Perceptual training for improved intelligibility of dysarthric speech

项目总结/摘要 存在非常少的有效的治疗方法来减轻构音障碍的可理解性负担，并且所有这些都需要 说话者为达到和保持增益而付出的认知和体力努力[1，2]。因此，个人 由于认知和身体障碍限制了他们修改语言的能力， 根本不是可行的治疗方案这构成了一个巨大的健康差距， 影响具有发育、认知和/或显著神经肌肉损伤的人群。这 该提案解决了临床实践中的这一关键差距，通过将行为改变的重量从 演讲者对听众。虽然构音障碍管理的一个新概念，但这个想法深深植根于 心理语言学，并支持我们的程序性研究机构表明，针对性的知觉 训练范例（其中听众熟悉降级的语音信号并且被提供有 说话者正在说的话的正字法转录）导致统计上和临床上显著的可懂度 [5-14]此外，我们有初步证据表明，这些可理解性结果 可能受到假设驱动的说话者参数的影响，例如语音节奏的声学可预测性 [5，15]和听众参数，如节奏感知的专业知识[5，6]。必要的下一步， 使针对听众的感知培训更接近临床实施和总体目标 本文提出的工作之一，是对说话者和听话者进行系统和严格的分析， 参数及其相互作用，调节并在某些情况下优化感知训练 提高可理解性的好处。为了实现这一目标，我们利用现有的构音障碍数据库， 演讲和两个完善的测试站点的大量听众。这个项目的关键成果是 建议将解释模型，占独特的和共同的贡献，发言者和听众 参数对构音障碍语音感知训练后可懂度改善幅度的影响。 重要的是，从这项工作中得出的解释性模型不仅可以为临床决策提供信息， 这一潜在治疗方案的候选资格，但也将在后续I期临床试验中加以利用， 识别训练任务相关参数（例如，剂量，反馈，程序），优化泛化和 与构音障碍言语的知觉训练相关的可懂度结果的维持。感知 训练提供了一个有前途的途径，提高可懂度构音障碍的讲话，通过抵消交际 构音障碍患者对其主要沟通伙伴-家人，朋友和 照顾者因此，这项工作为构音障碍的创新和急需的扩展奠定了基础 从语音清晰度管理到以语音清晰度为目标的补救--为语音清晰度干预奠定基础 对于目前不存在的个人来说，这是一个选项。

PROJECT SUMMARY/ABSTRACT There exist very few effective treatments that ease the intelligibility burden of dysarthria, and all of these require cognitive and physical effort on the part of the speaker to achieve and maintain gains [1,2]. Therefore, individuals with intelligibility deficits whose cognitive and physical impairments limit their ability to modify their speech are simply not viable treatment candidates. This constitutes a significant health disparity that disproportionately affects those populations with developmental, cognitive, and/or significant neuromuscular impairment. This proposal addresses this critical gap in clinical practice, by shifting the weight of behavioral change from the speaker to the listener. While a novel concept for dysarthria management, the idea is firmly rooted in the field of psycholinguistics and supported by our programmatic body of research showing that listener-targeted perceptual training paradigms (wherein listeners are familiarized with the degraded speech signal and provided with an orthographic transcription of what the speaker is saying) result in statistically and clinically significant intelligibility gains in dysarthria [5-14]. Further, we have preliminary evidence to suggest that these intelligibility outcomes may be influenced by hypothesis-driven speaker parameters, such as acoustic predictability of speech rhythm cues [5,15], and listener parameters, such as expertise in rhythm perception [5,6]. A requisite next step to bringing listener-targeted perceptual training closer to clinical implementation, and the overarching goal of the work proposed herein, is the systematic and rigorous analysis of the speaker and listener parameters, and their interactions, that modulate, and in some cases optimize, perceptual training benefits of intelligibility improvement. To achieve this aim, we utilize an existing database of dysarthric speech and a large cohort of listeners across two well-established testing sites. The key deliverable from this proposal will be explanatory models that account for the unique and joint contributions of speaker and listener parameters on the magnitude of intelligibility improvement following perceptual training with dysarthric speech. Importantly, the explanatory models derived from this work will not only inform clinical decision-making regarding candidacy for this potential treatment option, but also will be leveraged in a follow-on Phase I Clinical Trial to identify training task-related parameters (e.g., dose, feedback, procedures) that optimize both generalization and maintenance of intelligibility outcomes associated with perceptual training with dysarthric speech. Perceptual training offers a promising avenue for improving intelligibility of dysarthric speech by offsetting the communicative burden from the patient with dysarthria on to their primary communication partners—family, friends, and caregivers. Thus, this work sets the stage for an innovative and much needed extension of dysarthria management to listener-targeted remediation—laying the groundwork for a speech intelligibility intervention option for individuals for whom one currently does not exist.