Allyson D. Dykstra

Loudness perception and speech intensity control in Parkinson's disease

UNLABELLED The aim of this study was to examine loudness perception in individuals with hypophonia and Parkinsons disease. The participants included 17 individuals with hypophonia related to Parkinsons disease (PD) and 25 age-equivalent controls. The three loudness perception tasks included a magnitude estimation procedure involving a sentence spoken at 60, 65, 70, 75 and 80 dB SPL, an imitation task involving a sentence spoken at 60, 65, 70, 75 and 80 dB SPL, and a magnitude production procedure involving the production of a sentence at five different loudness levels (habitual, two and four times louder and two and four times quieter). The participants with PD produced a significantly different pattern and used a more restricted range than the controls in their perception of speech loudness, imitation of speech intensity, and self-generated estimates of speech loudness. The results support a speech loudness perception deficit in PD involving an abnormal perception of externally generated and self-generated speech intensity. LEARNING OUTCOMES Readers will recognize that individuals with hypophonia related to Parkinsons disease may demonstrate a speech loudness perception deficit involving the abnormal perception of externally generated and self-generated speech intensity.

Nature and the natural environment as health facilitators: the need to reconceptualize the ICF environmental factors

Purpose: This work examines the environmental factors component of the International Classification of Functioning, Disability, and Health (ICF) relative to current health-facilitating evidence about natural environmental factors. We argue that the environmental factors component warrants reconceptualization in order to offer an extended and more systematic framework for identifying and measuring health-facilitating natural environmental factors. Method: Current evidence highlighting the potential health-facilitating benefits of natural environmental factors is synthesized and considered in the context of the ICF framework and its coding system. Results: In its current form, the ICF’s conceptual framework and coding system are inadequate for identifying and measuring natural environmental factors in individuals and groups with and/or without health conditions. Conclusion: The ICF provides an advanced framework for health and disability that reflects contemporary conceptualizations about health. However, given the scope of emerging evidence highlighting positive health and well-being outcomes associated with natural environmental factors, we believe the environmental factors component requires further advancement to reflect this current knowledge. Reconceptualizing the environmental factors component supports a more holistic interpretation of the continuum of environmental factors as both facilitators and barriers. In doing so, it strengthens the ICF’s utility in identifying and measuring health-facilitating natural environmental factors. Implications for Rehabilitation Natural environmental factors constitute salient features of the environment with implications to health and disability, not simply aesthetic qualities. Fostering contact with nature and the natural environment may provide opportunities for respite and promote health benefits for individuals who experience a range of disability. Positive human-nature-health relationships may contribute to the maintenance and promotion of health at the population level.

Examining the relationship between speech intensity and self-rated communicative effectiveness in individuals with Parkinson's disease and hypophonia.

PURPOSE To examine the relationship between speech intensity and self-ratings of communicative effectiveness in speakers with Parkinsons disease (PD) and hypophonia. An additional purpose was to evaluate if self-ratings of communicative effectiveness made by participants with PD differed from ratings made by primary communication partners. METHODS Thirty participants with PD and 15 healthy older adults completed the Communication Effectiveness Survey. Thirty primary communication partners rated the communicative effectiveness of his/her partner with PD. Speech intensity was calculated for participants with PD and control participants based on conversational utterances. RESULTS Results revealed significant differences between groups in conversational speech intensity (p=.001). Participants with PD self-rated communicative effectiveness significantly lower than control participants (p=.000). Correlational analyses revealed a small but non-significant relationship between speech intensity and communicative effectiveness for participants with PD (r=0.298, p=.110) and control participants (r=0.327, p=.234). Self-ratings of communicative effectiveness made participants with PD was not significantly different than ratings made by primary communication partners (p=.20). CONCLUSIONS Obtaining information on communicative effectiveness may help to broaden outcome measurement and may aid in the provision of educational strategies. Findings also suggest that communicative effectiveness may be a separate and a distinct construct that cannot necessarily be predicted from the severity of hypophonia.

Evaluation of Speech Amplification Devices in Parkinson's Disease

PURPOSE The purpose of this study was to evaluate the efficacy of selected speech amplification devices in individuals with hypophonia and idiopathic Parkinsons disease (PD). METHOD This study compared the effectiveness of seven devices (ADDvox, BoomVox, ChatterVox, Oticon Amigo, SoniVox, Spokeman, and Voicette) to unamplified speech for 11 participants with PD during conversation in 65-dB SPL multitalker noise, using experience ratings collected from participant questionnaires and speech performance measures (i.e., speech-to-noise ratio [SNR], speech intensity, and intelligibility) obtained from audio recordings. RESULTS Compared with unamplified speech, device use increased SNR by 1.07-4.73 dB SPL and speech intensity by 1.1-5.1 dB SPL, and it significantly increased transcribed intelligibility from 13.8% to 58.9%. In addition, the type of device used significantly affected speech performance measures (e.g., BoomVox was significantly higher than most of the other devices for SNR, speech intensity, and intelligibility). However, experience ratings did not always correspond to performance measures. CONCLUSIONS This study found preliminary evidence of improved speech performance with device use for individuals with PD. A tentative hierarchy is suggested for device recommendations. Future research is needed to determine which measures will predict long-term device acceptance in PD.

A comprehensive description of functioning and disability in children with velopharyngeal insufficiency

UNLABELLED Children with velopharyngeal insufficiency (VPI) experience functional impairments in a variety of areas that extend beyond the primary physical impairment associated with this disorder. At present, the physical deficits associated with VPI have been studied extensively; however, a comprehensive description of social and communicative participation in this population is needed. Therefore, a biopsychosocial framework such as the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), may offer an enhanced understanding of the daily experiences of children with VPI. Specifically, the ICF-CY framework is intended to model complex nonlinear systems, and as such, to describe functioning as the interaction of multiple components from which a limitation in communicative participation may emerge. This paper describes how the ICF-CY framework can be utilized to comprehensively describe functioning and disability in children with VPI by describing the interaction of components of this framework. LEARNING OUTCOMES As a result of this activity, the reader will be able to: (1) discuss the utility of the ICF-CY in describing the multi-dimensional nature of velopharyngeal insufficiency (VPI); (2) describe interrelationships between functioning and disability in children with VPI; and (3) identify how limitations in communicative participation may emerge from the interaction of components of the ICF-CY in children with VPI.

Communicative participation and speech intelligibility: complexities and challenges

follow-up began at age 3 and included children born from 1990 to 2005, meaning many were 3-years-old before the 1997 introduction of the GMFCS; late ascertainment of GMFCS level may have been unavoidable. Possible bias introduced by stratifying at age 2 or 3 according to late assessments of functional level might explain some of the difference in survival estimates noted above. Many other factors may also contribute, including the remaining functional heterogeneity of the groups after stratification. Comparing outcomes (e.g. mortality) and sharing information between countries or care facilities should be encouraged and supported in order to improve our understanding of what treatments, therapies, or policies work best, and what working best means to the people involved. Proper stratification on variables that affect outcomes (mortality and others) will make such comparisons more meaningful.