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Van Der Bruggen S, De Letter M, Rietveld T. Effects of near-monotonous speech of persons with Parkinson's disease on listening effort and intelligibility. CLINICAL LINGUISTICS & PHONETICS 2023:1-14. [PMID: 37913529 DOI: 10.1080/02699206.2023.2272032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
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.
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Affiliation(s)
| | - Miet De Letter
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Toni Rietveld
- Department of Language and Communication, Radboud University Nijmegen, Harlingen, The Netherlands
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Wolfrum V, Lehner K, Heim S, Ziegler W. Clinical Assessment of Communication-Related Speech Parameters in Dysarthria: The Impact of Perceptual Adaptation. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-21. [PMID: 37486782 DOI: 10.1044/2023_jslhr-23-00105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
PURPOSE In current clinical practice, intelligibility of dysarthric speech is commonly assessed by speech-language therapists (SLTs), in most cases by the therapist caring for the patient being diagnosed. Since SLTs are familiar with dysarthria in general and with the speech of the individual patient to be assessed in particular, they have an adaptation advantage in understanding the patient's utterances. We examined whether and how listeners' assessments of communication-related speech parameters vary as a function of their familiarity with dysarthria in general and with the diagnosed patients in particular. METHOD Intelligibility, speech naturalness, and perceived listener effort were assessed in 20 persons with dysarthria (PWD). Patients' speech samples were judged by the individual treating therapists, five dysarthria experts who were unfamiliar with the patients, and crowdsourced naïve listeners. Adaptation effects were analyzed using (a) linear mixed models of overall scoring levels, (b) regression models of severity dependence, (c) network analyses of between-listener and between-parameter relationships, and (d) measures of intra- and interobserver consistency. RESULTS Significant advantages of dysarthria experts over laypeople were found in all parameters. An overall advantage of the treating therapists over nonfamiliar experts was only seen in listening effort. Severity-dependent adaptation effects occurred in all parameters. The therapists' responses were heterogeneous and inconsistent with those of the unfamiliar experts and the naïve listeners. CONCLUSIONS The way SLTs evaluate communication-relevant speech parameters of the PWD whom they care for is influenced not only by adaptation benefits but also by therapeutic biases. This finding weakens the validity of assessments of communication-relevant speech parameters by the treating therapists themselves and encourages the development and use of alternative methods.
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Affiliation(s)
- Vera Wolfrum
- Department of Neurology, Faculty of Medicine, RWTH Aachen University, Germany
| | - Katharina Lehner
- Clinical Neuropsychology Research Group, Institute for Phonetics and Speech Processing, Ludwig Maximilian University of Munich, Germany
| | - Stefan Heim
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Germany
- Research Center Jülich, Institute of Neurosciences and Medicine (INM-1), Germany
- JARA - Translational Brain Medicine, Aachen, Germany
| | - Wolfram Ziegler
- Clinical Neuropsychology Research Group, Institute for Phonetics and Speech Processing, Ludwig Maximilian University of Munich, Germany
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Schölderle T, Haas E, Ziegler W. Speech Naturalness in the Assessment of Childhood Dysarthria. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-11. [PMID: 37343549 DOI: 10.1044/2023_ajslp-23-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
PURPOSE This study investigated perceived speech naturalness estimated by adult listeners in typically developing children and children with dysarthria. We aimed to identify predictors of naturalness among auditory-perceptual parameters and to evaluate the concept of naturalness as a clinical marker of childhood dysarthria. METHOD In a listening experiment, naive adult listeners rated speech naturalness of 144 typically developing children (3-9 years old) and 28 children with neurological conditions (5-9 years old) on a visual analog scale. Speech samples were recorded using the materials of the Bogenhausen Dysarthria Scales-Childhood Dysarthria, which also provides for auditory-perceptual judgments covering all speech subsystems. RESULTS Children with dysarthria obtained significantly lower naturalness ratings compared to typically developing children. However, there was a substantial age effect observable in the typically developing children; that is, younger typically developing children were also perceived as somewhat unnatural. The ratings of the typically developing children were influenced by the occurrence of developmental speech features; for the children with neurological conditions, specific symptoms of dysarthria had an additional effect. In both groups, the perception of naturalness was predominantly determined by the children's articulation and intelligibility. CONCLUSIONS Both symptoms of childhood dysarthria and developmental speech features (e.g., regarding articulation and intelligibility) were associated to some extent with unnatural speech by the listeners. Thus, perceived speech naturalness appears less suitable as a marker of dysarthria in children than in adults.
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Affiliation(s)
- Theresa Schölderle
- Institute for Phonetics and Speech ProcessingLudwig-Maximilians-Universität München, München, Germany
| | - Elisabet Haas
- Institute for Phonetics and Speech ProcessingLudwig-Maximilians-Universität München, München, Germany
| | - Wolfram Ziegler
- Institute for Phonetics and Speech ProcessingLudwig-Maximilians-Universität München, München, Germany
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McAllister T, Nightingale C, Moya-Galé G, Kawamura A, Ramig LO. Crowdsourced Perceptual Ratings of Voice Quality in People With Parkinson's Disease Before and After Intensive Voice and Articulation Therapies: Secondary Outcome of a Randomized Controlled Trial. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1541-1562. [PMID: 37059078 PMCID: PMC10457080 DOI: 10.1044/2023_jslhr-22-00694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Limited research has examined the suitability of crowdsourced ratings to measure treatment effects in speakers with Parkinson's disease (PD), particularly for constructs such as voice quality. This study obtained measures of reliability and validity for crowdsourced listeners' ratings of voice quality in speech samples from a published study. We also investigated whether aggregated listener ratings would replicate the original study's findings of treatment effects based on the Acoustic Voice Quality Index (AVQI) measure. METHOD This study reports a secondary outcome measure of a randomized controlled trial with speakers with dysarthria associated with PD, including two active comparators (Lee Silverman Voice Treatment [LSVT LOUD] and LSVT ARTIC), an inactive comparator (untreated PD), and a healthy control group. Speech samples from three time points (pretreatment, posttreatment, and 6-month follow-up) were presented in random order for rating as "typical" or "atypical" with respect to voice quality. Untrained listeners were recruited through the Amazon Mechanical Turk crowdsourcing platform until each sample had at least 25 ratings. RESULTS Intrarater reliability for tokens presented repeatedly was substantial (Cohen's κ = .65-.70), and interrater agreement significantly exceeded chance level. There was a significant correlation of moderate magnitude between the AVQI and the proportion of listeners classifying a given sample as "typical." Consistent with the original study, we found a significant interaction between group and time point, with the LSVT LOUD group alone showing significantly higher perceptually rated voice quality at posttreatment and follow-up relative to the pretreatment time point. CONCLUSIONS These results suggest that crowdsourcing can be a valid means to evaluate clinical speech samples, even for less familiar constructs such as voice quality. The findings also replicate the results of the study by Moya-Galé et al. (2022) and support their functional relevance by demonstrating that the effects of treatment measured acoustically in that study are perceptually apparent to everyday listeners.
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Affiliation(s)
| | | | | | | | - Lorraine Olson Ramig
- University of Colorado Boulder
- National Center for Voice and Speech, Denver, CO
- Columbia University, New York, NY
- LSVT Global, Inc., Tucson, AZ
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Ziegler W, Schölderle T, Brendel B, Risch V, Felber S, Ott K, Goldenberg G, Vogel M, Bötzel K, Zettl L, Lorenzl S, Lampe R, Strecker K, Synofzik M, Lindig T, Ackermann H, Staiger A. Speech and Nonspeech Parameters in the Clinical Assessment of Dysarthria: A Dimensional Analysis. Brain Sci 2023; 13:brainsci13010113. [PMID: 36672094 PMCID: PMC9856358 DOI: 10.3390/brainsci13010113] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Nonspeech (or paraspeech) parameters are widely used in clinical assessment of speech impairment in persons with dysarthria (PWD). Virtually every standard clinical instrument used in dysarthria diagnostics includes nonspeech parameters, often in considerable numbers. While theoretical considerations have challenged the validity of these measures as markers of speech impairment, only a few studies have directly examined their relationship to speech parameters on a broader scale. This study was designed to investigate how nonspeech parameters commonly used in clinical dysarthria assessment relate to speech characteristics of dysarthria in individuals with movement disorders. Maximum syllable repetition rates, accuracies, and rates of isolated and repetitive nonspeech oral-facial movements and maximum phonation times were compared with auditory-perceptual and acoustic speech parameters. Overall, 23 diagnostic parameters were assessed in a sample of 130 patients with movement disorders of six etiologies. Each variable was standardized for its distribution and for age and sex effects in 130 neurotypical speakers. Exploratory Graph Analysis (EGA) and Confirmatory Factor Analysis (CFA) were used to examine the factor structure underlying the diagnostic parameters. In the first analysis, we tested the hypothesis that nonspeech parameters combine with speech parameters within diagnostic dimensions representing domain-general motor control principles. In a second analysis, we tested the more specific hypotheses that diagnostic parameters split along effector (lip vs. tongue) or functional (speed vs. accuracy) rather than task boundaries. Our findings contradict the view that nonspeech parameters currently used in dysarthria diagnostics are congruent with diagnostic measures of speech characteristics in PWD.
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Affiliation(s)
- Wolfram Ziegler
- Clinical Neuropsychology Research Group (EKN), Institute of Phonetics and Speech Processing, Ludwig-Maximilians-University, 80799 Munich, Germany
- Correspondence:
| | - Theresa Schölderle
- Clinical Neuropsychology Research Group (EKN), Institute of Phonetics and Speech Processing, Ludwig-Maximilians-University, 80799 Munich, Germany
| | - Bettina Brendel
- Clinic for Psychiatry and Psychotherapy, Neurophysiology & Interventional Neuropsychiatry, University of Tübingen, 72076 Tübingen, Germany
| | - Verena Risch
- Clinical Neuropsychology Research Group (EKN), Institute of Phonetics and Speech Processing, Ludwig-Maximilians-University, 80799 Munich, Germany
| | - Stefanie Felber
- Clinical Neuropsychology Research Group (EKN), Institute of Phonetics and Speech Processing, Ludwig-Maximilians-University, 80799 Munich, Germany
| | - Katharina Ott
- Department of Neurology, Klinikum Großhadern, Ludwig-Maximilians-University, 81377 Munich, Germany
| | - Georg Goldenberg
- Clinic for Neuropsychology, City Hospital Munich Bogenhausen, 81925 Munich, Germany
| | - Mathias Vogel
- Clinic for Neuropsychology, City Hospital Munich Bogenhausen, 81925 Munich, Germany
| | - Kai Bötzel
- Department of Neurology, Klinikum Großhadern, Ludwig-Maximilians-University, 81377 Munich, Germany
| | - Lena Zettl
- Medical Clinic and Outpatient Clinic IV, Ludwig-Maximilians-University, 81377 Munich, Germany
| | - Stefan Lorenzl
- Clinic for Neurology, Hospital Agatharied, 83734 Hausham, Germany
| | - Renée Lampe
- School of Medicine, Klinikum Rechts der Isar, Orthopedic Department, Research Unit for Pediatric Neuroorthopedics and Cerebral Palsy of the Buhl-Strohmaier Foundation, Technical University of Munich, 81675 Munich, Germany
| | - Katrin Strecker
- Department of Logopedics, Stiftung ICP Munich, Center for Cerebral Palsy, 81377 Munich, Germany
| | - Matthis Synofzik
- Department of Neurodegenerative Disease, Hertie-Institute for Clinical Brain Research, German Center for Neurodegenerative Diseases (DZNE), and Center for Neurology, University of Tübingen, 72076 Tübingen, Germany
| | - Tobias Lindig
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Hermann Ackermann
- Department of General Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076 Tübingen, Germany
| | - Anja Staiger
- Clinical Neuropsychology Research Group (EKN), Institute of Phonetics and Speech Processing, Ludwig-Maximilians-University, 80799 Munich, Germany
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Hirsch ME, Thompson A, Kim Y, Lansford KL. The Reliability and Validity of Speech-Language Pathologists’ Estimations of Intelligibility in Dysarthria. Brain Sci 2022; 12:brainsci12081011. [PMID: 36009074 PMCID: PMC9406197 DOI: 10.3390/brainsci12081011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 02/01/2023] Open
Abstract
This study examined the reliability and validity of speech-language pathologists’ (SLP) estimations of speech intelligibility in dysarthria, including a visual analog scale (VAS) method and a percent estimation method commonly used in clinical settings. Speech samples from 20 speakers with dysarthria of varying etiologies were used to collect orthographic transcriptions from naïve listeners n=70 and VAS ratings and percent estimations of intelligibility from SLPs n=21. Intra- and interrater reliability for the two SLP intelligibility measures were evaluated, and the relationship between these measures was assessed. Finally, linear regression was used to evaluate the relationship between the naïve listeners’ orthographic transcription scores and the two SLP intelligibility measures. The results indicated that the intrarater reliability for both SLP intelligibility measures was strong, and the interrater reliability between the SLP ratings was moderate to excellent. A moderate positive relationship between SLPs’ VAS ratings and percent estimations was also observed. Finally, both SLPs’ percent estimations and VAS ratings were predictive of naïve listeners’ orthographic transcription scores, with SLPs’ percent estimations being the strongest predictor. In conclusion, the average SLP percent estimations and VAS ratings are valid and reliable intelligibility measures. However, the validity and reliability of these measures vary between SLPs.
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Haas E, Ziegler W, Schölderle T. Intelligibility, Speech Rate, and Communication Efficiency in Children With Neurological Conditions: A Longitudinal Study of Childhood Dysarthria. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1817-1835. [PMID: 35763411 DOI: 10.1044/2022_ajslp-21-00354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE This study aimed to describe communication-related parameters (i.e., intelligibility, speech rate, and communication efficiency) and their developmental courses in children with neurological conditions against the background of typical development. In addition, interrelations between the developmental courses of communication-related parameters and auditory-perceptual ratings related to speech subsystems were investigated. METHOD Fourteen children with neurological conditions (CNC) and 14 typically developing children (CTD), matched for age and gender (four girls; 5;1-8;4 [years;months] at first examination), were assessed at three points in time over an 18-month period. Speech samples were collected using the Bogenhausener Dysarthrie Skalen-Kindliche Dysarthrien (English: Bogenhausen Dysarthria Scales-Childhood Dysarthria), a German tool for the assessment of childhood dysarthria. To assess intelligibility, naïve listeners transcribed audio samples of sentence repetitions of the children. Speech rate was measured by acoustic analyses, and communication efficiency was determined by multiplying the proportion of correctly transcribed syllables with speech rate. Age normalization was performed following a recently published approach. RESULTS On the group level, CNC had conspicuous raw and normalized scores for the three communication-related parameters and were more variable than the CTD group regarding their developmental courses. These differences were more pronounced for intelligibility than for speech rate. A strong relationship between communication-related and speech subsystems-related auditory-perceptual characteristics was apparent only between intelligibility and articulation/resonance. CONCLUSIONS For the first time, age-normalized scores for communication-related parameters were reported in children with neurological disorders and put into a developmental context within the framework of a longitudinal study. Age-normalized intelligibility was more vulnerable to large developmental changes than speech rate and was best predicted by changes in articulation and resonance. Overall, this study may contribute to a more comprehensive and valid clinical assessment of childhood dysarthria and to a better understanding of its developmental dynamics.
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Affiliation(s)
- Elisabet Haas
- Clinical Neuropsychology Research Group, Institute of Phonetics and Speech Processing, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Wolfram Ziegler
- Clinical Neuropsychology Research Group, Institute of Phonetics and Speech Processing, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Theresa Schölderle
- Clinical Neuropsychology Research Group, Institute of Phonetics and Speech Processing, Ludwig-Maximilians-Universität München, Munich, Germany
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