Abstract
Purpose
This study compared the performance of three amplification devices hypothesized to improve speech communication in individuals with hypophonia (HP), as well as to identify individuals' device preferences.
Method
Twenty-two individuals with HP and their primary communication partners participated in a cross-over design study comparing three different speech amplification devices: a wired portable amplifier (Device A), a wireless stationary amplifier (Device B), and a one-way personal communication system (Device C). Participants attended one laboratory visit followed by 1-week trial periods with each device. At the first visit, HP participants completed speech tasks with and without the devices, in quiet and in noise. Following the in-laboratory test period, participants trialed each device at home for approximately 1 week per device. Following completion of the study, participants indicated whether or not they would like to continue using a device.
Results
Overall, in the presence of noise, all three devices demonstrated significant improvements in speech-to-noise levels and speech intelligibility compared to no device. A clear device hierarchy emerged such that the personal communication device (Device C) was associated with significantly better speech outcomes compared to the other two devices. The majority of participants elected to continue using a device at the completion of the study. Device preferences, however, did not clearly reflect the objective device hierarchy that was found for the objective speech measures. Each of the three devices was selected as a preferred device by at least three participants at the completion of the study.
Conclusion
Results from this study demonstrated clear differences in device performance in three distinct forms of amplification devices for individuals with HP. Findings suggest that amplification device use may be beneficial for this clinical population and underscore the potential to improve device availability and device selection criteria in future research.
Supplemental Material

References
-
Abur, D., Enos, N. M., & Stepp, C. E. (2019). Visual analog scale ratings and orthographic transcription measures of sentence intelligibility in Parkinson's disease with variable listener exposure.American Journal of Speech-Language Pathology, 28(3), 1222–1232. https://doi.org/10.1044/2019_AJSLP-18-0275 -
Adams, S. G., & Dykstra, A. (2009). Hypokinetic dysarthria.InM. R. McNeil (Ed.), Clinical management of sensorimotor speech disorders. Thieme. -
Adams, S. G., Dykstra, A., Jenkins, M., & Jog, M. (2008). Speech-to-noise levels and conversational intelligibility in hypophonia and Parkinson's disease.Journal of Medical Speech-Language Pathology, 16(4), 165–172. -
Adams, S. G., Haralabous, O., Dykstra, A., Abrams, K., & Jog, M. (2005). Effects of multi-talker background noise on the intensity of spoken sentences in Parkinson's disease.Canadian Acoustics, 33(3), 94–95. -
Adams, S. G., & Lang, A. E. (1992). Can the Lombard effect be used to improve low voice intensity in Parkinson's disease.European Journal of Disorders of Communication, 27(2), 121–127. https://doi.org/10.3109/13682829209012034 -
Adams, S. G., Winnell, J., & Jog, M. (2010). Effects of interlocutor distance, multi-talker background noise, and a concurrent manual task on speech intensity in Parkinson's disease.Journal of Medical Speech-Language Pathology, 18(4), 1–9. - American Speech-Language-Hearing Association. (2020, May21). Augmentative and alternative communication
[Professional issues] . https://www.asha.org/Practice-Portal/Professional-Issues/Augmentative-and-Alternative-Communication/ -
Andreetta, M. D., Adams, S. G., Dykstra, A. D., & Jog, M. (2016). Evaluation of speech amplification devices in Parkinson's disease.American Journal of Speech-Language Pathology, 25(1), 29–45. https://doi.org/10.1044/2015_ajslp-15-0008 -
Ash, S., Jester, C., York, C., Kofman, O. L., Langey, R., Halpin, A., Firn, K., Perez, S. D., Chahine, L., Spindler, M., Dahodwala, N., Irwin, D. J., McMillan, C., Weintraub, D., & Grossman, M. (2017). Longitudinal decline in speech production in Parkinson's disease spectrum disorders.Brain and Language, 171, 42–51. https://doi.org/10.1016/j.bandl.2017.05.001 -
Bates, D., Mächler, M., Bolker, B., & Walker, S. (2015). Fitting linear mixed-effects models using lme4.Journal of Statistical Software, 67(1), 1–48. https://doi.org/10.18637/jss.v067.i01 -
Bertrand, A. N. (2009). Speech-language pathologists decision making pertaining to speech amplification devices: A survey[Master's thesis] . Texas A&M University-Kingsville. -
Boersma, P., & Weenink, D . (2011). Praat: Doing phonetics by computer(Version 5.3) [Computer program] . http://www.praat.org/ -
Bunton, K. (2008). Speech versus nonspeech: Different tasks, different neural organization.Seminars in Speech and Language, 29(4), 267–275. https://doi.org/10.1055/s-0028-1103390 -
Clark, J. P., Adams, S. G., Dykstra, A. D., Moodie, S., & Jog, M. (2014). Loudness perception and speech intensity control in Parkinson's disease.Journal of Communication Disorders, 51, 1–12. https://doi.org/10.1016/j.jcomdis.2014.08.001 -
Coates, C., & Bakheit, A. M. (1997). The prevalence of verbal communication disability in patients with Parkinson's disease.Disability and Rehabilitation, 19(3), 104–107. https://doi.org/10.3109/09638289709166834 -
Crandell, C., Charlton, M., Kinder, M., & Kreisman, B. (2001). Effects of portable sound field FM systems on speech perception in noise.Journal of Educational Audiology, 9, 8–12. -
Dalrymple-Alford, J. C., MacAskill, M. R., Nakas, C. T., Livingston, L., Graham, C., Crucian, G. P., Melzer, T. R., Kirwan, J., Keenan, R., Wells, S., Porter, R. J., Watts, R., & Anderson, T. J. (2010). The MoCA well-suited screen for cognitive impairment in Parkinson disease.Neurology, 75(19), 1717–1725. https://doi.org/10.1212/WNL.0b013e3181fc29c9 -
Darley, F. L., Aronson, A. E., & Brown, J. R. (1975). Motor speech disorders (pp. 2–297). Saunders. -
DeBonis, D. A., & Donohue, C. L. (2008). Survey of audiology: Fundamental for audiologists and health professionals (2nd ed.). Pearson Education. -
Donovan, N. J., Kendall, D. L., Young, M. E., & Rosenbek, J. C. (2008). The communicative effectiveness survey: Preliminary evidence of construct validity.American Journal of Speech-Language Pathology, 17(4), 335–347. https://doi.org/10.1044/1058-0360(2008/07-0010) -
Dromey, C. (2003). Spectral measures and perceptual ratings of hypokinetic dysarthria.Journal of Medical Speech-Language Pathology, 11(2), 85–94. -
Dykstra, A. D., Adams, S. G., & Jog, M. (2012). The effect of background noise on the speech intensity of individuals with hypophonia associated with Parkinson's disease.Journal of Medical Speech-Language Pathology, 20(3), 19–30. -
Dykstra, A. D., Adams, S. G., & Jog, M. (2015). Examining the relationship between speech intensity and self-rated communicative effectiveness in individuals with Parkinson's disease and hypophonia.Journal of Communication Disorders, 56, 103–112. https://doi.org/10.1016/j.jcomdis.2015.06.012 -
Fox, C. M., & Ramig, L. O. (1997). Vocal sound pressure level and self-perception of speech and voice in men and women with idiopathic Parkinson's disease.American Journal of Speech-Language Pathology, 6(2), 85–94. https://doi.org/10.1044/1058-0360.0602.85 -
Gamboa, J., Jiménez-Jiménez, F. J., Nieto, A., Montojo, J., Ortı́-Pareja, M., Molina, J. A., García-Albea, E., Cobeta, I., & Cobeta, I. (1997). Acoustic voice analysis in patients with Parkinson's disease treated with dopaminergic drugs.Journal of Voice, 11(3), 314–320. https://doi.org/10.1016/s0892-1997(97)80010-0 -
Greene, M. C., Watson, B., Gay, P., & Townsend, D. (1972). A therapeutic speech amplifier and its use in speech therapy.The Journal of Laryngology & Otology, 86(6), 595–605. https://doi.org/10.1017/S0022215100075629 -
Gustafsson, J. K., Södersten, M., Ternström, S., & Schalling, E. (2019). Voice use in daily life studied with a portable voice accumulator in individuals with Parkinson's disease and matched healthy controls.Journal of Speech, Language, and Hearing Research, 62(12), 4324–4334. https://doi.org/10.1044/2019_JSLHR-19-00037 -
Harkins, J., & Tucker, P. (2007). An Internet survey of individuals with hearing loss regarding assistive listening devices.Trends in Amplification, 11(2), 91–100. https://doi.org/10.1177/1084713807301322 -
Ho, A. K., Bradshaw, J. L., & Iansek, T. (2000). Volume perception in parkinsonian speech.Movement Disorders, 15(6), 1125–1131. https://doi.org/10.1002/1531-8257(200011)15:6<1125::AID-MDS1010>3.0.CO;2-R -
Ho, A. K., Bradshaw, J. L., Iansek, R., & Alfredson, R. (1999). Speech volume regulation in Parkinson's disease: Effects of implicit cues and explicit instructions.Neuropsychologia, 37(13), 1453–1460. https://doi.org/10.1016/S0028-3932(99)00067-6 -
Ho, A. K., Iansek, R., Marigliani, C., Bradshaw, J. L., & Gates, S. (1998). Speech impairment in a large sample of patients with Parkinson'ss disease.Behavioural Neurology, 11(3), 131–137. https://doi.org/10.1155/1999/327643 -
Kent, R. D., Kent, J. F., Rosenbek, J. C., Vorperian, H. K., & Weismer, G. (1997). A speaking task analysis of the dysarthria in cerebellar disease.Folia Phoniatrica et Logopaedica, 49(2), 63–82. https://doi.org/10.1159/000266440 -
Kent, R. D., Weismer, G., Kent, J. F., & Rosenbek, J. C. (1989). Toward phonetic intelligibility testing in dysarthria.The Journal of Speech and Hearing Disorders, 54(4), 482–499. https://doi.org/10.1044/jshd.5404.482 -
Koo, T. K., & Li, M. Y. (2016). A guideline of selecting and reporting intraclass correlation coefficients for reliability research.Journal of Chiropractic Medicine, 15(2), 155–163. https://doi.org/10.1016/j.jcm.2016.02.012 -
Kryter, K. D. (1994). The handbook of hearing and the effects of noise. Academic Press. -
Lane, H., & Tranel, B. (1971). The Lombard sign and the role of hearing in speech.Journal of Speech and Hearing Research, 14(4), 677–709. https://doi.org/10.1044/jshr.1404.677 -
Lansford, K. L., Borrie, S. A., & Barrett, T. S. (2019). Regularity matters: Unpredictable speech degradation inhibits adaptation to dysarthric speech.Journal of Speech, Language, and Hearing Research, 62(12), 4282–4290. https://doi.org/10.1044/2019_JSLHR-19-00055 -
Laplante-Lévesque, A., Hickson, L., & Worrall, L. (2010). Rehabilitation of older adults with hearing impairment: A critical review.Journal of Aging and Health, 22(2), 143–153. https://doi.org/10.1177/0898264309352731 -
Lenth, R . (2018). Emmeans: Estimated marginal means, aka least-squares means. https://CRAN.R-project.org/package=emmeans -
Logemann, J. A., Fisher, H. B., Boshes, B., & Blonsky, E. R. (1978). Frequency and cooccurrence of vocal tract dysfunctions in the speech of a large sample of Parkinson patients.The Journal of Speech and Hearing Disorders, 43(1), 47–57. https://doi.org/10.1044/jshd.4301.47 -
Ludlow, C. L., & Bassich, C. J. (1984). Relationships between perceptual ratings and acoustic measures of hypokinetic speech.InM. R. McNcil, J. C. Rosenbek, & A. E. Aronson (Eds.), The dysarthrias: Physiology, acoustics, perception, management (pp. 163–195). College-Hill Press. -
McAuliffe, M. J., Fletcher, A. R., Kerr, S. E., O'Beirne, G. A., & Anderson, T. (2017). Effect of dysarthria type, speaking condition, and listener age on speech intelligibility.American Journal of Speech-Language Pathology, 26(1), 113–123. https://doi.org/10.1044/2016_AJSLP-15-0182 -
Miller, N. (2012). Speech, voice and language in Parkinson's disease: Changes and interventions.Neurodegenerative Disease Management, 2(3), 279–289. https://doi.org/10.2217/nmt.12.15 -
Miller, N. (2013). Measuring up to speech intelligibility.International Journal of Language & Communication Disorders, 48(6), 601–612. https://doi.org/10.1111/1460-6984.12061 -
Miller, N., Allcock, L., Jones, D., Noble, E., Hildreth, A. J., & Burn, D. J. (2007). Prevalence and pattern of perceived intelligibility changes in Parkinson's disease.Journal of Neurology, Neurosurgery, & Psychiatry, 78(11), 1188–1190. https://doi.org/10.1136/jnnp.2006.110171 -
Moreau, C., Pennel-Ployart, O., Pinto, S., Plachez, A., Annic, A., Viallet, F., Destée, A., & Defebvre, L. (2011). Modulation of dysarthropneumophonia by low-frequency STN DBS in advanced Parkinson's disease.Movement Disorders, 26(4), 659–663. https://doi.org/10.1002/mds.23538 -
Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment.Journal of the American Geriatrics Society, 53(4), 695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x -
Nábĕlek, A., Donahue, A., & Letowski, T. (1986). Comparison of amplification systems in a classroom.Journal of Rehabilitation Research and Development, 23(1), 41–52. -
Olson, M., Lockhart, T. E., & Lieberman, A. (2019). Motor learning deficits in Parkinson's disease (PD) and their effect on training response in gait and balance: A narrative review.Frontiers in Neurology, 10, 62. https://doi.org/10.3389/fneur.2019.00062 -
Pick, H. L. J., Siegel, G. M., Fox, P. W., Garber, S. R., & Kearney, J. K. (1989). Inhibiting the Lombard effect.The Journal of the Acoustical Society of America, 85(2), 894–900. https://doi.org/10.1121/1.397561 -
Poll, G. H., Miller, C. A., & van Hell, J. G. (2016). Sentence repetition accuracy in adults with developmental language impairment: Interactions of participant capacities and sentence structures.Journal of Speech, Language, and Hearing Research, 59(2), 302–316. https://doi.org/10.1044/2015_JSLHR-L-15-0020 -
Ramig, L. O., Fox, C., & Sapir, S. (2004). Parkinson's disease: Speech and voice disorders and their treatment with the Lee Silverman voice treatment.Seminars in speech and language, 25(2), 169–180. Thieme. https://doi.org/10.1055/s-2004-825653 - R Core Team. (2018). R: A language and environment for statistical computing. R Foundation for Statistical Computing. https://www.R-project.org/
-
Schum, R. L., & Sivan, A. B. (1997). Verbal abilities in healthy elderly adults.Applied Neuropsychology, 4(2), 130–134. https://doi.org/10.1207/s15324826an0402_6 -
Scott, S., & Caird, F. (1983). Speech therapy for Parkinson's disease.Journal of Neurology, Neurosurgery, & Psychiatry, 46(2), 140–144. https://doi.org/10.1136/jnnp.46.2.140 -
Sidtis, D., Cameron, K., Bonura, L., & Sidtis, J. (2012). Speech intelligibility by listening in Parkinson speech with and without deep brain stimulation: Task effects.Journal of Neurolinguistics, 25(2), 121–132. https://doi.org/10.1016/j.jneuroling.2011.08.004 -
Skodda, S., Grönheit, W., Mancinelli, N., & Schlegel, U. (2013). Progression of voice and speech impairment in the course of Parkinson's disease: A longitudinal study.Parkinson's Disease, 2013, 389195. https://doi.org/10.1155/2013/389195 -
Spencer, K. A., Yorkston, K. M., & Duffy, J. R. (2003). Behavioral management of respiratory/phonatory dysfunction from dysarthria: A flowchart for guidance in clinical decision making.Journal of Medical Speech-Language Pathology, 11(2), xxxix–xxxix. -
Stathopoulos, E. T., Huber, J. E., Richardson, K., Kamphaus, J., DeCicco, D., Darling, M., Fulcher, K., & Sussman, J. E. (2014). Increased vocal intensity due to the Lombard effect in speakers with Parkinson's disease: Simultaneous laryngeal and respiratory strategies.Journal of Communication Disorders, 48, 1–17. https://doi.org/10.1016/j.jcomdis.2013.12.001 -
Tanaka, Y., Tsuboi, T., Watanabe, H., Kajita, Y., Nakatsubo, D., Fujimoto, Y., Ohdake, R., Ito, M., Atsuta, N., Yamamoto, M., Wakabayashi, T., Katsuno, M., & Sobue, G. (2016). Articulation features of Parkinson's disease patients with subthalamic nucleus deep brain stimulation.Journal of Parkinson's Disease, 6(4), 811–819. https://doi.org/10.3233/jpd-160838 -
Tomlinson, C. L., Stowe, R., Patel, S., Rick, C., Gray, R., & Clarke, C. E. (2010). Systematic review of levodopa dose equivalency reporting in Parkinson's disease.Movement Disorders, 25(15), 2649–2653. https://doi.org/10.1002/mds.23429 -
Tripoliti, E., Limousin, P., Foltynie, T., Candelario, J., Aviles-Olmos, I., Hariz, M. I., & Zrinzo, L. (2014). Predictive factors of speech intelligibility following subthalamic nucleus stimulation in consecutive patients with Parkinson's disease.Movement Disorders, 29(4), 532–538. https://doi.org/10.1002/mds.25816 -
Tröster, A. I., Jankovic, J., Tagliati, M., Peichel, D., & Okun, M. S. (2017). Neuropsychological outcomes from constant current deep brain stimulation for Parkinson's disease.Movement Disorders, 32(3), 433–440. https://doi.org/10.1002/mds.26827 -
Weismer, G. (2008). Speech intelligibility.InM. J. Ball, M. R. Perkins, N. Muller, & S. Howard (Eds.), The handbook of clinical linguistics (pp. 568–582). Blackwell. https://doi.org/10.1002/9781444301007.ch35 -
Yorkston, K. M., Beukelman, D. R., & Tice, R. (1996). Sentence Intelligibility Test[Computer software] . Institute for Rehabilitation Science and Engineering at Madonna Rehabilitation Hospital.