Narrative analysis in individuals with Parkinson's disease following intensive voice treatment: secondary outcome variables from a randomized controlled trial.

Communication is often impaired in individuals with Parkinson's disease (PD), typically secondary to sensorimotor deficits impacting voice and speech. Language may also be diminished in PD, particularly for production and comprehension of verbs. Evidence exists that verb processing is influenced by motor system modulation suggesting that verb deficits in PD are underpinned by similarities in the neural representations of actions that span motor and semantic systems. Conversely, subtle differences in cognition in PD may explain difficulty in processing of complex syntactic forms, which increases cognitive demand and is linked to verb use. Here we investigated whether optimizing motor system support for vocal function (improving loudness) affects change in lexical semantic, syntactic, or informativeness aspects of spoken discourse. Picture description narratives were compared for 20 Control participants and 39 with PD, 19 of whom underwent Lee Silverman Voice Treatment (LSVT LOUD®). Treated PD narratives were also contrasted with those of untreated PD and Control participants at Baseline and after treatment. Controls differed significantly from the 39 PD participants for verbs per utterance, but this difference was largely driven by untreated PD participants who produced few utterances but with verbs, inflating their verbs per utterance. Given intervention, there was a significant increase in vocal loudness but no significant changes in language performance. These data do not support the hypothesis that targeting this speech motor system results in improved language production. Instead, the data provide evidence of considerable variability in measures of language production across groups, particularly in verbs per utterance.

Crowdsourced Perceptual Ratings of Voice Quality in People With Parkinson's Disease Before and After Intensive Voice and Articulation Therapies: Secondary Outcome of a Randomized Controlled Trial.

PURPOSE: Limited research has examined the suitability of crowdsourced ratings to measure treatment effects in speakers with Parkinson's disease (PD), particularly for constructs such as voice quality. This study obtained measures of reliability and validity for crowdsourced listeners' ratings of voice quality in speech samples from a published study. We also investigated whether aggregated listener ratings would replicate the original study's findings of treatment effects based on the Acoustic Voice Quality Index (AVQI) measure. METHOD: This study reports a secondary outcome measure of a randomized controlled trial with speakers with dysarthria associated with PD, including two active comparators (Lee Silverman Voice Treatment [LSVT LOUD] and LSVT ARTIC), an inactive comparator (untreated PD), and a healthy control group. Speech samples from three time points (pretreatment, posttreatment, and 6-month follow-up) were presented in random order for rating as "typical" or "atypical" with respect to voice quality. Untrained listeners were recruited through the Amazon Mechanical Turk crowdsourcing platform until each sample had at least 25 ratings. RESULTS: Intrarater reliability for tokens presented repeatedly was substantial (Cohen's κ = .65-.70), and interrater agreement significantly exceeded chance level. There was a significant correlation of moderate magnitude between the AVQI and the proportion of listeners classifying a given sample as "typical." Consistent with the original study, we found a significant interaction between group and time point, with the LSVT LOUD group alone showing significantly higher perceptually rated voice quality at posttreatment and follow-up relative to the pretreatment time point. CONCLUSIONS: These results suggest that crowdsourcing can be a valid means to evaluate clinical speech samples, even for less familiar constructs such as voice quality. The findings also replicate the results of the study by Moya-Galé et al. (2022) and support their functional relevance by demonstrating that the effects of treatment measured acoustically in that study are perceptually apparent to everyday listeners.

The Acoustic Voice Quality Index (AVQI) in People with Parkinson's Disease Before and After Intensive Voice and Articulation Therapies: Secondary Outcome of a Randomized Controlled Trial.

OBJECTIVES: The majority of individuals with Parkinson's disease (PD) experience voice and speech problems during the course of the disease. Despite the importance of voice quality in communication and the documented disordered voice quality in PD, few studies have explored the effects of speech treatment on this variable. STUDY DESIGN/METHODS: A parallel arm, unblinded randomized controlled trial (RCT) was conducted with two active comparators, LSVT LOUD (n = 23) and LSVT ARTIC (n = 20), and an inactive comparator group of untreated individuals with PD (n = 22). A group of 20 healthy adults was also included for pre-treatment analysis. Voice recordings were obtained pre-treatment, immediately post-treatment and at 6-month follow-up. The acoustic voice quality index (AVQI) is reported here as a secondary outcome measure of the RCT. Linear mixed-effects regression analysis was performed with AVQI and sound pressure level (SPL) as dependent variables. Pearson correlation coefficient analysis was also conducted to explore the relationship between voice quality and SPL. RESULTS: Statistically significant improvements in AVQI and SPL from pre-treatment to post-treatment and follow-up were only observed in the LSVT LOUD group. Voice quality significantly improved only from pre-treatment to follow-up in the LSVT ARTIC group, whilst significant improvements in SPL were observed during maximum phonation only immediately post-treatment. No significant changes were observed in the untreated group. DISCUSSION: This study investigated the effects of intensive speech treatment targeting voice or targeting articulation on voice quality, as measured by the AVQI, in individuals with PD. Findings indicate that voice-focused treatment leads to greater improvements in voice quality in this population.

Intensive Voice Treatment (Lee Silverman Voice Treatment [LSVT LOUD]) for Children With Down Syndrome: Phase I Outcomes.

PURPOSE: This study examined the effects of an intensive voice treatment Lee Silverman Voice Treatment (LSVT LOUD) on children with Down syndrome (DS) and motor speech disorders. METHOD: A Phase I, multiple baseline, single-subject design with replication across nine participants with DS was used. Single-word intelligibility, acoustic measures of vocal functioning, and parent perceptions of pre- and posttreatment communication function were used as treatment outcome measures. RESULTS: All participants completed the full dose of LSVT LOUD and showed gains on one or more of the outcome measures. Patterns of posttreatment improvements were not consistent across participants but were more frequently observed on trained maximum performance tasks compared to tasks reflecting generalization of the treatment skillset. Some participants exhibited a stronger response to treatment, whereas others showed a mixed or weaker response. Parents liked the treatment protocol, perceived benefits from intensive intervention, and indicated they would strongly recommend LSVT LOUD to other parents who have children with DS and motor speech disorders. CONCLUSIONS: These preliminary results show that children with DS tolerated intensive voice treatment without adverse effects and made select meaningful therapeutic gains. The treatment evidence from this study warrants Phase II treatment studies using LSVT LOUD with a larger group of children with DS.

Immediate and long-term effects of speech treatment targets and intensive dosage on Parkinson's disease dysphonia and the speech motor network: Randomized controlled trial.

This study compared acoustic and neural changes accompanying two treatments matched for intensive dosage but having two different treatment targets (voice or articulation) to dissociate the effects of treatment target and intensive dosage in speech therapies. Nineteen participants with Parkinsonian dysphonia (11 F) were randomized to three groups: intensive treatment targeting voice (voice group, n = 6), targeting articulation (articulation group, n = 7), or an untreated group (no treatment, n = 6). The severity of dysphonia was assessed by the smoothed cepstral peak prominence (CPPS) and neuronal changes were evaluated by cerebral blood flow (CBF) recorded at baseline, posttreatment, and 7-month follow-up. Only the voice treatment resulted in significant posttreatment improvement in CPPS, which was maintained at 7 months. Following voice treatment, increased activity in left premotor and bilateral auditory cortices was observed at posttreatment, and in the left motor and auditory cortices at 7-month follow-up. Articulation treatment resulted in increased activity in bilateral premotor and left insular cortices that were sustained at a 7-month follow-up. Activation in the auditory cortices and a significant correlation between the CPPS and CBF in motor and auditory cortices was observed only in the voice group. The intensive dosage resulted in long-lasting behavioral and neural effects as the no-treatment group showed a progressive decrease in activity in areas of the speech motor network out to a 7-month follow-up. These results indicate that dysphonia and the speech motor network can be differentially modified by treatment targets, while intensive dosage contributes to long-lasting effects of speech treatments.

Single Word Intelligibility of Individuals with Parkinson's Disease in Noise: Pre-Specified Secondary Outcome Variables from a Randomized Control Trial (RCT) Comparing Two Intensive Speech Treatments (LSVT LOUD vs. LSVT ARTIC).

The majority of people with Parkinson's disease (PD) experience both prosodic changes (reduced vocal volume, reduced pitch range) and articulatory changes (imprecise articulation) that often limit speech intelligibility and may contribute to significant declines in quality of life. We conducted a randomized control trial comparing two intensive treatments, voice (LSVT LOUD) or articulation (LSVT ARTIC) to assess single word intelligibility in the presence of background noise (babble and mall). Participants (64 PD and 20 Healthy) read words from the diagnostic rhyme test (DRT), an ANSI Standard for measuring intelligibility of speech, before and after one month (treatment or no treatment). Teams of trained listeners blindly rated the data. Speech intelligibility of words in the presence of both noise conditions improved in PD participants who had LSVT LOUD compared to the groups that had LSVT ARTIC or no treatment. Intensive speech treatment targeting prominent prosodic variables in LSVT LOUD had a positive effect on speech intelligibility at the single word level in PD.

Remote Assessment of Parkinson's Disease Symptom Severity Using the Simulated Cellular Mobile Telephone Network.

Telemonitoring of Parkinson's Disease (PD) has attracted considerable research interest because of its potential to make a lasting, positive impact on the life of patients and their carers. Purpose-built devices have been developed that record various signals which can be associated with average PD symptom severity, as quantified on standard clinical metrics such as the Unified Parkinson's Disease Rating Scale (UPDRS). Speech signals are particularly promising in this regard, because they can be easily recorded without the use of expensive, dedicated hardware. Previous studies have demonstrated replication of UPDRS to within less than 2 points of a clinical raters' assessment of symptom severity, using high-quality speech signals collected using dedicated telemonitoring hardware. Here, we investigate the potential of using the standard voice-over-GSM (2G) or UMTS (3G) cellular mobile telephone networks for PD telemonitoring, networks that, together, have greater than 5 billion subscribers worldwide. We test the robustness of this approach using a simulated noisy mobile communication network over which speech signals are transmitted, and approximately 6000 recordings from 42 PD subjects. We show that UPDRS can be estimated to within less than 3.5 points difference from the clinical raters' assessment, which is clinically useful given that the inter-rater variability for UPDRS can be as high as 4-5 UPDRS points. This provides compelling evidence that the existing voice telephone network has potential towards facilitating inexpensive, mass-scale PD symptom telemonitoring applications.

Guidelines for Speech Recording and Acoustic Analyses in Dysarthrias of Movement Disorders.

Most patients with movement disorders have speech impairments resulting from sensorimotor abnormalities that affect phonatory, articulatory, and prosodic speech subsystems. There is widespread cross-discipline use of speech recordings for diagnostic and research purposes, despite which there are no specific guidelines for a standardized method. This review aims to combine the specific clinical presentations of patients with movement disorders, existing acoustic assessment protocols, and technological advances in capturing speech to provide a basis for future research in this field and to improve the consistency of clinical assessments. We considered 3 areas: the recording environment (room, seating, background noise), the recording process (instrumentation, vocal tasks, elicitation of speech samples), and the acoustic outcome data. Four vocal tasks, namely, sustained vowel, sequential and alternating motion rates, reading passage, and monologues, are integral aspects of motor speech assessment. Fourteen acoustic vocal speech features, including their hypothesized pathomechanisms with regard to typical occurrences in hypokinetic or hyperkinetic dysarthria, are hereby recommended for quantitative exploratory analysis. Using these acoustic features and experimental speech data, we demonstrated that the hyperkinetic dysarthria group had more affected speech dimensions compared with the healthy controls than had the hypokinetic speakers. Several contrasting speech patterns between both dysarthrias were also found. This article is the first attempt to provide initial recommendations for a standardized way of recording the voice and speech of patients with hypokinetic or hyperkinetic dysarthria; thus allowing clinicians and researchers to reliably collect, acoustically analyze, and compare vocal data across different centers and patient cohorts. © 2020 International Parkinson and Movement Disorder Society.

The effects of intensive speech treatment on intelligibility in Parkinson's disease: A randomised controlled trial.

BACKGROUND: More than 6,000,000 individuals worldwide are diagnosed with Parkinson's disease (PD). Nearly 90% develop speech signs that may substantially impair their speech intelligibility, resulting in losses in their communication and quality of life. Benefits of intensive speech treatment have been documented for a range of speech signs. However, the critical question of whether speech is more intelligible after treatment has not been investigated in a randomised controlled trial (RCT). We hypothesised that intensive speech treatment would improve speech intelligibility in PD. METHOD: Sixty-four patients with hypokinetic dysarthria secondary to PD participated in this single-centre, parallel arm, statistically-powered RCT. Reporting follows CONSORT guidelines for non-pharmacological treatment. Patients were recruited from US clinics and randomised using a statistician-derived minimisation algorithm, to intensive speech treatment (16 1-hour sessions/1 month) targeting voice (voice group) or targeting articulation (articulation group) or to an untreated group (no treatment group). Speech treatments were delivered by speech clinicians who specialised in treating patients with PD. Trial design minimised bias and supported equipoise. For intelligibility assessment, blinded listeners (n = 117) orthographically transcribed 57 patients' recorded, self-generated narrative speech samples, randomly presented in multi-talker babble noise. Listeners were American-English speakers, ages 18-35 years, with normal hearing. The primary outcome was baseline (pre-treatment) to post-treatment change in transcription accuracy (TA), recognised as the most objective measure of intelligibility. TA was defined as the percentage of words transcribed correctly. Listeners, data collectors, and data managers were blinded to treatment conditions and groups. Reliability was evaluated using intraclass correlation coefficients and differences amongst groups were evaluated by mixed-effects models, in accordance with the intention-to-treat approach.This trial was registered with ClinicalTrials.gov Identifier: NCT00123084. FINDINGS: Between June 23, 2016 and August 14, 2017, blinded listeners transcribed baseline and post-treatment speech samples for intelligibility assessment of 57 patients in the voice (n = 19), articulation (n = 19) and no treatment (n = 19) groups. Between-group differences (d) in changes from baseline to post-treatment in TA indicated significantly greater increases following treatment targeting voice than treatment targeting articulation (d = 26·2%, 95% CI 1·5 - 51·0; p = 0·04; ES=1·0). Differences between TA changes in the treatment targeting voice and in the no treatment group were significant (d = 42·8%, 95% CI 22·4 - 63·2; p = 0·0002; ES=1·8). Differences between TA changes in the treatment targeting articulation and in the no treatment group were not significant (d = 16·5%, 95% CI -6·1 - 39·2; p = 0·147; ES=0·9). INTERPRETATION: These findings provide the first RCT evidence that intensive speech treatment targeting voice improves speech intelligibility in PD. Thus, this evidence-based treatment may positively impact health-related quality of life for patients with PD globally when it is included in patient management.

Using Crowdsourced Listeners' Ratings to Measure Speech Changes in Hypokinetic Dysarthria: A Proof-of-Concept Study.

Purpose Interventions for speech disorders aim to produce changes that are not only acoustically measurable or perceptible to trained professionals but are also apparent to naive listeners. Due to challenges associated with obtaining ratings from suitably large listener samples, however, few studies currently evaluate speech interventions by this criterion. Online crowdsourcing technologies could enhance the measurement of intervention effects by making it easier to obtain real-world listeners' ratings. Method Stimuli, drawn from a published study by Sapir et al. ("Effects of intensive voice treatment (Lee Silverman Voice Treatment [LSVT]) on vowel articulation in dysarthric individuals with idiopathic Parkinson disease: Acoustic and perceptual findings" in Journal of Speech, Language, and Hearing Research, 50(4), 2007), were words produced by individuals who received intensive treatment (LSVT LOUD) for hypokinetic dysarthria secondary to Parkinson's disease. Thirty-six online naive listeners heard randomly ordered pairs of words elicited pre- and posttreatment and reported which they perceived as "more clearly articulated." Results Mixed-effects logistic regression indicated that words elicited posttreatment were significantly more likely to be rated "more clear." Across individuals, acoustically measured magnitude of change was significantly correlated with pre-post difference in listener ratings. Conclusions These results partly replicate the findings of Sapir et al. (2007) and demonstrate that their acoustically measured changes are detectable by everyday listeners. This supports the viability of using crowdsourcing to obtain more functionally relevant measures of change in clinical speech samples. Supplemental Material https://doi.org/10.23641/asha.12170112.

Speech treatment in Parkinson's disease: Randomized controlled trial (RCT).

BACKGROUND: As many as 89% of people with Parkinson's disease (PD) develop speech disorders. OBJECTIVES: This randomized controlled trial evaluated two speech treatments for PD matched in intensive dosage and high-effort mode of delivery, differing in subsystem target: voice (respiratory-laryngeal) versus articulation (orofacial-articulatory). METHODS: PD participants were randomized to 1-month LSVT LOUD (voice), LSVT ARTIC (articulation), or UNTXPD (untreated) groups. Speech clinicians specializing in PD delivered treatment. Primary outcome was sound pressure level (SPL) in reading and spontaneous speech, and secondary outcome was participant-reported Modified Communication Effectiveness Index (CETI-M), evaluated at baseline, 1, and 7 months. Healthy controls were matched by age and sex. RESULTS: At baseline, the combined PD group (n = 64) was significantly worse than healthy controls (n = 20) for SPL (P < 0.05) and CETI-M (P = 0.0001). At 1 and 7 months, SPL between-group comparisons showed greater improvements for LSVT LOUD (n = 22) than LSVT ARTIC (n = 20; P < 0.05) and UNTXPD (n = 22; P < 0.05). Sound pressure level differences between LSVT ARTIC and UNTXPD at 1 and 7 months were not significant (P > 0.05). For CETI-M, between-group comparisons showed greater improvements for LSVT LOUD and LSVT ARTIC than UNTXPD at 1 month (P = 0.02; P = 0.02). At 7 months, CETI-M between-group differences were not significant (P = 0.08). Within-group CETI-M improvements for LSVT LOUD were maintained through 7 months (P = 0.0011). CONCLUSIONS: LSVT LOUD showed greater improvements than both LSVT ARTIC and UNTXPD for SPL at 1 and 7 months. For CETI-M, both LSVT LOUD and LSVT ARTIC improved at 1 month relative to UNTXPD. Only LSVT LOUD maintained CETI-M improvements at 7 months. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

Evidence-based treatment of voice and speech disorders in Parkinson disease.

PURPOSE OF REVIEW: Voice and speech impairments are present in nearly 90% of people with Parkinson disease and negatively impact communication and quality of life. This review addresses the efficacy of Lee Silverman Voice Treatment (LSVT) LOUD to improve vocal loudness (as measured by vocal sound pressure level vocSPL) and functional communication in people with Parkinson disease. The underlying physiologic mechanisms of Parkinson disease associated with voice and speech changes and the strength of the current treatment evidence are discussed with recommendations for best clinical practice. RECENT FINDINGS: Two randomized control trials demonstrated that participants who received LSVT LOUD were significantly better on the primary outcome variable of improved vocSPL posttreatment than alternative and no treatment groups. Treatment effects were maintained for up to 2 years. In addition, improvements have been demonstrated in associated outcome variables, including speech rate, monotone, voice quality, speech intelligibility, vocal fold adduction, swallowing, facial expression and neural activation. Advances in technology-supported treatment delivery are enhancing treatment accessibility. SUMMARY: Data support the efficacy of LSVT LOUD to increase vocal loudness and functional communication in people with Parkinson disease. Timely intervention is essential for maximizing quality of life for people with Parkinson disease.

The impact of STN deep brain stimulation on speech in individuals with Parkinson's disease: the patient's perspective.

BACKGROUND: Speech disturbance is highly prevalent and disabling for individuals with Parkinson's disease (PD). Deep brain stimulation (DBS) has been found to adversely impact speech in a number of individuals with PD. This study investigated the differential speech profiles between individuals with PD with and without DBS from the patient's perspective. METHODS: A cross sectional research design was used. A total of 758 individuals with PD participated in this study, including 287 individuals with DBS and 471 individuals without DBS. Participants completed the Voice Handicap Index (VHI) and additional questions regarding speech symptoms and the impact of speech on social interaction. RESULTS: Independent of age and disease duration, there were statistically significant differences in perceived speech disturbance severity between the STN-DBS group and Non-DBS group, with the DBS group reporting more severe symptoms as well as more significant symptom interference with social interaction and with daily experiences encountered relating to functional, physical, and emotional issues of a voice disorder (VHI). Low volume was the "most common" speech symptom for all individuals with PD patients across both age (younger and older) and disease duration (6-10 years and 11+ years) cohorts. DBS had the greatest adverse impact on "slurred speech." CONCLUSION: DBS therapy's contribution to speech disturbance is gaining more attention, and the speech symptoms ensuing from and/or being exacerbated by DBS are in the incipient stages of being investigated. Implications for DBS therapy on perceived quality of life are discussed.

Robust fundamental frequency estimation in sustained vowels: detailed algorithmic comparisons and information fusion with adaptive Kalman filtering.

There has been consistent interest among speech signal processing researchers in the accurate estimation of the fundamental frequency (F(0)) of speech signals. This study examines ten F(0) estimation algorithms (some well-established and some proposed more recently) to determine which of these algorithms is, on average, better able to estimate F(0) in the sustained vowel /a/. Moreover, a robust method for adaptively weighting the estimates of individual F(0) estimation algorithms based on quality and performance measures is proposed, using an adaptive Kalman filter (KF) framework. The accuracy of the algorithms is validated using (a) a database of 117 synthetic realistic phonations obtained using a sophisticated physiological model of speech production and (b) a database of 65 recordings of human phonations where the glottal cycles are calculated from electroglottograph signals. On average, the sawtooth waveform inspired pitch estimator and the nearly defect-free algorithms provided the best individual F(0) estimates, and the proposed KF approach resulted in a ∼16% improvement in accuracy over the best single F(0) estimation algorithm. These findings may be useful in speech signal processing applications where sustained vowels are used to assess vocal quality, when very accurate F(0) estimation is required.

Effects of the Lee Silverman Voice Treatment (LSVT® LOUD) on hypomimia in Parkinson's disease.

Given associations between facial movement and voice, the potential of the Lee Silverman Voice Treatment (LSVT) to alleviate decreased facial expressivity, termed hypomimia, in Parkinson's disease (PD) was examined. Fifty-six participants--16 PD participants who underwent LSVT, 12 PD participants who underwent articulation treatment (ARTIC), 17 untreated PD participants, and 11 controls without PD--produced monologues about happy emotional experiences at pre- and post-treatment timepoints ("T1" and "T2," respectively), 1 month apart. The groups of LSVT, ARTIC, and untreated PD participants were matched on demographic and health status variables. The frequency and variability of facial expressions (Frequency and Variability) observable on 1-min monologue videorecordings were measured using the Facial Action Coding System (FACS). At T1, the Frequency and Variability of participants with PD were significantly lower than those of controls. Frequency and Variability increases of LSVT participants from T1 to T2 were significantly greater than those of ARTIC or untreated participants. Whereas the Frequency and Variability of ARTIC participants at T2 were significantly lower than those of controls, LSVT participants did not significantly differ from controls on these variables at T2. The implications of these findings, which suggest that LSVT reduces parkinsonian hypomimia, for PD-related psychosocial problems are considered.

Objective Automatic Assessment of Rehabilitative Speech Treatment in Parkinson's Disease.

Vocal performance degradation is a common symptom for the vast majority of Parkinson's disease (PD) subjects, who typically follow personalized one-to-one periodic rehabilitation meetings with speech experts over a long-term period. Recently, a novel computer program called Lee Silverman voice treatment (LSVT) Companion was developed to allow PD subjects to independently progress through a rehabilitative treatment session. This study is part of the assessment of the LSVT Companion, aiming to investigate the potential of using sustained vowel phonations towards objectively and automatically replicating the speech experts' assessments of PD subjects' voices as "acceptable" (a clinician would allow persisting during in-person rehabilitation treatment) or "unacceptable" (a clinician would not allow persisting during in-person rehabilitation treatment). We characterize each of the 156 sustained vowel /a/ phonations with 309 dysphonia measures, select a parsimonious subset using a robust feature selection algorithm, and automatically distinguish the two cohorts (acceptable versus unacceptable) with about 90% overall accuracy. Moreover, we illustrate the potential of the proposed methodology as a probabilistic decision support tool to speech experts to assess a phonation as "acceptable" or "unacceptable." We envisage the findings of this study being a first step towards improving the effectiveness of an automated rehabilitative speech assessment tool.

Innovative technology for the assisted delivery of intensive voice treatment (LSVT®LOUD) for Parkinson disease.

PURPOSE: To assess the feasibility and effectiveness of a newly developed assistive technology system, Lee Silverman Voice Treatment Companion (LSVT(®) Companion™, hereafter referred to as "Companion"), to support the delivery of LSVT(®)LOUD, an efficacious speech intervention for individuals with Parkinson disease (PD). METHOD: Sixteen individuals with PD were randomized to an immediate (n = 8) or a delayed (n = 8) treatment group. They participated in 9 LSVT LOUD sessions and 7 Companion sessions, independently administered at home. Acoustic, listener perception, and voice and speech rating data were obtained immediately before (pre), immediately after (post), and at 6 months post treatment (follow-up). System usability ratings were collected immediately post treatment. Changes in vocal sound pressure level were compared to data from a historical treatment group of individuals with PD treated with standard, in-person LSVT LOUD. RESULTS: All 16 participants were able to independently use the Companion. These individuals had therapeutic gains in sound pressure level, pre to post and pre to follow-up, similar to those of the historical treatment group. CONCLUSIONS: This study supports the use of the Companion as an aid in treatment of hypokinetic dysarthria in individuals with PD. Advantages and disadvantages of the Companion, as well as limitations of the present study and directions for future studies, are discussed.

Intensive treatment of dysarthria secondary to stroke.

This study investigated the impact of a well-defined behavioral dysarthria treatment on acoustic and perceptual measures of speech in four adults with dysarthria secondary to stroke. A single-subject A-B-A experimental design was used to measure the effects of the Lee Silverman Voice Treatment (LSVT(®) LOUD) on the speech of individual participants. Dependent measures included vocal sound pressure level, phonatory stability, vowel space area, and listener ratings of speech, voice and intelligibility. Statistically significant improvements (p < 0.05) in vocal dB SPL and phonatory stability as well as larger vowel space area were present for all participants. Listener ratings suggested improved voice quality and more natural speech post-treatment. Speech intelligibility scores improved for one of four participants. These data suggest that people with dysarthria secondary to stroke can respond positively to intensive speech treatments such as LSVT. Further studies are needed to investigate speech treatments specific to stroke.