Introduction

Question 1

Speech signs?

Answer 1

Are less visible than limb motor signs, but it often impair patient’s communication and reduce their quality of life.

Question 2

How is reductions in speech intelligibility characterised?

Answer 2

By decreased vocal loudness and imprecise articulation, among the salient (silmiinpistävä) signs of the motor speech disorder of hypokinetic dysarthria.

Question 3

What is reported to play a significant role in PD?

Answer 3

deficits in sensory feedback and internal cueing

Question 4

What may help to explain why neither medical treatments nor traditional speech treatments, which focus on motor speech symptoms alone, have consistently or significantly improved the degenerating speech in PD?

Answer 4

These concomitant deficits; deficits in sensory feedback and internal cueing may also play a significant role in the speech disorder associated with PD and

decreased vocal loudness and imprecise articulation, among the salient signs of the motor speech disorder of hypokinetic dysarthria

Question 5

Why is this unlike traditional speech treatment?

Answer 5

IT

1) focuses on a single treatment target of voice, as opposed to utilising multiple targets, such as respiration, loudness, rate, and articulation,
2) follows principles that promote motor learn- ing and activity-dependent neuroplasticity, including intensive dosage (16 1-hour sessions over one month), high effort treatment, and
3) retrains sensory feedback and internal cueing.

Question 6

What does RCT show as benefits of intensive speech treatment targeting voice?

Answer 6

across a range of speech variables, including objective acoustic measures of vocal loudness, articulation, intonation, and perceptual measures of voice quality and patients’ self-reported improvements in communicative effectiveness. These observations are consistent with neural findings (positron emission tomography and functional magnetic resonance imaging) following this intensive voice treatment. In addition, a positive treatment impact on swallowing disorders (dysphagia), frequently comorbid with dysarthria in patients with PD, has been reported

Question 7

What there hasn’t been do date (tähän mennessä)

Answer 7

there have been no RCT data to support the impact of speech treatment on intelligibility in this population.

Question 8

Why was articulation and voice separeted and why were they selected?
What was identified the strongest contributor to speech intelligibility in PD dysarthria?

Answer 8

To dissociate the specific contributions of the intensive dosage of treatment and the target of treatment, our design included two active treatment compa- rators: intensive treatment targeting voice, and targeting articulation.

Articulation was selected as a treatment target to address the well-established articulatory deficits in PD

The intensive treatment targeting articulation was developed by the clinical research team to impact the articulatory subsystem, which has, in fact, been identified as the strongest contributor to speech intelligibility in PD dysarthria

Question 9

What was hypothesised?

Answer 9

both intensive speech treatments would improve speech intelligibility in PD

Question 10

Intelligibility benefits from speech treatment targeting voice would stem (johtua)?

Answer 10

increase in vocal loudness, as well as from the impact of increased amplitude and coordination of movement gained across speech production sub- systems. This would result in improved articulation, intonation, and voice quality, as well as reduced speech rate; thus, increasing intelligibility

Question 11

Speech treatment targeting articulation was expected?

Answer 11

enhance = parantaa/edistää intelligibility primarily by increasing articulatory displacement and reducing speech rate