Effects of near-monotonous speech of persons with Parkinson's disease on listening effort and intelligibility.

The majority of patients with Parkinson's disease (PD) develop hypokinetic dysarthria with a disturbance of prosody. The most important acoustic characteristic of prosodic impairment in PD is a lack of fundamental frequency (F0)-variability. It is well established that a lack of F0-variability can negatively influence the speech intelligibility of neurotypical speakers in background noise. The purpose of this study was to investigate which aspect of processing speech realised by speakers with PD is affected by lack of intonation: intelligibility as measured by a transcription task, scaled intelligibility and/or perceived listening effort when there is no background noise. F0-flattening of Semantically Unpredictable Sentences (SUS) was achieved, while the natural F0-declination was preserved. This kind of F0-flattening affected scaled intelligibility and perceived listening effort, while transcription performance remained unchanged.

A serious game for speech training in dysarthric speakers with Parkinson's disease: Exploring therapeutic efficacy and patient satisfaction.

BACKGROUND: The increasing need for speech therapy due to our ageing population raises the demand on therapeutical resources. To meet this demand, innovative delivery of speech training is required. eHealth applications may provide a solution, as intensified and prolonged training is only possible and affordable in patients' home environment. AIMS: This study explores the effects on speech intelligibility of game-based speech training that provides automatic feedback on loudness, pitch and pronunciation. Additionally, we investigate how satisfied patients are with the game-based speech training and how they experience the automatic feedback. Furthermore, patients' preferences for game-based speech training compared with face-to-face training are explored. METHODS AND PROCEDURES: Eight adult dysarthric speakers with Parkinson's disease (PD) completed a 4-week game-based speech training in their home environment. For each speaker, 24 speech utterances were audio recorded 4 weeks before (T1), immediately before (T2) and immediately after (T3) the training. All speech samples were rated on speech intelligibility by 10 untrained listeners, by comparing them with the corresponding utterances realized by a healthy speaker. Changes over time were analysed using a linear mixed-effects analysis. Patient satisfaction with the game and the automatic feedback was assessed using a questionnaire. The preferences of patients were collected using a paired comparisons procedure in which the patients were asked whether they would prefer game-based or face-to-face speech training in four hypothetical scenarios with different hypothesized levels of speech improvement. OUTCOMES AND RESULTS: While there was no significant difference in speech intelligibility ratings between T1 and T2, we did find one between T2 and T3. At T3, speech intelligibility was rated higher than at T2, indicating positive effects of the game-based speech training. Patients generally seemed satisfied with the game as average ratings were above 7 on a 10-point rating scale. Generally, patients agreed with the automatic feedback and could use it to positively change the way they spoke. Patients prefer the training that provides the highest hypothetical improvement, and thus do not prefer face-to-face above game-based therapy. CONCLUSIONS AND IMPLICATIONS: The results of this study suggest that dysarthric speakers due to PD see game-based speech therapy as a valid alternative for face-to-face therapy and that it leads to an average improvement in speech intelligibility. For an optimal effect and user satisfaction it should preferably not be used in isolation but in combination with face-to-face training. In this manner, the strengths of both therapeutic deliveries can be harnessed. WHAT THIS PAPER ADDS: What is already known on this subject Dysarthric speech in patients with PD is known to benefit from intensified and long-term speech therapy. The increasing need for speech therapy due to our ageing population raises the demand on therapeutical resources making highly frequent and long-term therapy difficult. eHealth provides the opportunity to intensify and prolong speech training in patients' home environment. A drill-and-practice method was employed and investigated in a web-based speech application, indicating positive effects on speech intelligibility. However, participants indicated a lack of variation in exercises making the training less enjoyable. Other research showed that serious games can increase enjoyment during training. What this paper adds to existing knowledge The results of this study show that it is possible to develop a serious game that can be successfully used for speech training by patients with dysarthria due to PD. Comparing speech intelligibility ratings before and after training, we observed significant improvements in speech intelligibility ratings. Patients generally agree with the automatic feedback and can use it to positively change the way they speak. Average ratings were above 7 on a 10-point scale, indicating that patients are satisfied with the game. Patients prefer the type of training (game based or face to face) that provides the highest hypothetical improvement. What are the potential or actual clinical implications of this work? The results of this study suggest that game-based speech training can improve speech intelligibility in patients. This indicates that it can be considered a suitable approach in the treatment of patients with dysarthria due to PD. Patients do not prefer game-based training above face-to-face training in all scenarios. For that reason, for every patient one should carefully consider how to optimally combine game-based and face-to-face training.

Considerations on Effective Feedback in Computerized Speech Training for Dysarthric Speakers.

Introduction: In this article, we consider the role of feedback in computerized speech training for patients with dysarthric speech due to acquired neurological disorders such as Parkinson's disease and stroke. Methods: Based on literature from different fields, we review several issues that play a role when designing feedback for computerized speech training, including serious games. Results: Which speech dimensions (e.g., articulation, loudness) to target in computerized speech feedback, and at what level of detail to provide the feedback, depend on the focus of the specific speech therapy and the technical feasibility of providing reliable speech feedback. Furthermore, feedback that provides knowledge of results generally appears equally effective as knowledge of performance feedback, and is more easily provided in computerized speech training systems. Implicit feedback can be more motivating than explicit feedback (e.g., in serious games), but may be harder to understand. Multimodal feedback is preferred over unimodal feedback to ensure that the feedback message is optimally perceived. Mild negative task-oriented feedback can enhance effort but should be balanced with positive feedback, such as feedback referring to patients' progress. Finally, a balance should be found between the motivational advantages of high-frequency immediate feedback (e.g., in serious games) and the advantages of low-frequency and delayed feedback in preventing patients from becoming dependent on augmented feedback. Conclusions: Several aspects play a role in designing feedback for computerized speech training for dysarthric speakers. Decisions on these aspects should be made carefully, accounting for the specific characteristics of the patient group that is targeted, the focus of the specific speech therapy, and the technological possibilities that are available.

The paired t test and beyond: Recommendations for testing the central tendencies of two paired samples in research on speech, language and hearing pathology.

PURPOSE: In this tutorial we review current practice in the analysis of data obtained in designs involving two dependent samples and evaluate two conventional statistics: the t test for paired samples and its non-parametric alternative, the Wilcoxon Signed Ranks test (WSR). It is a sequel to our tutorial on the analysis of designs with two independent samples on the basis of non-count data (Rietveld & van Hout, 2015). The frequency with which these statistics are used is assessed on the basis of publications on disordered communication in Clinical Linguistics & Phonetics, Journal of Communication Disorders and Journal of Speech, Language and Hearing Research for the time interval 2006-2015. We conclude with a number of recommendations for the analysis and presentation of data. CONCLUSIONS: Researchers should more consistently present the relevant characteristics of their data (means, medians, SD, skewness, tailedness, outliers etc.) and explicitly consider the assumptions that apply to their statistical methods, such as correlations between data obtained on two occasions, interactions between participants and treatment, and the symmetry of difference scores, many of which are hardly ever reported or even tested. Two recommendations are particularly relevant. First, the WSR is not a proper test for central tendencies as a replacement of the conventional t test for paired samples whenever assumptions about the dependent variable are in doubt. Second, researchers should choose statistical procedures on the basis of the null hypothesis (H0) to be tested and not primarily on the basis of the type of data (ordinal or interval). Two relevant H0's in the field of speech-language pathology are: (1) µ1=µ2 (the mean obtained in condition 1 is equal to the mean in condition 2) and (2) p=0.5, which says: the probability to obtain (for instance) higher scores in condition 2 than in condition 1 is 0.5. We recommend the permuted t test for paired samples to test the first H0 and the permuted Brunner-Munzel rank test to test the second.

A pilot study into a possible relationship between diet and stuttering.

PURPOSE: There are theoretical and empirical reasons to consider a potential role for copper metabolism in the brain in how it could influence stuttering. However, a link between stuttering and dietary intake has never been researched in a systematic way. This pilot study therefore aimed to explore a possible association between ingested amounts of copper and thiamine (vitamin B1) with stuttering frequency using a double blind cross-over longitudinal paradigm. METHODS: 19 adults who stutter between 20 and 51 years old filled out an online survey for 9 consecutive weeks. The survey consisted of self-assessed fluency and mood state scales, as well as food journals. After 4 weeks, the participants consumed either copper or thiamine supplements for 2 weeks, followed by a 1-week washout period, and another period of two weeks taking the other supplement. Formal speech assessments were done pre/post baseline and at the end of each supplement intake. Participants were not informed about the nature of the supplements during the experiment and the investigators were blinded to the order of the supplements. RESULTS: The results demonstrated that copper and thiamine had no measurable effect on the amount of stuttering (self and formal assessments) but there was a moderate, significant correlation between mood state and fluency. CONCLUSION: The findings do not support notions of dietary influences of ingested copper or thiamine on stuttering but do provide modest support for a relationship between variations in stuttering and self-perceived anxiety.

An Exploratory Investigation of E-Rest: Teletherapy for Chronically Aphasic Speakers.

Delivering aphasia therapy via telecommunication may provide a means to deliver intensive therapy in a cost-effective way. Teletherapy, remotely-administered (language) treatment, may support the repetitive drill practices that people with chronic aphasia need to perform when learning to compensate for their lasting language difficulties. The use of teletherapy may allow speech and language pathologists (SLPs) to focus in-person sessions more strongly on the generalisation of therapy effects to daily life. This single subject study is an investigation whether a teletherapy application called e-REST meets the criteria of accessibility, user-friendliness, as well as effectiveness. e-REST, the teletherapy version of the Dutch and adapted Reduced Syntax Therapy, teaches chronically aphasic speakers of Dutch who experience difficulties in sentence production to convey their messages in a kind of telegraphic style. The results obtained suggest that it is reasonable to conduct a larger study into the user-friendliness, accessibility, effectiveness, and cost-effectiveness of e-REST.

Intuitive visualizations of pitch and loudness in speech.

Visualizing acoustic features of speech has proven helpful in speech therapy; however, it is as yet unclear how to create intuitive and fitting visualizations. To better understand the mappings from speech sound aspects to visual space, a large web-based experiment (n = 249) was performed to evaluate spatial parameters that may optimally represent pitch and loudness of speech. To this end, five novel animated visualizations were developed and presented in pairwise comparisons, together with a static visualization. Pitch and loudness of speech were each mapped onto either the vertical (y-axis) or the size (z-axis) dimension, or combined (with size indicating loudness and vertical position indicating pitch height) and visualized as an animation along the horizontal dimension (x-axis) over time. The results indicated that firstly, there is a general preference towards the use of the y-axis for both pitch and loudness, with pitch ranking higher than loudness in terms of fit. Secondly, the data suggest that representing both pitch and loudness combined in a single visualization is preferred over visualization in only one dimension. Finally, the z-axis, although not preferred, was evaluated as corresponding better to loudness than to pitch. This relation between sound and visual space has not been reported previously for speech sounds, and elaborates earlier findings on musical material. In addition to elucidating more general mappings between auditory and visual modalities, the findings provide us with a method of visualizing speech that may be helpful in clinical applications such as computerized speech therapy, or other feedback-based learning paradigms.

Stress "Deafness" Reveals Absence of Lexical Marking of Stress or Tone in the Adult Grammar.

A Sequence Recall Task with disyllabic stimuli contrasting either for the location of prosodic prominence or for the medial consonant was administered to 150 subjects equally divided over five language groups. Scores showed a significant interaction between type of contrast and language group, such that groups did not differ on their performance on the consonant contrast, while two language groups, Dutch and Japanese, significantly outperformed the three other language groups (French, Indonesian and Persian) on the prosodic contrast. Since only Dutch and Japanese words have unpredictable stress or accent locations, the results are interpreted to mean that stress "deafness" is a property of speakers of languages without lexical stress or tone markings, as opposed to the presence of stress or accent contrasts in phrasal (post-lexical) constructions. Moreover, the degree of transparency between the locations of stress/tone and word boundaries did not appear to affect our results, despite earlier claims that this should have an effect. This finding is of significance for speech processing, language acquisition and phonological theory.

The t test and beyond: Recommendations for testing the central tendencies of two independent samples in research on speech, language and hearing pathology.

PURPOSE: In this Tutorial we compare current practice of the analysis of data obtained in designs involving two independent samples with new developments in statistics and evidence on the behavior of conventional statistics. We included t tests, non-parametric alternatives, such as the Wilcoxon-Mann-Whitney test, and recently developed approaches, known as bootstrapping and randomization tests. The relative use of the different statistics is illustrated on the basis of counts carried out in three journals on disordered communication in the time interval 2005-2013: Clinical Linguistics & Phonetics, Journal of Communication Disorders and Journal of Speech, Language and Hearing Research. A number of recommendations are given to guide the researcher in the presentation and analysis of her/his data. CONCLUSIONS: The main messages are (a) that researchers should present more relevant features of their data (means, medians, SD, skewness, tailedness, outliers etc.), (b) not routinely use conventional non-parametric tests like Wilcoxon-Mann-Whitney test in case one or more of the assumptions of t tests are not met, and (c) should consider using less conventional, but robust statistics which have been developed and tested in the last decades.

Direct versus Indirect Treatment for Preschool Children who Stutter: The RESTART Randomized Trial.

OBJECTIVE: Stuttering is a common childhood disorder. There is limited high quality evidence regarding options for best treatment. The aim of the study was to compare the effectiveness of direct treatment with indirect treatment in preschool children who stutter. METHODS: In this multicenter randomized controlled trial with an 18 month follow-up, preschool children who stutter who were referred for treatment were randomized to direct treatment (Lidcombe Program; n = 99) or indirect treatment (RESTART-DCM treatment; n = 100). Main inclusion criteria were age 3-6 years, ≥3% syllables stuttered (%SS), and time since onset ≥6 months. The primary outcome was the percentage of non-stuttering children at 18 months. Secondary outcomes included stuttering frequency (%SS), stuttering severity ratings by the parents and therapist, severity rating by the child, health-related quality of life, emotional and behavioral problems, and speech attitude. RESULTS: Percentage of non-stuttering children for direct treatment was 76.5% (65/85) versus 71.4% (65/91) for indirect treatment (Odds Ratio (OR), 0.6; 95% CI, 0.1-2.4, p = .42). At 3 months, children treated by direct treatment showed a greater decline in %SS (significant interaction time x therapy: ß = -1.89; t(282.82) = -2.807, p = .005). At 18 months, stuttering frequency was 1.2% (SD 2.1) for direct treatment and 1.5% (SD 2.1) for indirect treatment. Direct treatment had slightly better scores on most other secondary outcome measures, but no differences between treatment approaches were significant. CONCLUSIONS: Direct treatment decreased stuttering more quickly during the first three months of treatment. At 18 months, however, clinical outcomes for direct and indirect treatment were comparable. These results imply that at 18 months post treatment onset, both treatments are roughly equal in treating developmental stuttering in ways that surpass expectations of natural recovery. Follow-up data are needed to confirm these findings in the longer term. TRIAL REGISTRATION: isrctn.org ISRCTN24362190.

Treatment intensity and childhood apraxia of speech.

BACKGROUND: Intensive treatment has been repeatedly recommended for the treatment of speech deficits in childhood apraxia of speech (CAS). However, differences in treatment outcomes as a function of treatment intensity have not been systematically studied in this population. AIM: To investigate the effects of treatment intensity on outcome measures related to articulation, functional communication and speech intelligibility for children with CAS undergoing individual motor speech intervention. METHODS & PROCEDURES: A total of 37 children (32-54 months of age) with CAS received 1×/week (lower intensity) or 2×/week (higher intensity) individual motor speech treatment for 10 weeks. Assessments were carried out before and after a 10-week treatment block to study the effects of variations in treatment intensity on the outcome measures. OUTCOMES & RESULTS: The results indicated that only higher intensity treatment (2×/week) led to significantly better outcomes for articulation and functional communication compared with 1×/week (lower intensity) intervention. Further, neither lower nor higher intensity treatment yielded a significant change for speech intelligibility at the word or sentence level. In general, effect sizes for the higher intensity treatment groups were larger for most variables compared with the lower intensity treatment group. CONCLUSIONS & IMPLICATIONS: Overall, the results of the current study may allow for modification of service delivery and facilitate the development of an evidence-based care pathway for children with CAS.

Relationship between perceptual learning in speech and statistical learning in younger and older adults.

Within a few sentences, listeners learn to understand severely degraded speech such as noise-vocoded speech. However, individuals vary in the amount of such perceptual learning and it is unclear what underlies these differences. The present study investigates whether perceptual learning in speech relates to statistical learning, as sensitivity to probabilistic information may aid identification of relevant cues in novel speech input. If statistical learning and perceptual learning (partly) draw on the same general mechanisms, then statistical learning in a non-auditory modality using non-linguistic sequences should predict adaptation to degraded speech. In the present study, 73 older adults (aged over 60 years) and 60 younger adults (aged between 18 and 30 years) performed a visual artificial grammar learning task and were presented with 60 meaningful noise-vocoded sentences in an auditory recall task. Within age groups, sentence recognition performance over exposure was analyzed as a function of statistical learning performance, and other variables that may predict learning (i.e., hearing, vocabulary, attention switching control, working memory, and processing speed). Younger and older adults showed similar amounts of perceptual learning, but only younger adults showed significant statistical learning. In older adults, improvement in understanding noise-vocoded speech was constrained by age. In younger adults, amount of adaptation was associated with lexical knowledge and with statistical learning ability. Thus, individual differences in general cognitive abilities explain listeners' variability in adapting to noise-vocoded speech. Results suggest that perceptual and statistical learning share mechanisms of implicit regularity detection, but that the ability to detect statistical regularities is impaired in older adults if visual sequences are presented quickly.

Phonological markers of information structure: an fMRI study.

In this fMRI study we investigate the neural correlates of information structure integration during sentence comprehension in Dutch. We looked into how prosodic cues (pitch accents) that signal the information status of constituents to the listener (new information) are combined with other types of information during the unification process. The difficulty of unifying the prosodic cues into overall sentence meaning was manipulated by constructing sentences in which the pitch accent did (focus-accent agreement), and sentences in which the pitch accent did not (focus-accent disagreement) match the expectations for focus constituents of the sentence. In case of a mismatch, the load on unification processes increases. Our results show two anatomically distinct effects of focus-accent disagreement, one located in the posterior left inferior frontal gyrus (LIFG, BA6/44), and one in the more anterior-ventral LIFG (BA 47/45). Our results confirm that information structure is taken into account during unification, and imply an important role for the LIFG in unification processes, in line with previous fMRI studies.

Cognitive and graded activity training can alleviate persistent fatigue after stroke: a randomized, controlled trial.

BACKGROUND AND PURPOSE: Fatigue is a common, persistent consequence of stroke, and no evidence-based treatments are currently available to alleviate fatigue. A new treatment combining cognitive therapy (CO) with graded activity training (GRAT), called COGRAT, was developed to alleviate fatigue and fatigue-related symptoms. This study compared the effectiveness of the COGRAT intervention with a CO-only intervention after a 3-month qualification period without intervention. METHODS: This randomized, controlled, assessor-blind clinical trial was conducted in 8 rehabilitation centers. Eighty-three stroke patients (>4 months after stroke) were randomly assigned to 12 weeks of CO or COGRAT after qualification. Seventy-three patients completed treatment and 68 were available at follow-up. Primary outcomes (Checklist Individual Strength-subscale Fatigue (CIS-f); self-observation list-fatigue (SOL-f)) and secondary outcomes (Hospital Anxiety and Depression Scale, Stroke-Adapted Sickness Impact Profile, SOL-pain, SOL-sleep-D, 6-minute walk test) were collected at baseline (before and after qualification period) and after treatment (immediate and 6-month follow-up). RESULTS: The qualification period showed stable outcome measures. Both treatments showed significant beneficial effects on fatigue (CIS-f: η(p)(2)=0.48, P<0.001) and other outcomes (except pain and anxiety) with intention-to-treat analyses. Gains for the COGRAT group exceeded those in the CO group on number of individuals showing clinical improvement on the CIS-f (≥8 points: 58% versus 24%) and on physical endurance (η(p)(2)=0.20, P<0.001). CONCLUSIONS: A 12-week cognitive therapy program can alleviate persistent fatigue after stroke. The best results are obtained when cognitive therapy is augmented with graded activity training. Clinical Trial Registration- URL: http://www.trialregister.nl. Unique identifier: NTR2704.

Evaluating the feasibility and the potential efficacy of e-learning-based speech therapy (EST) as a web application for speech training in dysarthric patients with Parkinson's disease: a case study.

OBJECTIVE: As a Web application for speech training, e-learning-based speech therapy (EST) is assumed to have potential for neurological patients who aim at independent speech training in their home environment. This article reports a case study of a patient with dysarthric speech due to Parkinson's disease (PD) who enrolled in a 4-week intensive speech training through EST. The primary goal was to investigate the feasibility and the potential efficacy of EST as a Web application for speech training in dysarthric patients with PD. MATERIALS AND METHODS: The participant used EST, following a speech training program containing parts of the pitch limiting voice treatment for patients with PD. The feasibility of EST for independent speech training in the home environment was verified through a questionnaire. The questionnaire addressed the participant's individual experiences with EST as well as the extent of satisfaction with technological features of EST, the content of the speech training, and the suitability of the home training environment. The potential efficacy of EST as a device to improve speech intelligibility was investigated using a repeated measures with randomized blocks design. The proportion of correct orthographic transcriptions of semantically unpredictable sentences as well as ratings of perceived intelligibility on a 10-point scale were used as measures for speech intelligibility. RESULTS: Outcomes of the questionnaire resulted in recommendations to enhance EST feasibility. Speech intelligibility, as measured by transcription scores, improved significantly after EST training. This improvement was maintained for 2 weeks after completing the EST training, whereas considerably lower scores were observed after 11 weeks without training. Subjective ratings of intelligibility did not show significant differences across time. CONCLUSIONS: The results of this case study confirm the potential of EST for patients with PD.

E-learning-based speech therapy: a web application for speech training.

Abstract In The Netherlands, a web application for speech training, E-learning-based speech therapy (EST), has been developed for patients with dysarthria, a speech disorder resulting from acquired neurological impairments such as stroke or Parkinson's disease. In this report, the EST infrastructure and its potentials for both therapists and patients are elucidated. EST provides patients with dysarthria the opportunity to engage in intensive speech training in their own environment, in addition to undergoing the traditional face-to-face therapy. Moreover, patients with chronic dysarthria can use EST to independently maintain the quality of their speech once the face-to-face sessions with their speech therapist have been completed. This telerehabilitation application allows therapists to remotely compose speech training programs tailored to suit each individual patient. Moreover, therapists can remotely monitor and evaluate changes in the patient's speech. In addition to its value as a device for composing, monitoring, and carrying out web-based speech training, the EST system compiles a database of dysarthric speech. This database is vital for further scientific research in this area.

Speaking in ellipses: the effect of a compensatory style of speech on functional communication in chronic agrammatism.

This study investigated whether a Dutch and adapted version of Reduced Syntax Therapy (REST) could stimulate and automatise the production of ellipses in Dutch-speaking, chronically agrammatic speakers (N = 12). Ellipses are syntactic frames in which slots for grammatical morphology tend to be lacking (e.g., everybody inside). When elliptical style is applied on a regular basis, the linguistic impairment is circumvented, at least for the greater part. We therefore hypothesised that REST increases participants' functional communication skills (i.e., communicative efficacy and efficiency). This is of relevance because not all chronically agrammatic speakers become skilled at employing ellipses independently. The results of the present study suggested that when elliptical style is applied regularly, chronically agrammatic speakers get their message across more efficiently when compared to error-strewn production of sentential style.

The validity of a simple outcome measure to assess stuttering therapy.

OBJECTIVE: The validity of a simple and not time-consuming self-assessment (SA) Scale was tested to establish progress after or during stuttering therapy. PATIENTS AND METHOD: The scores on the SA scale were related to (1) objective measures (percentage of stuttered syllables, and syllables per minute) and (2) (self-)evaluation tests (self-evaluation questionnaires and perceptual evaluations or judgments of disfluency, naturalness and comfort by naïve listeners). Data were collected from two groups of stutterers at four measurement times: pretherapy, posttherapy, 12 months after therapy and 24 months after therapy. The first group attended the Comprehensive Stuttering Program: an integrated program based on fluency shaping techniques, and the second group participated in a Dutch group therapy: the Doetinchem Method that focuses on emotions and cognitions related to stuttering. RESULTS: Results showed similar score patterns on the SA scale, the self-evaluation questionnaires, the objective measures over time, and significant correlations between the SA scale and syllables per minute, percentage of stuttered syllables, Struggle subscale of the Perceptions of Stuttering Inventory and judged fluency on the T1-T2 difference scores. CONCLUSION: We concluded that the validity of the SA measure was proved and therefore encourage the use of such an instrument when (stuttering) treatment efficacy is studied.

Language-specificity in the perception of paralinguistic intonational meaning.

This study examines the perception of paralinguistic intonational meanings deriving from Ohala's Frequency Code (Experiment 1) and Gussenhoven's Effort Code (Experiment 2) in British English and Dutch. Native speakers of British English and Dutch listened to a number of stimuli in their native language and judged each stimulus on four semantic scales deriving from these two codes: SELF-CONFIDENT versus NOT SELF-CONFIDENT, FRIENDLY versus NOT FRIENDLY (Frequency Code); SURPRISED versus NOT SURPRISED, and EMPHATIC versus NOT EMPHATIC (Effort Code). The stimuli, which were lexically equivalent across the two languages, differed in pitch contour, pitch register and pitch span in Experiment 1, and in pitch register, peak height, peak alignment and end pitch in Experiment 2. Contrary to the traditional view that the paralinguistic usage of intonation is similar across languages, it was found that British English and Dutch listeners differed considerably in the perception of "confident," "friendly," "emphatic," and "surprised." The present findings support a theory of paralinguistic meaning based on the universality of biological codes, which however acknowledges a language-specific component in the implementation of these codes.