Scott G. Adams

Purpose: The primary purpose of this study was to evaluate the effect of three different types of speech amplification devices on spontaneous speech intelligibility of people with hypophonia secondary to Parkinson's disease or parkinsonism. Method: Twenty-one individuals with hypophonia described pictures aloud to their primary communication partner in four device and two noise conditions. Device conditions included no device, a portable wired speech amplifier, a wireless stationary amplifier, and a one-way personal communication system. Noise conditions included quiet and 65-dB multitalker background noise. Speech intelligibility was evaluated from the perspective of two listener groups, familiar communication partners and naive listeners, as a function of device type and noise. Results: Overall, all three devices were associated with improved intelligibility, especially in noise and for longer utterances for both listener groups. Intelligibility was highest for the personal communication system and lowest for the portable wired amplifier. These results for spontaneous speech patterned similarly to those for read sentences reported for these same talkers and listeners in Knowles et al. (2020) . Conclusions: Speech amplification devices demonstrate measurable improvements in intelligibility of spontaneous speech in individuals with hypophonia. Findings add to a growing body of evidence of the potential effectiveness of speech amplification as a management tool for hypophonia. Supplemental Material: https://doi.org/10.23641/asha.31834960

Hypernasality is a common characteristic of several speech disorders and can significantly affect perceived speech intelligibility and quality. Nasometry quantifies nasalance by calculating the proportion of acoustic energy emitted from the nasal cavity relative to the combined nasal and oral acoustic output during speech production and is commonly used in clinical assessment and research. However, commercially available nasometers are costly and limited in portability, restricting their use in resource-limited or remote settings. The primary purpose of this study was to design and build a low-cost, open-source mobile nasometer prototype (“mNasometer”) by leveraging advances in 3D printing, off-the-shelf electronic components, and a custom open-source mobile application. A secondary aim was to compare the electroacoustic and subjective performance of mNasometer with that of a gold-standard commercial nasometer. Electroacoustic analyses focused on comparing long-term averaged spectra and the oral/nasal acoustic isolation between the gold-standard commercial nasometer and the proposed mNasometer, which incorporates a 3D-printed nasal separation plate. In addition, nasalance scores were collected from ten healthy young adult participants using both systems during structured speech production tasks (i.e., reading standard passages or nasal sentences). Agreement between devices was evaluated using correlational analyses and comparative statistical procedures. Long-term averaged spectra exhibited similar profiles between the commercial nasometer and the mNasometer across different test stimuli, indicating comparable capture of stimulus energy distributions. Although the mNasometer demonstrated reduced oral–nasal acoustic isolation relative to the commercial system, objective nasalance scores followed similar overall trends between devices, with statistically significant stimulus-dependent differences observed. Frame-wise correlational analyses revealed significant correlations between nasalance measures obtained from the commercial nasometer and the mNasometer across most of the speech production tasks, suggesting that the reduced isolation did not critically compromise measurement correspondence. In summary, the low-cost, open-source mNasometer prototype provides nasalance measurements that show promising agreement with those of a gold-standard commercial device. Its reduced cost and increased portability suggest potential for expanded research and field-based applications in the objective assessment of nasalance.

Purpose: This exploratory study evaluated the test–retest stability of three participation-based patient-reported outcome measures (PROMs) rated by individuals with Parkinson's disease (IWPD), primary communication partners (PCPs) serving as proxy raters, and control participants over three study visits spanning approximately 1 month. Method: Twenty-three IWPD and hypophonia, 23 PCPs, and 30 control participants attended three non-intervention experimental visits. During each visit, all participants completed three participation-based PROMs: Communicative Participation Item Bank (CPIB), Voice Activity and Participation Profile (VAPP), and Levels of Speech Usage Scale (LSUS). Proxy ratings for each PROM were completed by PCPs. Results: Results indicated significant differences between IWPD and control participants on all PROMs. IWPD exhibited lower scores on the CPIB and LSUS and higher scores on the VAPP compared to control participants. There was relative agreement in ratings between IWPD and their PCPs on all PROMs. Finally, there were relatively stable test–retest scores on all three PROMs over the three study visits, both within and between IWPD and PCPs. An exception was a statistically, but not clinically significant, decrease in CPIB scores between Visit 1 and Visit 3 for IWPD. Conclusions: This study has contributed to our understanding of the measurement properties of the CPIB, VAPP, and LSUS related to the test–retest stability of these measures over three time points in IWPD, proxy raters, and control participants. These findings provide additional context in the interpretation of participation-based PROMs in this clinical population and may prove to be useful in interpreting changes to participation-based PROM scores.

Introduction: Cerebellar ataxias are a heterogeneous group of disorders clinically manifest as impaired coordination during a voluntary motor task resulting from cortico-cerebellar brain network dysfunction, resulting in multiple motor systems including speech, upper limb dexterous movement and gait. Objective assessment of these dysfunctional motor domains provides vital clues in assessing the underlying pathophysiology. Methods: In this study, speech, upper limb kinematics and gait were studied using acoustic software (Praat), upper limb robot (KINARM) and gait carpet (Zeno Walkway with PKMAS). Clinical assessment was conducted using the Scale for the Assessment and Rating of Ataxia (SARA). Results: In speech analysis, ataxia patients had slower and variable ‘tuh’ syllable repetition performance than healthy controls. In KINARM reaching tasks, ataxia patients displayed less accuracy and efficacy as measured by endpoint error (EE) and mean perpendicular error, along with slower mean and peak velocity of arm movements, prolonged reaction time and increased inter-trial variability. Moreover, there were more EEs while applying load during arm movement. Gait analysis revealed reduced cadence, reduced stride velocity, reduced step length, longer time in the double support phase and increased variability of step length, stride velocity, double support percentage and gait cycle time. Conclusion: The study highlights the critical role played by the cerebellum during movement execution and has paved the way for more comprehensive future studies on degenerative cerebellar ataxia, incorporating kinematic measurements in multiple motor domains.

Purpose: The primary purpose of this study was to evaluate how individuals with hypophonia (HP; also referred to as HP participants) and their primary communication partners (PCPs; also referred to as PCP participants) rate communicative participation before and after experience with a speech amplification device. A secondary purpose was to evaluate pre- and post-device effects on self-rated communicative participation for each of the three speech amplification devices trialed outside of the laboratory. Method: Seventeen individuals with HP and their PCPs participated in a crossover design study that compared three different amplification devices: a wired belt-pack amplifier, a wireless stationary amplifier, and a personal frequency modulation (FM) system. Both the individuals with HP and their PCPs self-rated communicative participation at baseline and after trialing each device following 1-week device trial periods at home. Patient-reported outcome measures included the Communicative Effectiveness Survey (CES) and the Voice Activity and Participation Profile (VAPP). Following study completion, participants indicated whether they would like to select a specific device to continue using. Results: Overall, HP participants rated communicative participation following device use higher than that in the pre-device condition, with the FM system resulting in the overall highest VAPP ratings and second highest CES ratings. Furthermore, HP and PCP participants rated these measures similarly. Finally, HP participants who selected a device to continue using self-reported lower total communicative effectiveness scores and greater voice activity limitations and participation restrictions at baseline in comparison to the nonselectors. Conclusions: This study contributes to an increased understanding of how communicative participation is experienced within this clinical population resulting from speech amplification. It is suggested that the inclusion of participation-based outcome measurement is essential to ensure a multidimensional and comprehensive approach to device prescription for individuals with HP.

Purpose: The purpose of this study was to quantify changes in acoustic distinctiveness in two groups of talkers with Parkinson's disease as they modify across a wide range of speaking rates. Method: People with Parkinson's disease with and without deep brain stimulation and older healthy controls read 24 carrier phrases at different speech rates. Target nonsense words in the carrier phrases were designed to elicit stop consonants and corner vowels. Participants spoke at seven self-selected speech rates from very slow to very fast, elicited via magnitude production. Speech rate was measured in absolute words per minute and as a proportion of each talker's habitual rate. Measures of segmental distinctiveness included a temporal consonant measure, namely, voice onset time, and a spectral vowel measure, namely, vowel articulation index. Results: All talkers successfully modified their rate of speech from slow to fast. Talkers with Parkinson's disease and deep brain stimulation demonstrated greater baseline speech impairment and produced smaller proportional changes at the fast end of the continuum. Increasingly slower speaking rates were associated with increased temporal contrasts (voice onset time) but not spectral contrasts (vowel articulation). Faster speech was associated with decreased contrasts in both domains. Talkers with deep brain stimulation demonstrated more aberrant productions across all speaking rates. Conclusions: Findings suggest that temporal and spectral segmental distinctiveness are asymmetrically affected by speaking rate modifications in Parkinson's disease. Talkers with deep brain stimulation warrant further investigation with regard to speech changes they make as they adjust their speaking rate.

This paper investigated the performance of a number of acoustic measures, both individually and in combination, in predicting the perceived quality of sustained vowels produced by people impaired with Parkinson’s disease (PD). Sustained vowel recordings were collected from 51 PD patients before and after the administration of the Levodopa medication. Subjective ratings of the overall vowel quality were garnered using a visual analog scale. These ratings served to benchmark the effectiveness of the acoustic measures. Acoustic predictors of the perceived vowel quality included the harmonics-to-noise ratio (HNR), smoothed cepstral peak prominence (CPP), recurrence period density entropy (RPDE), Gammatone frequency cepstral coefficients (GFCCs), linear prediction (LP) coefficients and their variants, and modulation spectrogram features. Linear regression (LR) and support vector regression (SVR) models were employed to assimilate multiple features. Different feature dimensionality reduction methods were investigated to avoid model overfitting and enhance the prediction capabilities for the test dataset. Results showed that the RPDE measure performed the best among all individual features, while a regression model incorporating a subset of features produced the best overall correlation of 0.80 between the predicted and actual vowel quality ratings. This model may therefore serve as a surrogate for auditory-perceptual assessment of Parkinsonian vowel quality. Furthermore, the model may offer the clinician a tool to predict who may benefit from Levodopa medication in terms of enhanced voice quality.

Purpose: The aim of this study was to quantify changes in speech intelligibility in two cohorts of people with Parkinson's disease (PD; those with and without deep brain stimulation [DBS]) across a broad range of self-selected speech rate alterations in (a) read sentences and (b) extemporaneous speech (monologues).Method: Four speaker groups participated in this study: younger and older controls, people with PD undergoing standard pharmaceutical treatment, and people with PD and DBS. Naïve listeners rated the intelligibility of read sentences and extemporaneous monologues, spoken by participants at seven self-selected speech rates from very slow to very fast. Intelligibility was modeled as a function of group, speech rate condition, and speech task.Results: Overall, compared to habitual speech rate, slower speech rate conditions were not associated with changes in speech intelligibility, whereas faster-than-habitual conditions were associated in declines in intelligibility. Results were mediated by group and task effects, such that talkers with PD and DBS were more likely to see intelligibility benefits at slower self-selected speech rates and less likely to see detriments at faster rates, and these differences were amplified in monologues compared to sentences.Conclusion: Findings suggest differences in the ways in which slower and faster speech rate adjustments impact speech intelligibility in people with PD with and without DBS, with the latter demonstrating greater magnitudes of change.

Objective: The purpose of this study was to examine the effectiveness, satisfaction, and acceptance of a low-cost Lombard-response (LR) device in a group of individuals with Parkinson’s disease (IWPD) and their communication partners (CPs).Method: Sixteen IWPD and hypophonia and their CPs participated in the study. The IWPD wore a LR device that included a small MP3 player (Sony Walkman) and headphones playing a multi-talker noise audio file at 80 dB during lab-based speech tasks and during their daily conversational speech over a 2-week device trial period. Outcome measures included average conversational speech intensity and scores on a questionnaire related to speech impairment, communication effectiveness, and device satisfaction.Results: Conversational speech intensity of the IWPD is increased by 7 to 10 dB with the LR device. Following a 2-week trial period, eight of the IWPD (50%) gave the LR device moderate-to-high satisfaction and effectiveness ratings and decided to purchase the device for long-term daily use. At the 4-month follow-up, none of the IWPDs were still using the LR device. Device rejection was related to discomfort (loudness), headaches, interference with cognition, and difficulty controlling device.Conclusion: Short-term acceptance and satisfaction with the LR device was moderate, but long-term acceptance, beyond 4 months, was absent. Future studies are required to determine if other types of low-cost LR devices can be developed that improve long-term efficacy and device acceptance in IWPD and hypophonia.