Voice characteristics in the progression of Parkinson's disease

Speech, voice, and language outcomes following deep brain stimulation: A systematic review

BACKGROUND

Deep brain stimulation (DBS) reliably ameliorates cardinal motor symptoms in Parkinson's disease (PD) and essential tremor (ET). However, the effects of DBS on speech, voice and language have been inconsistent and have not been examined comprehensively in a single study.

OBJECTIVE

We conducted a systematic analysis of literature by reviewing studies that examined the effects of DBS on speech, voice and language in PD and ET.

METHODS

A total of 675 publications were retrieved from PubMed, Embase, CINHAL, Web of Science, Cochrane Library and Scopus databases. Based on our selection criteria, 90 papers were included in our analysis. The selected publications were categorized into four subcategories: Fluency, Word production, Articulation and phonology and Voice quality.

RESULTS

The results suggested a long-term decline in verbal fluency, with more studies reporting deficits in phonemic fluency than semantic fluency following DBS. Additionally, high frequency stimulation, left-sided and bilateral DBS were associated with worse verbal fluency outcomes. Naming improved in the short-term following DBS-ON compared to DBS-OFF, with no long-term differences between the two conditions. Bilateral and low-frequency DBS demonstrated a relative improvement for phonation and articulation. Nonetheless, long-term DBS exacerbated phonation and articulation deficits. The effect of DBS on voice was highly variable, with both improvements and deterioration in different measures of voice.

CONCLUSION

This was the first study that aimed to combine the outcome of speech, voice, and language following DBS in a single systematic review. The findings revealed a heterogeneous pattern of results for speech, voice, and language across DBS studies, and provided directions for future studies.

Exploring the impact of type II diabetes mellitus on voice quality

PURPOSE

This cross-sectional study aimed to investigate the potential of voice analysis as a prescreening tool for type II diabetes mellitus (T2DM) by examining the differences in voice recordings between non-diabetic and T2DM participants.

METHODS

60 participants diagnosed as non-diabetic (n = 30) or T2DM (n = 30) were recruited on the basis of specific inclusion and exclusion criteria in Iran between February 2020 and September 2023. Participants were matched according to their year of birth and then placed into six age categories. Using the WhatsApp application, participants recorded the translated versions of speech elicitation tasks. Seven acoustic features [fundamental frequency, jitter, shimmer, harmonic-to-noise ratio (HNR), cepstral peak prominence (CPP), voice onset time (VOT), and formant (F1-F2)] were extracted from each recording and analyzed using Praat software. Data was analyzed with Kolmogorov-Smirnov, two-way ANOVA, post hoc Tukey, binary logistic regression, and student t tests.

RESULTS

The comparison between groups showed significant differences in fundamental frequency, jitter, shimmer, CPP, and HNR (p < 0.05), while there were no significant differences in formant and VOT (p > 0.05). Binary logistic regression showed that shimmer was the most significant predictor of the disease group. There was also a significant difference between diabetes status and age, in the case of CPP.

CONCLUSIONS

Participants with type II diabetes exhibited significant vocal variations compared to non-diabetic controls.

Daily Phonatory Activity of Individuals With Parkinson's Disease

PURPOSE

This study evaluated the amount of phonatory activity of Persons with Parkinson disease (PwPD) compared to adults without Parkinson's disease measured over 3 days. The relationship between the amount of phonatory activity and Voice Handicap Index (VHI) total score was assessed as were differences in voicing activity across 3 days of data collection.

METHODS

Fifteen PwPD receiving dopaminergic medication and fifteen age and sex matched adults without Parkinson's disease completed the VHI and then wore a VocaLog vocal monitor (VM) for 3 consecutive days. From the VM data, the number of 1-second windows with dB sound pressure level > 0 were summed as a measure of phonatory activity (PA) and reported relative to the time the VM was worn (%PA).

RESULTS

The percentage of time the VM was worn did not differ between groups or across days. The PwPD had statistically significantly fewer minutes of PA per day than controls (F = 21.782, P < 0.001) by 54 minutes on average. The %PA also differed significantly (F = 31.825, P < 0.001) with a mean of 11.1% for PwPD and 18.6% for controls. Neither PA nor %PA differed across the 3 days of vocal monitoring. VHI total score was significantly correlated with PA (r = -0.436, P = 0.016) and %PA (r = -0.534, P = 0.002) for all participants.

CONCLUSIONS

The results indicate that PwPD engaged in less verbal communication in their daily environment compared to adults without Parkinson's disease. The findings support reports in the literature indicating that PwPD often have reduced communication participation. Measures such as %PA could serve as a quantifiable metric in future studies assessing communication changes in PwPD as a function of disease progression or therapeutic interventions.

Speech Amplification Device Usage for the Management of Hypophonia: A Survey of Speech-Language Pathologists

PURPOSE

The purpose of this study was to survey speech-language pathologists (SLPs) who assess and treat people with Parkinson's disease (PD) to gather insights into their decision making regarding their use or potential use of speech amplification technology for the management of hypophonia.

METHOD

A total of 111 SLPs who were currently practicing in the United States or Canada and had experience working with clients with PD for at least 2 years completed an anonymous Qualtrics survey. Questions were designed to probe the following areas: (a) degree of familiarity with amplification devices as a form of treatment for PD, (b) attitudes and perceptions of the implementation of these devices for PD, and (c) factors that influence the clinical decision to prescribe such devices.

RESULTS

Most participants (75; 71%) reported they had considered prescribing a device to at least one client with PD. When asked at which stages of speech or voice impairment they would consider the use of an amplification device for clients with PD, the most common response was for clients with moderate or severe hypophonia who were not stimulable for louder speech. However, 36 (32%) respondents indicated they would also consider an amplification device for clients who were stimulable for louder speech with severe hypophonia. When asked to rank the most important factors they would weigh when considering the prescription of an amplification device, they ranked the client's preference and comfort level as the most important consideration.

CONCLUSION

This study provides valuable clinical insights regarding how SLPs can approach utilizing speech amplification devices in the therapy environment.

Clinical Insights Into the Use of Speech Amplification Devices for Managing Hypophonia: Interviews With Speech-Language Pathologists

PURPOSE

The purpose of this qualitative interview study was to identify themes regarding considerations in the usage of speech amplification device usage for people with Parkinson's disease (PD) and hypophonia from the perspective of speech-language pathologists (SLPs).

METHOD

Eligible participants included SLPs currently practicing in the United States or Canada with experience working with clients with PD for at least 2 years. Ten SLPs participated in 60-min interviews conducted via Zoom. A semistructured interview guide was created prior to the interviews. The interviews were transcribed following their completion, and an iterative coding process was used to identify themes using thematic analysis.

RESULTS

Three main themes were identified from the interviews. The first theme encapsulated how clinicians described amplification devices as a potential treatment tool, which highlighted the nuances that may impact selecting an amplification device as a treatment option such as increased hypophonia or dysarthria severity and cognitive decline. The second theme highlighted how device selection depends on the individual needs of the user. Individual client characteristics (such as disease symptoms and individual needs and preferences) may impact the choice of amplification device. The last theme outlined the importance of involving family members in all stages of device use and involving other health care team members on a case-by-case basis.

CONCLUSIONS

The insights provided by the SLP participants help to understand the clinical decisions that are made when determining device candidacy, selecting a device, and evaluating device success. These insights can be used to improve research studies of augmentative management of hypophonia and guide more personalized management decisions.

Functional data analysis of prosodic prominence in Parkinson's disease: a pilot study

This study aims to reveal dynamic changes in prosodic prominence patterns associated with Parkinson's disease (PD). To fulfill this purpose, the study proposes an exploratory methodology involving measuring a novel syllable-based prosody index (SPI) and performing functional principal component analyses (fPCAs) in a semi-automatic manner. First, SPI trajectories were collected from 31 speakers with PD before and after speech therapy and from 36 healthy controls. Then, the SPI trajectories were converted to continuous functions using B-splines. Finally, the functional SPIs were examined using fPCAs. The results showed that PD was associated with an increase of overall prominence for male speakers. The findings regarding higher prominence patterns in PD were supported by traditional phonetic measurements. For female speakers, however, there were no significant differences in prosodic prominence between speakers with PD and healthy controls. The results encourage to explore the proposed methodology also in analyses of other forms of atypical speech.

Sex Differences in the Speech of Persons With and Without Parkinson's Disease

BACKGROUND

Sex differences are apparent in the prevalence and the clinical presentation of Parkinson's disease (PD), but their effects on speech have been less studied.

METHOD

Speech acoustics of persons with (34 females and 34 males) and without (age- and sex-matched) PD were examined, assessing the effects of PD diagnosis and sex on ratings of dysarthria severity and acoustic measures of phonation (fundamental frequency standard deviation, smoothed cepstral peak prominence), speech rate (net syllables per second, percent pause ratio), and articulation (articulatory-acoustic vowel space, release burst precision).

RESULTS

Most measures were affected by PD (dysarthria severity, fundamental frequency standard deviation) and sex (smoothed cepstral peak prominence, net syllables per second, percent pause ratio, articulatory-acoustic vowel space), but without interactions between them. Release burst precision was differentially affected by sex in PD. Relative to those without PD, persons with PD produced fewer plosives with a single burst: females more frequently produced multiple bursts, whereas males more frequently produced no burst at all.

CONCLUSIONS

Most metrics did not indicate that speech production is differentially affected by sex in PD. Sex was, however, associated with disparate effects on release burst precision in PD, which deserves further study.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24388666.

Screening of Voice Pathologies: Identifying the Predictive Value of Voice Acoustic Parameters for Common Voice Pathologies

BACKGROUND

Voice acoustic analysis is important for objectively assessing voice production and diagnosing voice disorders.

AIM

This study aimed to investigate the sensitivity of various voice acoustic parameters in differentiating common voice pathology types.

METHODS

Data from the publicly available Perceptual Voice Qualities Database were analyzed; the database includes recordings of participants with and without voice disorders. A wide range of acoustic parameters was estimated from the recordings, such as alpha ratio, harmonics-to-noise ratio (HNR), cepstral peak prominence smoothed (CPPS), pitch period entropy (PPE), fundamental frequency, jitter, shimmer, and sound pressure levels. The predictive capabilities of the parameters were evaluated using receiver operating characteristic curves. Linear regression analysis determined the associations between parameters and voice disorders. Principal component analysis was conducted to identify important parameters for distinguishing voice disorders.

RESULTS AND CONCLUSION

This study has identified significant differences in acoustic parameters between those with and without voice disorders. Notably, the combination of five parameters-namely, PPE, shimmer, jitter, CPPS, and HNR-was identified as a strong predictor in voice disorder screening. These findings contribute substantially to the field of voice disorders, offering valuable insights for screening and diagnosis.

Self-perceived affective, behavioral, and cognitive reactions associated with voice use in people with Parkinson's disease: a pilot study

PURPOSE

This study aimed to compare the affective, behavioral, and cognitive reactions related to vocal function in people with Parkinson's disease (PWPD) and healthy controls using the Behavior Assessment Battery - Voice (BAB-Voice). The test's internal consistency was also described.

METHODS

31 PWPD and 19 healthy controls were recruited from September 2020 to March 2021. Participants completed four BAB-Voice subtests: Speech Situation Checklist - Emotional Reaction (SSC-ER), the Speech Situation Checklist - Speech Disruption (SSC-SD), Behavior Checklist (BCL), and Communication Attitude Test for Adults (BigCAT), describing the experienced negative emotional reaction, voice disruptions, coping behaviors, and negative attitude regarding communication respectively. Subtest scores were calculated and analyzed.

RESULTS

The scores of the PWPD were significantly different from those of the controls (Pillai's Trace = 0.344, F[4] = 5.508, p = .001, ηp2 = .344): PWPD showed more negative emotions and voice problems, more coping behaviors, and more negative speech-related attitude compared to healthy controls. All subtests showed excellent internal consistency.

CONCLUSIONS

The BAB-Voice proved a tool with a good internal consistency that measured different psychosocial reactions in PWPD versus controls. PWPD exhibited significantly more negative emotions and voice problems in specific speech situations, more coping behaviors, and a more negative speech-related attitude. The specificity of information obtained from the BAB-Voice may aid in improving the treatment planning of voice disorders in PWPD.

High and Wide: An In Silico Investigation of Frequency, Intensity, and Vibrato Effects on Widely Applied Acoustic Voice Perturbation and Noise Measures

OBJECTIVES

This in silico study explored the effects of a wide range of fundamental frequency (fo), source-spectrum tilt (SST), and vibrato extent (VE) on commonly used frequency and amplitude perturbation and noise measures.

METHOD

Using 53 synthesized tones produced in Madde, the effects of stepwise increases in fo, intensity (modeled by decreasing SST), and VE on the PRAAT parameters jitter % (local), relative average perturbation (RAP) %, shimmer % (local), amplitude perturbation quotient 3 (APQ3) %, and harmonics-to-noise ratio (HNR) dB were investigated. A secondary experiment was conducted to determine whether any fo effects on jitter, RAP, shimmer, APQ3, and HNR were stable. A total of 10 sinewaves were synthesized in Sopran from 100 to 1000 Hz using formant frequencies for /a/, /i/, and /u/-like vowels, respectively. All effects were statistically assessed with Kendall's tau-b and partial correlation.

RESULTS

Increasing fo resulted in an overall increase in jitter, RAP, shimmer, and APQ3 values, respectively (P < 0.01). Oscillations of the data across the explored fo range were observed in all measurement outputs. In the Sopran tests, the oscillatory pattern seen in the Madde fo condition remained and showed differences between vowel conditions. Increasing intensity (decreasing SST) led to reduced pitch and amplitude perturbation and HNR (P < 0.05). Increasing VE led to lower HNR and an almost linear increase of all other measures (P < 0.05).

CONCLUSION

These novel data offer a controlled demonstration for the behavior of jitter (local) %, RAP %, shimmer (local) %, APQ3 %, and HNR (dB) when varying fo, SST, and VE in synthesized tones. Since humans will vary in all of these aspects in spoken language and vowel phonation, researchers should take potential resonance-harmonics type effects into account when comparing intersubject or preintervention and postintervention data using these measures.

Raising Awareness About Language- and Culture-Specific Considerations in the Management of Dysarthria Associated With Parkinson's Disease Within the United States

PURPOSE

The purpose of this article is to raise awareness about the importance of diverting from English-centric approaches in the management of dysarthria associated with Parkinson's disease (PD) in the United States, and embracing a language- and culture-specific perspective when working with linguistically and culturally diverse populations within the context of culturally responsive, precision medicine.

METHOD

This tutorial is divided into two primary components: a critical review of language universal and language-specific characteristics of dysarthria associated with PD and their relationship with speech intelligibility, and a practical guide to culturally responsive evidence-based practice for speech-language pathologists.

CONCLUSIONS

We offer a framework for linguistically and culturally appropriate considerations when working with clients with dysarthria associated with PD. While "universal" representations of dysarthria may be part of the big picture, language-specific contributions to speakers' intelligibility should be carefully examined to maximize treatment outcomes. Additionally, an evidence-based model that fully embraces clients' wishes and values within the context of culturally responsive, precision medicine should be prioritized, a practice that may include the use of interpreters.

HEAR4Health: a blueprint for making computer audition a staple of modern healthcare

Recent years have seen a rapid increase in digital medicine research in an attempt to transform traditional healthcare systems to their modern, intelligent, and versatile equivalents that are adequately equipped to tackle contemporary challenges. This has led to a wave of applications that utilise AI technologies; first and foremost in the fields of medical imaging, but also in the use of wearables and other intelligent sensors. In comparison, computer audition can be seen to be lagging behind, at least in terms of commercial interest. Yet, audition has long been a staple assistant for medical practitioners, with the stethoscope being the quintessential sign of doctors around the world. Transforming this traditional technology with the use of AI entails a set of unique challenges. We categorise the advances needed in four key pillars: Hear, corresponding to the cornerstone technologies needed to analyse auditory signals in real-life conditions; Earlier, for the advances needed in computational and data efficiency; Attentively, for accounting to individual differences and handling the longitudinal nature of medical data; and, finally, Responsibly, for ensuring compliance to the ethical standards accorded to the field of medicine. Thus, we provide an overview and perspective of HEAR4Health: the sketch of a modern, ubiquitous sensing system that can bring computer audition on par with other AI technologies in the strive for improved healthcare systems.

Voice improvement following conventional speech therapy combined with singing intervention in people with Parkinson's disease: A three-arm randomised controlled trial

BACKGROUND

Although speech and voice disorders are common in Parkinson's disease (PD), there is insufficient evidence to support the effectiveness of behavioural speech therapies in these patients.

AIMS

This study aimed to examine the effects of a new tele-rehabilitation program, a combining of conventional speech therapy and singing intervention, on voice deficits in patients with PD.

METHODS & PROCEDURES

This study was a three-armed, assessor-masked, randomised controlled trial. Thirty-three people with PD were randomly assigned to the combination therapy, conventional speech therapy, or singing intervention group. This study followed the Consolidated Standards of Reporting Trials guidelines for non-pharmacological treatment. Each patient participated in 12 tele-rehabilitation sessions over 4 weeks. The combination therapy group received speech and singing interventions simultaneously (respiratory, speech, voice, and singing exercises). Voice intensity as a primary outcome and the voice handicap index (VHI), maximum frequency range, jitter and shimmer as secondary outcomes were evaluated 1 week before the first intervention session, 1 week after the last intervention session and 3 months after the last evaluation.

OUTCOMES & RESULTS

The results of repeated measures analysis of variance showed a significant main effect of time on all outcomes in all three groups after treatment (p < 0.001). There was a significant group effect for voice intensity (p < 0.001), VHI (p < 0.001), maximum frequency range (p = 0.014) and shimmer (p = 0.001). The combination therapy group demonstrated a significant outperformance in the VHI and shimmer than the speech therapy (p = 0.038) and singing intervention (p < 0.001) groups. The results of this study also indicated that combination therapy group compared to singing intervention group had a larger effect on voice intensity (p < 0.001), shimmer (p < 0.001) and maximum frequency range (p = 0.048).

CONCLUSIONS & IMPLICATION

The results demonstrated that combining speech therapy with a singing intervention delivered through tele-rehabilitation might be more effective in improving voice problems in patients with PD.

WHAT THIS PAPER ADDS

What is already known on the subject Parkinson's disease (PD) is a neurological disorder that frequently causes disturbances in speech and voice, which negatively affect patients' quality of life. Although speech difficulties occur in 90% of patients with PD, evidence-based treatment options for speech and language problems in these patients are limited. Therefore, further studies are required to develop and assess evidence-based treatment programs. What this study adds The findings of this study showed that a combination therapy program including conventional speech therapy approaches and individual singing intervention provided through tele-rehabilitation may have a greater effect on the improvement of voice problems in people with PD compared to speech therapy and singing intervention alone. What are the clinical implications of this work? Tele-rehabilitation combination therapy is an inexpensive and enjoyable behavioural treatment. The advantages of this method are that it is easy to access, appropriate for many stages of voice problems in PD, requires no prior singing training, encourages voice health and self-management and maximises treatment resources available to people with PD. We believe that the results of this study can provide a new clinical basis for treatment of voice disorders in people with PD.

Continuous theta burst stimulation over right cerebellum for speech impairment in Parkinson's disease: study protocol for a randomized, sham-controlled, clinical trial

Background

Speech impairment is a common symptom of Parkinson's disease (PD) that worsens with disease progression and affects communication and quality of life. Current pharmacological and surgical treatments for PD have inconsistent effects on speech impairment. The cerebellum is an essential part of sensorimotor network that regulates speech production and becomes dysfunctional in PD. Continuous theta-burst stimulation (cTBS) is a non-invasive brain stimulation technique that can modulate the cerebellum and its connections with other brain regions.

Objective

To investigate whether cTBS over the right cerebellum coupled with speech-language therapy (SLT) can improve speech impairment in PD.

Methods

In this randomized controlled trial (RCT), 40 patients with PD will be recruited and assigned to either an experimental group (EG) or a control group (CG). Both groups will receive 10 sessions of standard SLT. The EG will receive real cTBS over the right cerebellum, while the CG will receive sham stimulation. Blinded assessors will evaluate the treatment outcome at three time points: pre-intervention, post-intervention, and at a 12-week follow-up. The primary outcome measures are voice/speech quality and neurobehavioral parameters of auditory-vocal integration. The secondary outcome measures are cognitive function, quality of life, and functional connectivity determined by resting-state functional magnetic resonance imaging (fMRI).

Significance

This trial will provide evidence for the efficacy and safety of cerebellar cTBS for the treatment of speech impairment in PD and shed light on the neural mechanism of this intervention. It will also have implications for other speech impairment attributed to cerebellar dysfunctions.

Clinical trial registration

www.chictr.org.cn, identifier ChiCTR2100050543.

The Dysarthric Expressed Emotional Database (DEED): An audio-visual database in British English

The Dysarthric Expressed Emotional Database (DEED) is a novel, parallel multimodal (audio-visual) database of dysarthric and typical emotional speech in British English which is a first of its kind. It is an induced (elicited) emotional database that includes speech recorded in the six basic emotions: "happiness", "sadness", "anger", "surprise", "fear", and "disgust". A "neutral" state has also been recorded as a baseline condition. The dysarthric speech part includes recordings from 4 speakers: one female speaker with dysarthria due to cerebral palsy and 3 speakers with dysarthria due to Parkinson's disease (2 female and 1 male). The typical speech part includes recordings from 21 typical speakers (9 female and 12 male). This paper describes the collection of the database, covering its design, development, technical information related to the data capture, and description of the data files and presents the validation methodology. The database was validated subjectively (human performance) and objectively (automatic recognition). The achieved results demonstrated that this database will be a valuable resource for understanding emotion communication by people with dysarthria and useful in the research field of dysarthric emotion classification. The database is freely available for research purposes under a Creative Commons licence at: https://sites.google.com/sheffield.ac.uk/deed.

Biomechanical Parameters of Voice in Parkinson's Disease Patients

INTRODUCTION

Previous research on voice in Parkinson's disease (PD) has consistently demonstrated alterations in acoustic parameters, including fundamental frequency (F0), maximum phonation time, Shimmer, and Jitter. However, investigations into acoustic parameter alterations in individuals with PD are limited.

METHODS

We conducted an experimental study involving 20 PD patients (six women and fourteen men). Subjective measures of voice (VHI-30 scale and GRBAS) and objective measures using the OnlineLAB App tool for analyzing biomechanical correlates of voice were recorded. The app analyzed a total of 22 biomechanical parameters of voice.

RESULTS

The results of subjective measures were consistent with findings from previous studies. However, the results of objective measures did not align with studies that employed acoustic measures.

CONCLUSIONS

The biomechanical analysis revealed alterations in various parameters according to gender. These findings open up a new avenue of research in voice analysis for patients with PD, whether through acoustic or biomechanical analysis, aiming to determine whether the observed changes in these patients' voices are attributable to age or disease progression. This line of investigation will help elucidate the relative contribution of these factors to vocal alterations in PD patients and provide a more comprehensive understanding of the underlying mechanisms.

Voice Acoustic Instability During Spontaneous Speech in Parkinson's Disease

BACKGROUND

In people with Parkinson's disease (PwPD), both motor and cognitive deficits influence voice and other aspects of communication. PwPD demonstrate vocal instability, but acoustic declines over the course of speaking are not well characterized and the role of cognition on these declines is unknown. We examined voice acoustics related to speech motor instability by comparing the first and the last utterances within a speech task. Our objective was to determine if mild cognitive impairment (MCI) status was associated with different patterns of acoustic change during these tasks.

METHODS

Participants with PD (n = 44) were enrolled at University of Massachusetts Chan Medical School and classified by gold-standard criteria as normal cognition (PD-NC) or mild cognitive impairment (PD-MCI). The speech was recorded during the Rainbow Passage and a picture description task (Cookie Theft). We calculated the difference between first and last utterances in fo mean and standardized semitones (STSD), cepstral peak prominence-smoothed (CPPS), and low to high ratio (LH). We used t-tests to compare the declines in acoustic parameters between the task types and between participants with PD-NC versus PD-MCI.

RESULTS

Mean fo, fo variability (STSD) and CPPS declined from the first to the last utterance in both tasks, but there was no significant difference in these declines between the PD-NC and PD-MCI groups. Those with PD-MCI demonstrated lower fo variability on the whole in both tasks and lower CPPS in the picture description task, compared to those with PD-NC.

CONCLUSIONS

Mean and STSD fo as well as CPPS may be sensitive to PD-MCI status in reading and spontaneous speech tasks. Speech motor instability can be observed in these voice acoustic parameters over brief speech tasks, but the degree of decline does not depend on cognitive status. These findings will inform the ongoing development of algorithms to monitor speech and cognitive function in PD.

Coordination Rigidity in the Gait, Posture, and Speech of Persons with Parkinson's Disease

Parkinson's disease (PD) is associated with reduced coordination abilities. These can result either in random or rigid patterns of movement. The latter, described here as coordination rigidity (CR), have been studied less often. We explored whether CR was present in gait, quiet stance, and speech-tasks involving coordination among multiple joints and muscles. Kinematic and voice recordings were used to compute measures describing the dynamics of systems with multiple degrees of freedom and nonlinear interactions. After clinical evaluation, patients with moderate stage PD were compared against matched healthy participants. In the PD group, gait dynamics was associated with decreased dynamic divergence-lower instability-in the vertical axis. Postural fluctuations were associated with increased regularity in the anterior-posterior axis, and voice dynamics with increased predictability, all consistent with CR. The clinical relevance of CR was confirmed by showing that some of those features contribute to disease classification with supervised machine learning (82/81/85% accuracy/sensitivity/specificity).

Perceptual and qualitative voice alterations detected by GIRBAS in patients with Parkinson's disease: is there a relation with lung function and oxygenation?

BACKGROUND

Impairments in respiration, voice and speech are common in people with Parkinson's disease (PD).

AIMS

To evaluate the prevalence of dysphonia, assessed by a specific acoustic evaluation and description of the voice by the speech therapist (GIRBAS), and its relation with lung function and oxygenation, in particular cough ability and during the night or exercise desaturation.

METHODS

This is a posthoc analysis of a prospective cross-sectional observational study on PD patients collecting anthropometric and clinical data, comorbidities, PD severity, motor function and balance, respiratory function at rest, during exercise and at night, voice function with acoustic analysis and presence of speech disorders, in addition to the GIRBAS scale. Based on GIRBAS Global dysphonia ('G') score, we divided patients into dysphonic (moderate-to-severe deviance from the euphonic condition) vs. no/mild dysphonic and analyzed the relations with respiratory impairments.

RESULTS

We analyzed 55 patients and found significant impairments in both respiratory and voice/speech functions. Most patients (85.5%) presented mild-to-severe deviance from the euphonic condition in at least one GIRBAS perceptual element (80% of cases for Global dysphonia) and only 14.5% did not show deviance in all elements simultaneously. At Odds Ratio analysis, the risk of presenting nocturnal desaturation and reduced peak cough expiratory flow was approximately 24 and 8 times higher, respectively, in dysphonic patients vs. those with no/mild dysphonia.

CONCLUSION

Perceptual and qualitative evaluation of the voice with GIRBAS showed that mild-to-severe dysphonia was highly prevalent in PD patients, and associated with nocturnal oxygen desaturation and poor cough ability.

Acoustic Voice and Speech Biomarkers of Treatment Status during Hospitalization for Acute Decompensated Heart Failure

This study investigates acoustic voice and speech features as biomarkers for acute decompensated heart failure (ADHF), a serious escalation of heart failure symptoms including breathlessness and fatigue. ADHF-related systemic fluid accumulation in the lungs and laryngeal tissues is hypothesized to affect phonation and respiration for speech. A set of daily spoken recordings from 52 patients undergoing inpatient ADHF treatment was analyzed to identify voice and speech biomarkers for ADHF and to examine the trajectory of biomarkers during treatment. Results indicated that speakers produce more stable phonation, a more creaky voice, faster speech rates, and longer phrases after ADHF treatment compared to their pre-treatment voices. This project builds on work to develop a method of monitoring ADHF using speech biomarkers and presents a more detailed understanding of relevant voice and speech features.

Community Choir Improves Vocal Production Measures in Individuals Living with Parkinson's Disease

OBJECTIVES

Parkinson's disease (PD) is a neurodegenerative disease leading to motor impairments and dystonia across diverse muscle groups including vocal muscles. The vocal production challenges associated with PD have received considerably less research attention than the primary gross motor symptoms of the disease despite having a substantial effect on quality of life. Increasingly, people living with PD are discovering group singing as an asset-based approach to community building that is purported to strengthen vocal muscles and improve vocal quality.

STUDY DESIGN/METHODS

The present study investigated the impact of community choir on vocal production in people living with PD across two sites. Prior to and immediately following a 12-week community choir at each site, vocal testing included a range of vocal-acoustic measures, including lowest and highest achievable pitch, duration of phonation, loudness, jitter, and shimmer.

RESULTS

Results showed that group singing significantly improved some, though not all, measures of vocal production. Group singing improved lowest pitch (both groups), duration (both groups), intensity (one group), and jitter (one group) and shimmer (both groups).

CONCLUSIONS

These findings support community choir as a feasible and scalable complementary approach to managing vocal production challenges associated with PD.

Singing and Speaking Ability in Parkinson's Disease and Spinocerebellar Ataxia

PURPOSE

This study examined spontaneous, spoken-to-a-model, and two sung modes in speakers with Parkinson's disease (PD), speakers with cerebellar disease (CD), and healthy controls. Vocal performance was measured by intelligibility scores and listeners' perceptual ratings.

METHOD

Participants included speakers with hypokinetic dysarthria secondary to PD, those with ataxic dysarthria secondary to CD, and healthy speakers. Participants produced utterances in four vocal modes: spontaneous speech, spoken-to-a-model, sung-to-a-model, and spontaneous singing. For spoken-to-a-model and sung-to-a-model modes, written material was provided the model. For spontaneous singing, participants sang songs that they endorsed as familiar.

DEPENDENT VARIABLES

In Experiment I, listeners orthographically transcribed the audio samples of the first three vocal modes. In Experiment IIa, raters evaluated the accuracy of the pitch and rhythm of the spontaneous singing of familiar songs. Finally, familiar songs and sung-to-a-model utterances were rated on a competency scale by a second group of raters (Experiment IIb).

RESULTS

Results showed increases in intelligibility during the spoken-to-a-model mode compared with the spontaneous mode in both PD and CD groups. Singing enhanced the vocal output of speakers with PD more than in speakers with CD, as measured by percent intelligibility. PD participants' pitch and rhythm accuracy and competency in singing familiar songs was rated more favorably than those produced by CD participants.

CONCLUSIONS

The findings reveal a vocal task effect for spoken utterances in both groups. Sung exemplars, more impaired in CD, suggest a significant involvement of the cerebellum in singing.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21809544.

Speech error rates after a sports-related concussion

Background

Alterations in speech have long been identified as indicators of various neurologic conditions including traumatic brain injury, neurodegenerative diseases, and stroke. The extent to which speech errors occur in milder brain injuries, such as sports-related concussions, is unknown. The present study examined speech error rates in student athletes after a sports-related concussion compared to pre-injury speech performance in order to determine the presence and relevant characteristics of changes in speech production in this less easily detected neurologic condition.

Methods

A within-subjects pre/post-injury design was used. A total of 359 Division I student athletes participated in pre-season baseline speech testing. Of these, 27 athletes (18-22 years) who sustained a concussion also participated in speech testing in the days immediately following diagnosis of concussion. Picture description tasks were utilized to prompt connected speech samples. These samples were recorded and then transcribed for identification of errors and disfluencies. These were coded by two trained raters using a 6-category system that included 14 types of error metrics.

Results

Repeated measures analysis of variance was used to compare the difference in error rates at baseline and post-concussion. Results revealed significant increases in the speech error categories of pauses and time fillers (interjections/fillers). Additionally, regression analysis showed that a different pattern of errors and disfluencies occur after a sports-related concussion (primarily time fillers) compared to pre-injury (primarily pauses).

Conclusion

Results demonstrate that speech error rates increase following even mild head injuries, in particular, sports-related concussion. Furthermore, the speech error patterns driving this increase in speech errors, rate of pauses and interjections, are distinct features of this neurological injury, which is in contrast with more severe injuries that are marked by articulation errors and an overall reduction in verbal output. Future studies should consider speech as a diagnostic tool for concussion.

Wide-Bandwidth Nanocomposite-Sensor Integrated Smart Mask for Tracking Multiphase Respiratory Activities

Wearing masks has been a recommended protective measure due to the risks of coronavirus disease 2019 (COVID-19) even in its coming endemic phase. Therefore, deploying a "smart mask" to monitor human physiological signals is highly beneficial for personal and public health. This work presents a smart mask integrating an ultrathin nanocomposite sponge structure-based soundwave sensor (≈400 µm), which allows the high sensitivity in a wide-bandwidth dynamic pressure range, i.e., capable of detecting various respiratory sounds of breathing, speaking, and coughing. Thirty-one subjects test the smart mask in recording their respiratory activities. Machine/deep learning methods, i.e., support vector machine and convolutional neural networks, are used to recognize these activities, which show average macro-recalls of ≈95% in both individual and generalized models. With rich high-frequency (≈4000 Hz) information recorded, the two-/tri-phase coughs can be mapped while speaking words can be identified, demonstrating that the smart mask can be applicable as a daily wearable Internet of Things (IoT) device for respiratory disease identification, voice interaction tool, etc. in the future. This work bridges the technological gap between ultra-lightweight but high-frequency response sensor material fabrication, signal transduction and processing, and machining/deep learning to demonstrate a wearable device for potential applications in continual health monitoring in daily life.

Speech and language characteristics differentiate Alzheimer's disease and dementia with Lewy bodies

Introduction

Early differential diagnosis of Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) is important, but it remains challenging. Different profiles of speech and language impairments between AD and DLB have been suggested, but direct comparisons have not been investigated.

Methods

We collected speech responses from 121 older adults comprising AD, DLB, and cognitively normal (CN) groups and investigated their acoustic, prosodic, and linguistic features.

Results

The AD group showed larger differences from the CN group than the DLB group in linguistic features, while the DLB group showed larger differences in prosodic and acoustic features. Machine-learning classifiers using these speech features achieved 87.0% accuracy for AD versus CN, 93.2% for DLB versus CN, and 87.4% for AD versus DLB.

Discussion

Our findings indicate the discriminative differences in speech features in AD and DLB and the feasibility of using these features in combination as a screening tool for identifying/differentiating AD and DLB.

Mixed kernel SVR addressing Parkinson's progression from voice features

Parkinson’s Disease (PD) is a progressive neurodegenerative disease with multiple motor and non-motor characteristics. PD patients commonly face vocal impairments during the early stages of the disease. In this article, the aim is to explain the Unified Parkinson’s Disease Rating Scale (UPDRS) as a measure of the progression of Parkinson’s disease using a set of covariates obtained from voice signals. In particular, a Support Vector Regression (SVR) model based on a combination of kernel functions is introduced. Theoretically, this proposal, that relies on a mixed kernel (global and local) produces an admissible kernel function. The optimal fitting was obtained for the combination given by the product of radial and polynomial basis. Important results are the non-linear relationships inferred from the features to the response, as well as a considerable improvement in prediction performance metrics, when compared to other learning approaches. Furthermore, with knowledge on factors such as age and gender, it is possible to describe the dynamics of patients’ UPDRS from the data collected during their monitoring. In summary, these advances could expand learning processes and intelligent systems to assist in monitoring the evolution of Parkinson’s disease.

Minimally Detectable Change of Speech Intelligibility in Speakers With Multiple Sclerosis and Parkinson's Disease

PURPOSE

This study sought to determine the minimally detectable change (MDC) of sentence intelligibility for speakers with multiple sclerosis (MS) and Parkinson's disease (PD).

METHOD

Speakers included 78 participants consisting of 32 neurologically healthy control speakers, 30 speakers with MS, and 16 speakers with PD. All speakers were recorded reading 11 sentences comprising the Speech Intelligibility Test (SIT), which were subsequently transcribed by inexperienced listeners. Percent correct scores were calculated for each sentence. An average percent correct score was also calculated for each speaker. The MDC at the 95% confidence interval was calculated using the following formula: MDC₉₅ = 1.96 × √2 × standard error of measurement. Speakers were divided into operationally defined categories of severity, and MDCs were calculated for each category to permit comparison to MDCs reported for speakers with amyotrophic lateral sclerosis (ALS). Kruskal-Wallis tests were conducted to compare MDCs between groups and severity categories.

RESULTS

The average MDC₉₅ for control speakers was 5.53% (range = 3.21%-7.47%) and was statistically smaller than MDCs for speakers with MS (average = 10.08%, range = 5.30%-15.62%) and those for speakers with PD (average = 10.98%, range = 8.60%-13.98%). Statistical analyses further revealed significant differences between MDCs across severity categories.

CONCLUSIONS

In agreement with previous work in ALS conducted under similar conditions (i.e., orthographic transcription of SIT sentences in a quiet listening environment), the MDC₉₅ of speech intelligibility ranged from 3% to 10% for speakers with MS and PD who have mildly impaired speech. These estimates are a step toward the development of a universal language with which to evaluate speech changes in a variety of patient populations.

Vocal changes in a zebra finch model of Parkinson's disease characterized by alpha-synuclein overexpression in the song-dedicated anterior forebrain pathway

Deterioration in the quality of a person's voice and speech is an early marker of Parkinson's disease (PD). In humans, the neural circuit that supports vocal motor control consists of a cortico-basal ganglia-thalamo-cortico loop. The basal ganglia regions, striatum and globus pallidus, in this loop play a role in modulating the acoustic features of vocal behavior such as loudness, pitch, and articulatory rate. In PD, this area is implicated in pathogenesis. In animal models of PD, the accumulation of toxic aggregates containing the neuronal protein alpha-synuclein (αsyn) in the midbrain and striatum result in limb and vocal motor impairments. It has been challenging to study vocal impairments given the lack of well-defined cortico-basal ganglia circuitry for vocalization in rodent models. Furthermore, whether deterioration of voice quality early in PD is a direct result of αsyn-induced neuropathology is not yet known. Here, we take advantage of the well-characterized vocal circuits of the adult male zebra finch songbird to experimentally target a song-dedicated pathway, the anterior forebrain pathway, using an adeno-associated virus expressing the human wild-type αsyn gene, SNCA. We found that overexpression of αsyn in this pathway coincides with higher levels of insoluble, monomeric αsyn compared to control finches. Impairments in song production were also detected along with shorter and poorer quality syllables, which are the most basic unit of song. These vocal changes are similar to the vocal abnormalities observed in individuals with PD.

Design of the PERSPECTIVE study: PERsonalized SPEeCh Therapy for actIVE conversation in Parkinson's disease (randomized controlled trial)

Objective

To evaluate the effectiveness of personalized and home-based speech therapy on quality of life, intelligibility, and social participation for people with Parkinson’s disease (PD) who have a reduced intelligibility of speech.

Background

Speech problems in PD have a profound negative impact on social interaction and quality of life. Evidence for speech therapy in PD is growing, but more work remains needed to explore its full potential. Efficacy exists for highly intensive standardized speech treatment programs, but not all patients can comply with this rather intense intervention, especially the more severely affected ones. Here, we aim to study the effectiveness of personalized and home-based (remote) speech therapy in PD on quality of life and speech. The intervention will be supported by a dedicated speech training app. We expect that this approach will improve speech intelligibility and quality of life in patients irrespective of disease stage.

Methods

We will perform a single blind, randomized controlled trial, comparing 8 weeks of speech therapy to no intervention using a waiting list design. A total of 215 PD patients with problems in intelligibility will be recruited by 12 highly experienced speech therapists. All patients will be measured at baseline and after 8 weeks (primary endpoint). Additionally, the experimental group will be re-assessed one more time, after a wash-out period of 24 weeks. The control group will receive deferred treatment after 8 weeks, but without additional follow-up assessments. Our primary outcome is quality of life (as measured with PDQ-39). Secondary outcomes include speech and voice quality, intelligibility, severity of voice and speech complaints, and caregiver burden.

Results

The inclusion of participants has started on March 1, 2019, and is expected to be finalized on April 1, 2021. We expect to have the first results in January 2022.

Conclusions

We will investigate the effectiveness of speech therapy in PD. Particular strengths of our study include a randomized and single-blinded design, the personalized treatment approach, the inclusion of PD patients irrespective of disease stage or severity of the speech complaint, the long-term follow-up, the adequate power, and the use of a patient-relevant primary endpoint. This will allow us to draw firm conclusions about the effectiveness of personalized and remote speech therapy for PD patients in all disease stages.

Trial registration

ClinicalTrials.govNCT03963388. Registered on May 24, 2019

Longitudinal Effects of Parkinson's Disease on Speech Breathing During an Extemporaneous Connected Speech Task

PURPOSE

A critical component to the development of any type of intervention to improve speech production in individuals with Parkinson's disease (PD) is a complete understanding of the speech impairments present at each stage of the disease and how these impairments change with disease progression. The purpose of this longitudinal study was to examine the impact of disease on speech production and speech breathing during an extemporaneous speech task in individuals with PD over the course of approximately 3.5 years.

METHOD

Eight individuals with PD and eight age- and sex-matched control participants produced an extemporaneous connected speech task on two occasions (Time 1 and Time 2) an average of 3 years 7 months apart. Dependent variables included sound pressure level; utterance length; speech rate; lung volume initiation, termination, and excursion; and percent vital capacity per syllable.

RESULTS

From Time 1 to Time 2, individuals with PD demonstrated decreased utterance length and lung volume initiation, termination, and excursion and increased speech rate. Control participants demonstrated decreased utterance length and lung volume termination and increased lung volume excursion and percent vital capacity per syllable from Time 1 to Time 2.

CONCLUSIONS

Changes in speech production and speech breathing variables experienced by individuals with PD over the course of several years are related to their disease process and not typical aging. Changes to speech breathing highlight the need to provide intervention focused on increasing efficient respiratory patterning for speech production.

Co-evolution of machine learning and digital technologies to improve monitoring of Parkinson's disease motor symptoms

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor impairments such as tremor, bradykinesia, dyskinesia, and gait abnormalities. Current protocols assess PD symptoms during clinic visits and can be subjective. Patient diaries can help clinicians evaluate at-home symptoms, but can be incomplete or inaccurate. Therefore, researchers have developed in-home automated methods to monitor PD symptoms to enable data-driven PD diagnosis and management. We queried the US National Library of Medicine PubMed database to analyze the progression of the technologies and computational/machine learning methods used to monitor common motor PD symptoms. A sub-set of roughly 12,000 papers was reviewed that best characterized the machine learning and technology timelines that manifested from reviewing the literature. The technology used to monitor PD motor symptoms has advanced significantly in the past five decades. Early monitoring began with in-lab devices such as needle-based EMG, transitioned to in-lab accelerometers/gyroscopes, then to wearable accelerometers/gyroscopes, and finally to phone and mobile & web application-based in-home monitoring. Significant progress has also been made with respect to the use of machine learning algorithms to classify PD patients. Using data from different devices (e.g., video cameras, phone-based accelerometers), researchers have designed neural network and non-neural network-based machine learning algorithms to categorize PD patients across tremor, gait, bradykinesia, and dyskinesia. The five-decade co-evolution of technology and computational techniques used to monitor PD motor symptoms has driven significant progress that is enabling the shift from in-lab/clinic to in-home monitoring of PD symptoms.

Scoping review of the relationship between diabetes and voice quality

AIMS

The objective of this scoping review is to synthesize all of the known information about the relationship between diabetes mellitus and voice quality and to explore its potential applications for new technology.

METHODS

We conducted a scoping literature review of articles published between March 2000 and September 2021 using the following databases: PubMed, Web of Science, Scopus, and Embase. Additionally, we did a manual search of Google Scholar. The search strategy abides by the PRISMA-ScR guidelines. Studies pertaining to the relationship between diabetes and the voice were categorized separately for further evaluation.

RESULTS

Out of the 2732 originally identified articles, nine were ultimately included in this scoping review. The chosen articles address both diabetes and its impact on a variety of vocal parameters.

CONCLUSIONS

There is currently very little research investigating the relationship between diabetes, neuropathy, and phonatory symptoms. Additionally, existing publications contain some contradictory findings. Further research that incorporates imaging technology is needed to clarify the physiological explanations for the differences observed between healthy individuals and those with diabetes mellitus. Such information can be used to develop noninvasive technology for diabetes diagnosis and monitoring.

Memory-Assisted Global Impression of Change (MAGIC)

BACKGROUND

The United States Food and Drug Administration is developing a series of patient-focused drug development guidance documents regarding the collection of patient experience data, including methods for understanding treatment benefit from the patient perspective. The goal of this research was to investigate the concern that the global impression of change scale is subject to recall error and thus not optimal for use as an anchor for estimating meaningful within-person change thresholds. We explored whether memory assistance for recalling baseline status would make a difference in how study participants diagnosed with Parkinson's disease (PD) responded to a patient global impression of change (PGIC) and patient global impression static (PGIS) item.

METHODS

The research was completed as a secondary objective of a non-interventional 28-day (± 4 days) study among persons with Parkinson's disease and associated motor fluctuations. At baseline, participants completed the PGIS and then recorded a voice message to their future self in which they spoke about how their PD had affected their "day-to-day" activities over the preceding few days. At the final visit, the PGIC and PGIS were completed, after which participants listened to their memory assistance voice recording, and then completed both items for a second time to calculate a memory-assisted global impression static and change scores (MAGIS and MAGIC, respectively). Spearman correlations (ρ) were examined for the pre- and post- memory assistance evaluations. The degree of agreement pre- and post-memory assistance was quantified using the Shrout & Fleiss intraclass correlation coefficient (ICC [2,1]). An ICC(2,1) ≥ 0.7 served as the pre-specified criterion of acceptability for both the ρ and ICC(2,1) values.

RESULTS

Participants in the analytic sample were mean age 68.7 and mostly white (91.7%) and male (69.4%). The average length of time since PD diagnosis was 6.5 years. Correlations between the PGIS and MAGIS were ρ = 0.88; correlations between PGIC and MAGIC were ρ = 0.86. The estimated ICC(2,1) for both the PGIS/MAGIS and PGIC/MAGIC exceeded target success criterion of ICC(2,1) ≥ 0.70.

CONCLUSION

Our results show that the MAGIS/MAGIC methodology is feasible and that memory assistance did not substantially alter the PGIS/PGIC scores at the final visit.

Progression of Self-Perceived Speech and Swallowing Impairment in Early Stage Parkinson's Disease: Longitudinal Analysis of the Unified Parkinson's Disease Rating Scale

PURPOSE

The purpose of this study was to investigate the presence and progression of self-perceived speech and swallowing impairments in newly diagnosed people with Parkinson's disease (PD) longitudinally across 6 years.

METHOD

Longitudinal data from the Parkinson's Progression Markers Initiative were analyzed across six consecutive years in a cohort of 269 newly diagnosed people with PD, and a subset of those (n = 211) who were assessed at every time point across the 6 years. Dependent variables included self-perceived ratings of speech and swallowing impairment severity from the Unified Parkinson's Disease Rating Scale. Patient-centered factors of age at diagnosis and motor phenotype were also assessed to determine if they were related to the change in self-perceived speech and swallowing impairments.

RESULTS

Overall, self-perceived speech and swallowing impairments were present in newly diagnosed people with PD, although over time, the degree of severity for both remained in the mild range. However, the rate of change over time was significant for perceived speech impairment, F(5.5, 1158.8) = 21.1, p < .001), and perceived swallowing impairment, F(5.2, 1082.6) = 8.6, p < .001. Changes for speech and swallowing impairment were both in the direction of progressive severity. There were no effects of age at diagnosis or motor phenotype on the degree of change for either speech or swallowing.

CONCLUSIONS

Self-perceptions of speech and swallowing impairment changed significantly over time in newly diagnosed people with PD (PWPD). Consistent with existing literature, self-perceptions of speech impairment were rated as more severe than those of swallowing impairment. These findings reveal that even in the early years postdiagnoses, PWPD are experiencing changes to speech and swallowing function, albeit within the mildly severe range. The presence of self-perceived mild speech and swallowing impairments in the initial years postdiagnosis may support the need for intervention to improve and or sustain function over time.

Speech Characteristics of Patients with Parkinson's Disease-Does Dopaminergic Medications Have a Role?

Objective  The present study aimed to investigate the effects of dopaminergic medication on voice, speech motor functions, and motor impairment in patients with Parkinson's disease (PD).

Materials and Methods  Twenty-five individuals (16 males and 9 females) with PD underwent comprehensive assessment of voice, speech, and motor functions in levodopa medication ON and medication OFF conditions. Age- and gender-matched healthy controls were recruited to compare speech and acoustic parameters. Multi-Dimensional Voice Program (MDVP) from Computerized Speech Laboratory (Model: 4500) was utilized for acoustic analysis of voice and the Voice Handicap Index (VHI) for the self-assessment of vocal function. Frenchay Dysarthria Assessment (FDA-2) and Unified Parkinson's Disease Rating Scale-III (UPDRS III) were used to evaluate speech motor and motor functions, respectively.

Statistical Analysis  The mean and standard deviation were used as descriptive statistics measures. Raw scores were obtained for FDA-2, DRS, VHI, MDVP parameters, and UPDRS-III in either medication condition. The Wilcoxon signed-rank test was performed to determine the statistical significance of the above measures in both genders across the medication conditions. Spearman's rank correlation coefficient was used to determine the relationship between motor speech function and motor impairment and between VHI and MDVP parameters across both medication conditions. The interrater reliability rating was established using Cohen's kappa.

Results  An improvement in lip and laryngeal functioning was found in the medication ON over medication OFF state in both males and females with PD. A few frequency and amplitude-related measures improved in the medication-ON state over the medication-OFF state. UPDRS-III scores reduced from the OFF state to the ON state, and no change in dysarthria severity or VHI was found in either gender or medication condition. No correlation was found between speech motor function and motor function or between VHI and acoustic parameters of voice in either medication condition.

Conclusions  Improvement in motor symptoms with levodopa was predominantly observed when compared with the minor improvements in a few aspects of speech motor function and vocal parameters. The results of this study suggest the need for speech therapy as a nonpharmacological treatment method for speech impairments in PD.

Parkinson's Disease Detection Based on Running Speech Data From Phone Calls

OBJECTIVE

Parkinson's Disease (PD) is a progressive neurodegenerative disorder, manifesting with subtle early signs, which often hinder timely and early diagnosis and treatment. The development of accessible, technology-based methods for longitudinal PD symptoms tracking in daily living offers the potential for transforming the disease assessment and accelerating PD diagnosis.

METHODS

A privacy-aware method for classifying PD patients and healthy controls (HC), on the grounds of speech impairment present in PD, is proposed here. Voice features from running speech signals were extracted from recordings passively captured over voice phone calls. Features are fed in a language-aware training of multiple- and single-instance learning classifiers, along with demographic variables, exploiting a multilingual cohort of 498 subjects (392/106 self-reported HC/PD patients) to classify PD.

RESULTS

By means of leave-one-subject-out cross-validation, the best-performing models yielded 0.69/0.68/0.63/0.83 area under the Receiver Operating Characteristic curve (AUC) for the binary classification of PD patient vs. HC in sub-cohorts of English/Greek/German/Portuguese-speaking subjects, respectively. Out-of-sample testing of the best performing models was conducted in an additional dataset, generated by 63 clinically-assessed subjects (24/39 HC/early PD patients). Testing has resulted in 0.84/0.93/0.83 AUC for the English/Greek/German-speaking sub-cohorts, respectively. Comparative analysis with other approaches for language-aware PD detection justified the efficiency of the proposed one, considering the ecological validity of the acquired voice data.

CONCLUSIONS

The present work demonstrates increased robustness in PD detection using voice data captured in-the-wild.

SIGNIFICANCE

A high-frequency, privacy-aware and unobtrusive PD screening tool is introduced for the first time, based on analysis of voice samples captured during routine phone calls.

Speech Rhythm Variation in Early-Stage Parkinson's Disease: A Study on Different Speaking Tasks

Patients with Parkinson's disease (PD) usually reveal speech disorders and, among other symptoms, the alteration of speech rhythm. The purpose of this study is twofold: (1) to test the validity of two acoustic parameters-%V, vowel percentage and VtoV, the mean interval between two consecutive vowel onset points-for the identification of rhythm variation in early-stage PD speech and (2) to analyze the effect of PD on speech rhythm in two different speaking tasks: reading passage and monolog. A group of 20 patients with early-stage PD was involved in this study and compared with 20 age- and sex-matched healthy controls (HCs). The results of the acoustic analysis confirmed that %V is a useful cue for early-stage PD speech characterization, having significantly higher values in the production of patients with PD than the values in HC speech. A simple speaking task, such as the reading task, was found to be more effective than spontaneous speech in the detection of rhythmic variations.

Objective vowel sound characteristics and their relationship with motor dysfunction in Asian Parkinson's disease patients

BACKGROUND

Speech impairments are very common in patients with Parkinson's disease (PD). However, knowledge of their objective characteristics and relationship to other motor symptoms amongst Asian PD patients is limited.

OBJECTIVES

To identify objective vowel sound characteristics in Thai PD patients and correlate with disease severity, as determined by UPDRS and various sub-scores.

METHOD

We evaluated 100 Thai PD patients, with a mean age of 66.56 years (±7.52) and HY of 2.7 (±1.08), and 101 age-matched controls. Phonatory evaluation, comprising of 15 objective parameters, was conducted using the Multi-Dimensional Voice Programme with a sustained /a/ phonation.

RESULTS

PD patients exhibited significantly higher values of all dimensions of the phonatory parameters evaluated compared to controls (All, p < 0.001) except for duration of sustained phonation, which was significantly shorter in PD patients. When early- and advanced-stage patients were compared, significantly different parameters were limited to frequency perturbation parameters (Jitt, p = 0.01; RAP, p = 0.013; PPQ, p = 0.01; sPPQ, p = 0.001; vF0, p = 0.011), and NHR (p = 0.028). Several significant and moderate correlations were observed between both STD and frequency perturbation parameters and UPDRS-III, bradykinesia sub-score, and gait and postural instability sub-score. Both vF0, and STD significantly correlated with UPDRS-III and sub-scores in advanced stage patients.

CONCLUSION

Our study provides objective evidence of phonatory dysfunction in Asian PD patients with certain characteristics correlated with advanced stage or different motor dysfunction. Sustained vowel phonation is a promising digital outcome for global phenotyping a large number of PD patients.

Exploring the Acoustic Perceptual Relationship of Speech in Parkinson's Disease

Purpose Auditory perceptual judgments are commonly used to diagnose dysarthria and assess treatment progress. The purpose of the study was to examine the acoustic underpinnings of perceptual speech abnormalities in individuals with Parkinson's disease (PD). Method Auditory perceptual judgments were obtained from sentences produced by 13 speakers with PD and five healthy older adults. Twenty young listeners rated overall ease of understanding, articulatory precision, voice quality, and prosodic adequacy on a visual analog scale. Acoustic measures associated with the speech subsystems of articulation, phonation, and prosody were obtained, including second formant transitions, articulation rate, cepstral and spectral measures of voice, and pitch variations. Regression analyses were performed to assess the relationships between perceptual judgments and acoustic variables. Results Perceptual impressions of Parkinsonian speech were related to combinations of several acoustic variables. Approximately 36%-49% of the variance in the perceptual ratings were explained by the acoustic measures indicating a modest acoustic perceptual relationship. Conclusions The relationships between perceptual ratings and acoustic signals in Parkinsonian speech are multifactorial and involve a variety of acoustic features simultaneously. The modest acoustic perceptual relationships, however, suggest that future work is needed to further examine the acoustic bases of perceptual judgments in dysarthria.

Longitudinal Speech Biomarkers for Automated Alzheimer's Detection

We introduce a novel audio processing architecture, the Open Voice Brain Model (OVBM), improving detection accuracy for Alzheimer's (AD) longitudinal discrimination from spontaneous speech. We also outline the OVBM design methodology leading us to such architecture, which in general can incorporate multimodal biomarkers and target simultaneously several diseases and other AI tasks. Key in our methodology is the use of multiple biomarkers complementing each other, and when two of them uniquely identify different subjects in a target disease we say they are orthogonal. We illustrate the OBVM design methodology by introducing sixteen biomarkers, three of which are orthogonal, demonstrating simultaneous above state-of-the-art discrimination for two apparently unrelated diseases such as AD and COVID-19. Depending on the context, throughout the paper we use OVBM indistinctly to refer to the specific architecture or to the broader design methodology. Inspired by research conducted at the MIT Center for Brain Minds and Machines (CBMM), OVBM combines biomarker implementations of the four modules of intelligence: The brain OS chunks and overlaps audio samples and aggregates biomarker features from the sensory stream and cognitive core creating a multi-modal graph neural network of symbolic compositional models for the target task. In this paper we apply the OVBM design methodology to the automated diagnostic of Alzheimer's Dementia (AD) patients, achieving above state-of-the-art accuracy of 93.8% using only raw audio, while extracting a personalized subject saliency map designed to longitudinally track relative disease progression using multiple biomarkers, 16 in the reported AD task. The ultimate aim is to help medical practice by detecting onset and treatment impact so that intervention options can be longitudinally tested. Using the OBVM design methodology, we introduce a novel lung and respiratory tract biomarker created using 200,000+ cough samples to pre-train a model discriminating cough cultural origin. Transfer Learning is subsequently used to incorporate features from this model into various other biomarker-based OVBM architectures. This biomarker yields consistent improvements in AD detection in all the starting OBVM biomarker architecture combinations we tried. This cough dataset sets a new benchmark as the largest audio health dataset with 30,000+ subjects participating in April 2020, demonstrating for the first time cough cultural bias.

Acoustic characteristics in relation to intelligibility reduction in noise for speakers with Parkinson's disease

Decreased speech intelligibility in noisy environments is frequently observed in speakers with Parkinson's disease (PD). This study investigated which acoustic characteristics across the speech subsystems contributed to poor intelligibility in noise for speakers with PD. Speech samples were obtained from 13 speakers with PD and five healthy controls reading 56 sentences. Intelligibility analysis was conducted in quiet and noisy listening conditions. Seventy-two young listeners transcribed the recorded sentences in quiet and another 72 listeners transcribed in noise. The acoustic characteristics of the speakers with PD who experienced large intelligibility reduction from quiet to noise were compared to those with smaller intelligibility reduction in noise and healthy controls. The acoustic measures in the study included second formant transitions, cepstral and spectral measures of voice (cepstral peak prominence and low/high spectral ratio), pitch variation, and articulation rate to represent speech components across speech subsystems of articulation, phonation, and prosody. The results show that speakers with PD who had larger intelligibility reduction in noise exhibited decreased second formant transition, limited cepstral and spectral variations, and faster articulation rate. These findings suggest that the adverse effect of noise on speech intelligibility in PD is related to speech changes in the articulatory and phonatory systems.

Comparing Ensemble-Based Machine Learning Classifiers Developed for Distinguishing Hypokinetic Dysarthria from Presbyphonia

It is essential to understand the voice characteristics in the normal aging process to accurately distinguish presbyphonia from neurological voice disorders. This study developed the best ensemble-based machine learning classifier that could distinguish hypokinetic dysarthria from presbyphonia using classification and regression tree (CART), random forest, gradient boosting algorithm (GBM), and XGBoost and compared the prediction performance of models. The subjects of this study were 76 elderly patients diagnosed with hypokinetic dysarthria and 174 patients with presbyopia. This study developed prediction models for distinguishing hypokinetic dysarthria from presbyphonia by using CART, GBM, XGBoost, and random forest and compared the accuracy, sensitivity, and specificity of the development models to identify the prediction performance of them. The results of this study showed that random forest had the best prediction performance when it was tested with the test dataset (accuracy = 0.83, sensitivity = 0.90, and specificity = 0.80, and area under the curve (AUC) = 0.85). The main predictors for detecting hypokinetic dysarthria were Cepstral peak prominence (CPP), jitter, shimmer, L/H ratio, L/H ratio_SD, CPP max (dB), CPP min (dB), and CPPF0 in the order of magnitude. Among them, CPP was the most important predictor for identifying hypokinetic dysarthria.

Parkinson's disease in women: Mechanisms underlying sex differences

Parkinson's disease is a neurodegenerative disease which is associated with different motor, cognitive and mood-related problems. Though it has been established that Parkinson's disease is less prevalent in women in comparison to men, the differences tend to diminish with the advancing age. Different genetic, hormonal, neuroendocrinal and molecular players contribute towards the differences in the Parkinson's disease pathogenesis. Furthermore, data available with respect to the therapeutic management of Parkinson's disease in females is limited; women often tend to suffer more from the side effects of the currently available drugs. The present review highlights the sex-specific differences which play a role in the manifestation of these symptoms and side effects of the currently available therapeutic strategies. We have also discussed the current and upcoming therapeutic strategies which are in the clinical trials such as adenosine 2A (A2A) receptor antagonists, estrogen replacement therapy, α-synuclein targeting vaccines and antibodies, Botulinum toxin A, Fas-associated factor-1 (FAF-1) inhibitors, thiazolidinediones, 5-HT1_A receptor agonists, dopamine D1/D5 receptor agonists, Glucagon-like peptide 1 (GLP-1) analogues and certain plant based principles for the treatment of Parkinson's disease in women.

Remote Assessment of Parkinson's Disease Symptom Severity Using the Simulated Cellular Mobile Telephone Network

Telemonitoring of Parkinson's Disease (PD) has attracted considerable research interest because of its potential to make a lasting, positive impact on the life of patients and their carers. Purpose-built devices have been developed that record various signals which can be associated with average PD symptom severity, as quantified on standard clinical metrics such as the Unified Parkinson's Disease Rating Scale (UPDRS). Speech signals are particularly promising in this regard, because they can be easily recorded without the use of expensive, dedicated hardware. Previous studies have demonstrated replication of UPDRS to within less than 2 points of a clinical raters' assessment of symptom severity, using high-quality speech signals collected using dedicated telemonitoring hardware. Here, we investigate the potential of using the standard voice-over-GSM (2G) or UMTS (3G) cellular mobile telephone networks for PD telemonitoring, networks that, together, have greater than 5 billion subscribers worldwide. We test the robustness of this approach using a simulated noisy mobile communication network over which speech signals are transmitted, and approximately 6000 recordings from 42 PD subjects. We show that UPDRS can be estimated to within less than 3.5 points difference from the clinical raters' assessment, which is clinically useful given that the inter-rater variability for UPDRS can be as high as 4-5 UPDRS points. This provides compelling evidence that the existing voice telephone network has potential towards facilitating inexpensive, mass-scale PD symptom telemonitoring applications.

Subcortical Involvement in Formulaic Language: Studies on Bilingual Individuals With Parkinson's Disease

Purpose An impoverished production of routinized expressions, namely, formulaic language, has been reported for monolingual speakers with Parkinson's disease (PD). Little is known regarding how formulaic expressions might be manifested in individuals with neurological damage who speak more than one language. This study investigated the processing of formulaic language across first language (L1) and second language (L2) in bilingual individuals with PD. Method Eleven Korean-English bilingual speakers with PD, who acquired Korean as L1 and English as L2, were recruited for this study. Two matched control groups composed of 11 healthy Korean-English bilingual individuals and 11 healthy native English speakers were included for comparison. Their performance on three structured tasks (comprehension, completion, and judgment-correction) and conversational speech was measured and compared across groups for analyses. Results The bilingual speakers with PD had significantly impaired comprehension of formulaic language in L1 and had lower proportions of formulaic expressions in their L1 conversational speech compared with the bilingual controls. Regarding L2, both bilingual groups with and without PD were comparable in their English performance across all tasks. Both groups performed significantly poorer in L2 structured tasks than the native English speakers. Spontaneous production of formulaic language in English (L2 for bilingual individuals) was similar across all three groups. Conclusions The results of this study contribute to the growing body of literature on impoverishment of formulaic language production following subcortical dysfunction. Additionally, findings here demonstrate a selective impairment of formulaic language performance in L1 but not L2 for bilinguals with PD, further supporting the role of the basal ganglia in native language.

Contribution of the Cerebellum and the Basal Ganglia to Language Production: Speech, Word Fluency, and Sentence Construction-Evidence from Pathology

Evidence reported in recent decades increasingly confirms that both the cerebellum and the basal ganglia, which are primarily involved in movement control, also have a significant role in a vast range of cognitive and affective functions. Evidence from pathology indicates that the disorders of some aspects of language production which follow damage of the cerebellum or respectively basal ganglia, i.e., disorders of speech, word fluency, and sentence construction, have identifiable neuropsychological profiles and that most manifestations can be specifically attributed to the dysfunctions of mechanisms supported by one or the other of these structures. The cerebellum and the basal ganglia are reciprocally interconnected. Thus, it is plausible that some disorders observed when damage involves one of these structures could be remote effects of abnormal activity in the other. However, in a purely clinical-neuropsychological perspective, primary and remote effects in the network are difficult to disentangle. Functional neuroimaging and non-invasive brain stimulation techniques likely represent the indispensable support for achieving this goal.

Estimation of Parkinson's disease severity from voice features of vowels and consonant

This study has investigated the efficiency of voice features in estimating the motor Unified Parkinson's Disease Rating Scale (UPDRS) score in Parkinson's disease (PD) patients. A total of 26 PD patients (mean age = 72) and 22 control subjects (mean age = 66.91) were recruited for the study. The sustained phonation /a/, /u/ and /m/ were collected in both off-state and on-state of Levodopa medication. The average motor UPDRS for PD off-state patients was 27.31, on-state was 20.42 and that of controls was 2.63. Voice features were extracted from the phonation tasks and were reduced to the most relevant 6 features for each phonation task using the Least Absolute Shrinkage and Selection Operator (LASSO) feature ranking method. The correlation between the reduced features and motor UPDRS was tested using the Spearman correlation coefficient test. AdaBoost regression learner was trained and used for automatically estimating the motor UPDRS score using the voice features. The results show that the vocal features for /m/ performed best by estimating the motor UPDRS score for PD off-state with the mean absolute error (MAE) of 3.52 and 5.90 for PD on-state. This study shows that assessment of voice can be used for day to day remote monitoring of PD patients.