The Effects of Speech Task on Lexical Stress in Parkinson's Disease.

PURPOSE: Hypokinetic dysarthria associated with Parkinson's disease (PD) is characterized by dysprosody, yet the literature is mixed with respect to how dysprosody affects the ability to mark lexical stress, possibly due to differences in speech tasks used to assess lexical stress. The purpose of this study was to compare how people with and without PD modulate acoustic dimensions of lexical stress-fundamental frequency, intensity, and duration-to mark lexical stress across three different speech tasks. METHOD: Twelve individuals with mild-to-moderate idiopathic PD and 12 age- and sex-matched older adult controls completed three speech tasks: picture description, word production in isolation, and word production in lists. Outcome measures were the fundamental frequency, intensity, and duration of the vocalic segments of two trochees (initial stress) and two iambs (final stress) spoken in all three tasks. RESULTS: There were very few group differences. Both groups marked trochees by modulating intensity and fundamental frequency and iambs by modulating duration. Task had a significant impact on the stress patterns used by both groups. Stress patterns were most differentiated in words produced in isolation and least differentiated in lists of words. CONCLUSIONS: People with PD did not demonstrate impairments in the production of lexical stress, suggesting that dysprosody associated with PD does not impact all types of prosody in the same way. However, there were reduced distinctions in stress marking that were more apparent in trochees than iambs. In addition, the task used to assess prosody has a significant effect on all acoustic measures. Future research should focus on the use of connected speech tasks to obtain more generalizable measures of prosody in PD.

Acoustic Measures of Voice and Physiologic Measures of Autonomic Arousal During Speech as a Function of Cognitive Load in Older Adults.

OBJECTIVES/HYPOTHESIS: The purpose of this study was to determine the relationships among cognitive loading, autonomic arousal, and acoustic measures of voice in healthy older adults. STUDY DESIGN: Prospective and observational. METHODS: Twelve healthy older adults (six females) produced a sentence containing an embedded Stroop task in each of two cognitive load conditions: congruent and incongruent. Three physiologic measures of autonomic arousal (pulse volume amplitude, pulse period, and skin conductance response amplitude) and four acoustic measures of voice (cepstral peak prominence, low-to-high spectral energy ratio, fundamental frequency, and sound pressure level) were analyzed in each cognitive load condition. RESULTS: A logistic regression model was used to predict the cognitive load condition using participant as a categorical predictor and the four acoustic measures and three autonomic measures as continuous predictors. Skin conductance response amplitude and pulse volume amplitude were both predictive of cognitive load; however, no acoustic measures of voice were statistically significant predictors of cognitive load for older adults. CONCLUSIONS: These findings support the idea that increased cognitive load is associated with increased autonomic nervous system activity in older adults. The lack of changes in acoustic measures of voice with increased cognitive load may result from age-related changes in vocal quality and speech subsystems.

Positive Changes in Certified Nursing Assistants' Communication Behaviors With People With Dementia: Feasibility of a Coaching Strategy.

Purpose This study investigated whether a 6-week coaching strategy resulted in positive changes in self-perceived knowledge and efficacy (SPKE) and positive communication behaviors in certified nursing assistants (CNAs) working with people with dementia in a skilled nursing facility. It also assessed the impact of the coaching strategy on negative responsive behaviors of people with dementia, such as yelling out, hitting, or spitting. Method Seven CNAs and seven people with dementia completed this study. Pretesting and posttesting were conducted for CNAs' SPKE. A single-subject, multiple-baseline design across five communication behaviors, the positive communication approach checklist, was completed to assess CNA communication behaviors after completion of a coaching strategy. Pretesting and posttesting of responsive behaviors of people with dementia were completed with the Cohen-Mansfield Agitation Inventory. Results Six out of seven CNAs improved their SPKE from pre- to postcoaching; however, this difference was not statistically significant. Per the positive communication approach checklist, there was a statistically significant increase, from baseline to follow-up, in CNA positive communication behaviors when interacting with people with dementia. The frequency of overall responsive behaviors of people with dementia significantly decreased from pre- to postcoaching, per the Cohen-Mansfield Agitation Inventory. Conclusions There is preliminary evidence to support the feasibility of a coaching strategy for the implementation of positive communication behaviors by CNAs when communicating with people with dementia. Negative responsive behaviors of people with dementia also decreased. Speech-language pathologists should consider acting as coaches to support positive communication for people with dementia. Supplemental Material https://doi.org/10.23641/asha.13564811.

Cognitive Load Affects Speech Motor Performance Differently in Older and Younger Adults.

Purpose The aim of this study was to determine the impact of cognitive load imposed by a speech production task on the speech motor performance of healthy older and younger adults. Response inhibition, selective attention, and working memory were the primary cognitive processes of interest. Method Twelve healthy older and 12 healthy younger adults produced multiple repetitions of 4 sentences containing an embedded Stroop task in 2 cognitive load conditions: congruent and incongruent. The incongruent condition, which required participants to suppress orthographic information to say the font colors in which color words were written, represented an increase in cognitive load relative to the congruent condition in which word text and font color matched. Kinematic measures of articulatory coordination variability and movement duration as well as a behavioral measure of sentence production accuracy were compared between groups and conditions and across 3 sentence segments (pre-, during-, and post-Stroop). Results Increased cognitive load in the incongruent condition was associated with increased articulatory coordination variability and movement duration, compared to the congruent Stroop condition, for both age groups. Overall, the effect of increased cognitive load was greater for older adults than younger adults and was greatest in the portion of the sentence in which cognitive load was manipulated (during-Stroop), followed by the pre-Stroop segment. Sentence production accuracy was reduced for older adults in the incongruent condition. Conclusions Increased cognitive load involving response inhibition, selective attention, and working memory processes within a speech production task disrupted both the stability and timing with which speech was produced by both age groups. Older adults' speech motor performance may have been more affected due to age-related changes in cognitive and motoric functions that result in altered motor cognition.

Acoustic Measures of Voice and Physiologic Measures of Autonomic Arousal during Speech as a Function of Cognitive Load.

OBJECTIVES/HYPOTHESIS: This study aimed to determine the relationship among cognitive load condition and measures of autonomic arousal and voice production in healthy adults. STUDY DESIGN: A prospective study design was conducted. METHODS: Sixteen healthy young adults (eight men, eight women) produced a sentence containing an embedded Stroop task in each of two cognitive load conditions: congruent and incongruent. In both conditions, participants said the font color of the color words instead of the word text. In the incongruent condition, font color differed from the word text, creating an increase in cognitive load relative to the congruent condition in which font color and word text matched. Three physiologic measures of autonomic arousal (pulse volume amplitude, pulse period, and skin conductance response amplitude) and four acoustic measures of voice (sound pressure level, fundamental frequency, cepstral peak prominence, and low-to-high spectral energy ratio) were analyzed for eight sentence productions in each cognitive load condition per participant. RESULTS: A logistic regression model was constructed to predict the cognitive load condition (congruent or incongruent) using subject as a categorical predictor and the three autonomic measures and four acoustic measures as continuous predictors. It revealed that skin conductance response amplitude, cepstral peak prominence, and low-to-high spectral energy ratio were significantly associated with cognitive load condition. CONCLUSIONS: During speech produced under increased cognitive load, healthy young adults show changes in physiologic markers of heightened autonomic arousal and acoustic measures of voice quality. Future work is necessary to examine these measures in older adults and individuals with voice disorders.

Autonomic Nervous System Responses During Perception of Masked Speech may Reflect Constructs other than Subjective Listening Effort.

Typically, understanding speech seems effortless and automatic. However, a variety of factors may, independently or interactively, make listening more effortful. Physiological measures may help to distinguish between the application of different cognitive mechanisms whose operation is perceived as effortful. In the present study, physiological and behavioral measures associated with task demand were collected along with behavioral measures of performance while participants listened to and repeated sentences. The goal was to measure psychophysiological reactivity associated with three degraded listening conditions, each of which differed in terms of the source of the difficulty (distortion, energetic masking, and informational masking), and therefore were expected to engage different cognitive mechanisms. These conditions were chosen to be matched for overall performance (keywords correct), and were compared to listening to unmasked speech produced by a natural voice. The three degraded conditions were: (1) Unmasked speech produced by a computer speech synthesizer, (2) Speech produced by a natural voice and masked byspeech-shaped noise and (3) Speech produced by a natural voice and masked by two-talker babble. Masked conditions were both presented at a -8 dB signal to noise ratio (SNR), a level shown in previous research to result in comparable levels of performance for these stimuli and maskers. Performance was measured in terms of proportion of key words identified correctly, and task demand or effort was quantified subjectively by self-report. Measures of psychophysiological reactivity included electrodermal (skin conductance) response frequency and amplitude, blood pulse amplitude and pulse rate. Results suggest that the two masked conditions evoked stronger psychophysiological reactivity than did the two unmasked conditions even when behavioral measures of listening performance and listeners' subjective perception of task demand were comparable across the three degraded conditions.

Autonomic correlates of speech versus nonspeech tasks in children and adults.

PURPOSE: To assess autonomic arousal associated with speech and nonspeech tasks in school-age children and young adults. METHOD: Measures of autonomic arousal (electrodermal level, electrodermal response amplitude, blood pulse volume, and heart rate) were recorded prior to, during, and after the performance of speech and nonspeech tasks by twenty 7- to 9-year-old children and twenty 18- to 22-year-old adults. RESULTS: Across age groups, autonomic arousal was higher for speech tasks compared with nonspeech tasks, based on peak electrodermal response amplitude and blood pulse volume. Children demonstrated greater relative arousal, based on heart rate and blood pulse volume, for nonspeech oral motor tasks than adults but showed similar mean arousal levels for speech tasks as adults. Children demonstrated sex differences in autonomic arousal; specifically, autonomic arousal remained high for school-age boys but not girls in a more complex open-ended narrative task that followed a simple sentence production task. CONCLUSIONS: Speech tasks elicit greater autonomic arousal than nonspeech tasks, and children demonstrate greater autonomic arousal for nonspeech oral motor tasks than adults. Sex differences in autonomic arousal associated with speech tasks in school-age children are discussed relative to speech-language differences between boys and girls.

An investigation of semantic similarity judgments about action and non-action verbs in Parkinson's disease: implications for the Embodied Cognition Framework.

The Embodied Cognition Framework maintains that understanding actions requires motor simulations subserved in part by premotor and primary motor regions. This hypothesis predicts that disturbances to these regions should impair comprehension of action verbs but not non-action verbs. We evaluated the performances of 10 patients with Parkinson's disease (PD) and 10 normal comparison (NC) participants on a semantic similarity judgment task (SSJT) that included four classes of action verbs and two classes of non-action verbs. The patients were tested both ON and OFF medication. The most salient results involved the accuracies and reaction times (RTs) for the action verbs taken as a whole and the non-action verbs taken as a whole. With respect to accuracies, the patients did not perform significantly worse than the NC participants for either the action verbs or the non-action verbs, regardless of whether they were ON or OFF their medication. And with respect to RTs, although the patients' responses were significantly slower than those of the NC participants for the action verbs, comparable processing delays were also observed for the non-action verbs; moreover, there was again no notable influence of medication. The major dissociation was therefore not between action and non-action verbs, but rather between accuracies (relatively intact) and RTs (relatively delayed). Overall, the data suggest that semantic similarity judgments for both action and non-action verbs are correct but slow in individuals with PD. These results provide new insights about language processing in PD, and they raise important questions about the explanatory scope of the Embodied Cognition Framework.

Influences of sentence length and syntactic complexity on the speech motor control of children who stutter.

PURPOSE: To investigate the potential effects of increased sentence length and syntactic complexity on the speech motor control of children who stutter (CWS). METHOD: Participants repeated sentences of varied length and syntactic complexity. Kinematic measures of articulatory coordination variability and movement duration during perceptually fluent speech were analyzed for 16 CWS and 16 typically developing children (CTD) between 4 and 6 years of age. Behavioral data from a larger pool of children were also examined. RESULTS: For both groups, articulatory coordination variability increased with sentence length. For syntactically simple sentences, CWS had higher coordination variability than CTD. There was no group difference in coordination variability for complex sentences. Coordination variability increased significantly with complexity for CTD, whereas that of CWS remained at the high level demonstrated for simple sentences. There was a trend for higher overall coordination variability in CWS compared with CTD. For both groups, movement duration was greater for syntactically complex, as compared with simple, sentences. CONCLUSIONS: Results indicate more variable speech motor coordination during fluent speech production in many CWS as compared with CTD. Disproportionate effects of length and complexity on coordination variability and duration were not found for CWS. Considerable individual differences in performance were observed.

The intonation-syntax interface in the speech of individuals with Parkinson's disease.

PURPOSE: This study examined the effect of Parkinson's disease (PD) on the intonational marking of final and nonfinal syntactic boundaries and investigated whether the effect of PD on intonation was sex specific. METHOD: Eight women and 8 men with PD and 16 age- and sex-matched control participants read a passage at comfortable pitch, rate, and loudness. Nuclear tones from final and nonfinal syntactic boundaries in clauses and lists were extracted. Measures of fundamental frequency (F0) were made on each tone contour. RESULTS: Individuals with PD demonstrated impaired differentiation of syntactic boundary finality/nonfinality with contour direction. They produced a lower proportion of falling contours in final boundaries and a higher proportion of falling contours in nonfinal boundaries than did control participants. Although not mediated by syntax, the effect of PD on F0 standard deviation (F0 SD) and pitch range in semitones (PRST) was sex specific. Women with PD produced greater F0 SD and PRST than did men with PD and women without PD. Men with PD produced lower PRST than did men without PD. CONCLUSIONS: Impaired intonational marking of syntactic boundaries likely contributes to dysprosody and reduced communicative effectiveness in PD. The effect of PD on intonation was sex specific. The results are not fully explained by PD-related motor execution impairments.