"I Just Want People to Think I'm Normal": An Interview Study of Young Swedish Women With Covert Stuttering.

PURPOSE: Research indicates that there is a tendency for females who stutter, more often than males, to use coping strategies that involve covering their stutter, for example, by avoiding situations that require verbal participation. The aim of the study is to increase knowledge about how covert stuttering develops and its impact on self-image and quality of life for women who stutter. METHOD: Eleven young women who stutter covertly were interviewed, and data were subjected to qualitative content analysis. Background information was obtained from the self-report instruments measuring the impact of stuttering on different aspects of life (Overall Assessment of the Speaker's Experiences of Stuttering) and degree of perceived social anxiety (Liebowitz Social Anxiety Scale, Self-Report). RESULTS: Three main themes were identified: (a) managing stuttering, (b) personal aspects, and (c) stuttering as a phenomenon. Shame and a desire to fit in emerged as distinct motives for covering stuttering. The women described that stuttering controlled both life choices and everyday life. Development of self-image had been strongly negatively affected, resulting in social anxiety. The women expressed a particular vulnerability of being a woman who stutters, due to societal norms of female behavior and a lack of female role models who stutter. CONCLUSIONS: The choice of coping strategy was motivated by a desire to "be normal." As a result, stuttering had come to dominate life and affect self-image and life choices. The study highlights the importance for clinicians to be alert to and aware of the fact that the experiences of women who stutter can lead them to develop coping strategies that have far-reaching negative consequences.

Longitudinal changes in functional connectivity in speech motor networks in apraxia of speech after stroke.

Objective: The cerebral substrates of apraxia of speech (AOS) recovery remain unclear. Resting state fMRI post stroke can inform on altered functional connectivity (FC) within cortical language networks. Some initial studies report reduced FC between bilateral premotor cortices in patients with AOS, with lowest FC in patients with the most severe AOS. However, longitudinal FC studies in stroke are lacking. The aims of the present longitudinal study in early post stroke patients with AOS were (i) to compare connectivity strength in AOS patients to that in left hemisphere (LH) lesioned stroke patients without a speech-language impairment, (ii) to investigate the relation between FC and severity of AOS, aphasia and non-verbal oral apraxia (NVOA) and (iii) to investigate longitudinal changes in FC, from the subacute phase to the chronic phase to identify predictors of AOS recovery. Methods: Functional connectivity measures and comprehensive speech-language assessments were obtained at 4 weeks and 6 months after stroke in nine patients with AOS after a LH stroke and in six LH lesioned stroke patients without speech-language impairment. Functional connectivity was investigated in a network for speech production: inferior frontal gyrus (IFG), anterior insula (aINS), and ventral premotor cortex (vPMC), all bilaterally to investigate signs of adaptive or maladaptive changes in both hemispheres. Results: Interhemispheric vPMC connectivity was significantly reduced in patients with AOS compared to LH lesioned patients without speech-language impairment. At 6 months, the AOS severity was associated with interhemispheric aINS and vPMC connectivity. Longitudinal changes in FC were found in individuals, whereas no significant longitudinal change in FC was found at the group level. Degree of longitudinal AOS recovery was strongly associated with interhemispheric IFG connectivity strength at 4 weeks. Conclusion: Early interhemispheric IFG connectivity may be a strong predictor of AOS recovery. The results support the importance of interhemispheric vPMC connection in speech motor planning and severity of AOS and suggest that also bilateral aINS connectivity may have an impact on AOS severity. These findings need to be validated in larger cohorts.

A Cross-Sectional Investigation of the Impact of Stuttering on Swedish Females and Males in Childhood, Adolescence, and Young Adulthood.

PURPOSE: We aimed to cross-sectionally describe the impact of stuttering on persons who stutter (PWS): children, adolescents, and young adults. Based on previous research on PWS and psychosocial health in the general population, we hypothesized that (a) the adverse impact of stuttering in PWS would be larger among adolescents than children and young adults and that (b) females, especially adolescent females, would report being more adversely impacted by their stuttering than males. METHOD: We pooled samples of Swedish PWS, obtaining 162 individuals (75 females and 87 males), aged 7-30 years. We measured the impact of stuttering using age-relevant versions of the Overall Assessment of the Speaker's Experience of Stuttering (OASES). The relationship between OASES score, age, and sex was described using a polynomial model with an interaction term between age and sex to allow for potential differences between females and males' age-related curves. RESULTS: The average trends were that (a) the impact of stuttering was greater for the adolescents than for the children and young adults, and (b) females, especially adolescent females, were on average more impacted by their stuttering than males. Taking self-reported speech fluency into account did not change this pattern. CONCLUSIONS: In line with findings on psychosocial health, communication attitude, and self-esteem in the general population, the impact of stuttering seems to be particularly adverse among adolescents, especially female adolescents. Thus, clinicians need to be aware of the risk that young girls who stutter may develop a negative attitude to speech and communication, and this should also be communicated to caregivers and teachers. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21554877.

Characterization of Mild and Moderate Dysarthria in Parkinson's Disease: Behavioral Measures and Neural Correlates.

Purpose: Alterations in speech and voice are among the most common symptoms in Parkinson's disease (PD), often resulting in motor speech disorders such as hypokinetic dysarthria. We investigated dysarthria, verbal fluency, executive functions, and global cognitive function in relation to structural and resting-state brain changes in people with PD. Methods: Participants with mild-moderate PD (n = 83) were recruited within a randomized controlled trial and divided into groups with varying degrees of dysarthria: no dysarthria (noDPD), mild dysarthria (mildDPD), moderate dysarthria (modDPD), and also combined mildDPD and modDPD into one group (totDPD). Voice sound level and dysphonia, verbal fluency, motor symptoms, executive functions, disease severity, global cognition, and neuroimaging were compared between groups. Gray matter volume and intensity of spontaneous brain activity were analyzed. Additionally, regressions between behavioral and neuroimaging data were performed. Results: The groups differed significantly in mean voice sound level, dysphonia, and motor symptom severity. Comparing different severity levels of dysarthria to noDPD, groups differed focally in resting-state activity, but not in brain structure. In totDPD, lower scores on semantic verbal fluency, a composite score of executive functions, and global cognition correlated with lower superior temporal gyrus volume. Conclusion: This study shows that severity of dysarthria may be related to underlying structural and resting-state brain alterations in PD as well as behavioral changes. Further, the superior temporal gyrus may play an important role in executive functions, language, and global cognition in people with PD and dysarthria.

Behavioural and neuroplastic effects of a double-blind randomised controlled balance exercise trial in people with Parkinson's disease.

Balance dysfunction is a disabling symptom in people with Parkinson's disease (PD). Evidence suggests that exercise can improve balance performance and induce neuroplastic effects. We hypothesised that a 10-week balance intervention (HiBalance) would improve balance, other motor and cognitive symptoms, and alter task-evoked brain activity in people with PD. We performed a double-blind randomised controlled trial (RCT) where 95 participants with PD were randomised to either HiBalance (n = 48) or a control group (n = 47). We found no significant group by time effect on balance performance (b = 0.4 95% CI [-1, 1.9], p = 0.57) or on our secondary outcomes, including the measures of task-evoked brain activity. The findings of this well-powered, double-blind RCT contrast previous studies of the HiBalance programme but are congruent with other double-blind RCTs of physical exercise in PD. The divergent results raise important questions on how to optimise physical exercise interventions for people with PD.Preregistration clinicaltrials.gov: NCT03213873.

Treatment of Hypophonia in Parkinson's Disease Through Biofeedback in Daily Life Administered with A Portable Voice Accumulator.

OBJECTIVES: The purpose of this study was to assess the outcome following continuous tactile biofeedback of voice sound level administered, with a portable voice accumulator to individuals with Parkinson's disease (PD). METHOD: Nine out of 16 participants with PD completed a 4-week intervention program where biofeedback of voice sound level was administered with the portable voice accumulator VoxLog during speech in daily life. The feedback, a tactile vibration signal from the device, was activated when the wearer used a voice sound level below an individually predetermined threshold level, reminding the wearer to increase voice sound level during speech. Voice use was registered in daily life with the VoxLog during the intervention period as well as during one baseline week, one follow-up week post intervention and 1 week 3 months post intervention. Self-to-other ratio (SOR), which is the difference between voice sound level and environmental noise, was studied in multiple noise ranges. RESULTS: A significant increase in SOR across all noise ranges of 2.28 dB (SD: 0.55) was seen for participants with scores above the cut-off for normal function (>26 points) on the cognitive screening test Montreal Cognitive Assessment (MoCA) (n = 5). No significant increase was seen for the group of participants with MoCA scores below 26 (n = 4). Forty-four percent ended their participation early, all which scored below 26 on MoCA (n = 7). CONCLUSIONS: Biofeedback administered in daily life regarding voice level may help individuals with PD to increase their voice sound level in relation to environmental noise in daily life, but only for a limited subset. Only participants with normal cognitive function as screened by MoCA improved their voice sound level in relation to environmental noise.

Using Portable Voice Accumulators to Study Transfer of Speech Outcomes Following Intervention - A Feasibility Study.

OBJECTIVES: To evaluate the process and scientific feasibility of using a portable voice accumulator (PVA) to study carry-over of treatment effects on speech and voice in people with mild-moderate Parkinson's disease. METHODS: The study was guided by the checklist in Consolidated Standards of Reporting Trials (CONSORT) 2010 statement: extension to randomized pilot and feasibility trials. Participants with Parkinson's disease were recruited within the context of a randomized controlled trial with random allocation to intervention with either HiCommunication, a program targeting speech and communication, or HiBalance, a program targeting balance and strength. Before and after intervention data was collected from standardized studio recordings of speech and registrations of voice use in daily life with the PVA VoxLog. RESULTS: Fifteen participants were included in the study and sufficient data was yielded from six of them. Reasons for insufficient data included technical issues and difficulties handling the PVA. Changes in voice sound level from pre to post intervention differed at an individual level when assessed in daily life compared to studio recordings. Registrations in daily life provided information on phonation ratio and ability to adapt voice sound level to environmental noise. CONCLUSION: This study highlights the challenges of studying intervention effects on voice use in daily life using a PVA. Improvements of test protocols in future studies are suggested. We exemplify how PVA data may generate a more detailed and ecologically valid picture of voice use complementing studio recordings of speech. Finally, we encourage technical development of more user-friendly PVAs.

HiCommunication as a novel speech and communication treatment for Parkinson's disease: A feasibility study.

INTRODUCTION: Speech and communication problems are common in Parkinson's disease (PD) and can result in social withdrawal and reduced quality of life. Intervention may improve symptoms but transfer and maintenance remain challenging for many. Access to treatment may also be limited. Group intervention incorporating principles for experience-dependent plasticity may address these challenges. The aim of this study was to develop and study feasibility aspects of a new intervention program for group training of speech and communication in people with PD. MATERIALS & METHODS: Development and content of the program called HiCommunication is described. Core target areas are voice, articulation, word-finding and memory. Five participants with mild-moderate PD completed this feasibility trial. Attendance rate and possible adverse events as well as the participants' experiences were documented. A speech recording and dysarthria testing were completed to study feasibility of the assessment procedure and evaluate possible changes in voice sound level and intelligibility. RESULTS: Attendance rate was 89%. No adverse events occurred. Participants reported a positive experience and limited fatigue. Assessment was completed in approximately 30 min and was well tolerated. Four of five participants had an increased voice sound level during text-reading postintervention and mean intelligibility improved. CONCLUSIONS: Results indicate that HiCommunication is feasible for people with mild-moderate PD. The program was appreciated and well tolerated. Positive outcomes regarding voice sound level and intelligibility were observed; however, the number of participants was very limited. The results motivate that effects of HiCommunication are further studied in a randomized controlled trial, which is ongoing.

Recovery of Apraxia of Speech and Aphasia in Patients With Hand Motor Impairment After Stroke.

Objective: Aphasia and apraxia of speech (AOS) after stroke frequently co-occur with a hand motor impairment but few studies have investigated stroke recovery across motor and speech-language domains. In this study, we set out to test the shared recovery hypothesis. We aimed to (1) describe the prevalence of AOS and aphasia in subacute stroke patients with a hand motor impairment and (2) to compare recovery across speech-language and hand motor domains. In addition, we also explored factors predicting recovery from AOS. Methods: Seventy participants with mild to severe paresis in the upper extremity were assessed; 50% of these (n = 35) had left hemisphere (LH) lesions. Aphasia, AOS and hand motor assessments and magnetic resonance imaging were conducted at 4 weeks (A1) and at 6 months (A2) after stroke onset. Recovery was characterized in 15 participants showing initial aphasia that also had complete follow-up data at 6 months. Results: All participants with AOS and/or aphasia had LH lesions. In LH lesioned, the prevalence of aphasia was 71% and of AOS 57%. All participants with AOS had aphasia; 80% of the participants with aphasia also had AOS. Recovery in aphasia (n = 15) and AOS (n = 12) followed a parallel pattern to that observed in hand motor impairment and recovery correlated positively across speech-language and motor domains. The majority of participants with severe initial aphasia and AOS showed a limited but similar amount of recovery across domains. Lesion volume did not correlate with results from behavioral assessments, nor with recovery. The initial aphasia score was the strongest predictor of AOS recovery. Conclusion: Our findings confirm the common occurrence of AOS and aphasia in left hemisphere stroke patients with a hand motor impairment. Recovery was similar across speech-language and motor domains, even in patients with severe impairment, supporting the shared recovery hypothesis and that similar brain recovery mechanisms are involved in speech-language and motor recovery post stroke. These observations contribute to the knowledge of AOS and its relation to motor and language functions and add information that may serve as a basis for future studies of post stroke recovery. Studies including neuroimaging and/or biological assays are required to gain further knowledge on shared brain recovery mechanisms.

Speech Function Following Deep Brain Stimulation of the Caudal Zona Incerta: Effects of Habitual and High-Amplitude Stimulation.

Purpose Deep brain stimulation (DBS) is often successful in alleviating motor symptoms of essential tremor (ET); however, DBS may also induce adverse speech effects. The caudal zona incerta (cZi) is a promising DBS target for tremor, but less is known about the consequences of cZi DBS for speech. This preliminary study examined how habitual cZi DBS and cZi stimulation at high amplitudes may affect speech function in persons with ET. Method Fourteen participants with ET were evaluated: off stimulation, on habitual cZi DBS, and with unilateral cZi stimulation at increasing stimulation amplitudes. At each stimulation condition, the participants read three 16-word sentences. Two speech-language pathologists made audio-perceptual consensus ratings of overall speech function, articulation, and voice using a visual sort and rate method. Rated functions when off stimulation, on habitual cZi DBS, and at maximal-amplitude stimulation were compared using Friedman nonparametric tests. For participants with bilateral habitual DBS (n = 5), the effects of bilateral and unilateral stimulation were described in qualitative terms. Results Habitual cZi DBS had no significant group-level effect on any of the investigated speech parameters. Maximal-amplitude stimulation had a small but significant negative effect on articulation. Participants with reduced articulatory precision (n = 9) had more medially placed electrodes than the nonaffected group (n = 5). Bilateral and unilateral left stimulation had comparable effects on speech. Conclusions Findings from this preliminary study of cZi DBS indicate that speech is generally not affected by stimulation at habitual levels. High-amplitude cZi stimulation may, however, induce adverse effects, particularly on articulation. Instances of decreased articulatory function were associated with stimulation of more medial electrode contacts, which could suggest cerebello-rubrospinal involvement.

Intra- and Interjudge Reliability of the Apraxia of Speech Rating Scale in Early Stroke Patients.

PURPOSE: There is a recognized need for a reliable assessment instrument for apraxia of speech (AOS) diagnosis for post stroke patients. In 2014, Strand and colleagues reported high to excellent intra- and interjudge reliability of the Apraxia of Speech Rating Scale (ASRS) in neurodegenerative speech and language disorders. Excellent interjudge reliability of the ASRS total score has also recently been reported in another study of individuals with chronic AOS after stroke, where the ratings were carried out by two experienced researchers not involved in the development of the instrument. However, it is still not fully determined whether the ASRS is a reliable instrument in assessment of patients in an early phase after stroke, where severe AOS is not uncommon. It is also not determined whether ASRS ratings can be performed reliably by practicing speech-language pathologists (SLPs) without long common experience and joint training. This study therefore addresses these questions. METHOD: The ASRS was administered to thirty-six individuals in the first six months after stroke. The assessment procedures were video recorded. Ten of the recordings were selected for the reliability study, representative of patients typically seen at the actual inpatient ward with varying degrees of AOS severity. Five SLPs from different hospital departments participated as raters. The raters viewed each video and independently rated the presence and severity of AOS using the ASRS. To study intrajudge reliability, a rescoring was performed after a minimum of three weeks. Reliability was calculated using the intraclass correlation coefficient (ICC). RESULTS: Intrajudge agreement for the ASRS total score varied from moderate to excellent (mean ICC = 0.69, 95 % CI [0.60, 0.77]) with most of the mean item level agreements within the categories 'moderate' or 'good. Interjudge reliability was poor for the ASRS total score (ICC = 0.42, 95 % CI [0.35, 0.50]). The item level results varied between moderate and poor, with lack of agreement on several items. CONCLUSIONS: For clinicians without expert knowledge of AOS and limited training using the ASRS, intra- and interjudge reliability of the ASRS is not satisfactory. Also, since some items in the protocol require a certain level of speech production to target the diagnostic marker, findings indicate that the ASRS in its present design has limitations in assessment of severe AOS. As suggested by Strand and colleagues, video examples that illustrate the ASRS characteristics could be one helpful alternative to support clinician training. A minor revision of response definitions of the scale may improve the applicability of the ASRS in severe AOS.

Larger reported impact of stuttering in teenage females, compared to males - A comparison of teenagers' result on Overall Assessment of the Speaker's Experience of Stuttering (OASES).

PURPOSE: The aim of this cross-sectional study was to explore the impact and experience of stuttering, and attitude to communication for female and male teenagers who stutter (TWS) in comparison with teenagers with no stutter (TWNS). METHODS: The Swedish version of the Overall Assessment of the Speaker's Experience of Stuttering (OASES-T-S), was administered to 56 TWS, 13-17 years old (26 females, 30 males). An adapted version of OASES, Attitude to Speech and Communication (ASC), was administered to 233 TWNS. The impact scores were analyzed in relation to sex in TWS and TWNS. RESULTS: Female TWS reported that stuttering had a greater impact on their life than it did on male TWS (on average 0.5 higher impact scores; Hedges' g = 0.87). The differences did not seem to be caused by differences in severity of overt stuttering symptoms. Female and male TWS particularly differed on items related to difficulties in day-to-day communication and affective/behavioral reactions to stuttering. Such sex differences were not as pronounced among TWNS, suggesting that teenage women may be more vulnerable to the negative impact of stuttering than men the same age. CONCLUSION: Female teenagers report more negative experiences and a greater tendency to use avoidance strategies than male teenagers.

Self-Reported Changes in Cognition, Communication and Swallowing in Multiple Sclerosis: Data from the Swedish Multiple Sclerosis Registry and from a National Survey.

PURPOSE: The aim of this study was to investigate self-reported cognition, speech, communication and swallowing changes in a large sample of individuals with multiple sclerosis (MS) in Sweden. A second aim was to update information about speech and language pathology (SLP) services received by people with MS (pwMS). METHOD: Self-ratings of cognition, speech/communication and swallowing registered by pwMS between 2012 and 2018 were retrieved from the Swedish MS Registry. In addition, more detailed information about speech, communication, swallowing and provision of SLP services was collected using an online survey distributed via a national patient organization. RESULTS: In total, entries from 5,289 pwMS were retrieved from the MS Registry. Nearly two thirds of the respondents reported that cognition was affected to some degree, whereas approximately one third perceived some difficulties with speech/communication. A smaller group reported swallowing problems. The majority of those who reported problems with speech/communication also reported problems with cognition. Among the 440 individuals who responded to the MS survey, word-finding difficulties were the most frequently self-reported problem related to communication, and the second most common problem was getting off topic. In all, close to four out of five respondents experienced at least one symptom related to speech and communication, such as speech-related fatigue or imprecise articulation. Swallowing difficulties were reported by one out of four respondents in the MS survey. As a result of their speech difficulties, up to one in three experienced changes in professional or social roles and participation. A limited number of respondents had received SLP services, the most common intervention being voice training. CONCLUSIONS: In MS, changes associated with cognition as well as speech/communication are frequent, cognitive-linguistic symptoms being the most common. Swallowing difficulties are also relatively prevalent. Access to SLP services seems to be insufficient compared to prevalence of perceived symptoms. Considering that the majority of pwMS are part of the working-age population, access to SLP services must be more highly prioritized and must address cognitive-linguistic problems as well as voice, speech and swallowing dysfunction.

Feasibility Aspects of Exploring Exercise-Induced Neuroplasticity in Parkinson's Disease: A Pilot Randomized Controlled Trial.

BACKGROUND: Recent studies indicate that exercise can induce neuroplastic changes in people with Parkinson's disease (PwPD). Reports of feasibility outcomes from existing pilot trials however are, of date, insufficient to enable replication by others in larger definitive trials. OBJECTIVE: To evaluate trial design for a definitive trial by exploring process and scientific feasibility. METHODS: The trial design was a parallel-group RCT pilot with a 1 : 1 allocation ratio to either HiBalance or an active control group (HiCommunication). Both groups received one-hour sessions twice weekly, plus home exercises weekly, for 10 weeks. Participants with mild-to-moderate Parkinson's disease (PD) were recruited via advertisement. Assessment included physical performance, structural and functional MRI, blood sampling, neuropsychological assessment, and speech/voice assessment. Process and scientific feasibility were monitored throughout the study. Process feasibility involved recruitment, participant acceptability of assessments and interventions, assessment procedures (focus on imaging, blood sampling, and dual-task gait analysis), and blinding procedures. Scientific feasibility involved trends in outcome response and safety during group training and home exercises. Data are presented in median, minimum, and maximum values. Changes from pre- to postintervention are reported descriptively. RESULTS: Thirteen participants were included (4 women, mean age 69.7 years), with a recruitment rate of 31%. Attendance rates and follow-up questionnaires indicated that both groups were acceptable to participate. Image quality was acceptable; however, diplopia and/or sleepiness were observed in several participants during MRI. With regard to dual-task gait performance, there appeared to be a ceiling effect of the cognitive tasks with seven participants scoring all correct answers at pretest. Blinding of group allocation was successful for one assessor but was broken for half of participants for the other. CONCLUSIONS: The overall trial design proved feasible to perform, but further strengthening ahead of the definitive RCT is recommended, specifically with respect to MRI setup, cognitive dual-tasks during gait, and blinding procedures. This trial is registered with NCT03213873.

Assessment of speech impairment in patients with Parkinson's disease from acoustic quantifications of oral diadochokinetic sequences.

This investigation aimed at determining whether an acoustic quantification of the oral diadochokinetic (DDK) task may be used to predict the perceived level of speech impairment when speakers with Parkinson's disease (PD) are reading a standard passage. DDK sequences with repeated [pa], [ta], and [ka] syllables were collected from 108 recordings (68 unique speakers with PD), along with recordings of the speakers reading a standardized text. The passage readings were assessed in five dimensions individually by four speech-language pathologists in a blinded and randomized procedure. The 46 acoustic DDK measures were merged with the perceptual ratings of read speech in the same recording session. Ordinal regression models were trained repeatedly on 80% of ratings and acoustic DDK predictors per dimension in 10-folds, and evaluated in testing data. The models developed from [ka] sequences achieved the best performance overall in predicting the clinicians' ratings of passage readings. The developed [pa] and [ta] models showed a much lower performance across all dimensions. The addition of samples with severe impairments and further automation of the procedure is required for the models to be used for screening purposes by non-expert clinical staff.

Development of a method for assessment of dysarthria in a foreign language: a pilot study.

Purpose: It is increasingly more common for Speech and Language Pathologists in Sweden to encounter individuals with dysarthria who speak a different language. The aim of the present pilot study was to develop and test a systematic method to be used in collaboration with an interpreter, for assessment of acquired dysarthria in people speaking a language not familiar to the Speech and Language Pathologist.Methods: Seven participants, speaking standard Arabic, were assessed by a Swedish speaking Speech and Language Pathologist using this method and with help of a certified interpreter. The participants were also assessed with equivalent test items from the Swedish "Dysarthria assessment," with instructions translated to Arabic, by a Speech and Language Pathologist speaking standard Arabic and the results were compared.Results: There were no significant differences between the assessments by the Swedish speaking Speech and Language Pathologist and the Arabic speaking Speech and Language Pathologist in the domains "Respiration and phonation," "Articulation," "Listener Comprehension" and "Severity of dysarthria." There was a significant difference between assessments in the domain "Oromotor and velopharyngeal function." Intra- and inter-rater reliability was also calculated using Intraclass Correlation Coefficient and their 95% Confidence Interval. Intra-rater reliability was excellent and inter-rater reliability was very good.Conclusion: The study indicates that a Speech and Language Pathologist, with help of an interpreter, can carry out an assessment of dysarthria in a language unknown to the Speech and Language Pathologist with results comparable to results from an assessment carried out by a Speech and Language Pathologist who speaks the foreign language.

Voice Use in Daily Life Studied With a Portable Voice Accumulator in Individuals With Parkinson's Disease and Matched Healthy Controls.

Purpose The purpose of this work was to study how voice use in daily life is impacted by Parkinson's disease (PD), specifically if there is a difference in voice sound level and phonation ratio during everyday activities for individuals with PD and matched healthy controls. A further aim was to study how variations in environmental noise impact voice use. Method Long-term registration of voice use during 1 week in daily life was performed for 21 participants with PD (11 male, 10 female) and 21 matched healthy controls using the portable voice accumulator VoxLog. Voice use was assessed through registrations of spontaneous speech in different ranges of environmental noise in daily life and in a controlled studio recording setting. Results Individuals with PD use their voice 50%-60% less than their matched healthy controls in daily life. The difference increases in high levels of environmental noise. Individuals with PD used an average voice sound level in daily life that was 8.11 dB (female) and 6.7 dB (male) lower than their matched healthy controls. Difference in mean voice sound level for individuals with PD and controls during spontaneous speech during a controlled studio registration was 3.0 dB for the female group and 4.1 dB for the male group. Conclusions The observed difference in voice use in daily life between individuals with PD and matched healthy controls is a 1st step to objectively quantify the impact of PD on communicative participation. The variations in voice use in different levels of environmental noise and when comparing controlled and variable environments support the idea that the study of voice use should include methods to assess function in less controlled situations outside the clinical setting.

The EXPANd trial: effects of exercise and exploring neuroplastic changes in people with Parkinson's disease: a study protocol for a double-blinded randomized controlled trial.

BACKGROUND: Parkinson's disease (PD) affects many physiological systems essential for balance control. Recent studies suggest that intensive and cognitively demanding physical exercise programs are capable of inducing plastic brain changes in PD. We have developed a highly challenging balance training (the HiBalance) program that emphasizes critical aspects of balance control through progressively introducing more challenging exercises which incorporates dual-tasking. Earlier studies have shown it to be effective in improving balance, gait and dual-tasking. The study design has thereafter been adjusted to link intervention-induced behavioral changes to brain morphology and function. Specifically, in this randomized controlled trial, we will determine the effects of the HiBalance program on balance, gait and cognition and relate this to task-evoked functional MRI (fMRI), as well as brain-derived neurotrophic factor (BDNF) in participants with mild-moderate PD. METHODS: One hundred participants with idiopathic PD, Hoehn & Yahr stage 2 or 3, ≥ 60 years of age, ≥ 21 on Montreal Cognitive Assessment will be recruited in successive waves and randomized into either the HiBalance program or to an active control group (the HiCommunication program, targeting speech and communication). Both interventions will be performed in small groups, twice a week with 1 h sessions for 10 weeks. In addition, a 1 h, once a week, home exercise program will also be performed. A double-blinded design will be used. At the pre- and post-assessments, participants will be assessed on balance (main outcome), gait, cognitive functions, physical activity, voice/speech function, BDNF in serum and fMRI (3 T Philips) during performance of motor-cognitive tasks. DISCUSSION: Since there is currently no cure for PD, findings of neuroplastic brain changes in response to exercise would revolutionize the way we treat PD, and, in turn, provide new hope to patients for a life with better health, greater independence and improved quality of life. TRIAL REGISTRATION: ClincalTrials.gov: NCT03213873, first posted July 11, 2017.

Long-term effects of Lee Silverman Voice Treatment on daily voice use in Parkinson's disease as measured with a portable voice accumulator.

This study examines the effects of an intensive voice treatment focusing on increasing voice intensity, LSVT LOUD® Lee Silverman Voice Treatment, on voice use in daily life in a participant with Parkinson's disease, using a portable voice accumulator, the VoxLog. A secondary aim was to compare voice use between the participant and a matched healthy control. Participants were an individual with Parkinson's disease and his healthy monozygotic twin. Voice use was registered with the VoxLog during 9 weeks for the individual with Parkinson's disease and 2 weeks for the control. This included baseline registrations for both participants, 4 weeks during LSVT LOUD for the individual with Parkinson's disease and 1 week after treatment for both participants. For the participant with Parkinson's disease, follow-up registrations at 3, 6, and 12 months post-treatment were made. The individual with Parkinson's disease increased voice intensity during registrations in daily life with 4.1 dB post-treatment and 1.4 dB at 1-year follow-up compared to before treatment. When monitored during laboratory recordings an increase of 5.6 dB was seen post-treatment and 3.8 dB at 1-year follow-up. Changes in voice intensity were interpreted as a treatment effect as no significant correlations between changes in voice intensity and background noise were found for the individual with Parkinson's disease. The increase in voice intensity in a laboratory setting was comparable to findings previously reported following LSVT LOUD. The increase registered using ambulatory monitoring in daily life was lower but still reflecting a clinically relevant change.

Assessment of voice, speech and communication changes associated with cervical spinal cord injury.

BACKGROUND: Respiratory muscle impairment following cervical spinal cord injury (CSCI) may lead to reduced voice function, although the individual variation is large. Voice problems in this population may not always receive attention since individuals with CSCI face other, more acute and life-threatening issues that need/receive attention. Currently there is no consensus on the tasks suitable to identify the specific voice impairments and functional voice changes experienced by individuals with CSCI. AIMS: To examine which voice/speech tasks identify the specific voice and communication changes associated with CSCI, habitual and maximum speech performance of a group with CSCI was compared with that of a healthy control group (CG), and the findings were related to respiratory function and to self-reported voice problems. METHODS & PROCEDURES: Respiratory, aerodynamic, acoustic and self-reported voice data from 19 individuals (nine women and 10 men, aged 23-59 years, heights = 153-192 cm) with CSCI (levels C3-C7) were compared with data from a CG consisting of 19 carefully matched non-injured people (nine women and 10 men, aged 19-59 years, heights = 152-187 cm). OUTCOMES & RESULTS: Despite considerable variability of performance, highly significant differences between the group with CSCI and the CG were found in maximum phonation time, maximum duration of breath phrases, maximum sound pressure level and maximum voice area in voice-range profiles (all p = .000). Subglottal pressure was lower and phonatory stability was reduced in some of the individuals with CSCI, but differences between the groups were not statistically significant. Six of 19 had voice handicap index (VHI) scores above 20 (the cut-off for voice disorder). Individuals with a vital capacity below 50% of the expected for an equivalent reference individual performed significantly worse than participants with more normal vital capacity. Completeness and level of injury seemed to impact vocal function in some individuals. CONCLUSIONS & IMPLICATIONS: A combination of maximum performance speech tasks, respiratory tasks and self-reported information on voice problems help to identify individuals with reduced voice function following CSCI. Early identification of individuals with voice changes post-CSCI, and introducing appropriate rehabilitation strategies, may help to minimize development of maladaptive voice behaviours such as vocal strain, which can lead to further impairments and limitations to communication participation.