Enhancing speech naturalness using respiratory treatment in Parkinsons disease

描述（由申请人提供）：尽管有充分记录的语音自然度缺陷，但很少有技术可用于增强帕金森病（PD）患者的语音自然度。因此，迫切需要识别和量化治疗技术的有效性，以提高PD患者的语音自然度，从而提高整体沟通效率。本提案的总体目标是评估呼吸治疗（呼气肌力量训练（埃姆斯特））对改善PD患者语言自然度的积极益处。在这个建议中，与PD相关的语音自然度的缺陷包括重音模式、话语长度和停顿行为的损害。患有PD的个体不太能够产生主动肌肉力量来响应讲话期间对呼吸系统的各种需求。因为降低的语音自然度至少部分是由于降低的呼气肌肉力量，所以埃姆斯特范例被设计成直接增强呼气肌肉力量。由于EMST后呼气肌力量增加，PD患者将利用增加的主动肌肉力量更好地响应语音需求。埃姆斯特对交际效果的影响，特别是对言语自然度的影响还有待研究。该提案的基本原理是，成功完成将导致第一个专门针对PD患者语音自然度的循证治疗技术。该提案的三个具体目标是：1）评估埃姆斯特在改善PD患者沟通有效性的整体测量方面的有效性，2）确定埃姆斯特导致的语音呼吸支持的潜在生理变化，以及3）确定响应于埃姆斯特而改变并有助于语音自然度变化的潜在语音特征。为了实现这些目标，将使用具有多个基线测量和4周培训期的前测-后测设计。将使用可懂度和语音自然度的感知评级、呼吸运动学以及语调、重音和停顿模式的声学分析来确定治疗的疗效。这一贡献意义重大，因为它是一系列研究的第一步 这有望导致呼吸干预的发展，旨在提高个人与PD的沟通效率。该项目的成功完成将为临床医生提供一种基于证据的治疗技术，用于PD患者的语音自然度降低，改善功能性语音结果和生理学。 公共卫生相关性：拟议的研究与公共卫生有关，因为它有望提供一种基于证据的治疗技术，以提高PD患者的语音自然度。这种治疗方法是创新的，因为它专注于直接改善语言的呼吸支持，作为一种增强语言自然度的方法，而不依赖于个人的认知能力。

DESCRIPTION (provided by applicant): Despite well-documented deficits in speech naturalness, there are few techniques available to enhance speech naturalness in individuals with Parkinson's disease (PD). Thus, there is a critical need to identify and quantify the effectiveness of therapy techniques that enhance speech naturalness in individuals with PD, thereby improving overall communicative effectiveness. The overall objective of this proposal is to assess the positive benefits of a respiratory treatment, Expiratory Muscle Strength Training (EMST), for improving speech naturalness in individuals with PD. The deficits in speech naturalness associated with PD targeted in this proposal include impairments in stress patterns, utterance length, and pausing behaviors. Individuals with PD are less able to produce active muscle forces to respond to the variety of demands placed on the respiratory system during speech. Because decreased speech naturalness is at least partially due to decreased expiratory muscle strength, the EMST paradigm is designed to directly enhance expiratory muscle strength. As a result of increased expiratory muscle strength post-EMST, individuals with PD will utilize increased active muscle forces to better respond to the demands of speech. Changes to communicative effectiveness, specifically speech naturalness, as a result of EMST have yet to be investigated. The rationale for the proposal is that successful completion will lead to the firs evidence-based treatment technique specifically designed to target speech naturalness in individuals with PD. The three specific aims of the proposal are: 1) to assess the effectiveness of EMST for improving global measures of communicative effectiveness in individuals with PD, 2) to identify the underlying physiologic changes to respiratory support for speech as a result of EMST, and 3) to identify the underlying speech characteristics that are altered in response to EMST and that contribute to changes in speech naturalness. To address these aims, a pre-test-post-test design with multiple baseline measures and a 4-week training period will be used. Perceptual ratings of intelligibility and speech naturalness, respiratory kinematics, and acoustic analyses of intonation, stress, and pause patterns will be used to determine the efficacy of the treatment. This contribution is significant because it is the first step in a continuum of research that is expected to lead to the development of respiratory interventions designed to improve communicative effectiveness in individuals with PD. Successful completion of this project will provide clinicians with an evidence-based treatment technique for reduced speech naturalness in individuals with PD that improves both functional speech outcomes and physiology. PUBLIC HEALTH RELEVANCE: The proposed research is relevant to public health because it is expected to provide an evidence-based treatment technique to enhance speech naturalness in individuals with PD. The treatment is innovative because it focuses on direct improvement of respiratory support for speech as a way to enhance speech naturalness without relying on an individual's cognitive abilities.