A follow-up investigation into the mechanisms that underlie improved recognition of dysarthric speech

Perceptual Learning of Dysarthria in Adolescence

PURPOSE

As evidenced by perceptual learning studies involving adult listeners and speakers with dysarthria, adaptation to dysarthric speech is driven by signal predictability (speaker property) and a flexible speech perception system (listener property). Here, we extend adaptation investigations to adolescent populations and examine whether adult and adolescent listeners can learn to better understand an adolescent speaker with dysarthria.

METHOD

Classified by developmental stage, adult (n = 42) and adolescent (n = 40) listeners completed a three-phase perceptual learning protocol (pretest, familiarization, and posttest). During pretest and posttest, all listeners transcribed speech produced by a 13-year-old adolescent with spastic dysarthria associated with cerebral palsy. During familiarization, half of the adult and adolescent listeners engaged in structured familiarization (audio and lexical feedback) with the speech of the adolescent speaker with dysarthria; and the other half, with the speech of a neurotypical adolescent speaker (control).

RESULTS

Intelligibility scores increased from pretest to posttest for all listeners. However, listeners who received dysarthria familiarization achieved greater intelligibility improvements than those who received control familiarization. Furthermore, there was a significant effect of developmental stage, where the adults achieved greater intelligibility improvements relative to the adolescents.

CONCLUSIONS

This study provides the first tranche of evidence that adolescent dysarthric speech is learnable-a finding that holds even for adolescent listeners whose speech perception systems are not yet fully developed. Given the formative role that social interactions play during adolescence, these findings of improved intelligibility afford important clinical implications.

A Perceptual Learning Approach for Dysarthria Remediation: An Updated Review

Purpose Early studies of perceptual learning of dysarthric speech, those summarized in Borrie, McAuliffe, and Liss (2012), yielded preliminary evidence that listeners could learn to better understand the speech of a person with dysarthria, revealing a potentially promising avenue for future intelligibility interventions. Since then, a programmatic body of research grounded in models of perceptual processing has unfolded. The current review provides an updated account of the state of the evidence in this area and offers direction for moving this work toward clinical implementation. Method The studies that have investigated perceptual learning of dysarthric speech (N = 24) are summarized and synthesized first according to the proposed learning source and then by highlighting the parameters that appear to mediate learning, culminating with additional learning outcomes. Results The recent literature has established strong empirical evidence of intelligibility improvements following familiarization with dysarthric speech and a theoretical account of the mechanisms that facilitate improved processing of the neurologically degraded acoustic signal. Conclusions There are no existing intelligibility interventions for individuals with dysarthria who cannot behaviorally modify their speech. However, there is now robust support for the development of an approach that shifts the weight of behavioral change from speaker to listener, exploiting perceptual learning to ease the intelligibility burden of dysarthria. To move this work from bench to bedside, recommendations for translational studies that establish best practices and candidacy for listener-targeted dysarthria remediation, perceptual training, are provided.

When Additional Training Isn't Enough: Further Evidence That Unpredictable Speech Inhibits Adaptation

Purpose Robust improvements in intelligibility following familiarization, a listener-targeted perceptual training paradigm, have been revealed for talkers diagnosed with spastic, ataxic, and hypokinetic dysarthria but not for talkers with hyperkinetic dysarthria. While the theoretical explanation for the lack of intelligibility improvement following training with hyperkinetic talkers is that there is insufficient distributional regularity in the speech signals to support perceptual adaptation, it could simply be that the standard training protocol was inadequate to facilitate learning of the unpredictable talker. In a pair of experiments, we addressed this possible alternate explanation by modifying the levels of exposure and feedback provided by the perceptual training protocol to offer listeners a more robust training experience. Method In Experiment 1, we examined the exposure modifications, testing whether perceptual adaptation to an unpredictable talker with hyperkinetic dysarthria could be achieved with greater or more diverse exposure to dysarthric speech during the training phase. In Experiment 2, we examined feedback modifications, testing whether perceptual adaptation to the unpredictable talker could be achieved with the addition of internally generated somatosensory feedback, via vocal imitation, during the training phase. Results Neither task modification led to improved intelligibility of the unpredictable talker with hyperkinetic dysarthria. Furthermore, listeners who completed the vocal imitation task demonstrated significantly reduced intelligibility at posttest. Conclusion Together, the results from Experiments 1 and 2 replicate and extend findings from our previous work, suggesting perceptual adaptation is inhibited for talkers whose speech is largely characterized by unpredictable degradations. Collectively, these results underscore the importance of integrating signal predictability into theoretical models of perceptual learning.

Generalized Adaptation to Dysarthric Speech

PURPOSE

Generalization of perceptual learning has received limited attention in listener adaptation studies with dysarthric speech. This study investigated whether adaptation to a talker with dysarthria could be predicted by the nature of the listener's prior familiarization experience, specifically similarity of perceptual features, and level of intelligibility.

METHOD

Following an intelligibility pretest involving a talker with ataxic dysarthria, 160 listeners were familiarized with 1 of 7 talkers with dysarthria-who differed from the test talker in terms of perceptual similarity (same, similar, dissimilar) and level of intelligibility (low, mid, high)-or a talker with no neurological impairment (control). Listeners then completed an intelligibility posttest on the test talker.

RESULTS

All listeners benefited from familiarization with a talker with dysarthria; however, adaptation to the test talker was superior when the familiarization talker had similar perceptual features and reduced when the familiarization talker had low intelligibility.

CONCLUSION

Evidence for both generalization and specificity of learning highlights the differential value of listeners' prior experiences for adaptation to, and improved understanding of, a talker with dysarthria. These findings broaden our theoretical knowledge of adaptation to degraded speech, as well as the clinical application of training paradigms that exploit perceptual processes for therapeutic gain.

Effects of Lexical and Somatosensory Feedback on Long-Term Improvements in Intelligibility of Dysarthric Speech

PURPOSE

Intelligibility improvements immediately following perceptual training with dysarthric speech using lexical feedback are comparable to those observed when training uses somatosensory feedback (Borrie & Schäfer, 2015). In this study, we investigated if these lexical and somatosensory guided improvements in listener intelligibility of dysarthric speech remain comparable and stable over the course of 1 month.

METHOD

Following an intelligibility pretest, 60 participants were trained with dysarthric speech stimuli under one of three conditions: lexical feedback, somatosensory feedback, or no training (control). Participants then completed a series of intelligibility posttests, which took place immediately (immediate posttest), 1 week (1-week posttest) following training, and 1 month (1-month posttest) following training.

RESULTS

As per our previous study, intelligibility improvements at immediate posttest were equivalent between lexical and somatosensory feedback conditions. Condition differences, however, emerged over time. Improvements guided by lexical feedback deteriorated over the month whereas those guided by somatosensory feedback remained robust.

CONCLUSIONS

Somatosensory feedback, internally generated by vocal imitation, may be required to affect long-term perceptual gain in processing dysarthric speech. Findings are discussed in relation to underlying learning mechanisms and offer insight into how externally and internally generated feedback may differentially affect perceptual learning of disordered speech.

Rhythm Perception and Its Role in Perception and Learning of Dysrhythmic Speech

PURPOSE

The perception of rhythm cues plays an important role in recognizing spoken language, especially in adverse listening conditions. Indeed, this has been shown to hold true even when the rhythm cues themselves are dysrhythmic. This study investigates whether expertise in rhythm perception provides a processing advantage for perception (initial intelligibility) and learning (intelligibility improvement) of naturally dysrhythmic speech, dysarthria.

METHOD

Fifty young adults with typical hearing participated in 3 key tests, including a rhythm perception test, a receptive vocabulary test, and a speech perception and learning test, with standard pretest, familiarization, and posttest phases. Initial intelligibility scores were calculated as the proportion of correct pretest words, while intelligibility improvement scores were calculated by subtracting this proportion from the proportion of correct posttest words.

RESULTS

Rhythm perception scores predicted intelligibility improvement scores but not initial intelligibility. On the other hand, receptive vocabulary scores predicted initial intelligibility scores but not intelligibility improvement.

CONCLUSIONS

Expertise in rhythm perception appears to provide an advantage for processing dysrhythmic speech, but a familiarization experience is required for the advantage to be realized. Findings are discussed in relation to the role of rhythm in speech processing and shed light on processing models that consider the consequence of rhythm abnormalities in dysarthria.

Use of Crowdsourcing to Assess the Ecological Validity of Perceptual-Training Paradigms in Dysarthria

PURPOSE

It has been documented in laboratory settings that familiarizing listeners with dysarthric speech improves intelligibility of that speech. If these findings can be replicated in real-world settings, the ability to improve communicative function by focusing on communication partners has major implications for extending clinical practice in dysarthria rehabilitation. An important step toward development of a listener-targeted treatment approach requires establishment of its ecological validity. To this end, the present study leveraged the mechanism of crowdsourcing to determine whether perceptual-training benefits achieved by listeners in the laboratory could be elicited in an at-home computer-based scenario.

METHOD

Perceptual-training data (i.e., intelligibility scores from a posttraining transcription task) were collected from listeners in 2 settings-the laboratory and the crowdsourcing website Amazon Mechanical Turk.

RESULTS

Consistent with previous findings, results revealed a main effect of training condition (training vs. control) on intelligibility scores. There was, however, no effect of training setting (Mechanical Turk vs. laboratory). Thus, the perceptual benefit achieved via Mechanical Turk was comparable to that achieved in the laboratory.

CONCLUSION

This study provides evidence regarding the ecological validity of perceptual-training paradigms designed to improve intelligibility of dysarthric speech, thereby supporting their continued advancement as a listener-targeted treatment option.

The Role of Somatosensory Information in Speech Perception: Imitation Improves Recognition of Disordered Speech

PURPOSE

Perceptual learning paradigms involving written feedback appear to be a viable clinical tool to reduce the intelligibility burden of dysarthria. The underlying theoretical assumption is that pairing the degraded acoustics with the intended lexical targets facilitates a remapping of existing mental representations in the lexicon. This study investigated whether ties to mental representations can be strengthened by way of a somatosensory motor trace.

METHOD

Following an intelligibility pretest, 100 participants were assigned to 1 of 5 experimental groups. The control group received no training, but the other 4 groups received training with dysarthric speech under conditions involving a unique combination of auditory targets, written feedback, and/or a vocal imitation task. All participants then completed an intelligibility posttest.

RESULTS

Training improved intelligibility of dysarthric speech, with the largest improvements observed when the auditory targets were accompanied by both written feedback and an imitation task. Further, a significant relationship between intelligibility improvement and imitation accuracy was identified.

CONCLUSIONS

This study suggests that somatosensory information can strengthen the activation of speech sound maps of dysarthric speech. The findings, therefore, implicate a bidirectional relationship between speech perception and speech production as well as advance our understanding of the mechanisms that underlie perceptual learning of degraded speech.

Visual speech information: a help or hindrance in perceptual processing of dysarthric speech

This study investigated the influence of visual speech information on perceptual processing of neurologically degraded speech. Fifty listeners identified spastic dysarthric speech under both audio (A) and audiovisual (AV) conditions. Condition comparisons revealed that the addition of visual speech information enhanced processing of the neurologically degraded input in terms of (a) acuity (percent phonemes correct) of vowels and consonants and (b) recognition (percent words correct) of predictive and nonpredictive phrases. Listeners exploited stress-based segmentation strategies more readily in AV conditions, suggesting that the perceptual benefit associated with adding visual speech information to the auditory signal-the AV advantage-has both segmental and suprasegmental origins. Results also revealed that the magnitude of the AV advantage can be predicted, to some degree, by the extent to which an individual utilizes syllabic stress cues to inform word recognition in AV conditions. Findings inform the development of a listener-specific model of speech perception that applies to processing of dysarthric speech in everyday communication contexts.

Cortical characterization of the perception of intelligible and unintelligible speech measured via high-density electroencephalography

High-density electroencephalography was used to evaluate cortical activity during speech comprehension via a sentence verification task. Twenty-four participants assigned true or false to sentences produced with 3 noise-vocoded channel levels (1--unintelligible, 6--decipherable, 16--intelligible), during simultaneous EEG recording. Participant data were sorted into higher- (HP) and lower-performing (LP) groups. The identification of a late-event related potential for LP listeners in the intelligible condition and in all listeners when challenged with a 6-Ch signal supports the notion that this induced potential may be related to either processing degraded speech, or degraded processing of intelligible speech. Different cortical locations are identified as neural generators responsible for this activity; HP listeners are engaging motor aspects of their language system, utilizing an acoustic-phonetic based strategy to help resolve the sentence, while LP listeners do not. This study presents evidence for neurophysiological indices associated with more or less successful speech comprehension performance across listening conditions.

Rhythm as a coordinating device: entrainment with disordered speech

PURPOSE

The rhythmic entrainment (coordination) of behavior during human interaction is a powerful phenomenon, considered essential for successful communication, supporting social and emotional connection, and facilitating sense-making and information exchange. Disruption in entrainment likely occurs in conversations involving those with speech and language impairment, but its contribution to communication disorders has not been defined. As a first step to exploring this phenomenon in clinical populations, the present investigation examined the influence of disordered speech on the speech production properties of healthy interactants.

METHOD

Twenty-nine neurologically healthy interactants participated in a quasi-conversational paradigm, in which they read sentences (response) in response to hearing prerecorded sentences (exposure) from speakers with dysarthria (n = 4) and healthy controls (n = 4). Recordings of read sentences prior to the task were also collected (habitual).

RESULTS

Findings revealed that interactants modified their speaking rate and pitch variation to align more closely with the disordered speech. Production shifts in these rhythmic properties, however, remained significantly different from corresponding properties in dysarthric speech.

CONCLUSION

Entrainment offers a new avenue for exploring speech and language impairment, addressing a communication process not currently explained by existing frameworks. This article offers direction for advancing this line of inquiry.

The role of linguistic and indexical information in improved recognition of dysarthric speech

This investigation examined perceptual learning of dysarthric speech. Forty listeners were randomly assigned to one of two identification training tasks, aimed at highlighting either the linguistic (word identification task) or indexical (speaker identification task) properties of the neurologically degraded signal. Twenty additional listeners served as a control group, passively exposed to the training stimuli. Immediately following exposure to dysarthric speech, all three listener groups completed an identical phrase transcription task. Analysis of listener transcripts revealed remarkably similar intelligibility improvements for listeners trained to attend to either the linguistic or the indexical properties of the signal. Perceptual learning effects were also evaluated with regards to underlying error patterns indicative of segmental and suprasegmental processing. The findings of this study suggest that elements within both the linguistic and indexical properties of the dysarthric signal are learnable and interact to promote improved processing of this type and severity of speech degradation. Thus, the current study extends support for the development of a model of perceptual processing in which the learning of indexical properties is encoded and retained in conjunction with linguistic properties of the signal.