From Speech Acoustics to Communicative Participation in Dysarthria: Toward a Causal Framework

Abstract

Purpose: We proposed and tested a causal instantiation of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework, linking acoustics, intelligibility, and communicative participation in the context of dysarthria. Method: Speech samples and communicative participation scores were collected from individuals with dysarthria ( n = 32). Speech was analyzed for two acoustic metrics (i.e., articulatory precision and speech rate), and an objective measure of intelligibility was generated from listener transcripts. Mediation analysis was used to evaluate pathways of effect between acoustics, intelligibility, and communicative participation. Results: We observed a strong relationship between articulatory precision and intelligibility and a moderate relationship between intelligibility and communicative participation. Collectively, data supported a significant relationship between articulatory precision and communicative participation, which was almost entirely mediated through intelligibility. These relationships were not significant when speech rate was specified as the acoustic variable of interest. Conclusion: The statistical corroboration of our causal instantiation of the ICF framework with articulatory acoustics affords important support toward the development of a comprehensive causal framework to understand and, ultimately, address restricted communicative participation in dysarthria.

ClearSpeechTogether: a rater blinded, single, controlled feasibility study of speech intervention for people with progressive ataxia

“…These findings highlight the importance of day-to-day opportunities to interact with others on long term effectiveness of communication performance. Another important finding was that although intelligibility and participation ratings were broadly related in line with Borrie et al’s [60] findings, this was not always the case. For example, participants who dropped in intelligibility in assessment 4 still maintained their participation benefits, and AD8, who showed no notable improvements in intelligibility, reported a considerable increase in confidence and participation.…”

Parkinson’s Disease and Communication : Intelligibility, Interaction and Participation

“…Communicative changes in Parkinson's disease are multi-faceted and may affect different abilities, such as speech and voice functions, language functions, and cognition (Miller, 2017;Saldert & Bauer, 2017;Schalling et al, 2017;Smith & Caplan, 2018). although the causal relationships and generalisability of these findings are not entirely clear (Borrie et al, 2022;Bryans et al, 2021). Improving speech and voice function will be relevant for many persons with Parkinson's disease to enhance communication in different situations and with different conversation partners.…”

“…Reduction of articulator range of movements due to hypokinesia and rigidity may cause articulatory undershoot (Duffy, 2020;Forrest et al, 1989). A consequence of reduced articulatory precision is deviation of the acoustic speech signal, which can affect intelligibility (Borrie et al, 2022).…”

“…Dykstra et al (2007) discuss how the ICF framework has a potential fo facilitate understanding of the complexity and interconnection between neurophysiology, reduced intelligibility, and psychosocial functioning in dysarthria. The pathways between acoustic measures, intelligibility, and participation in dysarthria have been explored by Borrie et al (2022), who observed a strong relationship between acoustic measures of articulatory precision and communicative participation, which was mediated through intelligibility.…”

Profiles of Dysarthria: Clinical Assessment and Treatment

“…Considering that the ultimate goal of all clinical and technological advancements is to help persons with dysarthria manage their everyday life, clinical research must also develop and refine robust ways of measuring communicative participation and constantly test the available diagnostic parameters for their predictive validity in relation to participation success [21]. The development of patient reported outcome measures (PROMs) as indicators of participation, and of communication-related speech parameters which serve as potential predictors, will becom increasingly important in this research [22].…”