Statistical learning and prosodic bootstrapping differentially affect neural synchronization during speech segmentation.

Neural oscillations constitute an intrinsic property of functional brain organization that facilitates the tracking of linguistic units at multiple time scales through brain-to-stimulus alignment. This ubiquitous neural principle has been shown to facilitate speech segmentation and word learning based on statistical regularities. However, there is no common agreement yet on whether speech segmentation is mediated by a transition of neural synchronization from syllable to word rate, or whether the two time scales are concurrently tracked. Furthermore, it is currently unknown whether syllable transition probability contributes to speech segmentation when lexical stress cues can be directly used to extract word forms. Using Inter-Trial Coherence (ITC) analyses in combinations with Event-Related Potentials (ERPs), we showed that speech segmentation based on both statistical regularities and lexical stress cues was accompanied by concurrent neural synchronization to syllables and words. In particular, ITC at the word rate was generally higher in structured compared to random sequences, and this effect was particularly pronounced in the flat condition. Furthermore, ITC at the syllable rate dynamically increased across the blocks of the flat condition, whereas a similar modulation was not observed in the stressed condition. Notably, in the flat condition ITC at both time scales correlated with each other, and changes in neural synchronization were accompanied by a rapid reconfiguration of the P200 and N400 components with a close relationship between ITC and ERPs. These results highlight distinct computational principles governing neural synchronization to pertinent linguistic units while segmenting speech under different listening conditions.

Cross-linguistic variation in word-initial cluster production in adult and child language: evidence from English and Norwegian.

Young children simplify word initial consonant clusters by omitting or substituting one (or both) of the elements. Vocalic insertion, coalescence and metathesis are said to be used more seldom (McLeod, van Doorn & Reed, 2001). Data from Norwegian children, however, have shown vocalic insertion to be more frequently used (Simonsen, 1990; Simonsen, Garmann & Kristoffersen, 2019). To investigate the extent to which children use this strategy to differing degrees depending on the ambient language, we analysed word initial cluster production acoustically in nine Norwegian and nine English speaking children aged 2;6-6 years, and eight adults, four from each language. The results showed that Norwegian-speaking children produce significantly more instances of vocalic insertions than English-speaking children do. The same pattern is found in Norwegian- versus English-speaking adults. We argue that this cross-linguistic difference is an example of the influence of prosodic-phonetic biases in language-specific developmental paths in the acquisition of speech.

Distinguishing Dementia With Lewy Bodies From Alzheimer Disease: What is the Influence of the GBA Genotype in Ashkenazi Jews?

Cognitive deficits beyond memory impairment, such as those affecting language production or executive functioning, can be useful in clinically distinguishing between dementia syndromes. We tested the hypothesis that Ashkenazi Jewish (AJ) patients who have dementia with Lewy bodies (DLB) and carry glucocerebrosidase (GBA) mutations will have verbal fluency deficits different from those found in Alzheimer disease (AD), whereas AJ patients with DLB who have no GBA mutations will have similar deficits in verbal fluency to those found in AD. We compared performance in phonemic and semantic verbal fluency tasks in 44 AJ patients with DLB and 20 patients with AD, matched for age, education, and age of immigration. All groups were found to have a deficit in semantic verbal fluency. On conducting the phonemic task, patients with DLB who carried GBA mutations scored more poorly than patients with AD, whereas DLB-noncarriers performed similarly to patients with AD. We suggest that verbal fluency tasks could serve as a possible clinical marker to subtype patients with DLB, with phonemic fluency being a marker for GBA-associated DLB.

How Well Does Diadochokinetic Task Performance Predict Articulatory Imprecision? Differentiating Individuals with Parkinson's Disease from Control Subjects.

OBJECTIVE: To investigate whether syllables produced in an oral diadochokinetic (DDK) task may be quantified so that persons with Parkinson's disease (PD) perceived to have reduced articulatory precision when reading may be correctly identified using that quantification. PATIENTS AND METHODS: Syllable sequences from 38 speakers with PD and 38 gender- and age-matched control speakers (normal controls [NC]) were quantified acoustically and evaluated in terms of (1) the speakers' ability to accurately predict speaker group membership (PD or NC) and (2) their ability to predict reduced/non-reduced articulatory precision. RESULTS: A balanced accuracy of 80-93% in predicting speaker group membership was achieved. The best measures were related to the proportion of a syllable made up of a vowel, amplitude slope and syllable-to-syllable variation in duration and amplitude. The best material was that based on /ka/. Reduced articulatory precision was accurately predicted from DDK measures in 89% of the samples. Release-transient prominence and voicing during the onset of plosives were particularly strong predictors. CONCLUSIONS: DDK sequences can predict articulatory imprecision as observed in another speech task. The linking of performance across speech tasks probably requires measures of stability in syllable durations and amplitudes, as well as measures of subsyllabic acoustic features.

Construct Validity of the Viking Speech Scale.

OBJECTIVE: The Viking Speech Scale (VSS) reliably classifies the speech performance of children with cerebral palsy. This paper aims to establish the construct validity of the VSS by testing the extent to which percentage intelligibility in single word speech and connected speech predicts VSS rating. PATIENTS AND METHODS: This is a secondary analysis of two sets of anonymised data collected for previous research. The full data set comprised 79 children with cerebral palsy from the US (n = 43) and the UK (n = 36): (43 boys, 36 girls); mean age 7.2 years (SD 3.3). Single word intelligibility was measured using the TOCS+ words for US children and Children's Speech Intelligibility Measure for the UK children. Connected speech intelligibility was measured from a subset of repeated sentences in TOCS+ for US children and picture description for the UK children. We used ordinal logistic regression to examine prediction of VSS rating by percentage single word and connected speech intelligibility scores in both samples. RESULTS: Percentage single word intelligibility and connected speech intelligibility predicted VSS rating in univariate and multivariate regression models for both the US and UK samples. CONCLUSION: Intelligibility predicts VSS for both single words and connected speech, establishing the construct validity of VSS.

Variation in language mixing in multilingual aphasia.

Mixing languages within a sentence or a conversation is a common practice among many speakers of multiple languages. Language mixing found in multilingual speakers with aphasia has been suggested to reflect deficits associated with the brain lesion. In this paper, we examine language mixing behaviour in multilingual people with aphasia to test the hypothesis that the use of language mixing reflects a communicative strategy. We analysed connected language production elicited from 11 individuals with aphasia. Words produced were coded as mixed or not. Frequencies of mixing were tabulated for each individual in each of her or his languages in each of two elicitation tasks (Picture sequence description, Narrative production). We tested the predictions that there would be more word mixing: for participants with greater aphasia severity; while speaking in a language of lower post-stroke proficiency; during a task that requires more restricted word retrieval; for people with non-fluent aphasia, while attempting to produce function words (compared to content words); and that there would be little use of a language not known to the interlocutors. The results supported three of the five predictions. We interpret our data to suggest that multilingual speakers with aphasia mix words in connected language production primarily to bypass instances of word-retrieval difficulties, and typically avoid pragmatically inappropriate language mixing.

Semantic fluency in aphasia: clustering and switching in the course of 1 minute.

BACKGROUND: Verbal fluency tasks are included in a broad range of aphasia assessments. It is well documented that people with aphasia (PWA) produce fewer items in these tasks. Successful performance on verbal fluency relies on the integrity of both linguistic and executive control abilities. It remains unclear if limited output in aphasia is solely due to their lexical retrieval difficulties or has a basis in their executive control abilities. Analysis techniques, such as temporal characteristics of word retrieved, clustering and switching, are better positioned to inform the debate surrounding the lexical and/or executive control contribution for success in verbal fluency. AIMS: To investigate the differences in quantitative (i.e., number of correct words) and qualitative (i.e., switching, clustering and word-retrieval times) performances on animal fluency task as a function of time between PWA and healthy control speakers (CS). METHODS & PROCEDURES: Animal fluency data for 60 s were collected from 34 PWA and 34 CS, and responses were time stamped. The 60-s period was divided into four equal intervals of 15 s each (i.e., 15, 30, 45 and 60 s). The number of correct words, cluster size, number of switches, within-cluster pause and between-cluster pause were evaluated as a function of four 15-s time intervals between PWA and CS. OUTCOMES & RESULTS: Compared with CS, PWA produced fewer words, had smaller cluster sizes and switched a fewer number of times. A decrease in the number of switches correlated with an increase in between-cluster pause durations. PWA showed longer within- and between-cluster pauses than CS. The two groups showed specific differences in the temporal pattern of the responses: as time evolved both PWA and CS showed decreased productivity for the number of correct words, but PWA reached the asymptote earlier in the time course than CS, neither group showed a change in cluster size, and the number of switches decreased as a function of time only for CS. CONCLUSIONS & IMPLICATIONS: The findings suggest that for PWA the search and retrieval process is less productive and more effortful. This is indicated by smaller cluster size, fewer switches associated with increased between-cluster pause durations, as well as overall slowed retrieval times for the words. This shows that the difficulties with verbal fluency performance in aphasia have a strong basis in their lexical retrieval processes, as well as some difficulties in the executive component of the task.

Effect of the number of presentations on listener transcriptions and reliability in the assessment of speech intelligibility in children.

BACKGROUND: The assessment of intelligibility is an essential part of establishing the severity of a speech disorder. The intelligibility of a speaker is affected by a number of different variables relating, inter alia, to the speech material, the listener and the listener task. AIMS: To explore the impact of the number of presentations of the utterances on assessments of intelligibility based on orthographic transcription of spontaneous speech, specifically the impact on intelligibility scores, reliability and intra-listener variability. METHODS & PROCEDURES: Speech from 12 children (aged 4:6-8:3 years; mean = 5:10 years) with percentage consonants correct (PCC) scores ranging from 49 to 81 was listened to by 18 students on the speech-language pathology (SLP) programme and by two recent graduates from that programme. Three conditions were examined during the transcription phase: (1) listening to each utterance once; (2) listening to each utterance a second time; and (3) listening to all utterances from a given child a third time after having heard all of its utterances twice. OUTCOMES & RESULTS: Statistically significant differences between intelligibility scores were found across the three conditions, i.e. the intelligibility score increased with the number of presentations while inter-judge reliability was unchanged. The results differed markedly across listeners, but each individual listener's results were very consistent across conditions. CONCLUSIONS & IMPLICATIONS: Information about the number of times an utterance is presented to the listener is important and should therefore always be included in reports of research involving intelligibility assessment. There is a need for further research and discussion on listener abilities and strategies.

Event- and interval-based measurement of stuttering: a review.

BACKGROUND: Event- and interval-based measurements are two different ways of computing frequency of stuttering. Interval-based methodology emerged as an alternative measure to overcome problems associated with reproducibility in the event-based methodology. No review has been made to study the effect of methodological factors in interval-based absolute reliability data or to compute the agreement between the two methodologies in terms of inter-judge, intra-judge and accuracy (i.e., correspondence between raters' scores and an established criterion). AIMS: To provide a review related to reproducibility of event-based and time-interval measurement, and to verify the effect of methodological factors (training, experience, interval duration, sample presentation order and judgment conditions) on agreement of time-interval measurement; in addition, to determine if it is possible to quantify the agreement between the two methodologies METHODS & PROCEDURES: The first two authors searched for articles on ERIC, MEDLINE, PubMed, B-on, CENTRAL and Dissertation Abstracts during January-February 2013 and retrieved 495 articles. Forty-eight articles were selected for review. Content tables were constructed with the main findings. MAIN CONTRIBUTION: Articles related to event-based measurements revealed values of inter- and intra-judge greater than 0.70 and agreement percentages beyond 80%. The articles related to time-interval measures revealed that, in general, judges with more experience with stuttering presented significantly higher levels of intra- and inter-judge agreement. Inter- and intra-judge values were beyond the references for high reproducibility values for both methodologies. Accuracy (regarding the closeness of raters' judgements with an established criterion), intra- and inter-judge agreement were higher for trained groups when compared with non-trained groups. Sample presentation order and audio/video conditions did not result in differences in inter- or intra-judge results. A duration of 5 s for an interval appears to be an acceptable agreement. Explanation for high reproducibility values as well as parameter choice to report those data are discussed. CONCLUSIONS & IMPLICATIONS: Both interval- and event-based methodologies used trained or experienced judges for inter- and intra-judge determination and data were beyond the references for good reproducibility values. Inter- and intra-judge values were reported in different metric scales among event- and interval-based methods studies, making it unfeasible to quantify the agreement between the two methods.

[Expressed emotion, mother-child relationship, and ADHD symptoms in preschool- a study on the validity of the German Preschool Five Minute Speech Sample]. / Expressed Emotion, Mutter-Kind-Beziehung und ADHS-Symptome im Vorschulalter.

An inadequate parent-child relationship with hostility, low warmth, and a lack of responsiveness/sensitivity on the part of the primary caregiver often accompanies a child's externalizing disorders and predicts a negative developmental course. The Preschool Five Minute Speech Sample (PFMSS) was developed to enable an economic assessment of components of an inadequate parent-child relationship. In this article we investigate aspects of the validity of the German version of the PFMSS. We analyze whether the PFMSS scales are associated with observed maternal sensitivity, symptoms of attention deficit-/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and maternal depressive symptoms. The sample consists of n = 114 families with 4- to 5-year-old children, whereof n = 65 (57 %) show heightened ADHD-symptoms. The families were recruited from local kindergardens. Maternal sensitivity was assessed by observing the mother-child interaction at home. ADHD, ODD, and maternal depressive ~symptoms were measured by clinical interviews and questionnaires. Most of the PFMSS scales showed the expected associations with maternal sensitivity, ADHD, and ODD symptoms of the child. The German PFMSS thus validly captures significant components of an inadequate mother-child relationship within the context of preschool externalizing behavior problems.

Scores on Riley's stuttering severity instrument versions three and four for samples of different length and for different types of speech material.

Riley stated that the minimum speech sample length necessary to compute his stuttering severity estimates was 200 syllables. This was investigated. Procedures supplied for the assessment of readers and non-readers were examined to see whether they give equivalent scores. Recordings of spontaneous speech samples from 23 young children (aged between 2 years 8 months and 6 years 3 months) and 31 older children (aged between 10 years 0 months and 14 years 7 months) were made. Riley's severity estimates were scored on extracts of different lengths. The older children provided spontaneous and read samples, which were scored for severity according to reader and non-reader procedures. Analysis of variance supported the use of 200-syllable-long samples as the minimum necessary for obtaining severity scores. There was no significant difference in SSI-3 scores for the older children when the reader and non-reader procedures were used. Samples that are 200-syllables long are the minimum that is appropriate for obtaining stable Riley's severity scores. The procedural variants provide similar severity scores.

Discriminant validity with a direct observational assessment system: Research with previously identified groups.

Based on a study of 40 school-age children (20 identified as "language disordered" and 20 as "normal language users"), the discriminant validity of a direct observational assessment system is investigated. Results indicate strong discriminant validity on most of the measurement parameters of this tool, Systematic Observation of Communicative Interaction. Discussion of the implications of these findings is provided.

Non-word repetition performance in Slovak-speaking children with and without SLI: novel scoring methods.

BACKGROUND: Non-word repetition (NWR) tasks have been found to correlate with language skills and to discriminate between groups of typically developing (TD) children and children with specific language impairment (SLI) across languages. AIMS: The main aim was to develop an easily-administered NWR screening test that could discriminate between Slovak-speaking TD children and children with SLI. The second aim was to establish if the novel scoring methods for NWR tasks were equally effective at differentiating between the TD versus SLI groups. As Slovak vowels are not reduced in unstressed syllables, it was also sought to establish whether scoring vowels (in addition to the consonants usually assessed in English language tests) would be informative. METHODS & PROCEDURES: The paper evaluated the performance of a new NWR task for Slovak-speaking children. Study 1 compared the performance of 60 TD children in three age groups: 3-year-olds (N = 20), 4-your-olds (N = 20) and 5-year-olds (N = 20). Five types of scoring methods were examined: whole-item, number of syllables, syllable structure, consonants, and vowels. Study 2 compared performance on the NWR task administered in Study 1 across three groups of child participants: an SLI group (N = 16), a TD age-matched group (N = 16), and a TD language-matched group (N = 14). OUTCOMES & RESULTS: Study 1 found an age effect in the TD sample for three out of five of the scoring methods tested (number of syllables, syllable structure, and consonants). Study 2 showed that all five of the scoring methods discriminated between: (1) the group of children with SLI and the TD language-matched (TDLM) sample and (2) the group of children with SLI and the TD age-matched (TDAM) group. CONCLUSIONS & IMPLICATIONS: The novel NWR tool reliably differentiated between children with SLI and TD children. Scoring cut-off points which demonstrated high rates of success at verifying true-positives (93.75%) and true-negatives (100%) are provided. The most informative scoring methods for Slavic languages (whole-item scoring and vowels correct) are identified and discussed.

[Evaluation of current assessment tools in early detection of developmental deviations in speech and language in the German preventive paediatric examination (Kindervorsorgeuntersuchung U8)]. / Analyse aktueller Untersuchungsinstrumente zur Früherkennung von Auffälligkeiten in Sprechen und Sprache in der pädiatrischen Vorsorgeuntersuchung U8.

OBJECTIVE: The current analysis is a contribution to application information and quality assurance. It is intended to evaluate and optimise the use of German developmental screening instruments to identify deficits in speech, speech fluency and language during the early paediatric toddler check-up Kindervorsorgeuntersuchung U8 in the age of 43-50 months. METHODS: A systematic literature search was conducted seeking current specific, standardised, norm-referenced assessment tools, particularly those relevant to the early detection of developmental speech and language retardation. They were subsequently evaluated quantitatively and qualitatively with specific regard to 15 psychometric criteria and construction features. RESULTS: 4 assessment tools (ETS 4-8; KiSS; SSV; TSVK-Screen) resulted from literature search. They were subjected to a detailed and rigorous comparative analysis. Quantitatively they met 7-12 of the 15 psychometric criteria whose quality was partly low or demonstrated survey standard to a lesser degree. CONCLUSION: These developmental screening instruments utilised in the paediatric toddler check-up U8 cannot be recommended without reservation with regard to a dichotomous decision (suspected disorder versus no suspected disorder). More qualificatory research focusing specifically on the existing screenings and the construction of new screening tools is required in order to gain vital developmental psychological information of the speech/language status of a child during the preventive paediatric examination U8. Alternatively, it should be evaded to the approach of taking diagnostic language developmental tests.

Assessment battery for communication (ABaCo): normative data.

The Assessment Battery for Communication (ABaCo) was introduced to evaluate pragmatic abilities in patients with cerebral lesions. The battery is organized into five evaluation scales focusing on separate components of pragmatic competence. In the present study, we present normative data for individuals 15-75 years of age (N = 300). The sample was stratified by age, sex, and years of education, according to Italian National Institute of Statistics indications in order to be representative of the general national population. Since performance on the ABaCo decreases with age and lower years of education, the norms were stratified for both age and education. The ABaCo is a valuable tool in clinical practice; the normative data provided here will enable clinicians to determine different kinds and specific levels of communicative impairments more precisely.

The impact of speech material on speech judgement in children with and without cleft palate.

BACKGROUND: The chosen method of speech assessment, including type of speech material, may affect speech judgement in children with cleft palate. AIM: To assess the effect of different speech materials on speech judgement in 5-year-old children born with or without cleft palate, as well as the reliability of materials by means of intra- and inter-transcriber agreement of consonant transcriptions. METHODS & PROCEDURES: Altogether 40 children were studied, 20 born with cleft palate, 20 without. The children were audio recorded at 5 years of age. Speech materials used were: single-word naming, sentence repetition (both developed for cleft palate speech assessment), retelling of a narrative and conversational speech. The samples were phonetically transcribed and inter- and intra-transcriber agreement was calculated. Percentage correct consonants (PCC), percentage correct places (PCP), percentage correct manners (PCM), and percentage active cleft speech characteristics (CSC) were assessed. In addition, an analysis of phonological simplification processes (PSP) was performed. OUTCOME & RESULTS: The PCC and CSC results were significantly more accurate in word naming than in all other speech materials in the children with cleft palate, who also achieved more accurate PCP results in word naming than in sentence repetition and conversational speech. Regarding PCM and PSP, performance was significantly more accurate in word naming than in conversational speech. Children without cleft palate did better, irrespective of the speech material. The medians of intra- and inter-transcriber agreement were good in both groups and all speech materials. The closest agreement in the cleft palate group was seen in word naming and the weakest in the retelling task. CONCLUSION & IMPLICATIONS: The results indicate that word naming is the most reliable speech material when the purpose is to assess the best speech performance of a child with cleft palate. If the purpose is to assess connected speech, sentence repetition is a reliable and also valid speech material, with good transcriber agreement and equally good articulation accuracy as in retelling and conversational speech. For typically developing children without a cleft palate, the chosen speech material appears not to affect speech judgement.

Verbal fluency in schizophrenia: does cognitive performance reflect the same underlying mechanisms in patients and healthy controls?

Verbal fluency is impaired in patients with schizophrenia, but the association with other cognitive domains remains unclear. Forty-seven patients with schizophrenia (DSM-IV) and 47 controls matched by age, gender, years of education, and vocabulary (Wechsler Adult Intelligence Scale-III) were assessed in terms of sociodemographic, clinical, and cognitive variables. Healthy controls performed significantly better than patients with schizophrenia in all cognitive measures. However, the way these cognitive domains were related differed across groups. Semantic fluency (SF) and phonological fluency (PF) were predicted by working memory (WM) in patients with schizophrenia, whereas the predictor in the healthy controls was processing speed (PS). Moreover, after dividing the sample of patients according to their performance on fluency tests, we found that a worse performance on SF or PF was predicted by WM. However, for patients with a better performance on fluency, the pattern was similar to that of healthy controls. Cognition may show a different pattern of interaction in schizophrenia, with less impaired patients showing a closer pattern to healthy controls. Therefore, we suggest that, depending on the severity of cognitive deficits, performance on neuropsychological tests may not reflect the same underlying mechanisms.

Articulation Rate in American English in a Corpus of YouTube Videos.

Previous studies of the temporal organization of speech in American English have found differences in speaking or articulation rate according to speaker dialect or location, but small sample sizes and incomplete geographic coverage have limited the generalizability of the findings. In this study, articulation rates in American English are calculated from the automatic speech-to-text transcripts of more than 29,000 hours of video from local government and civic organization channels on YouTube from the 48 contiguous US states, containing more than 230 million individual word timings. Two questions are considered: are there regional differences in articulation rate? And do urban speakers articulate faster than rural speakers? The study presents several methodological innovations: first, it identifies a genre of regional speech suitable for interregional comparisons (meetings of local governments or civic organizations). Second, it introduces a new method for the calculation of articulation rate using cue and word timestamps from caption files. Third, it leverages US Census data to correlate the articulation rate with population for a large number of localities. The study shows that, in line with previous studies, Southerners articulate slower, and Americans from the Upper Midwest more quickly. In addition, there is a small but positive correlation between population size and articulation rate. Articulation rates are mapped using a measure of local autocorrelation.

Research Note: Vocal Attack Time-Extended Analysis.

Normative data for vocal attack time (VAT) have previously been presented, but descriptive statistics and assessments of statistical significance of differences have previously been based on a data corpus that included both negative- and positive-valued VATs. Negative VAT values denote a glottal vocal attack, but, at the present time, the signification of the magnitude of a negative VAT value is unknown. The magnitude of a positive VAT value, on the other hand, conveys useful information about glottal behavior at the time of voice onset and is much more likely to be of use, especially in the clinical domain. We present descriptive statistics for the set of positive-valued VATs and demonstrate that the VAT differences between genders and among tone categories in Cantonese remain valid.

The Impact of Nasalance on Cepstral Peak Prominence and Harmonics-to-Noise Ratio.

OBJECTIVES/HYPOTHESIS: Cepstral peak prominence (CPP) has been reported as a reliable measure of dysphonia and a preferred alternative to harmonics-to-noise ratio (HNR). However, CPP has been observed to be sensitive to articulatory variation and vocal intensity. The aim of this study was to examine the impact of nasalance on CPP and HNR of voice signals. It was hypothesized that increased nasalance would be associated with decreased CPP. STUDY DESIGN: Within-subject correlation design. METHODS: Thirty vocally healthy female participants were recorded reading and producing a vowel in alternation with a nasal consonant while wearing a nasometer for calculation of nasalance. Recorded vowel, nasalized, and nasal segments of speech were used to calculate CPP using Analysis of Dysphonia in Speech and Voice software, and HNR and vocal intensity using Praat software. RESULTS: Significant main effects of conditions were observed for CPP. CPP values decreased significantly when phonation changed from vowel to nasalized vowel and to nasal. There was correlation between CPP and nasalance and between CPP and intensity. HNR was slightly higher in the nasal condition than in vowel. There was a weak correlation between HNR and nasalance. No correlation was found between HNR and intensity. CONCLUSIONS: CPP is sensitive to changes in vocal tract configuration caused by nasalization as well as intensity, whereas HNR is not. Therefore, CPP may reflect the periodicity in source signal or the filtering effects of vocal tract. Further research is needed to clarify the application and interpretation of CPP in clinical practice. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:E299-E304, 2019.