L12: Hypokinetic Dysarthria Assess Flashcards
___ to ___ % of PD patients will dev speech symptoms
60-80
PD speech symptoms are most commonly perceived (and the ones treated) as…
reduced loudness, reduced prosody, fast speech, poor voice quality, and imprecise consonants
short rushes and rapid rate are both unique to
parkinson’s, special to hypokinetic D
harsh and breathy are …
mono/reduced loudness =
often co-occuring but not distinctive characs
often why they seek therapy
one of the most common initial speech symptoms, pts complain that they are …
becoming soft spoken (hypophonic, hypophonia) and are becoming frustrated by frequent requests to repeat themselves
perception of reduced loudness is diff to evaluate bc
perception of reduced loudness is influenced by speaking context and level of background noise
patient may sound like they have adequate loudness in a quiet clinic room but fail to compensate to noisier situations
formal speech used during evaluations may produced…
louder speech than more informal everyday conversational speech (lab or clinic speech)
may need to evaluate speech in…
a variety of speaking situations and under a variety of background noises to determine extent of reduced loudness
PDs perceived to have lower overall speech loudness than any other
__/15 pts perceived as having loudness decay
dysarthric group
13/15
PDs had significantly lower speech loudness than ____
PDs had a ___ correlation bw speech loudness and mean speech intensity ….. which means….
what else is involved?
HCs
0.82
so low intensity doesn’t completely predict low loudness
PDs have a significantly more spectral tilt and less spectral energy in higher frequencies than HCs
Correction of the spectral tilt improves the correlation between low intensity and low loudness
May need to dev a voice amplifier where spectral tilt can be manipulated
PDs have reduced average ____ in conversation and other speech tasks
speech intensity
PD’s have greater than normal ______ across an utterance (only observed in some studies)
intensity decay
what are the 5 possible explanations for reduced speech intensity (hypophonia) in PD?
Laryngeal: bowed vocal folds during phonation, reduced adduction and medial compression
Respiratory: reduced vital capacity, reduced subglottal air pressure and restricted range of rib cage movements during speech breathing
Articulation: reduced size of oral movements during speech (i.e. reduced jaw opening)
Flexed posture.
Abnormal perception of self-loudness.
PDs give ______ ratings for conversations in noise and when talking at a distance
low communication effectiveness
PDs have significant reduction in ______ when talking in noise
inteligibility
PDs show a ______ response but there is variability across indvs
lombard
involuntary vocal response to background noise
speech-to-noise level obtained in diff noise conditions may
be a useful measure of hypophonia severity
perception of abnormal voice quality can often be
may have to be fairly…
the only speech symptom
may have to be fairly severe before pt seeks help
DAB, 1969;1975: found that w abnormal voice quality…
harshness and breathiness common and often co-occurred
66% (21/32) harsh
60% (19/32) breathy
Logemann et al, 1973;1978: found for abnormal voice quality
perceptual study of 200 PDs
89% had voice disorder (breathy, hoarse, rough, tremor)
45% voice disorder the only speech symptom
what are the 3 instrumental data options abnormal voice quality for Hypo D?
acoustic perturbation measures (harshness, breathiness)
maximum phonation time
laryngoscopic measures
acoustic perturbation measures (harshness, breathiness) reveal..
PDs had higher jitter and shimmer values than normals
maximum phonation time (for voice quality) reveals
MPT reduced (2 studies) or the same (3 studies) as normals
inconsistency may be related to severity of PDs tested or testing procedures (practice effects and # of trials)
laryngoscopic measures (for abnormal voice quality) reveals
30/32 PDs observed to have ‘bowing’ of the vocal folds during phonation (Hanson, 1984)
26/32 PDs had laryngeal asymmetry during phonation
more posterior & lateral position of one arytenoid
consistently associated with side of symptoms in unilateral PDs (Hanson et al, 1984)
perception of reduced prosodic variation can…
has subtle effects on…
speech situation/context/topic may…
occur early in disease
has subtle effects on communication so pt may not complain about it initially (ie. people think pt is depressed, or less interested in conversing with others, may be a less effective speaker in many work and social settings)
speech situation, context and topic may have significant influence on evaluation of prosody
darley et al (for reduced prosodic variation) found that
monopitch (31/32 PDs), monoloudness (32/32) & reduced stress (32/32) perceived as most deviant and distinctive dimensions
what are the two instrumental measures for perception of reduced prosodic variation?
- reduced pitch and loudness variability in sentences (SD of F0)
- lack of pitch declination across sentences (Slope of F0)
speech rate can be either…
abnormally fast or slow in PD
___% of 200s PDs had abnormal rate: ___% slow and ___% fast
20% of 200 PDs had abnormal rate: 9% slow 11% fast
rapid speech occurs in about ___% of PDs
rapid speech occurs in about 10% of PDs (6-13% across studies)
Darley 1975 found that ___% of PDs had intermittent short rushes of speech
60
what are the 2 instrumental data evidence that is available for perception of abnormal speech rate? what do they show?
diadichokinetics
- PDs /p,t,k/ rates are no different from normals (Kruel, 1972; Ludlow et al, 1987)
- Kent et al 2022 reviewed recent DDK studies in PD and found many studies have reported slower and more variable DDKs especially for /k/.
utterance durations
- selected individual PDs (approx. 10% of group) found to have abnormally short utterance durations (Adams, 1994; Metter & Hanson, 1983)
perception of imprecise consonants: darley 1975 found that
32/32 had imprecise consonants, 25/32 had reduced intelligibility ALS, spastic, and dystonia more severe than PDs
perception of imprecise consonants: Logemann et al 1978 found that
phonetic transcriptions of 90 PDs
inadequate vocal tract closure during stops, affricates and fricatives eg. stops and affricates became more fricative like (spirantized), fricatives reduced in frication noise
what are the 3 pieces of instrumental data that was found for perception of imprecise consonants?
1) Abnormal amount of spirantization of stops (Weismer, 1984b)
2) Frequent and abnormal amount of voicing into stop closures
(Weismer, 1984b)
3) reduced range/amplitude of lip, tongue and jaw movements during speech
(Forrest et al, 1989; Connor et al, 1989) – causal link to spirantization ?
what are the 5 perceptual and instrumental aspects of speech symptoms in PD?
perception of reduced loudness
perception of abnormal voice quality
perception of reduced prosodic variation
perception of abnormal rate of speech
perception of imprecise consonants
