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INSIGHTS INTO THE SPEECH INTELLIGIBILITY OF PERSONS WITH PARKINSON’S DISEASE IN RELATION TO THEIR SPEECH SEVERITY AND SPEECH USAGE Anju. B. Thomas1 & Swapna.N2 1 Speech Language Pathologist, Department of clinical services and 2 Reader in Speech Pathology, Department of Speech- Language Pathology, All India Institute of Speech and Hearing, Mysuru, Karnataka, India. Email id: firstname.lastname@example.org I. Introduction When the typical features of Parkinson disease(PD) like akinesia, rigidity and tremor affect the oral structures, persons with PD experience reduction in the range of movement of articulators, which eventually affect their speech quality, voice, articulation, resonance and fluency in different ranges. These affect the overall speech intelligibility and naturalness which can in turn lead to restrictions to socialisation, feelings of perceived stigmatization, and differences in self-identity. II. Need for the study The relationship between speech intelligibility, naturalness and speech usage has been less well studied. Similarly, there is a dearth of studies investigating the extent of impairment in speech intelligibility across stages. Further, the perceived speech severity by the client and its relationship with speech intelligibility and speech usage has also been less well investigated. III. Aim and Objectives Keeping this in view, the present study was planned to investigate the speech intelligibility and naturalness of persons with PD and its relationship with the speech usage and speech severity. The specific objectives were 1) To compare the word intelligibility, sentence intelligibility and narration intelligibility and speech naturalness between the early and middle stages of PD, 2) To compare the speech severity and speech usage between the early and middle stages of PD and 3) To assess the relationship of speech intelligibility and naturalness with speech severity and speech usage. IV. Method This study was carried out in 15 Kannada speaking individuals (12 males and 3 females) with idiopathic PD in the age range of 50-85 years. Among the 15 participants, 7 were in the early stages of the disease and 8 participants were in the middle stages. They were classified into Group I (Early) and Group II (Middle) based on the Hoehn and Yahr stages and the checklist on speech, motor, and swallowing problems. Speech intelligibility and speech naturalness was measured using the Protocol for assessment of speech intelligibility and speech naturalness in dysarthrics in Kannada. Based on the word, sentences and narration scores, average intelligibility score was computed .As a part of the speech naturalness assessment, the stress, intonation, pauses, rhythm, rate of speech, and articulatory profi-ciency were assessed. Level of speech usage rating was used to determine the level of speech usage in the participants according to their frequency, type, amount and importance of speaking situations generally face in their day to day life. Finally, speech severity was assessed by a speech severity rating scale, where the participant was requested to opt a particular item from the categories that best described their perceived speech difficulties. The data obtained were tabulated for each participant and was subjected to statistical analysis using the SPSS software version 21.0. V. Results and Discussion The results revealed that, the persons in the early stage of PD had significantly higher intelligibility scores and better naturalness levels in comparison to persons in the middle stage of the disease. Secondly, although no significant difference was found between the groups on speech usage and speech severity, median values indicated that the persons in the middle stage of PD used speech to a lesser extent and had higher speech severity ratings as compared to the persons in the early stage, indicating communication restrictions as the disease progressed. Thirdly, a statistically significant moderate positive correlation was found between the speech intelligibility and speech usage, whereas a negative correlation was found between speech naturalness and speech usage. However there was no correlation between clinician determined intelligibility and naturalness and speech severity. VI. Summary and Conclusions As the person with PD progresses, there is a significant decrease in their speech intelligibility and naturalness and there can be a restriction in their speech usage. This emphasises on the need to use the speech usage scale to identify speech intelligibility issues in persons with PD and treat them early so that their speech can be maintained without significant deterioration.
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