Vocal Dysfunction in Young-onset Parkinson’s Disease

Vocal dysfunction is well established in persons with older-onset Parkinson’s disease (PD), but has not been investigated in the young-onset PD (YOPD) population. Voice deficits associated with older-onset PD mirror the characteristics of vocal aging, suggesting that our current knowledge base of laryngeal dysfunction in the PD population is confounded by aging effects…

Contents

INTRODUCTION
Need for Study
Statement of Purpose
LITERATURE REVIEW
Prevalence and Incidence
Etiology and Risk Factors
Pathophysiology of Parkinson’s Signs
Diagnostic Criteria and Cardinal Motor Signs
Bradykinesia
Resting Tremor
Rigidity
Secondary Signs
Secondary Motor Signs
Sensory Signs and Proprioceptive Disturbances
Neuropsychiatric Deficits
Neuropsychological Deficits
Young-onset Parkinson’s Disease
Speech Disorders
Vocal Dysfunction
Voice Quality Deficits
Hypophonia
Phonatory Offset-onset Deficits
Aspiration Gesture
Laryngealization Gesture
Hypoprosodia
Pathophysiology of Laryngeal Function
Impact of Vocal Dysfunction on Quality of Life
Effect of Aging on Laryngeal Function and Voice
Voice and Speech Treatment Approaches
Pharmacological Methods
Surgical Methods
Speech Therapy
Biofeedback and Prosthetic Devices
Theoretical Implications: Direction for Current Research
RESEARCH OBJECTIVES AND HYPOTHESES
OBJECTIVE #1: IDENTIFY SELF-PERCEPTION OF VOICE AND SPEECH SYMPTOMS AND IMPACT ON QOL IN YOPD
Research Question #1(i)
Research Question #1(ii)
OBJECTIVE #2: IDENTIFY SPEAKER DIFFERENCES IN CLINICAL TASKS OF VOCAL FUNCTION
Research Question #2(i)
Research Question #2(ii)
OBJECTIVE #3: EFFECT OF SPEAKER GROUP, PHONETIC CONTEXT AND SPEAKING MODE ON MECHANISMS OF PHONATORY OFFSET-ONSET CONTROL
Research Question #3(i)
Research Question #3(ii)
Research Question #3(iii)
Research Question #3(iv)
Significance
METHODOLOGY
Speaker Recruitment and Selection Criteria
YOPD Speakers
HC Speakers
Speaker Tasks
Questionnaires
Visual Analogue Scale (VAS)
Voice Handicap Index (VHI)
SF-12 Health Survey (SF-12)
Clinical Tasks
Sustained Vowel Phonation
L-DDK Tasks
Fairy Tale Passage
Phonetic Context
Speaking Mode
Data Collection Procedure
Audio-recording Equipment
Calibration Procedure for Intensity
Auditory Masking Noise
Auditory Masking Procedure
Testing Protocol
L-DDK Task
Familiarization Task
Sustained Vowel Phonation Task
Fairy Tale Passage: Experimental Conditions
Completion of Questionnaires
Data Reduction Procedures-Dependent Measures
Scoring of Questionnaires
Preparation of Audio-Recorded Tasks for Acoustic Analyses
Acoustic Analyses of Sustained Vowel Phonations
Acoustic Analyses of L-DDK Tasks
Acoustic Analyses of Sentence Stimuli
Spectrographic Pattern Codes
Descriptive Codes for Multiple Gestures
Measure of Vowel Intensity for Sentences
Measure of Intervocalic Spectral Energy Change
Reliability
Statistical Analyses
RESULTS
PERCEIVED VOICE AND SPEECH SYMPTOMS AND IMPACT ON QOL
SPEAKER GROUP DIFFERENCES FOR ACOUSTIC MEASURES OF VOCAL FUNCTION ON CLINICAL TASKS
Voice Spectra Measures
L-DDK Measures
SPEAKER GROUP DIFFERENCES IN PHONATORY OFFSET-ONSET CONTROL IN VARYING PHONETIC CONTEXTS AND SPEAKING MODES
Intensity Measure
Intervocalic Spectral Energy Change Measure
Intra-group speaker differences
Descriptive analyses of spectrographic patterns
Mechanisms involving an open vocal tract
Mechanisms involving in an orally constricted vocal tract
Multiple phonatory offset-onset mechanisms
DISCUSSION
VOICE AND SPEECH SYMPTOMS AND THE NEGATIVE IMPACT ON QOL
PERFORMANCE ON CLINICAL TASKS
SPEAKER GROUP DIFFERENCES IN SPEECH INTENSITY AND PHONATORY OFFSETONSET
CONTROL OF LARYNGEAL AND ASPIRATION GESTURES IN VARIOUS SPEAKING MODES
Speaker group differences
Speech Intensity for Reading
Intervocalic Spectral Energy Change
Spectrographic Pattern Codes
Comparison of phonatory offset-onset mechanisms
Effects of voice mode manipulation
LIMITATIONS
CLINICAL IMPLICATIONS
THEORETICAL AND RESEARCH IMPLICATIONS
CONCLUSION
APPENDICES
REFERENCES

Author: Bassich-Zeren, Celia J.

Source: University of Maryland

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