Title: The effects of intensive voice treatment on speech intelligibility and acoustics of Mandarin speakers with hypokinetic dysarthria due to Parkinson’s disease
Description: Hypokinetic dysarthria is a speech disorder that commonly occurs in individuals with Parkinson’s disease (PD). However, little is known about the speech characteristics and the effects of speech treatment on the speech of Mandarin speakers with hypokinetic dysarthria (henceforth, Mandarin speakers with PD). The purpose of this dissertation was to investigate the effects of intensive voice treatment on the speech intelligibility and acoustics of this population. This dissertation consisted of three papers. The first paper, “Acoustic and perceptual speech characteristics of native Mandarin speakers with Parkinson’s disease,” investigated the general speech characteristics of 11 Mandarin speakers with PD. Intelligibility and acoustic outcomes were reported and compared to seven age- and gender-matched neurologically healthy controls. Findings from this study showed that Mandarin speakers with PD exhibited decreased intelligibility, local pitch variation, vowel space area, speech rate, and rate variation.

The second paper, “Effects of Loudness and Rate Manipulation Strategies on Speech Intelligibility and Acoustics of Mandarin Speakers With Parkinson’s Disease,” examined the effects of cueing to increase loudness and reduce speech rate on speech intelligibility and acoustics. Acoustic features including speech intensity, pitch range, pause duration, pause frequency, articulation rate, and vowel space area across 11 Mandarin speakers with PD were analyzed. The relationship between speech intelligibility and acoustic features was reported. Results showed that cueing for loud speech significantly increased intelligibility, but cueing for slow speech did not. Different cues had differential effects on the selected acoustic features. Cueing for loud speech resulted in increased vocal intensity and cueing for slow speech resulted in reduced articulation rate and increased pause frequency. In the loud speaking condition, greater vocal intensity and larger vowel space contributed to increased intelligibility, whereas in the slow condition, increased intensity, vowel space, as well as articulation rate, showed a trend toward contributing to increased intelligibility.

The third paper, “The Effects of Intensive Voice Treatment on Intelligibility in Mandarin Speakers with Parkinson’s Disease: Acoustic and perceptual findings,” investigated the short- and long-term effects of intensive voice treatment (Lee Silverman Voice Treatment LOUD) on speech intelligibility and acoustics of nine Mandarin speakers with PD. All speakers showed increased intelligibility from pretreatment to immediate post-treatment, and the improvement was maintained at the 6-month follow-up. Five acoustic features were analyzed. Speech intensity, vowel space, and speech rate changed significantly in positive directions immediately post-treatment, and the increases were retained up to six months. Global pitch variation increased immediately post-treatment but not at the 6-month follow-up. No changes were found in local pitch variation following treatment. Self-reported intelligibility, voice quality, confidence, frustration level, and communicative participation changed positively immediately after the completion of treatment and at the 6-month follow-up.

To conclude, the speech characteristics of Mandarin speakers with PD were generally consistent with those of English speakers with PD, except that speech was slower in the Mandarin speakers. Cueing to increase loudness and reduce rate had different effects on speech intelligibility and production, with louder speech yielding greater intelligibility and acoustic benefits. Following intensive voice treatment (LSVT LOUD), Mandarin speakers with PD increased their vocal intensity. Speech intelligibility, vowel space, global pitch variation and speech rate increased as a result of the treatment. Thus, some differences between Mandarin and English dysarthria and effects of cueing might be present, but as for English speakers, intensive treatment (specifically LSVT LOUD) focusing on increasing vocal intensity shows promise for increasing intelligibility and quality of life in Mandarin speakers with hypokinetic dysarthria. Future studies should include a larger number of participants and probe the effects of behavioral speech modifications and intensive voice treatment on lexical tone, and consider which physiological mechanisms might be associated with production of lexical tone, given that lexical tone is often crucial to differentiating word meaning in Mandarin.