Lee Silverman Voice Treatment (LSVT) has well-documented treatment efficacy for individuals with hypokinetic dysarthria associated with Parkinson's disease (PD). Positive changes have been noted after treatment not only for vocal loudness but also for many other speech dimensions, including intonation (monotonicity). There have been few studies investigating the effect of LSVT on lexical tone which, like intonation, is controlled by variations in fundamental frequency. This study involved 12 Cantonese speakers with idiopathic PD who were enrolled in a standard LVST treatment protocol. Speech data were collected 3-4 days before treatment and 1 day after treatment. A wide variety of perceptual and acoustic variables were analyzed. The results showed significant improvements in loudness and intonation after treatment, but no significant changes in lexical tone. These results have theoretical implications for the relationship between tone and intonation and for models of the physiological control of fundamental frequency. 1. Effect of LSVT on Lexical Tone in Speakers with Parkinson’s Disease Lee Silverman Voice Treatment (LSVT), which focuses on increasing vocal loudness, was developed for the treatment of voice and speech impairment in individuals with Parkinson’s disease (PD). The treatment protocol involves intensive treatment delivery (a one-hour session, four days a week for four weeks) and has been fully described elsewhere [1]. LSVT has well-documented treatment efficacy (e.g., [2, 3]). Positive changes have been noted not only for vocal loudness but also for many other speech dimensions, including intonation [1, 2]. Monotonicity, a disruption in intonation, is considered one of the hallmarks of hypokinetic dysarthria [4]. An estimated 60–70% of the world’s languages are tonal [5]; that is, where words of different meaning can be marked by variations in tone alone. Whereas intonation is associated with variation in fundamental frequency at the phrasal level, lexical tone is associated with variation in fundamental frequency at the syllable level. Cantonese (Chinese) has six contrastive tones, which vary according to pitch height and pitch contour [6]. Using the numerical system developed by Chao [7], where the first number represents the beginning level of the tone and the second number indicates the finishing level of the tone, the six lexical tones of Cantonese are 55 (high level), 35 (high rising), 33 (mid level), 21 (low falling), 23 (low rising), and 22 (low level). There have been few studies of hypokinetic dysarthria in speakers of lexical
References
[1]
L. O. Ramig, C. M. Bonitati, J. H. Lemke, and Y. Horii, “Voice treatment for patients with Parkinson disease: development and preliminary efficacy data,” Journal of Medical Speech Language Pathology, vol. 2, pp. 191–209, 1994.
[2]
C. M. Fox, C. E. Morrison, L. O. Ramig, and S. Sapir, “Current perspectives on the Lee Silverman voice treatment (LSVT) for individuals with idiopathic Parkinson disease,” American Journal of Speech-Language Pathology, vol. 11, no. 2, pp. 111–123, 2002.
[3]
C. Fox, L. Raming, M. Ciucci, S. Sapir, D. McFarland, and B. Farley, “The science and practice of LSVT/LOUD: neural plasticity-principled approach to treating individuals with Parkinson disease and other nuerological disorders,” Seminars in Speech and Language, vol. 27, no. 4, pp. 283–299, 2006.
[4]
F. Darley, A. Aronson, and J. Brown, Motor Speech Disorders, Saunders, Philadelphia, Pa, USA, 1975.
[5]
M. Yip, Tone, Cambridge University Press, Cambridge, UK, 2002.
[6]
R. S. Bauer and P. K. Benedict, Modern Cantonese Phonology, Mouton de Gruyter, Berlin, Germany, 1997.
[7]
Y. R. Chao, Cantonese Primer, Cambridge University Press, Cambridge, UK, 1947.
[8]
T. L. Whitehill, J. K.-Y. Ma, and A. S.-Y. Lee, “Perceptual characteristics of Cantonese hypokinetic dysarthria,” Clinical Linguistics and Phonetics, vol. 17, no. 4-5, pp. 265–271, 2003.
[9]
T. J. Vance, “An experimental investigation of tone and intonation in Cantonese,” Phonetica, vol. 33, no. 5, pp. 368–392, 1976.
[10]
T. L. Whitehill and L. L.-N. Wong, “Effect of intensive voice treatment on tone-language speakers with Parkinson's disease,” Clinical Linguistics and Phonetics, vol. 21, no. 11-12, pp. 919–925, 2007.
[11]
S. G. Adams and M. Jog, “Parkinson's disease,” in Clinical Management of Sensorimotor Speech Disorders, M. R. McNeil , Ed., pp. 365–379, Thieme, New York, NY, USA, 2009.
[12]
E. M. L. Yiu, “Linguistic assessment of Chinese-speaking aphasics: development of a Cantonese aphasia battery,” Journal of Neurolinguistics, vol. 7, no. 4, pp. 379–424, 1992.
[13]
L. O. Ramig, A. A. Pawlas, and S. Countryman, The Lee Silverman Voice Treatment: A Practical Guide to Treating the Voice and Speech Disorders in Parkinson Disease, National Center for Voice and Speech, Iowa City, IA, USA, 1995.
[14]
E. M.-L. Yiu and K. M.-K. Chan, A Simple Guide to Better Voicing: For Teachers and Professional Voice Users, INSTEP, Hong Kong, China, 2nd edition, 2003.
[15]
P. Boersma and D. Weenink, “Praat (Version 5.1),” Amsterdam, The Netherlands, 2008, http://www.praat.org/.
[16]
M. M.-N. Chow, Effect of Lee Silverman voice treatment [LSVT] on Cantonese speakers with Parkinson's disease: perceptual analysis, Unpublished undergraduate thesis, University of Hong Kong, Division of Speech and Hearing Sciences, 2009.
[17]
F. P.-H. Lee, Effects of Lee Silverman voice treatment [LSVT] on Cantonese speakers with Parkinson's Disease: acoustic analysis, Unpublished undergraduate thesis, University of Hong Kong, Division of Speech and Hearing Sciences, 2009.
[18]
C. Dromey, R. Kumar, A. E. Lang, and A. M. Lozano, “An investigation of the effects of subthalamic nucleus stimulation on acoustic measures of voice,” Movement Disorders, vol. 15, no. 6, pp. 1132–1138, 2000.
[19]
L. O. Ramig, S. Sapir, S. Countryman et al., “Intensive voice treatment (LSVT?) for patients with Parkinson's disease: a 2 year follow up,” Journal of Neurology Neurosurgery and Psychiatry, vol. 71, no. 4, pp. 493–498, 2001.
[20]
J. K. Y. Ma, V. Ciocca, and T. L. Whitehill, “Effect of intonation on Cantonese lexical tones,” The Journal of the Acoustical Society of America, vol. 120, no. 6, pp. 3978–3987, 2006.
[21]
T. L. Whitehill, V. Ciocca, and D. T. Y. Chow, “Acoustic analysis of lexical tone contrasts in dysarthria,” Journal of Medical Speech-Language Pathology, vol. 8, no. 4, pp. 337–344, 2000.
[22]
T. L. Whitehill, V. Ciocca, and S. L. M. Lam, “Fundamental frequency control in connected speech in Cantonese speakers with dysarthria,” in Speech Motor Control in Normal and Disordered Speech, B. Maassen, W. Hulswtijn, R. Kent, H. F. M. Peters, and P. H. M. M. van Lieshout, Eds., pp. 228–231, University of Nijmegen Press, Nijmegan, The Netherlands, 2001.
[23]
L. O. Ramig, S. Countryman, L. Thompson, and Y. Horii, “Comparison of two forms of intensive speech treatment for Parkinson disease,” Journal of Speech and Hearing Research, vol. 38, no. 6, pp. 1232–1251, 1995.
[24]
A. Lowit-Leuschel and G. J. Docherty, “Prosodic variation across sampling tasks in normal and dysarthric speakers,” Logopedics Phoniatrics Vocology, vol. 26, no. 4, pp. 151–164, 2001.
[25]
J. M. Liss and G. Weismer, “Qualitative acoustic analysis in the study of motor speech disorders,” Journal of the Acoustical Society of America, vol. 92, no. 5, pp. 2984–2987, 1992.
[26]
Y. Y. Fok-Chan, A Perceptual Study of Tones in Cantonese, University of Hong Kong Press, Hong Kong, China, 1974.
[27]
L. O. Ramig, “The role of phonation in speech intelligibility: a review and preliminary data from patient's with Parkinson's disease,” in Intelligibility in Speech Disorders, R. D. Kent, Ed., pp. 119–145, John Benjamins, Philadelphia, Pa, USA, 1992.
[28]
L. K.-H. So and B. J. Dodd, “Phonologically disordered Cantonese-speaking children,” Clinical Linguistics and Phonetics, vol. 8, no. 3, pp. 235–255, 1994.
[29]
S. F. Stokes and T. L. Whitehill, “Speech error patterns in Cantonese-speaking children with cleft palate,” European Journal of Disorders of Communication, vol. 31, no. 1, pp. 45–64, 1996.
[30]
C. Dromey, L. O. Ramig, and A. B. Johnson, “Phonatory and articulatory changes associated with increased vocal intensity in Parkinson disease: a case study,” Journal of Speech & Hearing Research, vol. 38, no. 4, pp. 751–764, 1995.