ClearSpeechTogether: a Rater Blinded, Single, Controlled Feasibility Study of Speech Intervention for People with Progressive Ataxia.

BACKGROUND: Progressive ataxias frequently lead to speech disorders and consequently impact on communication participation and psychosocial wellbeing. Whilst recent studies demonstrate the potential for improvements in these areas, these treatments generally require intensive input which can reduce acceptability of the approach. A new model of care-ClearSpeechTogether-is proposed which maximises treatment intensity whilst minimising demands on clinician. This study aimed to establish feasibility and accessibility of this approach and at the same time determine the potential benefits and adverse effects on people with progressive ataxias. METHOD: This feasibility study targeted people with progressive ataxia and mild-moderate speech and gross motor impairment. ClearSpeechTogether consisted of four individual sessions over 2 weeks followed by 20 patient-led group sessions over 4 weeks. All sessions were provided online. Quantitative and qualitative data were collected for evaluation. RESULTS: Nine participants completed treatment. Feasibility and acceptability were high and no adverse effects were reported. Statistical tests found significantly reduced vocal strain, improved reading intelligibility and increased participation and confidence. Participant interviews highlighted the value of group support internalisation of speech strategies and psycho-social wellbeing. DISCUSSION: ClearSpeechTogether presented a feasible, acceptable intervention for a small cohort of people with progressive ataxia. It matched or exceeded the outcomes previously reported following individual therapy. Particularly notable was the fact that this could be achieved through patient led practice without the presence of a clinician. Pending confirmation of our results by larger, controlled trials, ClearSpeechTogether could represent an effective approach to manage speech problems in ataxia.

Effects of Speaking Rate on Variability of Second Formant Frequency Transitions in Dysarthria.

INTRODUCTION: This study examined the utility of multiple second formant (F2) slope metrics to capture differences in speech production for individuals with dysarthria and healthy controls as a function of speaking rate. In addition, the utility of F2 slope metrics for predicting severity of intelligibility impairment in dysarthria was examined. METHODS: 23 speakers with Parkinson's disease and mild to moderate hypokinetic dysarthria (HD), 9 speakers with various neurological diseases and mild to severe ataxic dysarthria (AD), and 26 age-matched healthy control speakers (CON) participated in a sentence repetition task. Sentences were produced at habitual, fast, and slow speaking rate. A variety of metrics were derived from the rising second formant (F2) transition portion of the diphthong /ai/. To obtain measures of intelligibility for the two clinical speaker groups, 15 undergraduate SLP students participated in a transcription experiment. RESULTS: Significantly shallower slopes were found for the speakers with hypokinetic dysarthria compared to control speakers. Steeper F2 slopes were associated with increased speaking rate for all groups. Higher variability in F2 slope metrics was found for the speakers with ataxic dysarthria compared to the two other speaker groups. For both clinical speaker groups, there was a negative association between intelligibility and F2 slope variability metrics, indicating lower variability in speech production was associated with higher intelligibility. DISCUSSION: F2 slope metrics were sensitive to dysarthria presence, dysarthria type and speaking rate. The current study provided evidence that the use of F2 slope variability measures has additional value to F2 slope averaged measures for predicting severity of intelligibility impairment in dysarthria.

The efficacy of acoustic-based articulatory phenotyping for characterizing and classifying four divergent neurodegenerative diseases using sequential motion rates.

Despite the impacts of neurodegeneration on speech function, little is known about how to comprehensively characterize the resulting speech abnormalities using a set of objective measures. Quantitative phenotyping of speech motor impairments may have important implications for identifying clinical syndromes and their underlying etiologies, monitoring disease progression over time, and improving treatment efficacy. The goal of this research was to investigate the validity and classification accuracy of comprehensive acoustic-based articulatory phenotypes in speakers with distinct neurodegenerative diseases. Articulatory phenotypes were characterized based on acoustic features that were selected to represent five components of motor performance: Coordination, Consistency, Speed, Precision, and Rate. The phenotypes were first used to characterize the articulatory abnormalities across four progressive neurologic diseases known to have divergent speech motor deficits: amyotrophic lateral sclerosis (ALS), progressive ataxia (PA), Parkinson's disease (PD), and the nonfluent variant of primary progressive aphasia and progressive apraxia of speech (nfPPA + PAOS). We then examined the efficacy of articulatory phenotyping for disease classification. Acoustic analyses were conducted on audio recordings of 217 participants (i.e., 46 ALS, 52 PA, 60 PD, 20 nfPPA + PAOS, and 39 controls) during a sequential speech task. Results revealed evidence of distinct articulatory phenotypes for the four clinical groups and that the phenotypes demonstrated strong classification accuracy for all groups except ALS. Our results highlight the phenotypic variability present across neurodegenerative diseases, which, in turn, may inform (1) the differential diagnosis of neurological diseases and (2) the development of sensitive outcome measures for monitoring disease progression or assessing treatment efficacy.

Pausing and Sentence Stress in Children with Dysarthria due to Cerebral Palsy.

INTRODUCTION: Children with dysarthria due to cerebral palsy (CP) can experience problems manipulating intensity, fundamental frequency, and duration to signal sentence stress in an utterance. Pauses have been identified as a potential additional cue for stress-marking, which could compensate for this deficit. OBJECTIVE: This study aimed to determine whether children use pauses to signal stress placement, and whether this differs between typically developing children and those with CP. METHODS: Six children with CP and 8 typically developing children produced utterances with stresses on target words in 2 different positions. Pauses before and after the stressed target words were analyzed in terms of number, location, and duration. RESULTS: Both groups inserted pauses into their utterances. However, neither group used pause location or duration in a systematic manner to signal the position of the words stressed. CONCLUSIONS: The results suggest that pausing was not used strategically by either group to signal sentence stress. Further research is necessary to explore the value of pausing as a cue to stress-marking in general and as a potential compensatory strategy for speakers with dysarthria.

Feasibility and Acceptability of Lee Silverman Voice Treatment in Progressive Ataxias.

Communication difficulties have considerable impact on people with progressive ataxia, yet there are currently no evidence-based treatments. LSVT LOUD® focuses on the production of healthy vocal loudness whilst also improving breath support, vocal quality, loudness and articulation in participating patients. This study aimed to investigate whether Lee Silverman Voice Treatment (LSVT LOUD®) can improve communication effectiveness in these patients. We performed a rater-blinded, single-arm study investigating LSVT LOUD® treatment in a population of patients with progressive ataxia including Friedreich's ataxia (n = 18), spinocerebellar ataxia type 6 (n = 1), idiopathic cerebellar ataxia (n = 1), and spastic paraplegia 7 (n = 1). Twenty-one patients were recruited to the study, with 19 completing treatment. Sessions were administered via Skype in the LSVT-X format, meaning two sessions per week over a period of 8 weeks. Assessments included two baseline and two post-treatment measures and focused on outcome measures covering aspects ranging from physiological function to impact and participation. Results indicate improvements in patient-perceived outcomes for 14 of the 19 participants, in both speech and psychosocial domains. Speech data furthermore demonstrate significant improvements in prolonged vowel duration, and voice quality measures. Intelligibility and naturalness evaluations showed no change post-treatment. Patients reported high acceptability of the treatment itself, as well as administration by Skype. This is the largest treatment study for people with progressive ataxia published to date. It provides an indication that LSVT LOUD® can have a positive impact on communication in this patient group and could form the basis for larger-scale trials.

Dysphagia and mealtime difficulties in dementia: Speech and language therapists' practices and perspectives.

BACKGROUND: There is increasing recognition of the impact that dementia has upon swallowing and at mealtimes, and the significant effect this can have on people with dementia's health and well-being. However, there remains a paucity of evidence for assessment and intervention practices for dysphagia and mealtime difficulties. Furthermore, there is a limited understanding of how speech and language therapists (SLTs) support people with these dementia-related issues and what are the barriers and facilitators to practice. Further research is therefore needed to guide policy as well as service guideline and delivery development. AIMS: To establish the current practices of SLTs managing dementia-related dysphagia and mealtime difficulties in the UK and Republic of Ireland (ROI), and to establish their opinions and experiences of what challenges or supports to practice they have encountered. METHODS & PROCEDURES: An anonymous, cross-sectional web-based survey was developed and distributed to SLTs working in the UK and ROI. Respondents completed a questionnaire that consisted of open and closed questions across nine topic areas. Closed responses were evaluated using descriptive statistics; open-ended questions were analysed using conventional content analysis. OUTCOMES & RESULTS: A total of 310 people accessed the survey, and 125 respondents completed it fully. While respondents agreed on their role in dysphagia management, they varied in their views on the extent of their role in managing mealtime difficulties. Additionally, their self-rated knowledge of mealtime difficulties in dementia was lower than their dysphagia knowledge. The respondents predominantly based their management decisions on their clinical experience of working with people with dementia. They primarily used compensatory strategies and frequently cited the need for family and care staff training. Respondents also highlighted barriers to effective management and training provision such as inefficient referral systems, a lack of carer knowledge and lack of SLT resources. CONCLUSIONS & IMPLICATIONS: The results provide valuable insight into the issues facing SLTs practising in this area. The SLTs surveyed considered dysphagia a core part of their role when supporting people with dementia; however, respondents' views on mealtime difficulties varied. This highlights the need to establish consensus guidelines on the SLT's role in order to avoid variations in service delivery that could negatively impact the health and well-being of people with dementia. Moreover, further research to develop efficient and effective training for care staff supporting mealtime difficulties and dysphagia is essential. What this paper adds What is already known on the subject Research indicates that people with dementia develop dysphagia and mealtime difficulties as dementia progresses. SLTs often manage these, but there is no research on the effective assessment and management procedures, or guidance on best practice. What this paper adds to existing knowledge This paper provides an understanding of the variation in practice across the UK and ROI. Respondents described barriers to delivering an effective service and frequently linked these to the SLTs' resources as well as service constraints. What are the potential or actual clinical implications of this work? These findings support the need for future research to develop guidelines for SLT practice in this area. They also support the need to examine resource allocation and workforce management to enable SLTs to manage dementia-related dysphagia and mealtime difficulties effectively.

Head and neck cancer risk calculator (HaNC-RC)-V.2. Adjustments and addition of symptoms and social history factors.

OBJECTIVES: Head and neck cancer (HNC) diagnosis through the 2-week wait, urgent suspicion of cancer (USOC) pathway has failed to increase early cancer detection rates in the UK. A head and neck cancer risk calculator (HaNC-RC) has previously been designed to aid referral of high-risk patients to USOC clinics (predictive power: 77%). Our aim was to refine the HaNC-RC to increase its prediction potential. DESIGN: Following sample size calculation, prospective data collection and statistical analysis of referral criteria and outcomes. SETTING: Large tertiary care cancer centre in Scotland. PARTICIPANTS: 3531 new patients seen in routine, urgent and USOC head and neck (HaN) clinics. MAIN OUTCOME MEASURES: Data collected were as follows: demographics, social history, presenting symptoms and signs and HNC diagnosis. Univariate and multivariate regression analysis were performed to identify significant predictors of HNC. Internal validation was performed using 1000 sample bootstrapping to estimate model diagnostics included the area under the receiver operator curve (AUC), sensitivity and specificity. RESULTS: The updated version of the risk calculator (HaNC-RC v.2) includes age, gender, unintentional weight loss, smoking, alcohol, positive and negative symptoms and signs of HNC. It has achieved an AUC of 88.6% with two recommended triage referral cut-offs to USOC (cut-off: 7.1%; sensitivity: 85%, specificity: 78.3%) or urgent clinics (cut-off: 2.2%; sensitivity: 97.1%; specificity of 52.9%). This could redistribute cancer detection through USOC clinics from the current 60.9%-85.2%, without affecting total numbers seen in each clinical setting. CONCLUSIONS: The use of the HaNC-RC v.2 has a significant potential in both identifying patients at high risk of HNC early thought USOC clinics but also improving health service delivery practices by reducing the number of inappropriately urgent referrals.

What does it take to stress a word? Digital manipulation of stress markers in ataxic dysarthria.

BACKGROUND: Stress production is important for effective communication, but this skill is frequently impaired in people with motor speech disorders. The literature reports successful treatment of these deficits in this population, thus highlighting the therapeutic potential of this area. However, no specific guidance is currently available to clinicians about whether any of the stress markers are more effective than others, to what degree they have to be manipulated, and whether strategies need to differ according to the underlying symptoms. AIMS: In order to provide detailed information on how stress production problems can be addressed, the study investigated (1) the minimum amount of change in a single stress marker necessary to achieve significant improvement in stress target identification; and (2) whether stress can be signalled more effectively with a combination of stress markers. METHODS & PROCEDURES: Data were sourced from a sentence stress task performed by 10 speakers with ataxic dysarthria and 10 healthy matched control participants. Fifteen utterances perceived as having incorrect stress patterns (no stress, all words stressed or inappropriate word stressed) were selected and digitally manipulated in a stepwise fashion based on typical speaker performance. Manipulations were performed on F0, intensity and duration, either in isolation or in combination with each other. In addition, pitch contours were modified for some utterances. A total of 50 naïve listeners scored which word they perceived as being stressed. OUTCOMES & RESULTS: Results showed that increases in duration and intensity at levels smaller than produced by the control participants resulted in significant improvements in listener accuracy. The effectiveness of F0 increases depended on the underlying error pattern. Overall intensity showed the most stable effects. Modifications of the pitch contour also resulted in significant improvements, but not to the same degree as amplification. Integration of two or more stress markers did not result in better results than manipulation of individual stress markers, unless they were combined with pitch contour modifications. CONCLUSIONS & IMPLICATIONS: The results highlight the potential for improvement of stress production in speakers with motor speech disorders. The fact that individual parameter manipulation is as effective as combining them will facilitate the therapeutic process considerably, as will the result that amplification at lower levels than seen in typical speakers is sufficient. The difference in results across utterance sets highlights the need to investigate the underlying error pattern in order to select the most effective compensatory strategy for clients.

Rate-related kinematic changes in younger and older adults.

AIMS: This study aimed to investigate the effects of speech rate changes on kinematic characteristics and stability of speech movements in younger and older speakers using electromagnetic midsagittal articulography. PATIENTS AND METHODS: Eight young adults and 8 older adults engaged in a series of syllable repetition tasks of /pa/, /sa/ and /ta/ obtained at self-paced slow, habitual and fast speech rates, as well as in a series of metronome-guided speech rates, ranging from 2 to 4 syllables per second. The kinematic parameters duration, amplitude and peak velocity were obtained for opening and closing movements. RESULTS: Older speakers were able to increase speech rate to the same degree or higher compared to younger speakers in both pacing conditions. Kinematic data show that older adults increased duration and decreased peak velocity in closing movements of alveolar constrictions at slower rates more prominently than younger adults. The results on movement stability revealed no differences between age groups. CONCLUSIONS: The results suggest that an age-related difference in speed-accuracy trade-off can be ruled out. Differences in kinematic characteristics point towards the possibility that older adults aimed to facilitate a closed-loop control system to maintain movement stability at slower speech rates.

Digital health in head and neck cancer: a systematic review.

OBJECTIVE: Digital health tools are increasingly being recognised as effective interventions in monitoring chronic health conditions. This systematic review addressed how digital health is currently utilised in patients with head and neck cancer as an adjunct to care. METHOD: Studies of the development or evaluation of an eHealth, telemedicine or telemonitoring tool were eligible. A narrative synthesis was performed as per Preferred Reporting Items for Systematic Review and Meta-Analyses reporting guidelines. RESULTS: Twenty-nine studies of digital health tools in head and neck cancer were identified. Nine were randomised, controlled trials but most had concern of bias. Fourteen (48 per cent) of the interventions used multiple modes of delivery. The primary digital tool functions are symptom tracking and self-care, prehabilitation and rehabilitation, psychological support, and education, including decision aids. Most tools aimed to support patients during active cancer treatment. CONCLUSION: There are a small number of digital health tools for head and neck cancer patients; however, there is a lack of well-designed randomised, controlled trials to demonstrate effectiveness.

Phonological and phonetic marking of information status in Foreign Accent Syndrome.

BACKGROUND: Foreign Accent Syndrome (FAS) is a motor speech disorder in which a variety of segmental and suprasegmental errors lead to the perception of a new accent in speech. Whilst changes in intonation have been identified to contribute considerably to the perceived alteration in accent, research has rarely focused on how these changes impact on the pragmatic use of intonation. However, a greater understanding of the role of intonational changes in FAS and its impact on the functional use of intonation is fundamental to developing appropriate assessment and subsequently treatment strategies for FAS. AIMS: This study investigated intonation patterns in speakers with FAS and matched control participants with regard to their ability to signal new and given information (information status) within sentences. A phonetic and phonological perspective was taken with the aim of identifying the characteristics that were compromised in FAS to convey this linguistic function. METHODS & PROCEDURES: Four speakers with FAS and four control participants participated in the speech production experiment. The speech data were assessed perceptually, and examined in relation to the use of the phonetic parameters fundamental frequency (f0), intensity and duration as well as phonological categories, i.e. pitch accents and de-accentuation, using the autosegmental-metrical (AM) framework of intonational analysis. OUTCOMES & RESULTS: Both speaker groups employed all three phonetic parameters to differentiate between new and given information. However, groups differed regarding the use of phonological markers, with speakers with FAS frequently placing pitch accents on given information instead of de-accenting these elements. According to the perceptual evaluation, three of the four speakers with FAS had problems signalling information status. CONCLUSIONS & IMPLICATIONS: The fact that speakers with FAS marked information status similarly to control speakers at the phonetic level, but failed to do so using phonological categories highlights the importance of assessing phonetic as well as phonological features to gain detailed information about the functional use of intonation in FAS.

Task-based profiles of language impairment and their relationship to cognitive dysfunction in Parkinson's disease.

OBJECTIVE: Parkinson's Disease (PD) is associated with both motor and non-motor problems, such as cognitive impairment. Particular focus in this area has been on the relationship between language impairment and decline in other cognitive functions, with the literature currently inconclusive on how the nature and degree of language impairment relate to cognition or other measures of disease severity. In addition, little information is available on how language problems identified in experimental task set-ups relate to competency in self-generated language paradigms such as picture description, monologues or conversations. This study aimed to inform clinical management of language impairment in PD by exploring (1) language performance across a range of experimental as well as self-generated language tasks, (2) how the relationship between these two aspects might be affected by the nature of the cognitive and language assessment; and (3) to what degree performance can be predicted across the language tasks. METHODS: 22 non-demented people with PD (PwPD) and 22 healthy control participants performed a range of cognitive and language tasks. Cognitive tasks included a screening assessment in addition to tests for set shifting, short term memory, attention, as well as letter and category fluency. Language was investigated in highly controlled grammar tasks as well as a Sentence Generation and a Narrative. RESULTS: The study highlighted impaired ability in set-shifting and letter fluency in the executive function tasks, and a higher rate of grammatical and lexical errors across all language tasks in the PD group. The performance in the grammar task was linked to set shifting ability, but error rates in Sentence Generation and Narrative were independent of this. There was no relevant relationship between performances across the three language tasks. CONCLUSIONS: Our results suggest that there is a link between executive function and language performance, but that this is task dependent in non-demented PwPD. This has implications for the management of language impairment in PD, both for assessment and for designing effective interventions.

The use of technology in the management of children with phonological delay and adults with acquired dysarthria: A UK survey of current speech-language pathology practice.

PURPOSE: Technology is increasingly important for the speech-language pathology profession, but little is currently known about its use by clinicians. This study aimed to determine (i) the types of technology that speech-language pathologists (SLPs) in the UK have access to and use in practice and (ii) the barriers they encounter when assessing and treating adults with acquired dysarthria and children with phonological delay. METHOD: UK SLPs were invited to complete two online surveys covering device availability, the use of technology for the assessment and treatment of acquired dysarthria and phonological delay, and barriers to using technology. Results were analysed using descriptive statistics. RESULT: 126 SLPs completed the surveys. Most respondents had a range of devices available in clinic, including computer and touchscreen devices. Technology was primarily used for treatment to engage clients, provide direct feedback in sessions and encourage home practice. Reported key barriers include lack of knowledge and training, and technical support issues. CONCLUSION: The use of technology in UK clinical practice varies widely, and technology adoption is hampered by various barriers. Findings indicate a need for more collaborative work between SLPs, technologists and policy-makers to develop the evidence-base for technology use in the management of acquired dysarthria and phonological delay.

Symptom burden of people with progressive ataxia, and its wider impact on their friends and relatives: a cross-sectional study.

Background: Progressive ataxias are complex disorders that result in a wide variety of symptoms. Whilst we currently have a relatively good understanding of the symptom patterns associated with the various types of ataxia, and how these diseases progress over time, their impact on the person with ataxia is less well understood. In addition, little is known about how carers, friends and families are affected by them. This paper aims to provide preliminary information on the presence and impact of medical symptoms and day-to-day challenges on people with ataxia and their friends and relatives. Method: Data were extracted from a survey by Ataxia UK for their members. The views of 366 people with ataxia and 52 friends and relatives are reported. Data were analysed for the entire groups, as well as for the three most common ataxia types represented in the sample, Friedreich's ataxia, inherited ataxia (excluding Friedreich's ataxia), and cerebellar ataxia of unknown cause. Results: The survey confirmed the symptom patterns described in previous research, but further showed that the impact of these symptoms can vary across ataxia populations. Similar findings were observed for day-to-day challenges. Friends and relatives experienced similar challenges to people with ataxia, indicating that support provided has to consider those supporting people with ataxia as well as the patient. Respondents also highlighted limitations in terms of accessing support services, and not all services were able to cater fully to their specific needs. Conclusion: This study begins to provide information that can be used in further research to explore the needs of people with ataxia and their carers, friends, and relatives. Such research will support treatment trial design, ensuring patients' needs are considered, help to tailor support services to their needs, and ensure health care professionals have the necessary skills to fully address them.

Ataxias are movement disorders that result in poor coordination and can include a variety of other difficulties, including speech difficulties, heart conditions, and problems with eyesight. Every type of ataxia results in a different pattern of symptoms, and they also differ in the age at which symptoms first appear. In progressive ataxias, symptoms become more severe over time. The medical symptoms often impact daily living, such as moving about, eating and drinking, socialising, or the ability to work. They also affect those who live with or look after the person with ataxia. It is therefore important to collect people's views about how the symptoms of their condition affect their daily lives, and what kind of support helps to alleviate these. This paper reports the results of a survey of people with ataxia and their friends and relatives to explore these questions. It was highlighted that people with ataxia deal with a wide variety of medical symptoms and that these have important effects on their lives. It also showed that those caring for them are similarly affected and also need support. The study has highlighted several areas where more research needs to be conducted to provide effective support for people with ataxia and their friends and relatives, and to inform the design of treatment trials to ensure the needs of patients are being addressed.

Acoustic Identification of Sentence Accent in Speakers with Dysarthria: Cross-Population Validation and Severity Related Patterns.

Dysprosody is a hallmark of dysarthria, which can affect the intelligibility and naturalness of speech. This includes sentence accent, which helps to draw listeners' attention to important information in the message. Although some studies have investigated this feature, we currently lack properly validated automated procedures that can distinguish between subtle performance differences observed across speakers with dysarthria. This study aims for cross-population validation of a set of acoustic features that have previously been shown to correlate with sentence accent. In addition, the impact of dysarthria severity levels on sentence accent production is investigated. Two groups of adults were analysed (Dutch and English speakers). Fifty-eight participants with dysarthria and 30 healthy control participants (HCP) produced sentences with varying accent positions. All speech samples were evaluated perceptually and analysed acoustically with an algorithm that extracts ten meaningful prosodic features and allows a classification between accented and unaccented syllables based on a linear combination of these parameters. The data were statistically analysed using discriminant analysis. Within the Dutch and English dysarthric population, the algorithm correctly identified 82.8 and 91.9% of the accented target syllables, respectively, indicating that the capacity to discriminate between accented and unaccented syllables in a sentence is consistent with perceptual impressions. Moreover, different strategies for accent production across dysarthria severity levels could be demonstrated, which is an important step toward a better understanding of the nature of the deficit and the automatic classification of dysarthria severity using prosodic features.

A model for production, perception, and acquisition of actions in face-to-face communication.

The concept of action as basic motor control unit for goal-directed movement behavior has been used primarily for private or non-communicative actions like walking, reaching, or grasping. In this paper, literature is reviewed indicating that this concept can also be used in all domains of face-to-face communication like speech, co-verbal facial expression, and co-verbal gesturing. Three domain-specific types of actions, i.e. speech actions, facial actions, and hand-arm actions, are defined in this paper and a model is proposed that elucidates the underlying biological mechanisms of action production, action perception, and action acquisition in all domains of face-to-face communication. This model can be used as theoretical framework for empirical analysis or simulation with embodied conversational agents, and thus for advanced human-computer interaction technologies.

Prominence marking in parkinsonian speech and its correlation with motor performance and cognitive abilities.

OBJECTIVES: Research suggests that people with Parkinson's disease (PwPD) do not only suffer from motor but also non-motor impairment. This interdisciplinary study investigated how prominence marking is influenced by problems on the motoric and cognitive level. MATERIALS AND METHODS: We collected speech production data from 38 native German speakers: 19 PwPD (under medication) with a mild to moderate motor impairment, 13 males and 6 females (mean 66.2 years old, SD = 7.7), and 19 healthy age- and gender-matched control participants (mean 65.4 years old, SD = 9.3). Target words were produced in an accented and unaccented condition within a speech production task. The data were analyzed for intensity, syllable duration, F0 and vowel production. Furthermore, we assessed motor impairment and cognitive functions, i.e. working memory, task-switching, attention control and speed of information processing. RESULTS: Both groups were able to mark prominence by increasing pitch, syllable duration and intensity and by adjusting their vowel production. Comparisons between PwPD and control participants revealed that the vowel space was smaller in PwPD even in mildly impaired speakers. Further, task-switching as an executive function, which was tested with the trail making test, was correlated with modulation of F0 and intensity in PwPD: the worse the task-switching performance, the stronger intensity and F0 were modulated (target overshoot). Moreover, motor impairment within the PwPD group was related to a decrease in the acoustic vowel space (target undershoot), which further resulted in a decrease in speech intelligibility and naturalness. This behaviour of target over- and undershoot indicates an inefficient way of prominence marking in PwPD with mildly affected speech. CONCLUSION: PwPD with signs of mild dysarthria did not differ from the control speakers with respect to their strategies of prominence marking. However, only the PwPD overused F0 and intensity in prominent positions. Overmodulation of F0 and intensity was correlated with the patient's task-switching ability and reflected abnormalities in the regulatory mechanism for expressing prosodic prominence. This is the first study to report a link between cognitive skills and speech production at the phonetic level in PwPD.

Sentence stress in children with dysarthria and cerebral palsy.

Purpose: This study aimed to advance our understanding of how children with dysarthria and cerebral palsy (CP) realise sentence stress acoustically, and how well listeners could identify the position of the stressed word within these utterances. Method: Seven children with CP and eight typically developing children participated in the experiment. Stress on target words in two sentence positions was elicited through a picture-based question-answer paradigm. Acoustic parameters of stress [duration, intensity and fundamental frequency (F0)] were measured and compared between stressed and unstressed target words. For the perception experiment, ten listeners were asked to determine the position of the stressed word in the children's productions. Result: Acoustic measures showed that at group level the typically developing children used all three acoustic parameters to mark sentence stress, whereas the children with CP showed changes in duration only. Individual performance variations were evident in both groups. Perceptually, listeners were significantly better at identifying the stressed words in the utterances produced by the typically developing children than those of the children with CP. Conclusion: The results suggest that children with CP can manipulate temporal speech properties to mark stress. This ability to modulate acoustic-prosodic features could be harnessed in intervention to enhance children's functional communication.

Temporal and spatial variability in speakers with Parkinson's Disease and Friedreich's Ataxia.

Speech variability in groups of speakers with Parkinson's disease (PD) and with Friedreich's ataxia was compared with healthy controls. Speakers repeated the same phrase 20 times at one of two rates (fast or habitual). A non-linear analysis of variability was performed which used some of the principles behind the spatio-temporal index (STI). The STI usually employs variation in lip displacement over repetitions of the same utterance and a linear analysis of such signals is conducted to represent the combined variation in spatial and temporal control. When working with patients, audio measures (here we used speech energy) are preferred over kinematics ones as they are minimally disruptive to speech. Non-linear methods allow spatial variability to be estimated separately from temporal variability. The results are tentatively interpreted as showing that PD speakers were distinguished from healthy control speakers in spatial variability and ataxic speakers were distinguished from controls in temporal variability. These findings are consistent with the speech symptoms reported for these disorders. We conclude that the non-linear analysis using the speech energy measure is worth investigating further as it is potentially revealing of the differences underlying these two pathologies.

Convolutional Neural Networks for Pathological Voice Detection.

Acoustic analysis using signal processing tools can be used to extract voice features to distinguish whether a voice is pathological or healthy. The proposed work uses spectrogram of voice recordings from a voice database as the input to a Convolutional Neural Network (CNN) for automatic feature extraction and classification of disordered and normal voice. The novel classifier achieved 88.5%, 66.2% and 77.0% accuracy on training, validation and testing data set respectively on 482 normal and 482 organic dysphonia speech files. It reveals that the proposed novel algorithm on the Saarbruecken Voice Database can effectively been used for screening pathological voice recordings.