Speech-in-Noise Treatments for Hypophonia in Parkinson's Disease

Study Overview
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Brief Summary
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Hypophonia, or reduced speech intensity, is the most prevalent speech symptom in Parkinson's disease (PD) and often leads to significant difficulty communicating in most social situations. Behavioural treatments for hypophonia can be temporarily effective but many individuals fail to retain and transfer improvements beyond the context of the speech clinic. The present study will address the transfer of treatment problem using two new treatment programs. Both treatments focus on improving speech intensity during conversations in different social contexts and a wide range of background noise conditions. The Speech-in-Noise (SIN) treatment program involves training higher speech intensity during variable levels of background noise while receiving real-time intensity feedback from a speech therapist. The second treatment, the Speech-to-Noise Feedback (SNF) device treatment program, involves using a wearable SNF device to provide feedback about an ideal target speech-to-noise level in a wide range of background noise conditions. Forty individuals with PD and their communication partners (i.e. spouse) will be randomly assigned to one of the two treatment programs. To evaluate the effectiveness of the treatments, a wearable recording device will measure daily conversational speech intensity and background noise for 7 consecutive days before, 1 week after, and 12 weeks after treatment.

Detailed Description
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Parkinson's disease is one of the most common neurodegenerative diseases and is associated with several disabling motor and non-motor symptoms. About 70% of individuals with PD will develop speech impairments. Hypophonia, or reduced speech intensity, is the most prevalent speech symptom and often leads to significant difficulty communicating in most social situations. Behavioural treatments for hypophonia can be temporarily effective but many individuals fail to retain and transfer improvements beyond the context of the speech clinic. These transfer difficulties may be related to cognitive and sensorimotor deficits associated with PD that inhibit the incorporation of new speech strategies into habitual speech. This transfer of treatment problem is a longstanding and major concern in the treatment of speech in PD. The present study will address the transfer of treatment problem using two new treatment programs. Both treatments focus on improving speech intensity during conversations in different social contexts and a wide range of background noise conditions. The Speech-in-Noise (SIN) treatment program involves training higher speech intensity during variable levels of background noise while receiving real-time intensity feedback from a speech therapist in social situations inside and outside of the clinic. The second treatment, the Speech-to-Noise Feedback (SNF) device treatment program, involves using a wearable SNF device to provide feedback about an ideal target speech-to-noise level in a wide range of background noise conditions inside and outside of the speech clinic. Forty individuals with PD and their communication partners (i.e. spouse) will be randomly assigned to one of the two treatment programs. In addition, half of the participants will be randomly assigned to a 13-week delayed treatment group and serve as both untreated controls and treated participants. To evaluate the effectiveness of the treatments, measures of improvement in speech intensity and speech-to-noise levels will be obtained during everyday social conversations. A wearable recording device will measure daily conversational speech intensity and background noise for 7 consecutive days at three time points: before, 1 week after, and 12 weeks after treatment. The effectiveness of treatment will be also measured using two questionnaires and standard, lab-based speech assessments. It is anticipated that the evaluation and comparison of these two novel treatment paradigms will advance our understanding of procedures that are most effective for enhancing the transfer of treatment for hypophonia into everyday social conversations in individuals with Parkinson's disease.

Official Title
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Speech-in-Noise Treatments to Improve Hypophonia in Everyday Social Contexts for Individuals With Parkinson's Disease

Conditions
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Parkinson Disease, Speech Disorders

Intervention / Treatment
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* Behavioral: Speech-in-Noise Treatment Program
* Behavioral: Speech-to-Noise Feedback Device Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosed with idiopathic PD and hypophonia by a neurologist at least 6 months prior to participation. Stabilized on antiparkinsonian medication. Good general health. 45-85 years old. Pass a 50 dB hearing screening and cognitive screening (>20/30 on MOCA). Proficient enough in English to participate in speech testing. Exclusion Criteria: History of stroke or an additional neurological or motor control disorder. History of speech impairment that is unrelated to PD.

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Speech-in-Noise Treatment Program<br>A behavioural speech therapy program involving 12, one-hour treatment sessions over a 4-week period | Behavioral: Speech-in-Noise Treatment Program<br>* Speech therapy program for hypophonia.<br>|
| Active Comparator: Speech-to-Noise Feedback Device Program<br>A speech treatment program involving the use of a speech-to-noise feedback device during 12, one-hour treatment sessions over a 4-week period | Behavioral: Speech-to-Noise Feedback Device Program<br>* Speech Feedback device program for hypophonia.<br>|
| No Intervention: Delayed Treatment<br>Assessments but no intervention for a period of 13 weeks. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| speech-to-noise ratio | Average speech-to-noise ratio obtained from long-term conversation samples | 7 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| communication effectiveness ratings | Self-ratings of communication effectiveness using an 8-item questionnaire. | 7 days | 
| communication participation ratings | Self-ratings of communication participation using a 28 item questionnaire. | 7 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hypophonia