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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.

This study quantified the effects of face masks on spectral speech acoustics in healthy talkers using habitual, loud, and clear speaking styles. Harvard sentence lists were read aloud by 17 healthy talkers in each of the 3 speech styles without wearing a mask, when wearing a surgical mask, and when wearing a KN95 mask. Outcome measures included speech intensity, spectral moments, and spectral tilt and energy in mid-range frequencies which were measured at the utterance level. Masks were associated with alterations in spectral density characteristics consistent with a low-pass filtering effect, although the effect sizes varied. Larger effects were observed for center of gravity and spectral variability (in habitual speech) and spectral tilt (across all speech styles). KN95 masks demonstrated a greater effect on speech acoustics than surgical masks. The overall pattern of the changes in speech acoustics was consistent across all three speech styles. Loud speech, followed by clear speech, was effective in remediating the filtering effects of the masks compared to habitual speech.

During the COVID-19 pandemic, personal protective equipment such as facial masks and coverings were mandated all over the globe to protect against the virus. Although the primary aim of wearing face masks is to protect against viral transmission, they pose a potential burden on communication. The purpose of this scoping review was to identify the state of the evidence of the effect of facial coverings on acoustic and perceptual speech outcomes. The scoping review followed the framework created by Arksey & O’Malley (2005) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines (PRISMA-ScR; Tricco et al., 2018). The search was completed in May 2021 across the following databases: PubMed, EMBASE, PsycINFO, Web of Science, and Google Scholar. A total of 3,846 records were retrieved from the database search. Following the removal of duplicates, 3,479 remained for the title/abstract screen and 149 were selected for the full-text review. Of these, 52 were included in the final review and relevant data were extracted. The 52 articles included in the final review consisted of; 11 studied perceptual outcomes only, 16 studied acoustic outcomes only, and 14 studied both perceptual and acoustic outcomes. 13 of these investigated acoustic features that could be used for mask classification. Although the findings varied from article to article, many trends stood out. Many articles revealed that face masks act as a low pass filter, dampening sounds at higher frequencies; however, the frequency range and the degree of attenuation varied based on face mask type. All but five articles that reported on perceptual outcomes showed a common trend that wearing a face mask was associated with poorer speech intelligibility. The findings of the scoping review provided evidence that facial coverings negatively impacted speech intelligibility, which is likely due to a combination of auditory and visual cue degradation. Due to the continued prevalence of mask use, how facial coverings affect a wider variety of speaker populations, such as those with communication impairments, and strategies for overcoming communication challenges should be explored.

Talkers signal important information to listeners in part by manipulating prosodic prominence. In English, this is typically achieved by producing more prominent words with greater durations, intensity, f0, and hyperarticulation, though this tendency may be reduced in talkers with motor speech disorders. In the present study, older adults with and without Parkinson’s disease (PD) and dysarthria engaged in a simple instructional game activity in which they directed a research confederate to move around pictures on a board. Utterances were designed to manipulate prominence on stop-initial monosyllabic target words that differed in onset voicing and following vowel quality. Non-prominent words were repeated in the spoken instructions (“Move the pot above the chair, now move the [pot] above the box”), while prominent words contrasted with a minimal pair differing in onset voicing (“Move the pot above the chair, now move the [bot] above the chair”). Eleven people with PD and 11 age- and gender-matched controls participated. Overall, prominent words were longer, louder, and higher pitched, though control speakers modulated f0 to a greater extent than talkers with PD. Both groups modulated the amount of voicing during closure but not VOT as a means of increasing stop voicing contrasts in prominent words.

Objective:The purpose of this study was to examine the effectiveness, satisfaction, and acceptance of a low-cost Lombard-response (LR) device in a group of individuals with Parkinson’s disease (IWPD) and their communication partners (CPs).Method:Sixteen IWPD and hypophonia and their CPs participated in the study. The IWPD wore a LR device that included a small MP3 player (Sony Walkman) and headphones playing a multi-talker noise audio file at 80 dB during lab-based speech tasks and during their daily conversational speech over a 2-week device trial period. Outcome measures included average conversational speech intensity and scores on a questionnaire related to speech impairment, communication effectiveness, and device satisfaction.Results:Conversational speech intensity of the IWPD is increased by 7 to 10 dB with the LR device. Following a 2-week trial period, eight of the IWPD (50%) gave the LR device moderate-to-high satisfaction and effectiveness ratings and decided to purchase the device for long-term daily use. At the 4-month follow-up, none of the IWPDs were still using the LR device. Device rejection was related to discomfort (loudness), headaches, interference with cognition, and difficulty controlling device.Conclusion:Short-term acceptance and satisfaction with the LR device was moderate, but long-term acceptance, beyond 4 months, was absent. Future studies are required to determine if other types of low-cost LR devices can be developed that improve long-term efficacy and device acceptance in IWPD and hypophonia.

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.

Language impairment in Parkinson’s disease (PD) may be attributable to motor and action/event knowledge deficits. We predicted that cognitively intact PD participants would be impaired in anticipating objects in sentences from event-based thematic fit information. Twenty-four PD and 24 healthy age-matched participants completed comprehensive neuropsychological assessments. We recorded participants’ eye movements as they heard predictive (The fisherman rocks the boat) and non-predictive baseline sentences (Look at the bathtub). Predictive sentences contained target, agent-related, verb-related, and unrelated images. Baseline sentences used phonologically and semantically unrelated distractors. We tested effects of group (PD/control) on gaze using growth curve models. There were no significant differences between PD and control participants in either sentence type, suggesting that PD participants successfully and rapidly use combinatory thematic fit information to predict upcoming language. Additionally, we conducted an exploratory analysis contrasting PD and controls’ performance on low motion content versus high motion content verbs. This analysis revealed fewer predictive fixations in high-motion sentences only for healthy older adults, suggesting that people with Parkinson’s disease may adapt to their disease by relying on spared, non-action-simulation-based language prediction and processing mechanisms. Given that multiple studies have shown that individuals with PD have difficulty processing verbs, it is highly surprising that they match healthy adults in their ability to use verb meaning to predict upcoming nouns.

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.

Objective: To systematically evaluate how different deep brain stimulation of the subthalamic nucleus (STN-DBS) amplitude, frequency, and pulse-width electrical parameter settings impact speech intensity, voice quality, and prosody of speech in Parkinson’s disease (PD). Methods: Ten individuals with PD receiving bilateral STN-DBS treatments were seen for three baseline and five treatment visits. The five treatment visits involved an examination of the standard clinical settings as well as manipulation of different combinations of frequency (low, mid, and high), pulse width (low, mid, and high), and voltage (low, mid, and high) of stimulation. Measures of speech intensity, jitter, shimmer, harmonics–noise ratio, semitone standard deviation, and listener ratings of voice quality and prosody were obtained for each STN-DBS manipulation. Results: The combinations of lower frequency, lower pulse width, and higher voltage settings were associated with improved speech outcomes compared to the current standard clinical settings. In addition, decreased total electrical energy delivered to the STN appears to be associated with speech improvements. Conclusions: This study provides preliminary evidence that STN-DBS may be optimized for Parkinson-related problems with voice quality, speech intensity, and prosody of speech.

Face masks, now ubiquitous as a means of reducing COVID-19 transmission, have been shown to act as a low pass acoustic filter on speech. People with Parkinson’s disease (PwPD) and dysarthria may be especially vulnerable to the detrimental effects of masks, which may have negative consequences on spoken communication. The speech of PwPD has been shown to have lower concentrations of high frequency spectral energy and is perceptually characterized by a low speech volume and a breathy-hoarse voice quality. Increased vocal effort may aid in overcoming the filtering effects of masks. The purpose of this study was to quantify the effects of three masks (none, surgical, KN95) and three speech styles (habitual, clear, and loud) on the spectral characteristics of speech in PD. Fifteen PwPD and fifteen controls read aloud sentences with and without masks in three speech conditions. Measures of spectral tilt were taken from the long-term average spectra and modelled as a function of group, mask, and style. While both masks were associated with overall attenuation (steeper spectral tilt), a greater decrease was found for the PwPD (group by mask interaction). Loud speech, followed by clear speech, was effective in overcoming these effects for both groups.

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

Phonetic analysis is labor intensive, limiting the amount of data that can be considered. Recently, automated techniques (e.g., forced alignment based on Automatic Speech Recognition - ASR) have emerged allowing for much larger-scale analyses. For adult speech, forced alignment can be accurate even when the phonetic transcription is automatically generated, allowing for large-scale phonetic studies. However, such analyses remain difficult for children's speech, where ASR methods perform more poorly. The present study used a trainable forced aligner that performs well on adult speech to examine the effect of four factors on alignment accuracy of child speech: (1) Corpus - elicited speech (multiple children) versus spontaneous speech (single child); (2) Pronunciation dictionary - standard adult versus customized; (3) Training data - adult lab speech, corpus-specific child speech, all child speech, or a combination of child and adult speech; (4) Segment type - voiceless stops, voiceless sibilants, and vowels. Automatic and manual segmentations were compared. Greater accuracy was observed with (1) elicited speech, (2) customized pronunciations, (3) training on child speech, and (4) stops. These factors increase the utility of analyzing children's speech production using forced alignment, potentially allowing researchers to ask questions that otherwise would require weeks or months of manual-segmentation.

Phonetic analysis is labor intensive, limiting the amount of data that can be considered. Automated techniques (e.g., forced alignment based on Automatic Speech Recognition, ASR) have recently emerged allowing for larger-scale analysis. While forced alignment can be accurate for adult speech (e.g., Yuan & Liberman, 2009), ASR techniques remain a challenge for child speech (Benzeghiba et al., 2007). We used a trainable forced aligner (Gorman et al., 2011) to examine the effect of four factors on alignment accuracy with child speech: (1) Datasets CHILDES (McWhinney, 2000):—Spontaneous speech (single child)—Picture naming (multiple children, Paidologos data); (2) Phonetic Transcription—Manual—Automatic—CMU dictionary (Weide, 1998); (3) Training data—Adult lab data—one dataset of child data—All child data—Child & adult lab data; (4) Segment—voiceless stops—voiceless sibilants—vowels Automatically generated alignments were compared to hand segmentations. While there were limits on accuracy, in general, better results were obtained with (1) picture naming, (2) manual phonetic transcription, (3) training data including child speech, and (4) voiceless stops. These four factors increase the utility of analyzing children’s speech production using forced alignment, potentially allowing researchers to conduct larger-scale studies that would not otherwise be feasible.