthesised speech output

Aerospace medicine and biology: A continuing bibliography with indexes

This bibliography lists 138 reports, articles, and other documents introduced into the NASA scientific and technical information system in Jun. 1980