Enhancing speech naturalness using respiratory treatment in Parkinsons disease

描述(由申请人提供)：尽管语音自然度方面的缺陷得到了很好的证明，但几乎没有可用的技术来增强帕金森氏病(PD)患者的语音自然度。因此，迫切需要确定和量化治疗技术的有效性，这些技术可以增强帕金森氏症患者的言语自然度，从而改善整体交际效果。这项建议的总体目标是评估呼吸系统治疗--呼气肌力量训练(EMST)--对改善帕金森氏症患者言语自然度的积极益处。与帕金森病相关的言语自然度缺陷包括重音模式、话语长度和停顿行为方面的损害。帕金森氏症患者在说话时不能产生积极的肌肉力量来回应对呼吸系统的各种要求。由于语言自然度的下降至少部分是由于呼气肌肉力量的下降，Emst范例被设计为直接增强呼气肌肉力量。由于Emst后呼气肌肉力量的增加，帕金森病患者将利用更活跃的肌肉力量来更好地响应言语需求。交际有效性的变化，特别是言语的自然性，作为Emst的结果，还有待于调查。这项提议的基本原理是，成功完成治疗将导致首次以证据为基础的治疗技术，专门针对帕金森病患者的言语自然性而设计。该提案的三个具体目标是：1)评估Emst对改善帕金森病患者交际有效性的全球测量的有效性；2)确定Emst对言语呼吸支持的潜在生理变化；3)确定因Emst而改变的潜在言语特征，以及这些特征对言语自然度的影响。为了实现这些目标，将使用具有多个基线措施和为期4周的培训的测试前-测试后设计。将使用可理解性和语言自然度的感知评级、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效果。这一贡献意义重大，因为它是一系列研究的第一步。 预计这将导致呼吸干预措施的发展，旨在提高帕金森病患者的沟通效率。该项目的成功完成将为临床医生提供一种循证治疗技术，用于治疗帕金森病患者言语自然度降低，从而改善功能性言语结果和生理状况。 公共卫生相关性：这项拟议的研究与公共健康相关，因为它有望提供一种循证治疗技术，以提高帕金森氏症患者的言语自然度。这种疗法是创新的，因为它专注于直接改善对言语的呼吸支持，作为一种提高言语自然度的方式，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.