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- Speech intelligibility of Parkinson’s disease patients evaluated by different groups of healthcare professionals and naïve listenersPublication . Carvalho, Joana; Cardoso, Rita; Guimarães, Isabel; Ferreira, JoaquimABSTRACT Introduction: Speech intelligibility, how well a listener comprehends the speaker’s message, is related to the listener’ expertise and type of the message conveyed. There is no evidence about speech intelligibility in different groups of healthcare professionals and naïve listeners. Objectives: This study is the first to understand if there were differences in the speech intelligibility of Parkinson’s Disease (PD) patients by different experienced and naïve listeners, according to the speech stimuli and dysarthria severity. Materials and methods: Randomly digitised audio-files (50 words and 50 sentences) of 10 PD patients, one without dysarthria and 9 with different dysarthria severities (3 each: mild, moderate and severe dysarthria), were collected from a database of 60 PD patients’ audio-files. A jury panel was formed by five different listeners groups including 10 speech and language therapists, 10 neurologists, 10 PD relatives, 12 PD patients, and 10 people from the general population. The jury panel transcribed single words and sentences from the audio recordings, the percentage correctly understood was calculated and the results were compared between the groups. Results: Multiple comparisons showed significant speech intelligibility differences between healthcare professionals and naïve listerners in words (highest effect size, n2 = 0.7) and sentences (the highest effect size: n2 = 0.6). Pairwise comparisons revealed that those significant differences were specifically in words with moderate and severe dysarthria and sentences with all severity levels of dysarthria. Conclusion: The groups of healthcare professionals who work with dysarthria are more likely to understand the PD patients’ speech than the groups of naïve listeners.
- Speech and voice response to a Levodopa challenge in late-stage Parkinson’s diseasePublication . Fabbri, Margherita; Guimarães, Isabel; Cardoso, Rita; Coelho, Miguel; Guedes, Leonor Correia; Rosa, Mário M; Godinho, Catarina; Abreu, Daisy; Gonçalves, Nilza; Antonini, Angelo; Ferreira, JoaquimBackground: Parkinson’s disease (PD) patients are affected by hypokinetic dysarthria, characterized by hypophonia and dysprosody, which worsens with disease progression. Levodopa’s (l-dopa) effect on quality of speech is inconclusive; no data are currently available for late-stage PD (LSPD). Objective: To assess the modifications of speech and voice in LSPD following an acute l-dopa challenge. Method: LSPD patients [Schwab and England score <50/Hoehn and Yahr stage >3 (MED ON)] performed several vocal tasks before and after an acute l-dopa challenge. The following was assessed: respiratory support for speech, voice quality, stability and variability, speech rate, and motor performance (MDS-UPDRS-III). All voice samples were recorded and analyzed by a speech and language therapist blinded to patients’ therapeutic condition using Praat 5.1 software. results: 24/27 (14 men) LSPD patients succeeded in performing voice tasks. Median age and disease duration of patients were 79 [IQR: 71.5–81.7] and 14.5 [IQR: 11–15.7] years, respectively. In MED OFF, respiratory breath support and pitch break time of LSPD patients were worse than the normative values of non-parkinsonian. A correlation was found between disease duration and voice quality (R = 0.51; p = 0.013) and speech rate (R = −0.55; p = 0.008). l-Dopa significantly improved MDS-UPDRS-III score (20%), with no effect on speech as assessed by clinical rating scales and automated analysis. conclusion: Speech is severely affected in LSPD. Although l-dopa had some effect on motor performance, including axial signs, speech and voice did not improve. The applicability and efficacy of non-pharmacological treatment for speech impairment should be considered for speech disorder management in PD.
- The psychometric properties of the Voice Handicap Index in people with Parkinson’s diseasePublication . Guimães, Isabel; Cardoso, Rita; Pinto, Serge; Ferreira, JoaquimBackground. Psychosocial impact of dysphonia in people with Parkinson disease (PD) has been described with the Voice Handicap Index (VHI); however, its psychometric properties when applied in this population are not described. Objective. The objective of this study was to examine the psychometric properties of the VHI in people with PD. Methods. A cross-sectional study of 151 subjects without cognitive impairment (90 people with PD and 61 controls) was carried out. The VHI was applied along with clinician-based (Mini Mental State Examination, Hoehn and Yahr staging, and Movement Disorder Society-Unified Parkinson’s Disease Rating Scale) and patient-based (selfrated voice severity) outcome measures. The psychometric properties of the VHI analyzed were the feasibility, reliability, and construct validity. Results. The average age of the PD population studied was 67 years; 51% had a primary level of education and 81% were retired. On average, they had disease onset duration of 11 years, a mild disease stage, mild to moderate global motor disability and impairment, and a normal to mild self-rated voice severity. The psychometric attributes of the VHI demonstrated that the questionnaire is feasible (missing data less than 1%), reliable (Cronbach α > 0.9), and valid (71.5% of the total variance is explained by five factors, correlates with voice severity, PD disability, and impairment, and differentiates subjects with PD from subjects without PD). Conclusion. The VHI is a reliable and valid tool that can be recommended for the population under study although further work is required to investigate its utility in advanced stages of disease.
- Automatic detection of Parkinson’s disease: an experimental analysis of common speech production tasks used for diagnosisPublication . Pompili, Anna; Abad, Alberto; Romano, Paolo; Martins, Isabel P; Cardoso, Rita; Santos, Helena; Carvalho, Joana; Guimarães, Isabel; Ferreira, JoaquimParkinson’s disease (PD) is the second most common neurodegenerative disorder of mid-to-late life after Alzheimer’s disease. During the progression of the disease, most individuals with PD report impairments in speech due to deficits in phonation, articulation, prosody, and fluency. In the literature, several studies perform the automatic classification of speech of people with PD considering various types of acoustic information extracted from different speech tasks. Nevertheless, it is unclear which tasks are more important for an automatic classification of the disease. In this work, we compare the discriminant capabilities of eight verbal tasks designed to capture the major symptoms affecting speech. To this end, we introduce a new database of Portuguese speakers consisting of 65 healthy control and 75 PD subjects. For each task, an automatic classifier is built using feature sets and modeling approaches in compliance with the current state of the art. Experimental results permit to identify reading aloud prosodic sentences and story-telling tasks as the most useful for the automatic detection of PD.
- (Dys)Prosody in Parkinson’s disease: effects of medication and disease progression on intonation and prosodic phrasingPublication . Frota, Sónia; Cruz, Marisa; Cardoso, Rita; Guimarães, Isabel; Ferreira, Joaquim; Pinto, Serge; Vigário, MarinaAbstract: The phonology of prosody has received little attention in studies of motor speech disorders. The present study investigates the phonology of intonation (nuclear contours) and speech chunking (prosodic phrasing) in Parkinson’s Disease (PD), as a function of medication intake and progression of the disease. Following methods of the prosodic and intonational phonology frameworks, we examined the ability of 30 PD patients to use intonation categories and prosodic phrasing structures in ways similar to 20 healthy controls to convey similar meanings. Speech data from PD patients were collected before and after a dopaminomimetic drug intake and were phonologically analyzed in relation to nuclear contours and intonational phrasing. Besides medication, disease duration and presence of motor fluctuations were also factors included in the analyses. PD patients showed a decreased ability to use nuclear contours and prosodic phrasing. Medication improved intonation regardless of disease progression, but did not help with dysprosodic phrasing. In turn, disease duration and motor fluctuations affected phrasing patterns, but had no impact on intonation. Our study demonstrated that the phonology of prosody is impaired in PD, and prosodic categories and structures may be differently affected, with implications for the understanding of PD neurophysiology and therapy.
- Psychosocial impact of Parkinson’s disease-associated dysarthria: cross-cultural adaptation and validation of the Dysarthria Impact Profile into european portuguesePublication . Cardoso, Rita; Guimarães, Isabel; Santos, Helena; Loureiro, Rita; Domingos, Josefa; Abreu, Daisy; Gonçalves, Nilza; Pinto, Serge; Ferreira, JoaquimAim: The present study sought to make a cross-cultural adaptation of the Dysarthria Impact Profile (DIP) for European Portuguese (EP) and validate it for use in Parkinson’s disease (PD) patients. Methods: The cross-cultural adaptation was carried out in accordance with the guidelines. The EP version of the DIP was administered to 80 people with PD, and 30 sex- and age-matched control participants. Psychometric properties, acceptability, feasibility reliability (internal consistency and intrarater agreement) and validity (construct, convergent and known-groups validity) were assessed using other assessment tools (motor disability and impairment, and voice impact). Results: Overall, the EP-DIP final version has the same conceptual meaning, semantics, idiomatic and score equivalences as the original version. Statistical analyses showed adequate feasibility (missing data <5%), good acceptability (ceiling or floor effects <15%; high requests of assistance to complete the questionnaire), satisfactory internal consistency (Cronbach’s α = 0.9), weak-to-moderate intrarater reliability, good construct validity, strong convergent validity (with the Voice Handicap Index; Spearman’s P = −0.8) and good known-groups validity (between those with PD and control participants). Conclusions: The EP-DIP version displays the salient features of a valid patient-based assessment tool used to measure the psychosocial impact of slight-to-mild dysarthria in people with PD.
- Dysarthria in individuals with Parkinson’s disease: a protocol for a binational, cross-sectional, case-controlled study in rrench and european portuguese (FraLusoPark)Publication . Pinto, Serge; Cardoso, Rita; Sadat, Jasmin; Guimarães, Isabel; Mercier, Céline; Santos, Helena; Atkinson-Clement, Cyril; Carvalho, Joana; Welby, Pauline; Oliveira, Pedro; D’Imperio, Mariapaola; Frota, Sónia; Letanneux, Alban; Vigario, Marina; Cruz, Marisa; Martins, Isabel Pavão; Viallet, François; Ferreira, JoaquimIntroduction: Individuals with Parkinson’s disease (PD) have to deal with several aspects of voice and speech decline and thus alteration of communication ability during the course of the disease. Among these communication impairments, 3 major challenges include: (1) dysarthria, consisting of orofacial motor dysfunction and dysprosody, which is linked to the neurodegenerative processes; (2) effects of the pharmacological treatment, which vary according to the disease stage; and (3) particular speech modifications that may be language-specific, that is, dependent on the language spoken by the patients. The main objective of the FraLusoPark project is to provide a thorough evaluation of changes in PD speech as a result of pharmacological treatment and disease duration in 2 different languages (French vs European Portuguese). Methods and analysis: Individuals with PD are enrolled in the study in France (N=60) and Portugal (N=60). Their global motor disability and orofacial motor functions is assessed with specific clinical rating scales, without (OFF) and with (ON) pharmacological treatment. 2 groups of 60 healthy age-matched volunteers provide the reference for between-group comparisons. Along with the clinical examinations, several speech tasks are recorded to obtain acoustic and perceptual measures. Patient-reported outcome measures are used to assess the psychosocial impact of dysarthria on quality of life. Ethics and dissemination: The study has been approved by the local responsible committees on human experimentation and is conducted in accordance with the ethical standards. A valuable largescale database of speech recordings and metadata from patients with PD in France and Portugal will be constructed. Results will be disseminated in several articles in peer-reviewed journals and in conference presentations. Recommendations on how to assess speech and voice disorders in individuals with PD to monitor the progression and management of symptoms will be provided.
- Cross-cultural adaptation and validation of the swallowing disturbance questionnaire and the sialorrhea clinical scale in portuguese patients with Parkinson’s diseasePublication . Cardoso, Rita; Guimarães, Isabel; Santos, Helena; Carvalho, Joana; Abreu, Daisy; Gonçalves, Nilza; Ferreira, JoaquimIntroduction: To date, no valid outcome measure has been developed in European Portuguese (EP) to evaluate the Parkinsons’ Disease (PD) patients’ (PwP) reports regarding their swallowing disturbances. Objectives: The aim of this study was to translate and cross-culturally adapt the Swallowing Disturbance Questionnaire (SDQ) and the Sialorrhea Clinical Scale for PD (SCS-PD) into EP and to determine its clinimetric properties in PwP. Materials and Methods: The original English SDQ and SCS-PD versions were cross-culturally adapted following recommendations established in international guidelines. The validation process involved 75 PwP and 65 healthy sex- and age-matched participants. Results: The EP versions of the SDQ and SCS-PD are equivalent to the original versions (content, depth, and scoring). Statistical analyses for the SDQ tool revealed good feasibility (missing data <5%), acceptability (no floor or ceiling effects), excellent internal consistency (Cronbach's = 0.95), good construct validity (78.5% revealed large to moderate loadings), moderate convergent validity (r = 0.60), good divergent validity (r = 0.40), good known-groups validity (p-value<.05) and a fair sensitivity and specificity (AUC = 0.700). Statistical analyses for the SCS-PD tool shows good feasibility, reasonable acceptability (floor effect), good internal consistency (Cronbach's a¼0.85), good construct validity (85.7% showed between large to moderate loadings), good convergent validity (r = 0.78), good divergent validity (r = 0.39), good known groups validity (p-value < .05) and a fair sensitivity and specificity (AUC = 0.704). Conclusions: The EP versions of the SDQ and SCS-PD maintained the characteristics of the original versions and therefore consistent tools to be used in PwP.
- Frenchay dysarthria assessment (FDA-2) in Parkinson’s disease: cross-cultural adaptation and psychometric properties of the european portuguese versionPublication . Cardoso, Rita; Guimarães, Isabel; Santos, Helena; Loureiro, Rita; Domingos, Josefa; Abreu, Daisy; Gonçalves, Nilza; Pinto, Serge; Ferreira, JoaquimHypokinetic dysarthria is a common symptom in those with Parkinson’s disease (PD); there is currently no standardized or validated tool for assessing speech in this population. To translate into European Portuguese (EP) the FDA-2 and perform a cultural adaptation followed by an evaluation of its psychometric properties in PD in a sample of people with PD in different stages of disease progression. Translation, back-translation, experts’ analysis, pretest and final version test were performed. The EP version of the FDA-2 was administered to 80 people with PD (PwP) with dysarthria, feasibility and acceptability, reliability (internal consistency and inter-rater reliability) and validity (face and convergent) were measured. Overall, the EP-FDA-2 proved to be similar to the original demonstrating the same conceptual meanings, semantics, idiomatic and score equivalences. It has good feasibility (missing data\5 %), acceptability (ceiling and floor effects \15 %), a high reliability of the total score (0.94), an excellent inter-rater agreement for the total score (0.96) and moderate to large construct validity for 81 % of its items. It is well correlated with the gold standard for disease severity assessment in PD, the MDS-UPDRS. The EPFDA- 2 has shown the salient features of a valid tool that can be used by speech and language therapists in the assessment of dysarthria in PD in clinical practice as in the research field.