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Purpose: The primary purpose of this study was to evaluate how individuals with hypophonia (HP; also referred to as HP participants) and their primary communication partners (PCPs; also referred to as PCP participants) rate communicative participation before and after experience with a speech amplification device. A secondary purpose was to evaluate pre- and post-device effects on self-rated communicative participation for each of the three speech amplification devices trialed outside of the laboratory. Method: Seventeen individuals with HP and their PCPs participated in a crossover design study that compared three different amplification devices: a wired belt-pack amplifier, a wireless stationary amplifier, and a personal frequency modulation (FM) system. Both the individuals with HP and their PCPs self-rated communicative participation at baseline and after trialing each device following 1-week device trial periods at home. Patient-reported outcome measures included the Communicative Effectiveness Survey (CES) and the Voice Activity and Participation Profile (VAPP). Following study completion, participants indicated whether they would like to select a specific device to continue using. Results: Overall, HP participants rated communicative participation following device use higher than that in the pre-device condition, with the FM system resulting in the overall highest VAPP ratings and second highest CES ratings. Furthermore, HP and PCP participants rated these measures similarly. Finally, HP participants who selected a device to continue using self-reported lower total communicative effectiveness scores and greater voice activity limitations and participation restrictions at baseline in comparison to the nonselectors. Conclusions: This study contributes to an increased understanding of how communicative participation is experienced within this clinical population resulting from speech amplification. It is suggested that the inclusion of participation-based outcome measurement is essential to ensure a multidimensional and comprehensive approach to device prescription for individuals with HP.

Purpose: The purpose of this study is to quantify the combined effects of face masks and effortful speech styles on speech intensity, spectral moments, and measures of spectral balance in talkers with Parkinson's disease. Method: Fifteen people with Parkinson's disease and 15 healthy, older controls read aloud sentences in three face mask conditions and three speech style conditions. Mask conditions included no mask, surgical masks, and KN95 masks. Speech styles included habitual, clear, and loud. Acoustic measures of intensity, spectral moments, and spectral balance were modeled as a function of speaker group, mask, and speech style. Results: Overall, talkers with PD demonstrated lower concentrations of high-frequency spectral energy in their speech. Face masks attenuated high-frequency energy, whereas clear followed by loud speaking styles amplified high frequencies. Overall, the attenuation observed by face masks was preserved across speech styles, and both mask and speech patterns were observed to be similar across groups. Discussion: Clear and loud speech styles were effective in compensating for the damping effects of masks in talkers with and without PD. However, given that people with PD demonstrated poorer overall spectral balance compared to controls, the gains afforded by speaking clearly or loudly may be limited when wearing a face mask.

Purpose The purpose of this study was to quantify changes in acoustic distinctiveness in two groups of talkers with Parkinson's disease as they modify across a wide range of speaking rates. Method People with Parkinson's disease with and without deep brain stimulation and older healthy controls read 24 carrier phrases at different speech rates. Target nonsense words in the carrier phrases were designed to elicit stop consonants and corner vowels. Participants spoke at seven self-selected speech rates from very slow to very fast, elicited via magnitude production. Speech rate was measured in absolute words per minute and as a proportion of each talker's habitual rate. Measures of segmental distinctiveness included a temporal consonant measure, namely, voice onset time, and a spectral vowel measure, namely, vowel articulation index. Results All talkers successfully modified their rate of speech from slow to fast. Talkers with Parkinson's disease and deep brain stimulation demonstrated greater baseline speech impairment and produced smaller proportional changes at the fast end of the continuum. Increasingly slower speaking rates were associated with increased temporal contrasts (voice onset time) but not spectral contrasts (vowel articulation). Faster speech was associated with decreased contrasts in both domains. Talkers with deep brain stimulation demonstrated more aberrant productions across all speaking rates. Conclusions Findings suggest that temporal and spectral segmental distinctiveness are asymmetrically affected by speaking rate modifications in Parkinson's disease. Talkers with deep brain stimulation warrant further investigation with regard to speech changes they make as they adjust their speaking rate.

PurposeThe aim of this study was to quantify changes in speech intelligibility in two cohorts of people with Parkinson's disease (PD; those with and without deep brain stimulation [DBS]) across a broad range of self-selected speech rate alterations in (a) read sentences and (b) extemporaneous speech (monologues).MethodFour speaker groups participated in this study: younger and older controls, people with PD undergoing standard pharmaceutical treatment, and people with PD and DBS. Naïve listeners rated the intelligibility of read sentences and extemporaneous monologues, spoken by participants at seven self-selected speech rates from very slow to very fast. Intelligibility was modeled as a function of group, speech rate condition, and speech task.ResultsOverall, compared to habitual speech rate, slower speech rate conditions were not associated with changes in speech intelligibility, whereas faster-than-habitual conditions were associated in declines in intelligibility. Results were mediated by group and task effects, such that talkers with PD and DBS were more likely to see intelligibility benefits at slower self-selected speech rates and less likely to see detriments at faster rates, and these differences were amplified in monologues compared to sentences.ConclusionFindings suggest differences in the ways in which slower and faster speech rate adjustments impact speech intelligibility in people with PD with and without DBS, with the latter demonstrating greater magnitudes of change.

Purpose This study compared the performance of three amplification devices hypothesized to improve speech communication in individuals with hypophonia (HP), as well as to identify individuals' device preferences. Method Twenty-two individuals with HP and their primary communication partners participated in a cross-over design study comparing three different speech amplification devices: a wired portable amplifier (Device A), a wireless stationary amplifier (Device B), and a one-way personal communication system (Device C). Participants attended one laboratory visit followed by 1-week trial periods with each device. At the first visit, HP participants completed speech tasks with and without the devices, in quiet and in noise. Following the in-laboratory test period, participants trialed each device at home for approximately 1 week per device. Following completion of the study, participants indicated whether or not they would like to continue using a device. Results Overall, in the presence of noise, all three devices demonstrated significant improvements in speech-to-noise levels and speech intelligibility compared to no device. A clear device hierarchy emerged such that the personal communication device (Device C) was associated with significantly better speech outcomes compared to the other two devices. The majority of participants elected to continue using a device at the completion of the study. Device preferences, however, did not clearly reflect the objective device hierarchy that was found for the objective speech measures. Each of the three devices was selected as a preferred device by at least three participants at the completion of the study. Conclusion Results from this study demonstrated clear differences in device performance in three distinct forms of amplification devices for individuals with HP. Findings suggest that amplification device use may be beneficial for this clinical population and underscore the potential to improve device availability and device selection criteria in future research. Supplemental Material https://doi.org/10.23641/asha.12735875

PurposeHeterogeneous child speech was force-aligned to investigate whether (a) manipulating specific parameters could improve alignment accuracy and (b) forced alignment could be used to replicate published results on acoustic characteristics of /s/ production by children.MethodIn Part 1, child speech from 2 corpora was force-aligned with a trainable aligner (Prosodylab-Aligner) under different conditions that systematically manipulated input training data and the type of transcription used. Alignment accuracy was determined by comparing hand and automatic alignments as to how often they overlapped (%-Match) and absolute differences in duration and boundary placements. Using mixed-effects regression, accuracy was modeled as a function of alignment conditions, as well as segment and child age. In Part 2, forced alignments derived from a subset of the alignment conditions in Part 1 were used to extract spectral center of gravity of /s/ productions from young children. These findings were compared to published results that used manual alignments of the same data.ResultsOverall, the results of Part 1 demonstrated that using training data more similar to the data to be aligned as well as phonetic transcription led to improvements in alignment accuracy. Speech from older children was aligned more accurately than younger children. In Part 2, /s/ center of gravity extracted from force-aligned segments was found to diverge in the speech of male and female children, replicating the pattern found in previous work using manually aligned segments. This was true even for the least accurate forced alignment method.ConclusionsAlignment accuracy of child speech can be improved by using more specific training and transcription. However, poor alignment accuracy was not found to impede acoustic analysis of /s/ produced by even very young children. Thus, forced alignment presents a useful tool for the analysis of child speech.Supplemental Materialhttps://doi.org/10.23641/asha.7070105

Purpose The settings of 3 electrical stimulation parameters were adjusted in 12 speakers with Parkinson's disease (PD) with deep brain stimulation of the subthalamic nucleus (STN-DBS) to examine their effects on vowel acoustics and speech intelligibility. Method Participants were tested under permutations of low, mid, and high STN-DBS frequency, voltage, and pulse width settings. At each session, participants recited a sentence. Acoustic characteristics of vowel production were extracted, and naive listeners provided estimates of speech intelligibility. Results Overall, lower-frequency STN-DBS stimulation (60 Hz) was found to lead to improvements in intelligibility and acoustic vowel expansion. An interaction between speaker sex and STN-DBS stimulation was found for vowel measures. The combination of low frequency, mid to high voltage, and low to mid pulse width led to optimal speech outcomes; however, these settings did not demonstrate significant speech outcome differences compared with the standard clinical STN-DBS settings, likely due to substantial individual variability. Conclusions Although lower-frequency STN-DBS stimulation was found to yield consistent improvements in speech outcomes, it was not found to necessarily lead to the best speech outcomes for all participants. Nevertheless, frequency may serve as a starting point to explore settings that will optimize an individual's speech outcomes following STN-DBS surgery. Supplemental Material https://doi.org/10.23641/asha.5899228