Treating Speech Movement Hypokinesia in Parkinson's Disease: Does Movement Size Matter? Purpose This study evaluates the effects of a novel speech therapy program that uses a verbal cue and gamified augmented visual feedback regarding tongue movements to address articulatory hypokinesia during speech in individuals with Parkinson's disease (PD). Method Five participants with PD participated in an ABA single-subject design ... Research Article
Research Article  |   November 08, 2018
Treating Speech Movement Hypokinesia in Parkinson's Disease: Does Movement Size Matter?
 
Author Affiliations & Notes
  • Elaine Kearney
    Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
    University Health Network—Toronto Rehabilitation Institute, Ontario, Canada
  • Brandon Haworth
    University Health Network—Toronto Rehabilitation Institute, Ontario, Canada
    Department of Electrical Engineering and Computer Science, York University, Toronto, Ontario, Canada
  • Jordan Scholl
    Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
    University Health Network—Toronto Rehabilitation Institute, Ontario, Canada
  • Petros Faloutsos
    University Health Network—Toronto Rehabilitation Institute, Ontario, Canada
    Department of Electrical Engineering and Computer Science, York University, Toronto, Ontario, Canada
  • Melanie Baljko
    University Health Network—Toronto Rehabilitation Institute, Ontario, Canada
    Department of Electrical Engineering and Computer Science, York University, Toronto, Ontario, Canada
  • Yana Yunusova
    Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
    University Health Network—Toronto Rehabilitation Institute, Ontario, Canada
    Sunnybrook Research Institute, Biological Sciences, Toronto, Ontario, Canada
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Elaine Kearney: elaine.kearney@mail.utoronto.ca
  • Editor-in-Chief: Julie Liss
    Editor-in-Chief: Julie Liss×
  • Editor: Bharath Chandrasekaran
    Editor: Bharath Chandrasekaran×
Article Information
Speech, Voice & Prosodic Disorders / Special Populations / Older Adults & Aging / Speech / Research Articles
Research Article   |   November 08, 2018
Treating Speech Movement Hypokinesia in Parkinson's Disease: Does Movement Size Matter?
Journal of Speech, Language, and Hearing Research, November 2018, Vol. 61, 2703-2721. doi:10.1044/2018_JSLHR-S-17-0439
History: Received November 23, 2017 , Revised April 19, 2018 , Accepted May 29, 2018
 
Journal of Speech, Language, and Hearing Research, November 2018, Vol. 61, 2703-2721. doi:10.1044/2018_JSLHR-S-17-0439
History: Received November 23, 2017; Revised April 19, 2018; Accepted May 29, 2018

Purpose This study evaluates the effects of a novel speech therapy program that uses a verbal cue and gamified augmented visual feedback regarding tongue movements to address articulatory hypokinesia during speech in individuals with Parkinson's disease (PD).

Method Five participants with PD participated in an ABA single-subject design study. The treatment aimed to increase tongue movement size using a combination of a verbal cue and augmented visual feedback and was conducted in 10 45-min sessions over 5 weeks. The presence of visual feedback was manipulated during treatment. Articulatory working space of the tongue was the primary outcome measure and was examined during treatment and in cued and uncued sentences pre- and posttreatment. Changes in speech intelligibility in response to a verbal cue pre- and posttreatment were also examined.

Results During treatment, 4/5 participants showed a beneficial effect of visual feedback on tongue articulatory working space. At the end of the treatment, they used larger tongue movements when cued, relative to their pretreatment performance. None of the participants, however, generalized the effect to the uncued sentences. Speech intelligibility of cued sentences was judged as superior posttreatment only in a single participant.

Conclusions This study demonstrated that using an augmented visual feedback approach is beneficial, beyond a verbal cue alone, in addressing articulatory hypokinesia in individuals with PD. An optimal degree of articulatory expansion might, however, be required to elicit a speech intelligibility benefit.

Acknowledgments
This research was supported by the Parkinson's Society of Canada Pilot Project Grant, the Natural Sciences and Engineering Research Council Discovery Grant, and the Centre for Innovation in Information Visualization and Data-Driven Design. The first author was also supported by a National Institute on Deafness and Other Communication Disorders Grant R01 DC016270, awarded to C. Stepp and F. Guenther. Portions of this study were presented at the 7th International Conference on Speech Motor Control in Groningen, the Netherlands, in July 2017. The authors are grateful to the participants and their families for taking part in this study. The authors also thank Madhura Kulkarni and Vincci Tau for their assistance with this project.
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