Role of Therapeutic Devices in Enhancing Speech Intelligibility and Vocal Intensity in an Individual with Parkinson’s Disease

The prevailing speech therapy techniques for treating hypokinetic dysarthria in individuals with Parkinson\u27s disease (PD) yields improvements within the clinical setting, however, maintenance and generalization of acquired behaviors continue to be a challenge. The purpose of this study was to investigate the effects of portable therapeutic devices including Ambulatory Phonation Monitor with biofeedback (APM) and auditory masker in maintenance and carryover of improved speech. Our participant was an individual diagnosed with PD for the past 25 years who continued to display speech disturbances despite undergoing several behavioral speech therapy programs and neurosurgical procedures. Speech intelligibility and average intensity measures under automatic, elicited, and spontaneous speech tasks were recorded pre- and postusage of APM and auditory masker for a period of 1 week each. Preliminary findings showed no significant difference in the measures between means (P\u3e0.05) across all tasks for both the devices. Suggestions for future research on therapeutic devices are discussed

Factors influencing the efficacy of delayed auditory feedback in treating dysarthria associated with Parkinson\u27s disease

Parkinson\u27s disease patients exhibit a high prevalence of speech deficits including excessive speech rate, reduced intelligibility, and disfluencies. The present study examined the effects of delayed auditory feedback (DAF) as a rate control intervention for dysarthric speakers with Parkinson\u27s disease. Adverse reactions to relatively long delay intervals are commonly observed during clinical use of DAF, and seem to result from improper matching of the delayed signal. To facilitate optimal use of DAF, therefore, clinicians must provide instruction, modeling, and feedback. Clinician instruction is frequently used in speech-language therapy, but has not been evaluated during use of DAF-based interventions. Therefore, the primary purpose of the present study was to evaluate the impact of clinician instruction on the effectiveness of DAF in treating speech deficits. A related purpose was to compare the effects of different delay intervals on speech behaviors. An A-B-A-B single-subject design was utilized. The A phases consisted of a sentence reading task using DAF, while the B phases incorporated clinician instruction into the DAF protocol. During each of the 16 experimental sessions, speakers read with four different delay intervals (0 ms, 50 ms, 100 ms, and 150 ms). During the B phases, the experimenter provided verbal feedback and modeling pertaining to how precisely the speaker matched the delayed signal. Dependent variables measured were speech rate, percent intelligible syllables, and percent disfluencies. Three males with Parkinson\u27s disease and an associated dysarthria participated in the study. Results revealed that for all three speakers, DAF significantly reduced reading rate and produced significant improvements in either intelligibility (for Speaker 3) or fluency (for Speakers 1 and 2). A delay interval of 150 ms produced the greatest reductions in reading rates for all three speakers, although any of the DAF settings used was sufficient to produce significant improvements in either intelligibility or fluency. In addition, supplementing the DAF intervention with clinician instruction resulted in significantly greater gains achieved with DAF. These findings confirmed the effectiveness of various intervals of DAF in improving speech deficits in Parkinson\u27s disease speakers, particular when patients are provided with instruction and modeling from the clinician

Speech function in persons with Parkinson\u27s disease: effects of environment, task and treatment

Parkinson’s Disease (PD) is a degenerative neurological disease affecting aspects of movement, including speech. Persons with PD are reported to have better speech functioning in the clinical setting than in the home setting, but this has not been quantified. New methodologies in ambulatory measures of speech are emerging that allow investigation of non-clinical settings. The following questions are addressed: Is speech different between environments in PD and in healthy controls? Can clinical tasks predict speech behaviors in the home? Is treatment proven effective by measures in the home? What can we glean from methods of measurement of speech function in the home? The experiment included 13 persons with PD and 12 healthy controls, studied in the clinical and home environments, and 7 of those 13 persons with PD participated in a treatment study. Major findings included: Spontaneous speech intelligibility, not intensity, was the differentiating factor between persons with PD and healthy controls. Intelligibility and intensity were not related. Both groups presented with higher sentence intensity in the home environment. Spontaneous speech intelligibility in the clinic was related to spontaneous speech intelligibility in the home. The Sentence Intelligibility Test emerged as the best predictor of spontaneous speech intelligibility in the home. Differences between pilot treatment groups measured in the home on intensity and intelligibility were not large enough to make a clinical trial feasible. Individual differences may account for many of these results, for example more severely impaired patients may have shown different data. Drawing conclusions regarding the home environment via measures outside the home should be carefully considered. Ambulatory measures of speech are a viable option for studying speech function in non-clinical settings, and technology is advancing. Further investigation is needed to develop methodologies and normative values for speech in the home

Group Speech Therapy in Individuals With Parkinson Disease: Face-to-Face Versus Telemedicine

The purpose of this study was to evaluate the outcomes of group speech therapy for individuals with Parkinson Disease (IWPD) in general and to compare outcomes of group treatment delivered face-to-face (FtF) versus delivery via telemedicine (TM). Twenty-seven IWPD received group treatment based on a modified version of LSVT® in either an FtF or TM format. Outcome measures were collected pre- and post-treatment, which included vocal intensity (dB), Voice Handicap Index (VHI) scores, and self-ratings. Results indicated that vocal intensity and self-ratings of loudness significantly increased for both the FtF and TM groups. VHI scores and the five remaining self-ratings were not significantly improved for either group following treatment, although the data on all measures from the FtF group did show improvement. The findings of this study support the short-term effectiveness of FtF and TM group therapy for improving vocal intensity and participant self-ratings of loudness in IWPD

A Multi-Smartwatch System for Assessing Speech Characteristics of People with Dysarthria in Group Settings

Speech-language pathologists (SLPs) frequently use vocal exercises in the treatment of patients with speech disorders. Patients receive treatment in a clinical setting and need to practice outside of the clinical setting to generalize speech goals to functional communication. In this paper, we describe the development of technology that captures mixed speech signals in a group setting and allows the SLP to analyze the speech signals relative to treatment goals. The mixed speech signals are blindly separated into individual signals that are preprocessed before computation of loudness, pitch, shimmer, jitter, semitone standard deviation and sharpness. The proposed method has been previously validated on data obtained from clinical trials of people with Parkinson disease and healthy controls.Comment: 6 page, 9 figure, 1 table, 8 equations, Proceedings e-Health Networking, Applications and Services (Healthcom), 2015 IEEE 17th International Conference on, Boston, USA. 201

Models and Analysis of Vocal Emissions for Biomedical Applications

The MAVEBA Workshop proceedings, held on a biannual basis, collect the scientific papers presented both as oral and poster contributions, during the conference. The main subjects are: development of theoretical and mechanical models as an aid to the study of main phonatory dysfunctions, as well as the biomedical engineering methods for the analysis of voice signals and images, as a support to clinical diagnosis and classification of vocal pathologies

PERIORAL BIOMECHANICS, KINEMATICS, AND ELECTROPHYSIOLOGY IN PARKINSON'S DISEASE

This investigation quantitatively characterized the orofacial biomechanics, labial kinematics, and associated electromyography (EMG) patterns in individuals with Parkinson's disease (PD) as a function of anti-PD medication state. Passive perioral stiffness, a clinical correlate of rigidity, was sampled using a face-referenced OroSTIFF system in 10 mildly diagnosed PD and 10 age/sex-matched control elderly. Labial movement amplitudes and velocities were evaluated using a 4-dimensional computerized motion capture system. Associated perioral EMG patterns were sampled to examine the characteristics of perioral muscles and compensatory muscular activation patterns during repetitive syllable productions. This study identified several trends that reflect various characteristics of perioral system differences between PD and control subjects: 1. The presence of high tonic EMG patterns after administration of dopaminergic treatment indicated an up-regulation of the central mechanism, which may serve to regulate orofacial postural control. 2. Multilevel regression modeling showed greater perioral stiffness in PD subjects, confirming the clinical correlate of rigidity in these patients. 3. Similar to the clinical symptoms in the upper and lower limb, a reduction of range of motion (hypokinesia) and velocity (bradykinesia) was evident in the PD orofacial system. Administration of dopaminergic treatment improved hypokinesia and bradykinesia. 4. A significant correlation was found between perioral stiffness and the range of labial movement, indicating these two symptoms may result in part from a common neural substrate. 5. As speech rate increased, PD speakers down-scaled movement amplitude and velocity compared to the control subjects, reflecting a compensatory mechanism to maintain target speech rates. 6. EMG from orbicularis oris inferior (OOIm) and depressor labii inferioris (DLIm) muscles revealed a limited range of muscle activation level in PD speakers, reflecting the underlying changes in motor unit firing behavior due to basal ganglia dysfunction. The results of this investigation provided a quantitative description of the perioral stiffness, labial kinematics, and EMG patterns in PD speakers. These findings indicate that perioral stiffness may provide clinicians a quantitative biomechanical correlate to medication response, movement aberrations, and EMG compensatory patterns in PD. The utilization of these objective assessments will be helpful in diagnosing, assessing, and monitoring the progression of PD to examine the efficacy of pharmacological, neurosurgical, and behavioral interventions

Delivering the Lee Silverman Voice Treatment (LSVT) by web camera: a feasibility study

Background: Speech disorders are a feature of Parkinson's disease, typically worsening as the disease progresses. The Lee Silverman Voice Treatment (LSVT) was developed to address these difficulties. It targets vocal loudness as a means of increasing vocal effort and improving coordination across the subsystems of speech. Aims: Currently LSVT is not widely available, and there are practical difficulties associated with the delivery of an intensive treatment in an environment of resource constraints in the National Health Service (NHS). Delivery of LSVT over the World-Wide Web may address some of these difficulties. Methods & Procedures: A feasibility study is reported in which three individuals with speech disorders resulting from Parkinson's disease received LSVT over the Internet, using broadband connection and a web camera. Participants were seen face to face for every fourth session in order to build a personal relationship, measure vocal sound pressure level (SPL) during treatment, and to review and prepare homework tasks. All other sessions were delivered over the Internet. Outcomes & Results: Broadly similar treatment gains were found between individuals treated over the Internet and those treated face to face. Gains were maintained or improved at an assessment two months after the treatment. Conclusions & Implications: This study demonstrates that delivery of LSVT over the Internet is feasible, and that a larger trial would be appropriate to establish cost and treatment effectiveness