Abstract
Clear speech refers to intentionally modifying conversational speech to maximise intelligibility. This study aimed to compare the speech behaviour of patients with progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and Parkinson's disease (PD) under conversational and clear speech conditions to gain greater pathophysiological insight. A total of 68 participants including 17 PD, 17 MSA, 17 PSP and 17 healthy controls (HC) performed two readings of the same standardized passage. During the first reading, participants were instructed to read the text in an ordinary way, while during the second reading to read the text as clearly as possible. Acoustic analyses were based upon measurements of mean loudness, loudness variability, pitch variability, vowel articulation, articulation rate and speech severity. During clear speech production, PD patients were able to achieve improvements mainly in loudness (p < 0.05) and pitch variability (p < 0.001), leading to a reduction in overall speech severity (p < 0.001), whereas PSP and MSA patients were able to modulate only articulation rate (p < 0.05). Contrary to HC and PD groups, which slowed or maintained articulation rate, PSP and MSA groups employed a markedly faster articulation rate under the clear speech condition indicating an opposing approach to speech adaptation. Patients with atypical Parkinsonism showed a different strategy to intentionally improve their speech performance following a simple request to produce speech more clearly compared to PD, suggesting important therapeutic implications for speech rehabilitation management.
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References
Antonini A, Leenders KL, Vontobel P, Maguire RP, Missimer J, Psylla M, Günther I (1997) Complementary PET studies of striatal neuronal function in the differential diagnosis between multiple system atrophy and Parkinson's disease. Brain 120:2187–2195. https://doi.org/10.1093/brain/120.12.2187
Armstrong MJ (2018) Progressive supranuclear palsy: an update. Curr Neurol Neurosci Rep 18:12. https://doi.org/10.1007/s11910-018-0819-5
Beukelman DR, Fager S, Ullman C, Hanson E, Logemann J (2002) The impact of speech supplementation and clear speech on the intelligibility and speaking rate of people with traumatic brain injury. J Med Speech Lang Pathol 10:237–242
Boersma P, Weenink D (2001) Praat, a system for doing phonetics by computer. Glot Int 5:341–345
Brown P, Marsden C (1998) What do the basal ganglia do? Lancet 351:1801–1804. https://doi.org/10.1016/S0140-6736(97)11225-9
Darley FL, Aronson AE, Brown JR (1969) Clusters of deviant speech dimensions in the dysarthrias. J Speech Hear Res 12:462–496
Duffy JR (2013) Motor speech disorders: substrates, differential diagnosis, and management, 3rd edn. Mosby, St. Louis, MO
Fanciulli A, Stankovic I, Krismer F, Seppi K, Levin J, Wenning GK (2019) Multiple system atrophy. Int Rev Neurobiol 149:137–192. https://doi.org/10.1016/bs.irn.2019.10.004
Ford M, Malone L, Nyikos I, Yelisetty R, Bickel C (2010) Gait training with progressive external auditory cueing in persons with Parkinson’s disease. Arch Phys Med Rehabil 91:1255–1261. https://doi.org/10.1016/j.apmr.2010.04.012
Gerstenecker A, Mast B, Duff K, Ferman TJ, Litvan I (2013) Executive dysfunction is the primary cognitive impairment in progressive supranuclear palsy. Arch Clin Neuropsychol 28:104–113. https://doi.org/10.1093/arclin/acs098
Gilman S, Wenning GK, Low PA, Brooks DJ, Mathias CJ et al (2008) Second consensus statement on the diagnosis of multiple system atrophy. Neurology 71:670–676. https://doi.org/10.1212/01.wnl.0000324625.00404.15
Goberman AM, Elmer LW (2005) Acoustic analysis of clear versus conversational speech in individuals with Parkinson disease. J Commun Disord 38:215–230. https://doi.org/10.1016/j.jcomdis.2004.10.001
Harel BT, Cannizzarom MS, Cohen H, Reilly N, Snyder PJ (2004) Acoustic characteristics of Parkinsonian speech: a potential biomarker of early disease progression and treatment. J Neurolinguistics 17:439–453. https://doi.org/10.1016/j.jneuroling.2004.06.001
Ho AK, Iansek R, Marigliani C, Bradshaw JL, Gates S (1998) Speech impairment in a large sample of patients with Parkinson's disease. Behav Neurol 11:131–137
Höglinger GU, Respondek G, Stamelou M, Kurz C, Josephs KA et al (2017) Clinical diagnosis of progressive supranuclear palsy: The movement disorder society criteria. Mov Disord 32:853–864. https://doi.org/10.1002/mds.26987
Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184. https://doi.org/10.1136/jnnp.55.3.181
Huh YE, Park J, Suh MK, Lee SE, Kim J, Jeong Y, Kim HT, Cho JW (2015) Differences in early speech patterns between Parkinson variant of multiple system atrophy and Parkinson's disease. Brain Lang 147:14–20. https://doi.org/10.1016/j.bandl.2015.04.007
Hustad KC, Weismer G (2007) Interventions to improve intelligibility and communicative success for speakers with dysarthria. In: Weismer G (ed) Motor speech disorders. Plural, San Diego, pp 217–228
Kearney E, Giles R, Haworth B, Faloutsos P, Baljko Y (2017) Sentence-Level Movements in Parkinson's Disease: Loud, Clear, and Slow Speech. J Speech Lang Hear Res 60:3426–3440. https://doi.org/10.1044/2017_JSLHR-S-17-0075
Kluin KJ, Foster NL, Berent S, Gilman S (1993) Perceptual analysis of speech disorders in progressive supranuclear palsy. Neurology 43:563–566. https://doi.org/10.1212/wnl.43.3_part_1.563
Kluin KJ, Gilman S, Lohman M, Junck L (1996) Characteristics of the dysarthria of multiple system atrophy. Arch Neurol 53:545–548. https://doi.org/10.1001/archneur.1996.00550060089021
Lam J, Tjaden K (2016) Clear Speech Variants: An Acoustic Study in Parkinson's Disease. J Speech Lang Hear Res 59:631–646. https://doi.org/10.1044/2015_JSLHR-S-15-0216
Litvan I, Hauw JJ, Bartko JJ, Lantos PL, Daniel SE, Horoupian DS, McKee A, Dickson D, Bancher C, Tabaton M, Jellinger K, Anderson DW (1996) Validity and reliability of the preliminary NINDS neuropathologic criteria for progressive supranuclear palsy and related disorders. J Neuropathol Exp Neurol 55:97–105. https://doi.org/10.1097/00005072-199601000-00010
Navntoft CA, Dreyer JK (2016) How compensation breaks down in Parkinson's disease: insights from modeling of denervated striatum. Mov Disord 31:280–289. https://doi.org/10.1002/mds.26579
Oliveira R, Gurd J, Nixon P, Marshall J, Passingham R (1997) Micrographia in Parkinson’s disease: the effect of providing external cues. J Neurol Neurosurg Psychiatry 63:429–433. https://doi.org/10.1136/jnnp.63.4.429
O'Sullivan SS, Massey LA, Williams DR, Silveira-Moriyama L, Kempster PA, Holton JL, Revesz T, Lees AJ (2008) Clinical outcomes of progressive supranuclear palsy and multiple system atrophy. Brain 131:1362–1372. https://doi.org/10.1093/brain/awn065
Park S, Theodoros D, Finch E, Cardell E (2016) Be clear: a new intensive speech treatment for adults with nonprogressive dysarthria. Am J Speech Lang Pathol 25:97–110. https://doi.org/10.1044/2015_AJSLP-14-0113
Park Y (2018) Efficacy of intensive treatment of dysarthria for people with multiple system atrophy. Phonetics Speech Sci 10:163–171
Payan CA, Viallet F, Landwehrmeyer BG, Bonnet AM, Borg M, Durif F et al (2011) Disease severity and progression in progressive supranuclear palsy and multiple system atrophy: validation of the NNIPPS–Parkinson Plus Scale. PLoS ONE 6:e22293. https://doi.org/10.1371/journal.pone.0022293
Payton KL, Uchanski RM, Braida LD (1994) Intelligibility of conversational and clear speech in noise and reverberation for listeners with normal and impaired hearing. J Acoust Soc Am 95:1581–1592. https://doi.org/10.1121/1.408545
Poewe W, Seppi K, Tanner CM, Halliday GM, Brundin P, Volkmann J, Schrag AE, Lang AE (2017) Parkinson disease. Nat Rev Dis Primers 3:17013. https://doi.org/10.1038/nrdp.2017.13
Ramig LO, Sapir S, Countryman S et al (2001) Intensive voice treatment (LSVT) for patients with Parkinson's disease: a 2 year follow up. J Neurol Neurosurg Psychiatry 71:493–498. https://doi.org/10.1136/jnnp.71.4.493
Rusz J, Cmejla R, Ruzickova H, Ruzicka E (2011) Quantitative acoustic measurements for characterization of speech and voice disorders in early untreated Parkinson's disease. J Acoust Soc Am 129:350–367. https://doi.org/10.1121/1.3514381
Rusz J, Cmejla R, Tykalova T, Ruzickova H, Klempir J, Majerova V, Picmausova J, Roth J, Ruzicka E (2013a) Imprecise vowel articulation as a potential early marker of Parkinson's disease: effect of speaking task. J Acoust Soc Am 134:2171–2181. https://doi.org/10.1121/1.4816541
Rusz J, Cmejla R, Ruzickova H, Klempir J, Majerova V, Picmausova J, Roth J, Ruzicka E (2013b) Evaluation of speech impairment in early stages of Parkinson’s disease: a prospective study with the role of pharmacotherapy. J Neural Transm 120:319–329. https://doi.org/10.1007/s00702-012-0853-4
Rusz J, Bonnet C, Klempir J, Tykalova T, Baborova E, Novotny M, Rulseh A, Ruzicka E (2015) Speech disorders reflect differing pathophysiology in Parkinson's disease, progressive supranuclear palsy and multiple system atrophy. J Neurol 262:992–1001. https://doi.org/10.1007/s00415-015-7671-1
Rusz J, Hlavnicka J, Tykalova T, Novotny M, Dusek P, Sonka K, Ruzicka E (2018) Smartphone allows capture of speech abnormalities associated with high risk of developing Parkinson’s disease. IEEE Trans Neural Syst Rehabil Eng 26:1495–1507. https://doi.org/10.1109/tnsre.2018.2851787
Sale P, Castiglioni D, De Pandis MF, Torti M, Dall'armi V, Radicati FG, Stocchi F (2015) The Lee Silverman Voice Treatment (LSVT®) speech therapy in progressive supranuclear palsy. Eur J Phys Rehabil Med 51:569–574
Sapir S (2014) Multiple factors are involved in the dysarthria associated with Parkinson's disease: a review with implications for clinical practice and research. J Speech Lang Hear Res 57:1330–1343. https://doi.org/10.1044/2014_JSLHR-S-13-0039
Schreckenberger M, Hägele S, Siessmeier T, Buchholz HG, Armbrust-Henrich H, Rösch F, Gründer G, Bartenstein P, Vogt T (2004) The dopamine D2 receptor ligand 18F-desmethoxyfallypride: an appropriate fluorinated PET tracer for the differential diagnosis of parkinsonism. Eur J Nucl Med Mol Imaging 31:1128–1135. https://doi.org/10.1007/s00259-004-1465-5
Skodda S, Visser W, Schlegel U (2011) Acoustical analysis of speech in progressive supranuclear palsy. J Voice 25:725–731. https://doi.org/10.1016/j.jvoice.2010.01.002
Tjaden K, Lam J, Wilding G (2013) Vowel acoustics in Parkinson’s disease and multiple sclerosis: comparison of clear, loud, and slow speaking conditions. J Speech Lang Hear Res 56:1485–1502. https://doi.org/10.1044/1092-4388(2013/12-0259)
Tjaden K, Sussman JE, Wilding GE (2014) Impact of clear, loud, and slow speech on scaled intelligibility and speech severity in Parkinson's disease and multiple sclerosis. J Speech Lang Hear Res 57:779–792. https://doi.org/10.1044/2014_JSLHR-S-12-0372
Tykalova T, Rusz J, Klempir J, Cmejla R, Ruzicka E (2017) Distinct patterns of imprecise consonant articulation among Parkinson's disease, progressive supranuclear palsy and multiple system atrophy. Brain Lang 165:1–9. https://doi.org/10.1016/j.bandl.2016.11.005
Wenning GK, Litvan I, Tolosa E (2011) Milestones in atypical and secondary Parkinsonisms. Mov Disord 26:1083–1095. https://doi.org/10.1002/mds.23713
Whitfield JA, Goberman AM (2014) Articulatory-acoustic vowel space: application to clear speech in individuals with Parkinson's disease. J Commun Disord 51:19–28. https://doi.org/10.1016/j.jcomdis.2014.06.005
Yorkston K, Beukelman DR, Strand E, Hakel M (2010) Clinical management of speakers with motor speech disorders, 3rd edn. Pro-Ed, Austin, TX
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This study was supported by the Czech Ministry of Health project NV19-04-00120. All rights reserved.
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Skrabal, D., Tykalova, T., Klempir, J. et al. Dysarthria enhancement mechanism under external clear speech instruction in Parkinson's disease, progressive supranuclear palsy and multiple system atrophy. J Neural Transm 127, 905–914 (2020). https://doi.org/10.1007/s00702-020-02171-5
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DOI: https://doi.org/10.1007/s00702-020-02171-5