Audiology and Speech Pathology - Research Publications
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ItemA controlled trial of ParkinSong singing groups to improve communication and wellbeing in Parkinson’s disease(Wiley, 2018-10)Objective: To explore the effects of a therapeutic group singing intervention (ParkinSong) on communication and wellbeing outcomes for people living with Parkinson’s disease. Background: Communication impairment is one of the most common symptoms of Parkinson’s disease, significantly impacting quality of life, yet few seek help for this. [1] Singing shares many of the neural networks and structural mechanisms used during speech. [2] Therapeutic group singing sessions can be designed specifically to target the functional communication issues resulting from Parkinson’s disease and to provide rhythmic cues to stimulate and organise motor speech output. [3] Methods: A controlled clinical trial measured the effects of a ParkinSong group singing intervention, at 2 dosage levels (weekly versus monthly) over 3 months, on voice, speech, respiratory, and wellbeing outcomes for 77 people living with Parkinson’s disease. The ParkinSong model comprises high effort vocal and respiratory tasks, speech exercises, group singing, and social communication opportunities. Control participants took part in regular peer support and/or creative activity groups that did not involve singing. Results: ParkinSong intervention participants demonstrated significant improvements in vocal intensity (p=0.001), maximum expiratory pressure (p=0.006), and voice-related quality of life (p=0.020) in comparison to controls. Weekly ParkinSong participants increased vocal intensity more than monthly participants (p = 0.011). Vocal intensity declined in non-treatment control groups. No changes in speech intelligibility, maximum phonation length, or health-related quality of life were observed. Conclusions: Group singing is an effective and engaging therapy to increase loudness and increase respiratory function in people with mild to moderately severe Parkinson’s disease References: 1. Miller N, Noble E, Jones D, Deane KHO, Gibb C. Survey of speech and language therapy provision for people with Parkinson’s disease in the United Kingdom: patients’ and carers’ perspectives. Int J Lang Commun Disord 2010;46(2):179-88. 2. Amorim GOD, Albuquerque LCA, Pernambuco LDA, Balata PMM, Luckwü-Lucena BT, Silva HJD. Contributions of neuroimaging in singing voice studies: a systematic review. Revista CEFAC 2017;19(4):556-64. 3. Tamplin J, Baker FA. Therapeutic singing protocols for addressing acquired and degenerative speech disorders in adults. Music Therapy Perspectives 2017.
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ItemEfficacy of Parkinsong Groups for improving Communication and Wellbeing in Parkinson's Disease(World Federation of Music Therapy, 2017)Communication impairment is one of the most common symptoms of Parkinson’s disease, significantly impacting quality of life (Miller, 2012). Speech characteristics may include a soft, monotone, breathy or hoarse voice quality, imprecise articulation, dysprosody and dysfluency (Skodda et al., 2013). These characteristics, combined with reduced nonverbal communication, cognitive-linguistic impairment and poor self-perception of speech, make communication difficult and lead to self-consciousness, reduced likelihood to participate in conversation, and the avoidance of social interaction that requires speaking. Communication difficulties can compound issues of depression and related social isolation (Miller et al., 2006).
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ItemNo Preview AvailableSpeech as a marker of early stage Huntington's Disease onset(Blackwell Publishing, 2011)
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ItemNo Preview AvailableIs age or culture important for the use of speech as a marker of depression?(Frontiers Research Foundation, 2012)Speech is a marker of depression severity and treatment response. Following on from a multisite randomised control trial which demonstrated the feasibility and validity of obtaining neurophysiologically based acoustic measures of depression in 25-65 year old English speakers, we sought to determine the efficacy of the methods in related clinically important cohorts: defined by age and language. 125 adults with major depression were recruited into an 8-week, open label observational study. Four cohorts were included: two English speaking groups (‘younger’ (n= 38) (18-25 years) and ‘older’ (n=27) (60-78 years)) and two Chinese speaking groups (Mandarin (n=29) and Cantonese speakers (n=31)). Participants beginning new treatments for depression were clinically evaluated at baseline, study midpoint (4 weeks), and end-point (8 weeks). After face to face assessment, participants completed the Quick Inventory of Depressive Symptomatology - Interactive Voice Response (QIDS-IVR) version using touch-tone telephones. Speech samples were also recorded for analysis of acoustic characteristics as clinical markers of depression severity and response to treatment. Timing-based measures of speech production, particularly during the performance of automatic speech tasks, showed the most significant correlations with overall depression severity. Specifically, associations between depression severity and total recording durations, pause times, pause variability, and speaking rates were consistent with previous studies. Few acoustic markers of speech, however, were significantly correlated with treatment response. Speech was significantly correlated with depression severity in all groups. Altered speech production and its relationship with clinician defined clinician treatment response was not clearly demonstrated, possibility due to low treatment response rates.
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ItemNo Preview AvailablePotential for optimising Deep Brain stimulation through tremor quantification(Duraspace, 2013)Introduction: Deep Brain Stimulation (DBS) can be used to minimise tremor when pharmaceutical therapies fail. DBS devices emit a bi-phasic pulse train with variable: » Amplitude » Pulse Duration » Frequency. These parameters are set based on clinical observation of tremor and side-effects. Aims: Develop an objective measure of tremor severity. Determine the influence of each stimulus parameter on measured tremor. Method: 6 adults with DBS implants in the Posterior Subthalamic Area to alleviate tremor were recruited. Tremor was recorded using a sensitive motion tracking system with sensors placed on the elbows and wrists. Stimulus amplitude, pulse-duration & frequency were systematically adjusted. Patients were asked to hold their arms out and complete finger-nose exercises during measurements. Following objective measures of tremor were calculated: » RMS Amplitude » Velocity » Power Spectral Density » Frequency » C90 volume. C90 Volume is the volume of an ellipsoid that covers 90% of the data when plotted on a x, y, z plane. Pearson’s Correlations were calculated between: » Each objective measure » Angular & translational measures » Clinical ratings & objective measures. Results: As expected all measures except frequency were significantly (p < 0.05) inter-correlated. Correlations between angular and translational data were marginal. Clinical ratings were correlated (p < 0.05) to angular RMS in all patients. Best correlations with clinical ratings were seen with C90 volume in 3 patients (p < 0.01). Conclusion: The proposed objective measures can be used to quantify tremor severity. Further investigation is required to determine the best objective measure. Real-time implementation might lead to automated stimulus optimisation.
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ItemClinical assessment of dysphagia in neurodegeneration (CADN): reliability and validity(John Wiley & Sons, 2016)Background and aims: Progressive neurological disease typically results in swallowing deficits (dysphagia). Current tools used to assess dysphagia are often unstandardized, qualitative or do not cover aspects beyond ability to swallow water. The CADN was developed to provide a quantitative method for describing and monitoring dysphagia in neurodegenerative disease. Methods: Assessment items were selected for their utility, validity and reliability based on clinical expertise and consideration of existing tools. 138 (predominately PD, but including hereditary ataxia) patients were assessed using CADN by two raters blinded to diagnosis. Additional outcome measures included a reference assessment (videofluoroscopic assessment of swallowing (VFSS)), the SWAL-QoL (patient survey) and the Montreal Cognitive Assessment (MoCA). Results: Clinical data derived from the VFSS and SWALQoL correlated significantly with CADN total and subsections (both impairment and functional components). Reliability of repeat assessments conducted within two days of each other was high. English, German and Spanish versions were developed. Conclusion: The CADN provides quantitative data on the nature and severity of dysphagia making it suitable for characterising deficits and monitoring change in function resulting from treatment or disease progression. It can be administered in less than 10 minutes. Disclosure: Work is supported by the Alexander von Humboldt Foundation, Germany and the National Health and Medical Research Council of Australia.
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ItemNo Preview AvailableSpeech as a reliable marker of alertness and performance impairment under conditions of acute sleep deprivation(Oxford University Press, 2017-04-28)The acoustic properties of speech are a reliable marker of changes in the central nervous system. Measures of speech timing and frequency have been used to assess impairment in clinical patient groups, including stroke, Huntington’s disease, and depression. Associations between speech properties and impaired performance have also been described in healthy individuals under periods of sleep deprivation. In the current study, we aimed to compare the time course of speech outcomes to other objective measures of alertness during 40 hours of sleep deprivation. Methods Twenty-three healthy volunteers (18 males; mean age=25.41 ± 5.73 years) underwent 40 hours of acute sleep deprivation under constant routine conditions. Speech tasks were administered every four hours, beginning three hours after scheduled waketime. The Psychomotor Vigilance Test (PVT), Karolinska Sleepiness Scale (KSS), and EEG collected during the Karolinksa Drowsiness Test (KDT) were measured bi-hourly. Objective measures of speech were derived using spectral, cepstral and timing analyses. Results Acoustic parameters displayed impairment across 40-h of sustained wakefulness. Measures of speech timing (e.g. speech rate) and frequency deteriorated significantly following 23 hours awake compared to baseline (first 16 hours awake). Impairment peaked around 31 hours of wakefulness before showing slight improvements. These findings were consistent with laboratory standard assessments of sleepiness and vigilant attention. Conclusion The time course of changes in the acoustic properties of speech are comparable to those changes observed in alertness and performance impairment across 40 h of sleep deprivation. These findings suggest the acoustic properties of speech may be a reliable indicator of alertness/drowsiness, with utility for development of objective and non-invasive systems to identify and manage sleep-related impairment in workplace settings. Support (If Any) The study was supported by the Cooperative Research Centre for Alertness, Safety and Productivity.
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ItemNo Preview AvailableArticulatory disturbance in Friedreich’s ataxia: An electropalatographic study(Wiley, 2009)Objective: To use the instrumentation of electropalatography (EPG) to investigate the spatial and temporal aspects of linguopalatal contact during consonant production in a group of individuals with Friedreich’s Ataxia (FRDA). Background: FRDA is an autosomal neurodegenerative disease primarily affecting the spinocerebellar tracts, the corticospinal path- ways and the dorsal columns. Clinical manifestation generally begins in childhood, with the individual becoming wheelchair bound in early adulthood and life expectancy being markedly reduced. Dysarthria constitutes a core symptom of FRDA, presenting between 5 and 19 years post onset of disease. Perceptual and acoustic studies have revealed an articulatory disturbance to be prominent in the dysarthria associated with FRDA. Methods: The subject group consisted of seven individuals, four females and three males, with confirmation of FRDA. The mean age of the group was 41.71 years (SD 5 8.3) with an age range of 35 to 56 years. A group of 14 non-neurologically impaired adults served as controls. The Reading EPG3 system was used to measure the amount and pattern of linguopalatal contact at the point of maximum contact and the consonant phase durations for an array of consonants, /t/, /l/, /s/, /k/. All consonants were word initial position, within words of CV and CVC construction, embedded into short sentences and repeated aloud five times by each subjects while wearing an EPG palate. Results: The FRDA group exhibited normal spatial configurations of linguopalatal contact. Temporal measures revealed significantly prolonged closure phase durations for each consonant singleton, con- tributing to longer consonant phase durations compared to the control group. Conclusions: The FRDA group demonstrated disturbances in artic- ulatory timing while maintaining normal linguopalatal contact pat- terns. The results are discussed in relation to the neuropathophysio- logical effects of spinocerebellar degeneration on speech motor control systems.
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ItemAcoustic analysis of the effects of 24 hours of sustained wakefulness(Australasian Speech Science and Technology Association, 2010)The effect of 24 hours of sustained wakefulness on the speech of healthy adults is poorly documented. Therefore, speech samples were systematically acquired (e.g., every four hours) from 18 healthy adults over 24 hours. Stimuli included automated and extemporaneous tasks, sustained vowel and a read passage. Measures of timing and frequency were derived acoustically using Praat and significant changes were observed on all tasks. The effect of fatigue on speech was found to be strongest just before dawn (after 22 hours). Key features of timing (e.g., mean pause length), frequency (e.g., F4 variation) and power (alpha ratio) changed as a function of increasing levels of fatigue. Index Terms: fatigue, voice, tiredness, clinical marker