Enhancing speech naturalness using respiratory treatment in Parkinsons disease

描述（由申请人提供）：尽管有充分的证据表明帕金森病患者在语言自然度方面存在缺陷，但很少有技术可以提高帕金森病患者的语言自然度。因此，迫切需要识别和量化治疗技术的有效性，以提高PD患者的语言自然度，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（EMST）对改善PD患者语言自然度的积极益处。与PD相关的语言自然性缺陷包括重音模式、话语长度和停顿行为的损伤。PD患者在讲话时产生活跃肌肉力量来应对呼吸系统的各种需求的能力较弱。由于语音自然度的下降至少部分是由于呼气肌力量的下降，因此EMST范例被设计为直接增强呼气肌力量。由于emst后呼气肌力量增加，PD患者将利用增加的活动肌肉力量来更好地响应言语需求。EMST对交际效果的改变，特别是语言的自然度，还有待研究。该提案的基本原理是，成功完成将导致第一个以证据为基础的治疗技术，专门针对PD患者的语言自然性。该提案的三个具体目标是：1)评估EMST在改善PD患者沟通有效性的全球措施方面的有效性，2)确定EMST对语音呼吸支持的潜在生理变化，以及3)确定响应EMST而改变的潜在语音特征，这些特征有助于语音自然度的变化。为了实现这些目标，将使用具有多个基线测量和4周训练期的前测试-后测试设计。可理解度和语音自然度的感知评分、呼吸运动学、语调、重音和停顿模式的声学分析将用于确定治疗效果。这一贡献意义重大，因为它是连续研究的第一步

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.