%0 Journal Article
%T A Cognitive-Perceptual Approach to Conceptualizing Speech Intelligibility Deficits and Remediation Practice in Hypokinetic Dysarthria
%A Kaitlin L. Lansford
%A Julie M. Liss
%A John N. Caviness
%A Rene L. Utianski
%J Parkinson's Disease
%D 2011
%I Hindawi Publishing Corporation
%R 10.4061/2011/150962
%X Hypokinetic dysarthria is a common manifestation of Parkinson's disease, which negatively influences quality of life. Behavioral techniques that aim to improve speech intelligibility constitute the bulk of intervention strategies for this population, as the dysarthria does not often respond vigorously to medical interventions. Although several case and group studies generally support the efficacy of behavioral treatment, much work remains to establish a rigorous evidence base. This absence of definitive research leaves both the speech-language pathologist and referring physician with the task of determining the feasibility and nature of therapy for intelligibility remediation in PD. The purpose of this paper is to introduce a novel framework for medical practitioners in which to conceptualize and justify potential targets for speech remediation. The most commonly targeted deficits (e.g., speaking rate and vocal loudness) can be supported by this approach, as well as underutilized and novel treatment targets that aim at the listener's perceptual skills. 1. Introduction Hypokinetic dysarthria, a common manifestation of ParkinsonĄ¯s disease (PD), affects roughly 90% of the patient population [1, 2]. Moreover, hypokinetic dysarthria is a prominent feature of more severe and medically refractory parkinsonian disorders (e.g., progressive supranuclear palsy, multiple systems atrophy). Hypokinetic dysarthria is characterized perceptually by varying degrees of reduced pitch variation (monotonicity), reduced loudness, breathy voice, imprecise consonants, variable speaking rate, and short rushes of speech [1, 3, 4]. Reduced intelligibility occurs when these abnormal speech features interfere with the listenerĄ¯s ability to understand the spoken message. Intelligibility deficits can significantly reduce quality of life, contribute to depression and feelings of isolation, and hinder the ability to maintain gainful employment [5, 6]. Unlike trunk and limb motor impairments in PD, speech deficits typically do not respond vigorously to pharmacological or surgical interventions (see [7, 8] for reviews of the literature). Thus behavioral treatments to improve speech intelligibility constitute the bulk of speech treatment for this population. Behavioral interventions by speech-language pathologists primarily aim to reduce or compensate for the underlying speech deficits to improve speech intelligibility [1]. Despite a growing body literature that generally supports the efficacy of various interventions, much work remains to establish a rigorous evidence base [9¨C11].
%U http://www.hindawi.com/journals/pd/2011/150962/