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Dysarthria in individuals with Parkinson's disease: a protocol for a binational, cross-sectional, case-controlled study in French and European Portuguese (FraLusoPark)



Individuals with Parkinson's disease (PD) have to deal with several aspects of voice and speech decline and thus alteration of communication ability during the course of the disease. Among these communication impairments, three major challenges include: (1) dysarthria, consisting of orofacial motor dysfunction and dysprosody, which is linked to the neurodegenerative processes; (2) effects of the pharmacological treatment, which vary according to the disease stage; (3) particular speech modifications that may be language-specific, that is dependent on the language spoken by the patients. The main objective of the FraLusoPark project is to provide a thorough evaluation of changes in PD speech as a result of pharmacological treatment and disease duration in two different languages (French vs European Portuguese).
Dysarthria in individuals with
Parkinsons disease: a protocol for
a binational, cross-sectional,
case-controlled study in French and
European Portuguese (FraLusoPark)
Serge Pinto,
Rita Cardoso,
Jasmin Sadat,
Isabel Guimarães,
Céline Mercier,
Helena Santos,
Cyril Atkinson-Clement,
Joana Carvalho,
Pauline Welby,
Pedro Oliveira,
Mariapaola DImperio,
Sónia Frota,
Alban Letanneux,
Marina Vigario,
Marisa Cruz,
Isabel Pavão Martins,
François Viallet,
Joaquim J Ferreira
To cite: Pinto S, Cardoso R,
Sadat J, et al. Dysarthria in
individuals with Parkinsons
disease: a protocol for
a binational, cross-sectional,
case-controlled study in
French and European
Portuguese (FraLusoPark).
BMJ Open 2016;6:e012885.
Prepublication history for
this paper is available online.
To view these files please
visit the journal online
Received 30 May 2016
Revised 21 September 2016
Accepted 21 October 2016
For numbered affiliations see
end of article.
Correspondence to
Dr Serge Pinto;
Introduction: Individuals with Parkinsons disease
(PD) have to deal with several aspects of voice and
speech decline and thus alteration of communication
ability during the course of the disease. Among these
communication impairments, 3 major challenges
include: (1) dysarthria, consisting of orofacial motor
dysfunction and dysprosody, which is linked to the
neurodegenerative processes; (2) effects of the
pharmacological treatment, which vary according to the
disease stage; and (3) particular speech modifications
that may be language-specific, that is, dependent on
the language spoken by the patients. The main
objective of the FraLusoPark project is to provide a
thorough evaluation of changes in PD speech as a
result of pharmacological treatment and disease
duration in 2 different languages (French vs European
Methods and analysis: Individuals with PD are
enrolled in the study in France (N=60) and Portugal
(N=60). Their global motor disability and orofacial
motor functions is assessed with specific clinical rating
scales, without (OFF) and with (ON) pharmacological
treatment. 2 groups of 60 healthy age-matched
volunteers provide the reference for between-group
comparisons. Along with the clinical examinations,
several speech tasks are recorded to obtain acoustic
and perceptual measures. Patient-reported outcome
measures are used to assess the psychosocial impact
of dysarthria on quality of life.
Ethics and dissemination: The study has been
approved by the local responsible committees on
human experimentation and is conducted in
accordance with the ethical standards. A valuable large-
scale database of speech recordings and metadata
from patients with PD in France and Portugal will be
constructed. Results will be disseminated in several
articles in peer-reviewed journals and in conference
presentations. Recommendations on how to assess
speech and voice disorders in individuals with PD to
monitor the progression and management of
symptoms will be provided.
Trial registration number: NCT02753192,
Dysarthria in Parkinsons disease (PD)
Dysarthria denotes a motor speech disorder
resulting from a lesion of the peripheral or
central nervous system.
Dysarthria and
the psychosocial aspects of communication
impairments are particularly disabling for
individuals with PD. During the progression
of the disease, between 70% and 79% of
individuals with PD mention that speech
and functional communication are
contributing to social isolation
and degradation of social interactions.
These speech and communication disorders
Strengths and limitations of this study
A multicentre (binational), cross-sectional, case-
controlled study.
A cross-linguistic, multiparametric and holistic
study of speech in Parkinsons disease (PD).
An interdisciplinary approach bringing together
data analyses from the speech sciences and
A clinically reasonable number of individuals
with PD.
No analysis of phonetic alterations and so far,
not a longitudinal study: unable to address
individualsspeech deterioration with time.
Pinto S, et al.BMJ Open 2016;6:e012885. doi:10.1136/bmjopen-2016-012885 1
Open Access Protocol
worsen along with the aggravation of other non-motor
symptoms such as self-perception, depression
and cog-
nitive impairment.
In addition to the alteration of
speech intelligibility, signally a motor-driven speech
decit, it is also important to consider the importance
of cognitive impairment on everyday communication in
individuals with PD.
Dysarthria can appear at any stage
of PD, and usually worsens as the disease progresses,
which suggests that it is also linked to the evolution of
the pathological processes and non-dopaminergic brain
The main decits of PD speech are: loss of
intensity (hypophonia), monotony of pitch and loud-
ness, reduced stress, inappropriate silences, short rushes
of speech, variable rate, imprecise consonant articula-
tion and dysphonia (harsh and breathy voice).
Previous studies have shown that treatments in PD
have variable effects on these voice and speech
18 19
Although behavioural treatments mainly focus on two
key indices of PD speech, pitch and intensity, dysprosody
has been understudied. Yet prosody decits represent an
acoustic hallmark of dysarthria. First, perceptual and
acoustic investigations of PD speech have reported
alterations on fundamental frequency (F0), as part of
speakersreduced phonatory capacity, and thus the
reduction of the frequency range is an indicator of dys-
arthria in PD.
In particular, individuals with PD show a
loss of the upper part of the frequency range.
Degradation of prosody has been found to impact
speech intelligibility and communication (eg, see
ref. 22). Second, the temporal organisation of speech in
PD has been addressed in reading tasks.
In French,
for example, speech rate tends to be slower in PD,
which in turn seems to be correlated with longer pause
times. Average durations of pauses are found to be
longer in individuals with PD than in healthy indivi-
duals, while the average duration of sound sequences
are similar.
24 25
Studying dysprosody is thus important
for differential diagnosis, identifying severity and the
need and focus of treatment.
Remaining challenges to assess dysarthria in PD: the
rationale of the FraLusoPark study
Individuals with PD have to cope with several issues that
contribute to voice and speech decline and thus to the
alteration of communication ability during the course of
the disease. Among these communication impairments,
three major challenges include: (1) dysarthria, consist-
ing of orofacial motor dysfunction and dysprosody,
which is linked to the neurodegenerative processes; (2)
the effects of the pharmacological treatment, which vary
according to the disease stage and (3) the particular
speech modications that may be language-specic, that
is, dependent on the language spoken by the patients.
The main objective of the FraLusoPark project is to
provide an extensive evaluation of dysarthric speech in
PD as a result of pharmacological treatment and disease
duration, using acoustic parameters (voice and
prosody), perceptual markers (intelligibility) and
patient-reported outcome measures (PROMs; psycho-
social impact on quality of life) in speakers of two differ-
ent languages (French and European Portuguese).
Based on a large-scale binational collaboration, the
interdisciplinary FraLusoPark project aims to address
these issues by providing important insights in the
domains of neurodegenerative disorders, speech
sciences, neuropsychology, clinical research and patient
Medication effects along disease progression
Early studies assessing the effect of the levodopa
(L-dopa) on PD speech found favourable results,
arguing for a benecial effect, as for limb impair-
However, the long-term use of L-dopa is asso-
ciated with motor complications which occur in up to
80% of patients.
30 31
This may be the reason why the fol-
lowing studies reported no improvement
32 33
detrimental effects of L-dopa on speech.
34 35
recent studies face similar problems: benecial effects of
L-dopa can be observed in advanced patients with
36 37
whereas a lack of improvement is reported for
speech parameters in early stage patients with PD.
It is
also commonly accepted that in the later stages of PD,
non-motor symptoms (dementia, psychosis, depression
and apathy) are a major source of disability together
with axial symptoms (eg, alteration of gait, balance,
posture, speech).
Thus, both clinicians and researchers
have to dissociate various intermingled effects. For
example, when individuals with PD respond to L-dopa at
an early stage of the disease, in time they are likely to
experience speech decline that may be the result of the
degeneration of non-dopaminergic structures and/or
adverse effects of L-dopa (ie, dyskinesia). Despite the
large number of recent studies that have focused on the
effect of L-dopa on speech in PD,
the question of
disease evaluation still remains a matter of debate.
Language specificities of prosody
One missing component in the description of PD
speech decits is language-specic aspects, in particular
of dysprosody. Prosodic information, including inton-
ation, tempo, stress and rhythm, serves many functions
for the listener and speaker: it helps to segment the con-
tinuous ow of spoken language into words, groups
these words into phrases for interpretation, and indi-
cates the relative importance and function of the inter-
preted meanings.
Each language has its own
prosodic structure. For example, although they are sister
languages, French and European Portuguese (both
Romance languages) differ prosodically in a number of
important ways. European Portuguese has contrastive
lexical stress: each content word (noun, adjective, verb,
etc) has one syllable that is particularly salient or
stressed, and changing the position of the lexical stress
can change the meaning of a word.
47 4951
Stressed sylla-
bles may be accompanied by a pitch accent, realised as a
2Pinto S, et al.BMJ Open 2016;6:e012885. doi:10.1136/bmjopen-2016-012885
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modulation in F0 (eg, a rise or a fall) and aligned in
language-specic ways with the syllable. In contrast,
French has a xed stress, characterised by a systematic
F0 rise on the last syllable in a word.
52 53
In French,
stress is not a property of the word, but of a larger unit
called the accentual phrase that can include one or
more content words and any preceding function words
(articles, prepositions, etc), often realised with F0 rises
at its right and left edges. French listeners use these F0
rises as cues to word segmentation, nding the begin-
ning and ends of words in the speech stream, and to
lexical access, retrieving words from the mental
48 54
Such differences across languages make the compari-
son of prosodic decits in individuals with PD particu-
larly interesting. Very few studies of PD dysprosody have
looked beyond global measures to examine the extent to
which linguistically important, language-specic patterns
are affected.
55 56
Therefore, studying speech in indivi-
duals with PD whose languages include different pros-
odic modulations is essential in determining the role of
prosody in patientsspeech intelligibility and quality of
life. Does a Portuguese patient experience different
communication impairments compared with a French
patient? If this is the case, could this difference be
related, for example, to the fact that in Portuguese stress
is distinctive and varies in position? Finally, how do these
differences relate to disease duration and pharmaco-
logical treatment? Our project presents a novel
approach to these questions and is characterised by the
collection of cross-linguistic data in a single cohort.
FraLusoPark is a binational (data collection is performed
in two countries: France and Portugal), cross-sectional
(data are collected once for each participant) and case-
controlled (both individuals with PD and control subjects
are recruited) study, carried out in two different lan-
guages (French and European Portuguese).
Aims and hypotheses
The main objectives of our project are to evaluate modu-
lations in voice/speech acoustics parameters (acoustics
and prosody), perceptual markers (intelligibility) and
PROMs (psychosocial impact of dysarthria in PD) across
two different languages (French and European
Our three a priori hypotheses are the following: (1)
global acoustic features are altered similarly in French
and Portuguese individuals with PD; (2) language-
specic prosodic patterns are altered differently in
French and Portuguese individuals with PD and (3) the
impact of speech disorders on intelligibility and quality
of life depends on the cultural and linguistic environ-
ment. In addition, the FraLusoPark project will allow for
a better understanding of the progression of speech
symptoms and their response to pharmacological
treatment, which is important for pathophysiological
aspects and clinical management.
Two groups of 60 healthy volunteers (one in France
and one in Portugal) are age-matched and sex-matched
with the individuals with PD to provide control refer-
ences for the obtained performance measures.
Individuals with PD are recruited in France (N=60;
Neurology Department, Centre Hospitalier du Pays
dAix, Aix-en-Provence, France) and in Portugal (N=60;
Movement Disorders Unit, Hospital de Santa Maria,
Lisbon, and Campus Neurológico Sénior (CNS), Torres
Vedras, Portugal) and correspond to the UK Parkinsons
Disease Brain Bank Criteria
for the diagnosis of idio-
pathic PD. Individuals with PD and healthy controls are
all native speakers of French or European Portuguese
speakers (FrenchEuropean Portuguese bilinguals were
excluded) and right-handed (Handedness Edinburgh
test >80%).
Inclusion and exclusion criteria of patients
with PD and healthy controls are summarised in table 1.
To assess the effects of L-dopa at various stages of the
disease, we consider three subgroups of patients (N=20
patients each): subgroup 1, early, with a disease duration
between 0 and 3 years and no motor uctuations; sub-
group 2, medium, with a disease duration between 4
and 9 years, or between 0 and 3 years and experiencing
motor uctuations; subgroup 3, advanced, with a disease
duration of over 10 years.
Study design
Healthy control participants undergo the same non-
invasive assessments and examinations as individuals
with PD. The only difference for patients is that they are
evaluated twice, in the OFF and ON L-dopa states. This
entails: (1) at least 12 hours after withdrawal of all
anti-Parkinsonian drugs and (2) following at least 1 hour
after the administration of the usual medication. The
full study design is illustrated in gure 1.
Speech recordings
In a quiet room, specialised speech recording equip-
ment (EVA2 system, SQLab, Aix-en-Provence, France;; Marantz PMD661 MKII recorder,
USA) is used for the speech/voice recordings.
Participants are recorded while performing several
speech production tasks with increasing complexity in a
xed order: (1) steady vowel /a/phonation (at a com-
fortable pitch and loudness) repeated three times; (2)
maximum phonation time (vowel /a/sustained as long
as possible on one deep breath at a comfortable pitch
and loudness), repeated twice; (3) oral diadochokinesia
(repetition of the pseudoword pataka at a fast rate for
30 s); (4) reading aloud of 10 words and 10 sentences
created by adapting the intelligibility part of V.2 of the
Frenchay Dysarthria Assessment (FDA-2);
(5) reading
aloud of a short text (The North Wind and the Sun,
French and European Portuguese adaptations);
50 60
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storytelling speech guided by visual stimuli ( pictures
from the wordless story Frog, Where are you?,
for the
rationale of using this procedure and this book, see
ref. 62); (7) reading aloud of a set of sentences with
specic language-dependent prosodic properties (31
sentences in French, 20 in European Portuguese); and
(8) free conversation for 3 min.
Acoustic measures
The acoustic measures characterise dimensions of aero-
phonatory control.
For the steady vowel /a/phonation,
two kinds of measures will be extracted: rst, for a
macro analysis, F0 (Hz) and F0 variation (%); and
second, for a micro analysis, perturbation measures such
as jitter factor (%), absolute shimmer (dB) and
harmonics-to-noise ratio (HNR, %). For the maximal
phonation time, the longest duration (in seconds) of
the sustained vowel /a/will be extracted. For the oral
diadochokinesia task, the extracted measures will be the
following: (1) the number of breath groups, that is, the
period during which the pseudoword was repeated in a
single expiration, (2) the ratio between the cumulated
speech duration of the breath groups and the total dur-
ation of the session, that is, the proportion of speech,
(3) the articulatory rate (syllables/second), (4) the
pause-to-sound ratio (%) and (5) the speech proportion
per number of breath groups. As an initial step to inves-
tigate global prosodic aspects of PD speech compared
with the speech of healthy controls, we will extract the
F0 curve of one sentence selected from the short text
(The North Wind and the Sun). This sentence is
selected to be comparable across French and European
Portuguese in terms of semantics and syllable length.
This will provide a global phrasal pattern of F0 and
intensity for patients and controls within and across lan-
guages (see below in the discussion for subsequent
studies). A summary of the acoustic measures that will
be analysed is listed in table 2.
Clinical assessments
The neurological assessment is the Unied Parkinsons
Disease Rating Scale,
using the revised version pro-
vided by the Movement Disorders Society (MDS-UPDRS).
The FDA-2 is used to assess the functions of the speech
Figure 1 Overview of the
FraLusoPark study design.
Patient OFF-medication
assessments (clinical history,
speech recordings and clinical
assessments, without medication)
are shown in dark grey.
ON-medication assessments
(speech recordings and clinical
assessments after medication are
effective) are shown in light grey.
Table 1 Inclusion and exclusion criteria
All participants
Inclusion criteria
Age between 35 and 85 years
Good cooperation
Ability to understand the information sheet
Given signed consent
Enrolled in a medical insurance plan
Other stable medical problems not interfering with the proposed study
Idiopathic Parkinsons disease*
Absence of any neurological, psychiatric or behavioural pathology
Exclusion criteria
French/Portuguese not native language, or bilingual
Participant under tutorship or guardianship, or any other administrative or legal dependence
No cooperation or consent withdrawn
Cognitive deficits, severe depression, dementia, psychosis (including medication-induced) or behavioural, neurological,
medical, psychological disorders that may interfere with evaluations
Non-idiopathic Parkinsons disease*
Deep brain stimulation*
Severe motor impairment impeding participation in the study*
*Patients with Parkinsons disease.
Control subjects.
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reecting the state of the muscular effectors
involved in speech production. The original FDA-2, in
English, includes an evaluation of intelligibility through
10 words and 10 short sentences. Using the same meth-
odology, we developed a set of cross-linguistically
adapted words and sentences in French and European
Portuguese that will be used for the intelligibility assess-
ment in each language. During the OFF medication
state, individuals with PD will be administered the FDA-2
and the motor part ( part 3) of the MDS-UPDRS.
During the ON medication state, these two assessments
are performed together with the non-motor ( part 1.A)
and motor complication ( part 4) part of the
MDS-UPDRS. During the ON medication state, the parti-
cipantscognitive abilities are evaluated using the
Montreal Cognitive Assessment (MoCA),
and the
Clinical Global Impression (CGI) is also reported.
healthy controls, the assessment is similar to that of the
patients with PD during ON medication (except part 4
of the MDS-UPDRS). A summary of the clinical assess-
ments is given in table 3.
Patient-reported outcome measures
PROMs, such as the Dysarthria Impact Prole (DIP),
are used to obtain self-reported information about the
functional impact of an individuals speech/communica-
tion impairment.
Additional self-assessments focus on
the patientsperception of their quality of life (the
39-Item Parkinsons Disease Questionnaire
70 71
and on how voice/speech impairment
may induce a handicap (Voice Handicap Index, VHI).
The French
and European Portuguese adapted DIP,
74 75
and PDQ-39
are used in our study. The
Patient Global Impression (PGI) scoring
and the Beck
Depression Inventory (BDI)
are also administered.
The MDS-UPDRS also includes a patient self-assessment
(parts 1.B and 2), which is administered together with
the other questionnaires in the ON condition. For
healthy controls, the assessment is the same as for
individuals with PD. A summary of the PROMs from the
self-administered questionnaires are listed in table 3.
Statistical analyses
The analyses of the data (acoustic, clinical measures and
PROMs) will be performed with linear mixed-effects
models that account for the variability across individuals,
using the latest version of the statistical software R (R
Development Core Team. R: a language and environ-
ment for statistical computing. R Foundation for
Statistical Computing, Vienna, Austria: 2014. ISBN 3--
900051-07-0, For each per-
formance measure, the between-group factors group
(patients vs controls), disease duration (early vs medium
vs advanced) and language (French vs European
Portuguese) will be investigated. In addition, we will
explore the effects of the within-patient factor medication
(OFF vs ON) for all measures. Further relevant
participant-related measures such as age, gender and
education level will also be taken into account in the
The present study will provide a unique, thorough and
reliable assessment of PD voice, speech and prosody dis-
orders and an evaluation of the impact of these aspects
on the quality of life of individuals with PD.
Main and subsequent analyses of the FraLusoPark study
Acoustic and prosodic measurements (table 2), clinical
assessment and PROMs (table 3) are the dependent
variables to be analysed according to the statistical plan.
These ndings will be reported in the primary analysis
as the main results of the project. However, the
FraLusoPark investigation protocol will allow us to
conduct additional analyses focusing on specic subdi-
mensions of speech and voice decits. There are at least
four such subsequent analyses, exploring important
Table 2 Acoustic measures
Speech tasks Function assessed Acoustic measures
Steady vowel /a/ phonation Phonation Mean F0 (Hz)
F0 variation (SD, in Hz)
Shimmer (%)cycle-to-cycle F0 variation
Jitter (%)cycle-to-cycle intensity variation
HNR (%)
Maximal phonation time of the vowel /a/ Aero-phonatory control Longest duration (in seconds)
Oral diadochokinesia Supralaryngeal articulatory control Number of breath groups
Proportion of breath groups (%)
Articulatory rate (in syllables/second)
Pause-to-sound ratio (%)
Speech proportion ratio (%)
Reading aloud of text Prosody F0 range (Hz)
Intensity (dB)
F0, fundamental frequency; HNR, harmonics-to-noise ratio.
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Table 3 Clinical assessments and patient-reported outcome measures
Description Subsections
Minimummaximum scores
(worst values in bold)
A. Clinical assessments
Movement Disorders SocietyUnified Parkinsons Disease Rating Scale
(MDS-UPDRS)Assessment of motor and non-motor features of
Parkinsons disease
Non-motor experience of daily livingmotor experience of
daily livingmotor examinationmotor complications
Frenchay Dysarthria Assessment, second edition (FDA-2)Assessment of
speech and voice organs
Montreal Cognitive Assessment (MoCA)Global assessment of cognitive
VisuospatialNamingMemoryAttentionVerbal fluency
Clinical Global Impression (CGI)Global impression of the clinician for the
Speech 17
B. Patient-reported outcome measures (PROMs)
39-Item Parkinsons Disease Questionnaire (PDQ-39)Quality of life in
Parkinsons disease
MobilityDaily living activitiesEmotional well-being
StigmaSocial supportCognitionCommunicationBody
Voice Handicap Index (VHI)
PhysicalFunctionalEmotional 0120
Dysarthria Impact Profile (DIP)Psychosocial impact of speech deficits
Effect of dysarthria on meAccepting my dysarthriaHow I
feel others react to my speechHow dysarthria affects my
communicationDysarthria relative to other worries and
Patient Global Impression (PGI)Global impression of the patient on the
Speech 17
Beck Depression Inventory (BDI)Global assessment of the depression
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aspects of PD speech and communication in more
First, the intelligibility part of the FDA-2
requires the
words and sentences produced by the patient to be per-
ceptually rated by the clinician in charge of the assess-
ment. Since these speech productions are recorded
during the FraLusoPark protocol, an evaluation of
speech intelligibility by panels of auditory judges in
France and Portugal will be run. This will allow an add-
itional and unbiased judgement of speech and voice dis-
orders beyond that of the speech therapists and experts
involved in the study. This approach further comple-
ments the global assessment of dysarthric speech in
patients with PD.
Second, further prosodic analysis will be conducted
on the dened sets of sentences, which manipulate
language-general and language-specic details of
prosody. One particular focus will be the analysis of
tonal alignment in the F0 curve, that is, the temporal
coordination of high and low tones with specic syllables
in the sentences.
Tonal alignment is likely to be a
relevant factor in the study of PD dysprosody since it
relies on the precise coordination of glottal and supra-
glottal articulatory gestures required to achieve
language-specic temporal patterns for pitch accents
and boundary tones.
Third, taking into consideration patientspersonal
feelings with respect to the physical, psychological and
social domains has received increasing interest over the
past decade. Individuals with PD are affected by voice
and speech disorders, which contribute to an impair-
ment of general communication abilities. Individuals
with PD are therefore less likely to participate in conver-
sations or social interactions.
Several studies suggest
that a growing discomfort in verbal communication
during the progression of the disease leads to an import-
ant negative impact on social life.
70 84 85
Taken together,
these studies argue for experimental designs that
include different types of speech assessments (clinical,
perceptual, instrumental and psychosocial), as in the
current protocol, and that explore the relationships
between these different measures. Further analyses will
therefore focus on linking the different dimensions of
voice and speech description (eg, acoustic measures,
FDA-2) with the contributions of various participant-
related measures such as intelligibility, cognition and
functional communication.
Fourth, production and prosodic parameters from
the three different speech tasks (ie, short text reading,
orientated picture description and conversation) will
be compared. This will allow us to compare speech
and voicing disorders in increasingly more complex
communication contexts. These comparisons are of
interest since communication abilities in PD are quite
different in the presence of external cueing, such as
during reading, compared with spontaneous speech,
which involves more complex speech planning
Finally, the FraLusoPark study might provide us the
opportunity to address the deterioration of the speech
of individuals with PD over time. In a longitudinal
follow-up study, we would recruit a subgroup of patients
from group 1 (disease duration up to 4-year) and group
2 (disease duration between 4 and 10 years). These
patients would be evaluated again at a later point in
time (about 5 years after the original recordings). This
would allow us to describe the precise progression of
speech decits associated with PD within the same indi-
vidual for French and Portuguese speakers.
This study has been approved by the local responsible
committees on human experimentation (France:
Comité de Protection des Personnes, Sud Méditerranée
1, project reference number 13-84, approval date 9
January 2014; Portugal: Ethics Committee of the Lisbon
Academic Medical Centre, project reference number
239-14, approval date 1 June 2014). The study is con-
ducted in accordance with the ethical standards of the
Declaration of Helsinki.
The patients are included in
the study after providing their written informed consent.
The FraLusoPark trial is registered under the reference
NCT02753192 (26 April 2016) on https://clinicaltrials.
Results of the FraLusoPark project will be dissemi-
nated at several research conferences at the national
and international levels and published as articles in
peer-reviewed journals and clinical magazines. The pub-
lication strategy is based on one principal article report-
ing the main results of the project and several
subsequent articles deriving from it, including more
detailed analyses of specic subdimensions of the
speech and voice decits.
Owing to inter-speaker variability, any generalisation
drawn from speech parameters in the clinical population
requires data from a large number of speakers.
FraLusoPark project is in line with this idea in that it builds
a large-scale corpus of PD speech recordings and includes a
large set of metadata (clinical examinations, speech
measurements, linguistic features, patient-based indices).
This allows a more accurate description of PD dysarthria,
documenting the evolution of the symptoms and their
response to pharmacological treatment. Both in medical
and linguistic ( domains, data sharing is
important to maximise the lifetime value of human
health data. It is our intention to contribute to this prac-
tice by archiving our data for long-term preservation and
making them accessible after the completion of our
Furthermore, an important recommendation from the
International Classication of Functioning, Disability
and Health
is to improve quality of healthcare and to
encourage clinicians to adopt a more holistic approach
Pinto S, et al.BMJ Open 2016;6:e012885. doi:10.1136/bmjopen-2016-012885 7
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to the assessment and treatment of patients. Research in
the eld of speech sciences needs to incorporate this
vantage point when studying pathological speech. The
FraLusoPark project is in line with this perspective and
will provide important recommendations for speech and
voice assessments in patients with PD. This will be
helpful to health practitioners and clinicians when mon-
itoring the progression of symptoms and their manage-
ment, and will also advance our understanding of
dysarthria in PD within a cross-linguistic and cross-
cultural context.
Author affiliations
Aix Marseille Université, Centre National de la Recherche Scientifique
(CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
Brain and Language Research Institute, Aix-en-Provence, France
Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of
Lisbon, Lisbon, Portugal
Speech Therapy Department, Escola Superior de Saude do Alcoitão,
Alcabideche, Portugal
Neurology Department, Centre Hospitalier du Pays dAix, Aix-en-Provence,
Centre of Linguistics, School of Arts and Humanities, University of Lisbon,
Lisbon, Portugal
Neurology Department, Faculty of Medicine, Language Research Laboratory,
University of Lisbon, Lisbon, Portugal
Contributors SP and JJF are the principal investigators of the FraLusoPark
study. They designed the study and ensure the good performance of the
study. JJF and FV are the neurologists in charge of patient recruitment and
neurological assessments. RC, JS, HS, CM, JC, FV and SP perform data
acquisition and other clinical examinations. RC, JS, PO and IG are in charge
of the pre-processing and analyses of acoustic measurements. CA-C and AL
are in charge of the analyses of the PROMs and clinical assessments. PW,
PO, MD, MC, SF and MV are the linguistic experts in charge of the prosody
evaluations. IPM is the neurobehaviour, language and cognition expert. SP
wrote the draft of the present article. All coauthors commented and revised it
critically for important intellectual content, and approved the final version to
be published.
Funding This study is supported by a bilateral transnational funding between
France and Portugal: support from the French government, through the
French National Agency for Research (ANRAgence Nationale de la
Recherchegrant number ANR-13-ISH2-0001-01) and from the Portuguese
government, through the Portuguese National Foundation for Science and
Technology (FCTFundação para a Ciência e a Tecnologiagrant number
FCT-ANR/NEU-SCC/0005/2013). CA-C wishes to thank his PhD grant scheme
co-funders: PACA Regional Council and Orthomalin (http://www.orthomalin.
Competing interests None declared.
Patient consent Obtained.
Ethics approval France: Comité de Protection des Personnes, Sud
Méditerranée 1, project reference number 13-84, approval date 09/01/2014;
Portugal: Ethics Committee of the Lisbon Academic Medical Centre, project
reference number 239-14, approval date 12/06/2014.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement We addressed this point in the Ethics and
disseminationsection of the article, as follows: Both in medical (eg, http://
population-and-patient-studies/) and linguistic ( domains, data
sharing is important to maximise the lifetime value of human health data. It is
our intention to contribute to this practice by archiving our data for long-term
preservation and making them accessible after the completion of our
Open Access This is an Open Access article distributed in accordance with
the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license,
which permits others to distribute, remix, adapt, build upon this work non-
commercially, and license their derivative works on different terms, provided
the original work is properly cited and the use is non-commercial. See: http://
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Open Access
... Indeed, a recent study on PD reported that a longer disease duration is associated with a lower speech therapy efficacy [28]. The ROC analyses we conducted provided a cut-off of the DIP, below which the complaint of the patients should be further discussed with them and possibly, the patients could be referred to a speech/language therapist for additional counselling: clinicians could use the DIP as a tool to precisely estimate the psychosocial consequences of dysarthria [29]. Furthermore, to better manage dysarthria, it is crucial to include patient-reported difficulties in functional communication [26] as indicators of both dysarthria's psychosocial impact [29] and speech therapy management [27,30,31]. ...
... The ROC analyses we conducted provided a cut-off of the DIP, below which the complaint of the patients should be further discussed with them and possibly, the patients could be referred to a speech/language therapist for additional counselling: clinicians could use the DIP as a tool to precisely estimate the psychosocial consequences of dysarthria [29]. Furthermore, to better manage dysarthria, it is crucial to include patient-reported difficulties in functional communication [26] as indicators of both dysarthria's psychosocial impact [29] and speech therapy management [27,30,31]. Thus, using the DIP as a psychosocial indicator can be useful to correctly adjusting a speech rehabilitation program [32,33]. ...
Full-text available
Background: Dysarthria in neurological disorders can have psychosocial consequences. The dysarthric speaker's perspective towards the disorder's psychosocial impact is essential in its global assessment and management. For such purposes, assessment tools such as the Dysarthria Impact Profile (DIP) are indispensable. Objective: We aimed to confirm the relevance of using the DIP to quantify the psychosocial consequences of dysarthria in neurological diseases. Methods: We studied 120 participants, 15 healthy controls and 105 patients with different kinds of dysarthria induced by several neurological disorders (Parkinson's disease [PD], Huntington's disease, dystonia, cerebellar ataxia, progressive supranuclear palsy [PSP], multiple system atrophy, lateral amyotrophic sclerosis). All participants underwent a cognitive evaluation and a speech intelligibility assessment and completed three self-reported questionnaires: the 36-Item Short Form Health Survey, the Voice Handicap Index (VHI), and the DIP. Results: The psychometric properties of the DIP were confirmed, including internal consistency (α = 0.93), concurrent validity (correlation with the VHI: r = -0.77), and discriminant validity (accuracy = 0.93). Psychosocial impact of dysarthria was revealed by the DIP for all patients. Intelligibility loss was found strongly correlated with the psychosocial impact of dysarthria: for a similar level of intelligibility impairment, the DIP total score was similar regardless of the pathological group. However, our findings suggest that the psychosocial impact measured by the DIP could be partially independent from the severity of dysarthria (indirectly addressed here via speech intelligibility): the DIP was able to detect patients without any intelligibility impairment, but with a psychosocial impact. Conclusions: All patients reported a communication complaint, attested by the DIP scores, despite the fact that not all patients, notably PD, ataxic, and PSP patients, had an intelligibility deficit. The DIP should be used in clinical practice to contribute to a holistic evaluation and management of functional communication in patients with dysarthria.
... These factors may affect the fruitfulness of the spontaneous speech, which would broaden its diversity in the performance of acoustic analysis. The comparable performance in the acoustic analysis between reading task and spontaneous speech 22 highlights the potential that it is possible to use the reading task alone to detect rhythmic differences between PD patients and controls, allowing future large-scale screening in the pooled database from various sources 23 . This model may also have the potential to be applied to stored voice database as a retrospective analysis to identify subjects who may have PD. ...
Full-text available
Hypomimia and voice changes are soft signs preceding classical motor disability in patients with Parkinson’s disease (PD). We aim to investigate whether an analysis of acoustic and facial expressions with machine-learning algorithms assist early identification of patients with PD. We recruited 371 participants, including a training cohort (112 PD patients during “on” phase, 111 controls) and a validation cohort (74 PD patients during “off” phase, 74 controls). All participants underwent a smartphone-based, simultaneous recording of voice and facial expressions, while reading an article. Nine different machine learning classifiers were applied. We observed that integrated facial and voice features could discriminate early-stage PD patients from controls with an area under the receiver operating characteristic (AUROC) diagnostic value of 0.85. In the validation cohort, the optimal diagnostic value (0.90) maintained. We concluded that integrated biometric features of voice and facial expressions could assist the identification of early-stage PD patients from aged controls.
... Additionally, typical articulatory problems exhibited by PD patients are referred to as dysarthia. Also, the speech can fade away at the end of the sentences; likewise, patients may speak slowly and with a breathy kind of speech [1,2]. ...
... Participants 20 controls and 20 PD patients (fulfilling the UK's Parkinson's disease Society Brain Bank Criteria, Gibb & Lee 1988;Pinto et al. 2016 for a description of the protocol) Materials 20 sentences from corpora previously designed to study sentence types and prosodic phrasing were read in response to a context previously presented (Frota & Cruz 2012-2015). ...
Full-text available
Parkinson's disease (PD) is characterized by a neurodegenerative chronic disorder with a motor symptomatology presence (WHO 2006). ü This disease affects 1%-2% world's population (60+ y.o.) and is classically characterized by a symptomatic triad that includes rest tremor, akinesia and hypertonia. Although the motor expression of the symptoms involves mainly the limbs, the muscles implicated in speech production are also subject to specific dysfunctions. PD speech is characterized by an impairment in phonation, in articulation, and in prosody (Tykalova et al. 2014). ü Previous studies of (dys)prosody in PD focused on simple acoustic analysis of prosodic parameters to describe overall trends (Skodda et al. 2009, 2011; Tykalova et al. 2014; Harris et al. 2016; Barnish et al. 2017), or on professional listeners' judgments of prosodic communicative efficiency (Martens et al. 2011). Structural properties of prosody have not been examined. ü Sentence modality and chunking the speech stream into units are two of prosody's main functions. These functions affect phrase-level meanings in ways that are structured by the language-specific prosodic system, and play a crucial role in communication. Portuguese (EP) uses contrasting nuclear contours to express modality, and intonational phrase breaks for chunking (Frota 2014). Main Goals ü To examine the expression of sentence modality and prosodic phrasing in PD-considering disease duration (G1: 1-5 years; G2: ≥10 years) and medication (OFF: no medication vs. ON: 1 hour after a dopaminomimetic drug intake): (i) presence/absence and type of pitch accent and boundary tone, and (ii) presence/absence of intonational breaks. ü Research questions: Is the expression of various sentence types and pragmatic meanings disturbed (broad and narrow focus statements, requests, commands, yes-no questions, initial calls, insistent calls)? Is prosodic phrasing in utterances containing several intonational phrases disturbed (as in the case of parentheticals or topics)? FraLusoPark-Dysarthria in Parkinson's disease: Lusophony vs. Francophony (FCT-ANR/NEU-SCC/0005/2013) Sentence modality UID/LIN/00214/2013 Figure 3. Narrow focus statement produced by a G2 speaker Off (top), and a G1 speaker ON (bottom). Phrasing Figure 2. PD: medication and disease duration. Left panel: Nuclear contours (data for all sentence types); Right panel: Phrasing (expected intonational phrase breaks). à The categorical prosody of sentence modality and chunking is disturbed in PD. However, the different prosodic functions are affected differently. à Medication improved the expression of sentence types and meanings regardless of disease progression, but did not help with dysprosodic speech chunking. à The underlying mechanisms of chunking (phrasing requires speech planning), unlike that of modality (which is more directly pitch-related), seem to be less dependent on dopaminergic deficits, with implications for PD neurophysiology and therapy, as well as for our understanding of models of prosody. Figure 1. Controls and PD. Left panel: Nuclear contours (data for all sentence types); Right panel: Phrasing (expected intonational phrase breaks). Figure 4. Presence/absence of intonational breaks (IP, level 4): 2-IP utterance produced by a G2 speaker ON (top); utterance with a parenthetical produced by a G1 OFF (bottom). 'e' marks phrasing deviations from the expected pattern.
... For comparison, an unpaced finger tapping task was also used for testing whether variability in spontaneous manual rhythmic production was related to variability in orofacial and gait tasks. Orofacial rhythmic abilities were tested with an oral diadochokinesis task (repetition of a pseudoword at a fast rate for 30 s), 38 providing measures of orofacial motor control, irrespective of speech dimensions, such as intonation or phonetic components. Patients repeated the three-syllable pseudoword pataka; their productions were acquired with a suitable digital recorder (Zoom H4SP © ). ...
Full-text available
Individuals with Parkinson’s disease (PD) experience rhythm disorders in a number of motor tasks such as i) oral diadochokinesis, ii) finger tapping, and iii) gait. These common motor deficits may be signs of “general dysrhythmia”, a central disorder spanning across effectors and tasks, and potentially sharing the same neural substrate. However, to date, little is known about the relationship between rhythm impairments across domains and effectors. To test this hypothesis, we assessed whether rhythmic disturbances in three different domains (i.e., orofacial, manual, and gait) can be related in PD. Moreover, we investigated whether rhythmic motor performance across these domains can be predicted by rhythm perception, a measure of central rhythmic processing not confounded with motor output. Twenty-two PD patients (mean age: 69.5 ± 5.44) participated in the study. They underwent neurological and neuropsychological assessments, and they performed three rhythmic motor tasks. For oral diadochokinesia, participants had to repeatedly produce a trisyllable pseudoword. For gait, they walked along a computerized walkway. For the manual task, patients had to repeatedly produce finger taps. The first two rhythmic motor tasks were unpaced, and the manual tapping task was performed both without a pacing stimulus and musically-paced. Rhythm perception was also tested. We observed that rhythmic variability of motor performances (inter-syllable, inter-tap, and inter-stride time error) was related between the three functions. Moreover, rhythmic performance was predicted by rhythm perception abilities, as demonstrated with a logistic regression model. Hence, rhythm impairments in different motor domains are found to be related in PD and may be underpinned by a common impaired central rhythm mechanism, revealed by a deficit in rhythm perception. These results may provide a novel perspective on how interpret the effects of rhythm-based interventions in PD, within and across motor domains.
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Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s-type dementia. It is known that these types of diseases cause a significant decline in the quality of life of the people who suffer from them and in their next of kin. Understanding the physical and psychosocial effects of neurodegenerative diseases contributes to clinical decision-making. It is for the above mentioned that the present study aims to examine the current evidence regarding the direct impact that phonoaaudiological disorders of motor origin generate on the quality of life in people with PD. A systematic review of the literature was carried out. The articles were searched in the following databases: PUBMED, SCIELO and WOS, during the months of June and July of the year 2020, constituting a sample of 12 works, with a maximum age of 10 years. The analysed publications mainly describe the aspects of quality of life that are affected in people with PD, who suffer dysphagia or dysarthria, all this through the application of different questionnaires which evaluate different aspects of this concept. The results of the review show the importance of considering within the intervention process the component of quality of life in people with E.P, since the scores obtained according to the instruments applied indicate a decrease of this component and even more with the progress of the disease, which translates into worse quality of life related to food and speech.
Le domaine des recherches en Phonétique Clinique vise à améliorer nos connaissances sur les pathologies de la parole en confrontant les méthodes et les recherches en phonétique avec les données cliniques et les diagnostics des cliniciens. En France, la Phonétique Clinique s’est développée depuis une trentaine d’années dans une communauté importante de phonéticiens, linguistes, informaticiens, ingénieurs, médecins, orthophonistes et cliniciens, qui s’est autostructurée autour de ce champ de recherche. Le LPL a une très longue expérience dans ce domaine au travers de nombreuses collaborations avec les centres hospitaliers de la région et autres partenaires au niveau national. Ces collaborations ont permis l’élaboration de nombreux projets portant sur des pathologies très variées (dysphonies, maladie de Parkinson, SLA, sclérose en plaques, cancers de la cavité buccale et de l’oropharynx, apraxie, etc.). Les méthodologies traditionnelles de la phonétique (analyses de la production et de la perception de la parole) ont été adaptées de façon à répondre aux contraintes spécifiques de la parole pathologique. Notamment, l’aérophonométrie, la mesure de l’intelligibilité de la parole, la transcription de la parole pathologique ou encore le choix des paramètres de l’analyse acoustique ont été fortement questionnés et améliorés par les recherches du LPL. Les questionnements de recherche sont multiples en phonétique clinique mais peuvent, dans un premier temps, s’articuler autour de deux grandes questions : (1) quelles sont les apports des recherches en phonétique sur la compréhension des pathologies de la parole ? ;(2) en quoi les pathologies de la parole permettent-elles de mieux comprendre les mécanismes complexes qui régissent la production et la perception de la parole ? Aussi, l’ensemble des travaux sont menés avec le double objectif, d’une part, d’apporter une aide aux cliniciens dans l’évaluation de la sévérité du trouble que ce soit pour un bilan ponctuel ou dans une évaluation thérapeutique (rééducation, traitement chirurgical, pharmacologique, électrophysiologique), et d’autre part d’améliorer nos connaissances sur la parole en caractérisant les productions considérées comme « atypiques ». Sans être exhaustif, cet article offre un panorama des recherches en phonétique clinique du LPL. Après un bref historique rappelant l’émergence de la phonétique clinique au LPL, il s’organise autour des travaux actuels menés du LPL sur les pathologies laryngées, les perturbations motrices, l’intelligibilité de la parole et les troubles de planification de la parole. Les premiers travaux au LPL alliant phonétique et préoccupations cliniques remontent au milieu des années 1970-1980. Ces études n’ont véritablement constitué un axe de recherche au LPL que dans les années 1990 avec la mise en place de collaborations étroites avec le service ORL du CHU de la Timone à Marseille autour de l’analyse des pathologies de la voix. Ces recherches fondatrices n’ont cessé de se développer et ont vu leur champ d’investigation s’élargir sur les troubles de la parole et sur les troubles neurologiques de la motricité ou de la planification de la parole, dans lesquels les collaborations avec le service de neurologie du CH du Pays d’Aix ont été décisives. Ces collaborations cliniques ont par ailleurs soutenu la valorisation et la diffusion de ces recherches dans le monde socioéconomique, notamment avec l’invention, la fabrication et la commercialisation du dispositif d’Évaluation Vocale Assistée (EVA). Les pathologies laryngées ont été le premier périmètre exploré et ont donné lieu à de nombreuses publications. L’établissement d’un bilan vocal à la fois perceptif et instrumental a monopolisé l’essentiel des efforts. Néanmoins, et malgré l’apport du traitement automatique de la parole, l’approche instrumentale issue de la phonétique reste peu appliquée en pratique clinique pour diverses raisons abordées dans l’article. Des perspectives sont proposées et peuvent ouvrir de nouveaux horizons à la phonétique clinique. Les pathologies laryngées ont également permis d’interroger le fonctionnement linguistique et la représentation phonologique des unités du langage, notamment au regard du trait de voisement, sur lequel repose un contraste lexical de base et quasi-universel dans les langues du monde. Les perturbations motrices dont les symptômes sur la parole sont regroupés sous le terme de dysarthrie ont fait aussi l’objet de travaux importants au laboratoire, notamment dans le cadre de la maladie de Parkinson. Ces études ont apporté des éléments au modèle physiopathologique de la maladie en mesurant divers paramètres de la parole dans un contexte de monitoring de la maladie. Par exemple, les effets thérapeutiques (médicamenteux ou électrophysiologiques) ont été étudiés via des analyses instrumentales acoustiques et physiologiques (aérodynamique). La dimension prosodique a également reçu une place importante. Ces travaux ont permis de mettre en lumière les caractéristiques de la parole des patients parkinsoniens en intégrant les interactions entre les troubles pathologiques et la structure linguistique à différents niveaux d’organisation. La mesure de l’intelligibilité de la parole, qui a souvent sous-tendu les recherches du laboratoire, a aussi pris de l’ampleur et a été intégré à une perspective clinique d’abord avec les travaux sur la maladie de Parkinson, puis dans le cadre des séquelles de cancers de la cavité orale et de l’oropharynx. Les biais relatifs à la perception de la parole ont donné lieu à diverses alternatives aux batteries de tests d’intelligibilité permettant de proposer des solutions linguistiquement justifiées et adaptées à la pratique clinique. Elles ont aussi permis d’étudier plus précisément l’articulation entre les divers niveaux perceptifs impliqués dans le décodage et la compréhension de la parole. Plus récemment, les questions relatives à la planification de la production de parole ont émergé au sein du laboratoire. Les pathologies de la parole et la phonétique clinique offrent un cadre pour tester ces questions. Des recherches comparant des sujets sains vs. atteints de déficits cognitifs liés à la sclérose en plaques sont menés au LPL pour explorer comment les contraintes cognitives influencent la planification de la parole. Ces études montrent que, contrairement aux présupposés théoriques soutenant que la planification de la parole est automatique (ne faisant pas intervenir des traitements cognitifs liés au langage ou à la mémoire de travail, par exemple), les sujets ont des stratégies de production de la parole qui varient selon leurs capacités cognitives. Enfin, il nous semble qu’un défi épistémologique et multidisciplinaire se pose maintenant à la phonétique clinique. Cliniciens et phonéticiens ont appris à chercher et travailler ensemble sur des problématiques complexes ayant un enjeu de recherche fondamentale mais aussi sociétal et de santé publique. Le défi est donc de promouvoir l’interaction et l’intercompréhension des enjeux qui meuvent ces deux communautés. Les phonéticiens doivent ainsi pouvoir proposer des champs d’application de leurs connaissances adaptées aux problématiques réelles et pratiques des cliniciens ; et inversement, les cliniciens doivent pouvoir mieux proposer des observations qui interrogent et nourrissent les réflexions sur les modèles de production, de perception et de compréhension de la parole et du langage.
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Intonational phonology analyses of nuclear falls often treat the tones that make up falling contours either as separate tonal events, i.e. as a single-tone pitch accent and an edge tone of some sort, or as part of a bitonal accent. This work evaluates the competing phonological analyses for the broad and narrow focus nuclear falls in European Portuguese declaratives. By exploring the factors that may affect the alignment of the H(igh) and L(ow) targets, such as proximity to prosodic edges and distance between word stresses, evidence is presented in support of the bitonal hypothesis for both the neutral and the focus falls. Subsequently, the relation between the H and L targets is shown to differ in the two bitonal accents, supporting a leading/trailing tone distinction whereby the leading tone is timed independently of the T* and the trailing tone is timed with reference to the T*. Besides bringing phonetic data to bear on the phonological organisation of pitch contours, the results have consequences for the view of intonation primes as tonal targets (rather than configurations) and bitonal accents as structured (rather than flat) tonal units.
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In the last 20-30 years, there have been numerous arguments from cognition, linguistics, and technology for assuming that the words, on one side, and the tonal specification of an utterance, on the other side, are stored and created independently of each other (Liberman 1978, Goldsmith 1979, Pierrehumbert 1980; see Ladd 2008 for a synthesis of the autosegmental-metrical approach of intonation, or AM theory). But this independence comes at a price: tune and words have to be synchronised with each other in time. Tonal alignment is concerned with how target tones are temporally coordinated, or synchronized, with prosodic units (e.g., syllables) and their constituents (the segments that make up syllables). A large body of alignment studies in laboratory phonology have therefore explicitly tested the basic tenet of the AM theory, i.e. that underlying tonal structure is reflected in the signal through the presence of well-defined fundamental frequency (f0) targets, which are specified both in terms of tonal alignment and according to some well-defined melodic value (scaling). Among the two “coordinates”, alignment with the segmental string (i.e., the temporal distance from edges of segments or syllables) has been the most studied aspect so far, including acoustic, production and perception studies, all of which will be reviewed below. Earlier alignment studies set out to question the controversial nature of intonational primitives: finding evidence for the existence of static tonal targets characterized by stable temporal and melodic coordinates calls into question the validity of the primacy of intonational movements (traditionally represented by the British School approaches and the IPO system (cf. 'O Connor & Arnold 1961, 't Hart & Collier 1975). Indeed, the question of the alignment of intonation contours and their impact on perception was first investigated in contour approaches to intonation. For instance, the IPO school, while developing a rule-based generative approach to intonation, extensively investigated the alignment of rises and falls and found that an early vs. late alignment with the segmental string could induce different interpretations of the contour, hence different meanings (cf. §9.3 below). Here I shall more closely concentrate on the insights of AM theory in stimulating laboratory investigations of tonal alignment. Despite the growing attention of the prosody community to alignment studies, there is still a great deal of controversy about the forces as well as the exact mechanism driving the alignment of tonal targets with segmental gestures, and many issues remain unsettled, as will be shown in this section. Among the most significant points in question are how best to tease apart the phonetics and the phonology of alignment, and how to identify universally motivated tendencies (both from a production and a perception standpoint) in both intonational and tonal languages. It should be noted that the choice of concentrating upon tonal alignment regularities relative to specific segmental landmarks or regions is generally not theoretically (acoustically, perceptually and/or articulatorily) driven, making the study of alignment mostly an exploratory enterprise at this point, though certainly not devoid of interest.
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The dysprosody of Parkinsonian’s disease (PD) has been partly interpreted as a disorder affecting the variation of fundamental frequency (F0), the monotonous intonation of speech being the consequence of the tonal range reduction. To date, some controversial results have been reported concerning the average pitch which has been found either increased or comparable to that of control subjects (see Gentil et al., Rev. Neurol., 1995, 151: 105-112). However in most of these studies, the pharmacological status of the patients was not systematically controlled. The aim of this study was to analyse the F0 during speech production in a more exhaustive manner by sampling the signal at every 10 ms interval over the entire reading of a text. The tonal and dynamic properties of the frequency distribution were assessed by measuring the average voice pitch, the limits and the dynamics of tonal variations. 10 male PD patients were tested during ”off ” state and after L-DOPA treatment; they were compared with an age-matched group of 10 male control subjects. The results showed that comparing to normals the voice intonation of PD patients during ”off” state is caracterised by a significant reduction of the tonal dynamics of F0 and by a significant lowering of the average and the maximum limit of voice pitch. In these patients, the L-DOPA treatment significantly increased the tonal dynamics, the average and the maximum limit of voice pitch, so that no significant difference was observed between treated patients and control subjects. (Abstract also published in Movement Disorders 15(3): S131)
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This paper investigates the tonal structure of nuclear falls and rises in European Portuguese declarative and question intonation. Declarative sentences, wh-questions and yes–no questions are examined. The interaction between utterance type and the expression of broad and narrow focus is also inspected. The alternative phonological analyses for the falling and rising patterns are evaluated in detail. It is shown that a system of phonological contrasts between accentual tones and intonational-phrase boundary tones provides a unified account of all the contours examined. Specifically, the I-boundary tone bears the utterance type distinguishing function (declarative Li vs. interrogative LHi/HLi), while the bitonal nuclear tone carries the focus marker (broad focus H+L* vs. narrow focus H*+L/L*+H). The phrase accent category can be dispensed with. A brief comparison with the role played by accentual and phrase tones in the same tunes of other Romance languages highlights some similarities and differences in the melodic systems within Romance.
Background: Communication is fundamental to human interaction and the development and maintenance of human relationships and is frequently affected in Parkinson's disease (PD). However, research and clinical practice have both tended to focus on impairment rather than participation aspects of communicative deficit in PD. In contrast, people with PD have reported that it is these participation aspects of communication that are of greatest concern to them rather than physical speech impairment. Objective: To systematically review the existing body of evidence regarding the association between cognitive status and/or intelligibility and everyday communication in PD. Methods: Five online databases were systematically searched in May 2015 (Medline Ovid, EMBASE, AMED, PsycINFO and CINAHL) and supplementary searches were also conducted. Two reviewers independently evaluated retrieved records for inclusion and then performed data extraction and quality assessment using standardised forms. Articles were eligible for inclusion if they were English-language original peer-reviewed research articles, book chapters or doctoral theses investigating the associations between at least one of cognitive status and level of intelligibility impairment and an everyday communication outcome in human participants with PD. Results: 4816 unique records were identified through database searches with 16 additional records identified through supplementary searches. 41 articles were suitable for full-text screening and 15 articles (12 studies) met the eligibility criteria. 10 studies assessed the role of cognitive status and 9 found that participants with greater cognitive impairment had greater everyday communication difficulties. 4 studies assessed the role of intelligibility and all found that participants with greater intelligibility impairment had greater everyday communication difficulties, although effects were often weak and not consistent. Conclusions: Both cognitive status and intelligibility may be associated with everyday communicative outcomes in PD. The contribution of intelligibility to everyday communication appears to be of small magnitude, suggesting that other factors beyond predominantly motor-driven impairment-level changes in intelligibility may play an important role in everyday communication difficulties in PD.
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The Movement Disorder Society Task Force for Rating Scales for Parkinson's Disease prepared a critique of the Unified Parkinson's Disease Rating Scale (UPDRS). Strengths of the UPDRS include its wide utilization, its application across the clinical spectrum of PD, its nearly comprehensive coverage of motor symptoms, and its clinimetric properties, including reliability and validity. Weaknesses include several ambiguities in the written text, inadequate instructions for raters, some metric flaws, and the absence of screening questions on several important non-motor aspects of PD. The Task Force recommends that the MDS sponsor the development of a new version of the UPDRS and encourage efforts to establish its clinimetric properties, especially addressing the need to define a Minimal Clinically Relevant Difference and a Minimal Clinically Relevant Incremental Difference, as well as testing its correlation with the current UPDRS. If developed, the new scale should be culturally unbiased and be tested in different racial, gender, and age-groups. Future goals should include the definition of UPDRS scores with confidence intervals that correlate with clinically pertinent designations, "minimal," "mild," "moderate," and "severe" PD. Whereas the presence of non-motor components of PD can be identified with screening questions, a new version of the UPDRS should include an official appendix that includes other, more detailed, and optionally used scales to determine severity of these impairments.