Pohdinta Flashcards
Aikaisemmat todisteet versus nyt tämä koe?
While previous evidence indicates that intensive speech treatment targeting voice can make short- and longterm improvements across a range of variables in PD, the present study pro- vides the first RCT evidence that intensive speech treatment targeting voice significantly improves speech intelligibility in this
neurodegenerative disorder.
Only treatment?
Only treatment targeting voice yielded statistically significant gains in transcription accuracy (TA), the primary outcome variable, when compared to treatment targeting articulation and no treatment. Intra- and inter-listener reliability of TA was high.
IN previous studies in PD?
patients were simply asked to speak louder (i.e., not treated), a mini- mum gain of 5% in intelligibility for sentences in noise was used as a benchmark for determining clinical meaningfulness
What post-treatment gain in TA reported in this study suggests?
post-treatment gain of 31,5% in TA reported here for the voice group strongly (ES 1,2) suggests that implementation of speech treatment targeting voice would generate a clinically meaningful improvement in intelligibility. These speech intelligibility outcomes are added to previously published gains following treatment targeting voice.
Taken together, these data suggest?
Meaningful improvements in communication and thus, in health-related quality of life, would be expected when this treatment is included in patient management.
What was odd about articulation group?
Although articulation has been considered the strongest contributor to intelligibility in PD dysarthria, the post-treatment gain of 6,8% in the articulation group was not statistically significant. However, potential benefits of treatment targeting articulation may be worth exploring for patient populations that typically exhibit more severe oral motor deficits.
What they say about treatment targeting voice to be explaneided?
The mechanisms underlying the intelligibility improvements following intensive speech treatment targeting voice could be twofold. First, a goal of treatment targeting voice is to increase vocal loudness. Previous outcome data from the current patient group indicated that increases in SPL, the acoustic correlate of vocal loudness, were greater for the voice group than for the articulation group. Logically, increasing vocal loudness, and therefore, audibility, in patients with PD, many of whom present with decreased vocal loudness, would likely increase their intelligibility.
Secondly, beyond audibility, intelligibility benefits from intensive treatment targeting voice may stem from the impact of increased amplitude and coordination of movement gained across speech production subsystems when patients increase their vocal effort. That is, driving amplitude through the single target of voice may engage neurophysiological and biomechanical linkages between the vocal and the articulatory subsystems, thereby optimising treatment efficiency. In support of this explanation, Neel found that while artificially amplifying habitual speech in patients with PD increased their intelligibility, having the patients speak loudly yielded even greater intelligibility improvements, when SPLs were matched. These findings add support to the explanation of increased activity across motor systems, including in the phonatory and articulatory subsys- tems, contributing to improved intelligibility when voice is the target of intensive speech treatment.
Comparing these two groups the difference is due?
It is not due to the intensive treatment dosage.
The significant decrease in TA in the no treatment group could be explained by?
the slightly higher (nonsignificant) TA levels at baseline relative to other groups and regression (”taantuminen”) toward the mean.
The study methodology permitted for the first time?
patients’ originally-produced vocal loudness to be replicated for listeners, resulting in the dimension of vocal loudness being included in intelligibility assessment for the first time in an RCT.
Limitations?
limitation of narrative speech, studied here, however, is its inherent variability in length, linguistic complexity, and predictability. Still, the method for sentence selection was systematic and the sentences were comparable in number of words across groups and conditions.
Moreover, the study was statistically powered for patient and listener sample sizes and reliability of the findings was high.
Another possible limitation is that, whereas speech treatment targeting voice is implemented internationally (by approximately 20,000 clinicians in 70 countries, including telemedicine applications), this study involved only American English speakers.
Although these treatment studies report positive outcomes in languages other than English?
replication of rigorous intelligibility research is needed across linguistic and cultural backgrounds to assess intelligibility gains as a function of treatment internationally.
What is important current and future direction?
Research evaluating broad clinical translation of such findings to other populations, such as individuals with ataxia, cerebral palsy , or presbyphonia
