Therapeutic Approaches to Dysarthria: Acoustic and Perceptual Correlates

 描述(由申请人提供)：在150万患有特发性帕金森病(PD)的美国人中，90%的人将经历构音障碍；在50万患有多发性硬化症(MS)的美国人中，50%将经历构音障碍。构音障碍会影响就业、休闲活动和社会关系，对生活质量和社会参与造成毁灭性的后果。因此，最大限度地提高感知语言充分性的治疗技术的知识，如以可理解性的黄金标准感知结构为索引，是至关重要的。由于缺乏公正的比较研究，选择一种技术而不是其他技术往往是基于反复试验或反映临床医生的偏见，这两者都与循证实践相抵触。该项目从一开始就试图解决构音障碍治疗技术的相对优点方面知识的这一关键差距。为此，过去资金周期发表的研究比较了三种常见的全球性构音障碍治疗技术的声学和知觉优点，包括1)速率操纵，2)提高嗓音强度，3)MS和PD以及年龄和性别匹配的神经典型说话者的清晰语音。整体治疗技术本身就会引起共同出现的声学变化(例如，持续时间、节段性发音)。由于缺乏一个解释性的、基于声学的可理解性模型，导致或解释整体治疗技术改善感知结果的声学变化(S)是未知的。确定解释构音障碍清晰度变化的声学变量，不仅将极大地促进对清晰度的理论理解，而且将加强科学基础 接受治疗。专注于那些可解释提高清晰度的声学变量的治疗可能会进一步加速治疗的进展。重要的是，之前的研究 资金周期表明了语音分析的前景-识别可解释构音障碍清晰度的节段性和超段性声学变量的重新合成。在这项工作的基础上，继续的首要目标是促进基于声学的可理解性解释模型的发展。我们的方法1)使用已建立的感知程序和声学测量，2)使用创新的分析-再合成技术，允许得出关于伴随构音障碍治疗技术的声学变化与可懂度之间的解释关系的结论，以及3)利用机器学习的方法来建立声学可懂度的预测模型。这项工作的影响在于它有助于1)提高对可理解性的概念性理解，2)加强治疗的科学基础，以及3)优化构音障碍治疗技术的临床实施。

 DESCRIPTION (provided by applicant): 90% of the 1.5 million Americans living with idiopathic Parkinson's disease (PD) and 50% of the 500,000 Americans living with Multiple Sclerosis (MS) will experience dysarthria. Dysarthria has devastating consequences for life quality and participation in society due to its effects on employment, leisure activities and social relationships. Knowledge of therapy techniques for maximizing perceived speech adequacy, as indexed by the gold standard perceptual construct of intelligibility is thus of vital importance. Owing to the scarcity of impartial comparative studies, the choice of one technique over others is often based on trial and error or reflects clinician bias, both of which are at odds with evidence-based practice. This project has sought to address this critical gap in knowledge regarding the comparative merits of dysarthria treatment techniques since its inception. Toward this end, published studies from the past funding cycle compared the acoustic and perceptual merits of three common, global dysarthria treatment techniques including 1) rate manipulation, 2) an increased vocal intensity and 3) clear speech in MS and PD as well as age and sex matched neurotypical talkers. Global treatment techniques by their very nature elicit co-occurring acoustic changes (e.g., duration, segmental articulation). Because an explanatory, acoustically-based model of intelligibility is lacking, the acoustic change(s) causing or explainin the improved perceptual outcomes of global treatment techniques are unknown. Determining the acoustic variables explaining intelligibility variation in dysarthria would not only tremendousy advance theoretical understanding of intelligibility but also would strengthen the scientific basis for treatment. Treatment focused on those acoustic variables explanatory for improved intelligibility may further accelerate progress in therapy. Importantly, research from the previous funding cycle suggests the promise of speech analysis-resynthesis for identifying segmental and suprasegmental acoustic variables explanatory for intelligibility in dysarthria. Building upon this work, the overarching goal of the continuation is to contribute towards development of an acoustically-based explanatory model of intelligibility. Our approach 1) employs established perceptual procedures and acoustic measures, 2) uses an innovative analysis-resynthesis technique that permits conclusions concerning the explanatory relationship between acoustic changes accompanying dysarthria therapy techniques and intelligibility, and 3) leverages methods from machine learning to build a predictive model of intelligibility from acoustics. The impact of this work is in its contribution to 1) advancing conceptual understanding of intelligibility, 2) strengthening the scientific basis for treatment, and 3) optimizing clinical implementation of dysarthria therapy techniques.