This study investigated the role of loudness perception and selected auditory processes in 17 participants with hypophonia related to Parkinson's disease (PD) and 25 controls. For most of the five loudness perception tasks (magnitude estimation, imitation, speech-to-noise judgment, magnitude production, magnitude production in noise), the PD participants produced a significantly different pattern and used a more restricted range than the controls in their self-generated estimates of speech intensity and judgments of speech loudness.Results from two self-assessment questionnaires (CETI-M, M-SAPP) found that the PD participants perceived themselves as less effective communicators than controls. An audiometric evaluation suggested that the PD participants may have abnormalities related to higher admittance values, higher acoustic reflex thresholds and higher pure-tone thresholds for lower frequencies. These results suggest that individuals with PD may have a speech loudness perception deficit involving the abnormal perception of externally-generated and self-generated speech intensity stimuli.

Regardless of the underlying neuromotor impairment, an almost universal consequence of dysarthria is a reduction in speech intelligibility. The purpose of this article is to examine critically and to discuss issues related directly to speech intelligibility in speakers with dysarthria. Reduced speech intelligibility resulting from dysarthria is examined using the World Health Organization's International Classification of Functioning, Disability and Health (ICF) conceptual framework. We propose that the ICF conceptual framework facilitates an awareness of the multidimensional nature of disablement. Furthermore, the ICF facilitates a broad understanding of the complex nature of dysarthria, ranging from the neuroanatomical and physiological substrates contributing to reduced speech intelligibility, to the effects of this type of communication disorder on an individual's functioning in society and beyond. Finally, a case example is presented that describes how the ICF can be applied to an individual with dysarthria and reduced speech intelligibility.

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The ICF provides an advanced framework for health and disability that reflects contemporary conceptualizations about health. However, given the scope of emerging evidence highlighting positive health and well-being outcomes associated with natural environmental factors, we believe the environmental factors component requires further advancement to reflect this current knowledge. Reconceptualizing the environmental factors component supports a more holistic interpretation of the continuum of environmental factors as both facilitators and barriers. In doing so, it strengthens the ICF's utility in identifying and measuring health-facilitating natural environmental factors.

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