Perceptual training for improved intelligibility of dysarthric speech

项目摘要/摘要 很少有有效的治疗方法来减轻构音障碍的可理解性负担，而所有这些都需要 说话人为实现和保持收益而付出的认知和体力努力[1，2]。因此，个人 有可理解性缺陷的人，其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。这构成了巨大的健康差距，不成比例地 影响那些有发育、认知和/或严重神经肌肉功能障碍的人群。这 该提案解决了临床实践中的这一关键差距，将行为变化的权重从 扬声器对准听众。虽然构音障碍的治疗是一个新的概念，但这个想法坚定地植根于 心理语言学和我们的计划性研究机构支持的，表明以听众为目标的知觉 训练范例(其中收听者熟悉退化的语音信号并向其提供 说话者所说内容的拼写)导致统计上和临床上有意义的可理解性 构音障碍方面的进展[5-14]。此外，我们有初步证据表明，这些可理解性的结果 可能受假设驱动的说话人参数的影响，例如语音节奏的声学可预测性 线索[5，15]和听者参数，如节奏感知方面的专业知识[5，6]。一个必要的下一步是 使以听众为目标的知觉培训更接近临床实施，以及总体目标 本文提出的工作之一是对说话人和听话人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知觉训练 提高清晰度的好处。为了实现这一目标，我们利用了现有的关节功能障碍数据库 演讲和一大群听众，分布在两个完善的测试地点。由此产生的主要可交付成果 提案将是解释性模型，说明说话者和听话者的独特和共同贡献 用构音障碍进行知觉训练后清晰度改善幅度的参数。 重要的是，从这项工作中得到的解释性模型不仅将为临床决策提供信息 这一潜在治疗方案的候选资格，但也将在后续的I期临床试验中加以利用，以 确定与培训任务相关的参数(例如，剂量、反馈、程序)，以优化推广和 与构音障碍的知觉训练相关的可理解性结果的维持。感性的 训练为改善构音障碍的可理解性提供了一条很有希望的途径，因为它抵消了交际性 构音障碍患者的负担转嫁给他们的主要沟通伙伴--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 以听众为目标的补救管理--为言语清晰度干预奠定基础 为当前不存在的个人提供的选项。

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.