An Efficacy Study of Voice Quality Using Cepstral Analyses of Phonation in Parkinson's Disease before and after SPEAK-OUT!®.

INTRODUCTION: SPEAK-OUT!® is a behavioral treatment for hypokinetic dysarthria in persons with Parkinson's disease (PD) that has become an alternative to the gold-standard Lee Silverman Voice Treatment (LSVT) in recent years. Acoustic evaluation of the efficacy of SPEAK-OUT!® therapy has focused on prosody. The purpose of this study was to investigate SPEAK-OUT!® efficacy in terms of vocal quality and its impact on quality of life. Vocal quality was measured acoustically using cepstral peak prominence (CPP) analysis and the Acoustic Voice Quality Index (AVQI) and perceptually using clinical ratings of speech performance. Impact on quality of life was measured with the Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-RQOL). An additional goal of this study was to investigate whether dysarthria severity and disease duration were predictive of changes in voice quality due to SPEAK-OUT!®. METHODS: Pre- and post-therapy data included PD participants' acoustic and perceptual ratings of audio recordings. Demographic data included age, sex, diagnosis, duration of PD, and severity of dysarthria. RESULTS: Participants achieved significant improvement in the vowel and sentence CPP smoothed (CPPS) mean score as well as in their AVQI score post SPEAK-OUT!® treatment. Improvements in AVQI correlated negatively with disease duration and positively with dysarthria severity. DISCUSSION/CONCLUSION: SPEAK-OUT!® is effective in improving voice quality in patients with hypokinetic dysarthria due to idiopathic PD. Patients with more severe dysarthria and with a shorter disease duration may benefit the most, supporting earlier intervention. As for the type of measurement, AVQI combines acoustics from both vowel and sentence contexts and may therefore be the measure of choice over CPPS (vowel) or CPPS (sentence).

Prosodic Improvement in Persons with Parkinson Disease Receiving SPEAK OUT!® Voice Therapy.

BACKGROUND/AIMS: Hypokinetic dysarthria in Parkinson disease (PD) hinders the ability to verbally communicate and interferes with activities of daily living. SPEAK OUT!® is a therapy program designed to improve functional communicative ability. In contrast to the Lee Silverman Voice Treatment program, SPEAK OUT!® promotes speaking with intent to effect loud speech. This study evaluated the efficacy of SPEAK OUT!® in persons with idiopathic PD in 3 domains: self-reported voice handicap, clinical ratings of dysarthria and prosody, and acoustic analysis of prosody. PARTICIPANTS AND METHODS: Pre-/post-therapy data included PD participants' scores on the Voice Handicap Index (VHI) and the Voice-Related Quality of Life (V-RQOL) questionnaire, audio recordings, perceptual evaluation scores, and demographic data, such as age, sex, handedness, diagnosis, and onset of PD. RESULTS: Participants achieved a statistically and clinically significant improvement in speech intensity, pitch range, normalized pairwise variability index for pitch, sustained vowel duration, reading intelligibility, and vocal quality after SPEAK OUT!® training, consistent with both of the self-report voice scores, i.e., the VHI and the V-RQOL, and with the perceptual speech evaluation scores. Longer PD duration was associated with lowered efficacy. CONCLUSIONS: SPEAK OUT!® is effective and should be administered as early as possible after disease onset.

The Collaboverse: A Collaborative Data-Sharing and Speech Analysis Platform.

PURPOSE: Collaboration in the field of speech-language pathology occurs across a variety of digital devices and can entail the usage of multiple software tools, systems, file formats, and even programming languages. Unfortunately, gaps between the laboratory, clinic, and classroom can emerge in part because of siloing of data and workflows, as well as the digital divide between users. The purpose of this tutorial is to present the Collaboverse, a web-based collaborative system that unifies these domains, and describe the application of this tool to common tasks in speech-language pathology. In addition, we demonstrate its utility in machine learning (ML) applications. METHOD: This tutorial outlines key concepts in the digital divide, data management, distributed computing, and ML. It introduces the Collaboverse workspace for researchers, clinicians, and educators in speech-language pathology who wish to improve their collaborative network and leverage advanced computation abilities. It also details an ML approach to prosodic analysis. CONCLUSIONS: The Collaboverse shows promise in narrowing the digital divide and is capable of generating clinically relevant data, specifically in the area of prosody, whose computational complexity has limited widespread analysis in research and clinic alike. In addition, it includes an augmentative and alternative communication app allowing visual, nontextual communication.

Reading Warm-Up, Reading Skill, and Reading Prosody When Reading the My Grandfather Passage: An Exploratory Study Born Out of the Motor Planning Theory of Prosody and Reading Prosody Research.

PURPOSE: The Motor Planning Theory of Prosody and reading prosody research indicate that "out of the blue" oral reading, as practiced in clinical and research settings, invokes surface rather than covert prosody, particularly when readers are recorded, less skilled, and/or speech impaired. Warm-up is not considered in passage reading for motor-speech assessment. We report on a preliminary study aimed to investigate the effect of warm-up on reading prosody in two conditions: silent reading alone and reading "out of the blue" followed by silent reading. A secondary aim of the study was to examine the effect of reading skill on reading prosody. METHOD: Twenty-one monolingual, English-speaking volunteers were recorded reading the My Grandfather Passage (GP) while their eye movements were tracked. Participants were randomly assigned to one of two reading conditions: (a) silent-oral (SO) and (b) oral-silent-oral (OSO). In the SO condition, participants read the GP silently as a warm-up for the subsequent oral reading. In the OSO condition, participants first read the GP aloud ("out of the blue") and then read the same passage silently with the instruction to do this in preparation for a second oral reading. Reading skill was quantified using eye-voice span and Wide Range Achievement Test-Fourth Edition testing. Reading prosody was evaluated using pause indexes, the Acoustic Multidimensional Prosody Index, and speech rate. CONCLUSIONS: One oral reading before a silent reading but not a silent reading alone before oral reading was shown to affect reading prosody. In terms of reading skill, results indicate that predictive associations patterned differently in the reading conditions explored, suggesting different underlying skill sets.

Long-term phonatory instability in ataxic dysarthria.

AIMS: Long-term phonatory instability can be quantified using cyclical and noncyclical measures. The objective of this study is to evaluate phonation in ataxic dysarthria and a control group of normal speakers to answer two main questions: (1) How common is elevated cyclical and noncyclical instability in ataxic dysarthria compared to that in a normal control group? (2) Is cyclical instability predictive of noncyclical instability? METHODS: Vowel prolongations of ataxic-dysarthric and normal speakers were compared using the Motor Speech Profile module of the Computerized Speech Lab. Cyclical measures included tremor rate, amplitude and periodicity. Noncyclical measures included the coefficient of variation for loudness and frequency. RESULTS: Noncyclical measures are elevated in a subset of speakers with ataxic dysarthria regardless of whether cyclical instability (vocal tremor) is present. Cyclical instability was detected in nearly half the patients. Interestingly, elevations in both types of measures also described phonation of a number of the participants in the control group. CONCLUSION: Combined use of cyclical and noncyclical measures can document aspects of phonation in ataxic dysarthria that have clinical implications.

Prosody and Spoken Word Recognition in Early and Late Spanish-English Bilingual Individuals.

Purpose: This study was conducted to compare the influence of word properties on gated single-word recognition in monolingual and bilingual individuals under conditions of native and nonnative accent and to determine whether word-form prosody facilitates recognition in bilingual individuals. Method: Word recognition was assessed in monolingual and bilingual participants when English words were presented with English and Spanish accents in 3 gating conditions: onset only, onset plus prosody/word length only, and onset plus prosody. Word properties were quantified to assess their influence on word recognition in the onset-only condition. Results: Word recognition speed was proportional to language experience. In the onset-only condition, only word frequency facilitated word recognition across groups. Addition of duration information or prosodic word form did not facilitate word recognition in bilingual individuals the way it did in monolingual individuals. For the bilingual groups, Spanish accent significantly facilitated recognition in the presence of prosodic information. Word attributes were far more consequential in the English accent than in the Spanish accent condition. Conclusions: Word rhyme information, word properties, and accent affect gated word recognition differently in monolingual and bilingual individuals. Top-down strategies emanating from word properties that may facilitate single-word recognition are experience and context dependent and become less available in the presence of a nonnative accent.

Altered saccadic targets when processing facial expressions under different attentional and stimulus conditions.

Depending on a subject's attentional bias, robust changes in emotional perception occur when facial blends (different emotions expressed on upper/lower face) are presented tachistoscopically. If no instructions are given, subjects overwhelmingly identify the lower facial expression when blends are presented to either visual field. If asked to attend to the upper face, subjects overwhelmingly identify the upper facial expression in the left visual field but remain slightly biased to the lower facial expression in the right visual field. The current investigation sought to determine whether differences in initial saccadic targets could help explain the perceptual biases described above. Ten subjects were presented with full and blend facial expressions under different attentional conditions. No saccadic differences were found for left versus right visual field presentations or for full facial versus blend stimuli. When asked to identify the presented emotion, saccades were directed to the lower face. When asked to attend to the upper face, saccades were directed to the upper face. When asked to attend to the upper face and try to identify the emotion, saccades were directed to the upper face but to a lesser degree. Thus, saccadic behavior supports the concept that there are cognitive-attentional pre-attunements when subjects visually process facial expressions. However, these pre-attunements do not fully explain the perceptual superiority of the left visual field for identifying the upper facial expression when facial blends are presented tachistoscopically. Hence other perceptual factors must be in play, such as the phenomenon of virtual scanning.

Botox treatment in adductor spasmodic dysphonia: a meta-analysis.

Over the years many studies have been conducted to document the treatment effects of Botulinum toxin type A in adductor spasmodic dysphonia. The results of these studies have led to the view that overall Botulinum toxin treatment is moderately effective. This study reviews efficacy research qualitatively and quantitatively to determine the extent to which this conclusion is fully supported by the data. Although the data indicate moderate overall improvement as a result of Botulinum toxin treatment, they also suggest significant variation across patients, measurements, and treatment conditions. This result, together with methodological limitations and lack of standardization in BT efficacy research, justifies caution when making inferences regarding BT treatment benefit in adductor spasmodic dysphonia.

Prosody in apraxia of speech.

Prosody is a complex process that involves modulation of pitch, loudness, duration, and linearity in the acoustic stream to serve linguistic and affective communication goals. It arises from the interaction of distributed neural networks that may be anatomically and functionally lateralized. Intrinsic prosody is mediated largely through left hemisphere mechanisms and encompasses those elements of linguistic microstructure (e.g., syllabic magnitudes and durations, basic consonantal and vocalic gesture specifications, and so) that yield the segmental aspects of speech. Extrinsic prosody is processed primarily by right hemisphere (RH) mechanisms and involves manipulation of intonation across longer perceptual groupings. Intrinsic prosody deficits can lead to several core symptoms of speech apraxia such as difficulty with utterance initiation and syllable transitionalization and may lead to the establishment of inappropriate syllable boundaries. The intrinsic prosody profiles associated with acquired apraxia of speech, developmental speech apraxia, and ataxic dysarthria may aid in the clinical differentiation of these disorders.

Perseveration and other repetitive verbal behaviors: functional dissociations.

This article will review types of perseveration from a neurolinguistic perspective. During the course of the article, continuous, stuck-in-set, and recurrent perseveration will be placed in contradistinction to several other types of repetitive behaviors commonly associated with neurogenic communication disorders. These include echolalia in mixed transcortical aphasia; conduite d'approche and conduite d'ecart in fluent aphasias; lexical and nonlexical automatisms in nonfluent aphasias; palilalia in neuromotor disorders, such as Parkinson's disease (PD); and sound, syllable, word, and phrase repetitions in neurogenic stuttering. When differentiating these phenomena from perseveration, it is helpful to consider the salient factors that condition observed behaviors in individual patients, such as overall speech fluency, inventory of available utterances, nature of eliciting tasks, and propositionality of responses. Information such as communication disorder diagnosis, underlying etiology, and known sites of lesion from each patient's total clinical profile may also assist with differentiation.