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1 Laryngeal Aerodynamic and Respiratory Kinematic Strategies to Increase Vocal Intensity as a Result of the Lombard Effect: Speakers with Parkinson s Disease Elaine T. Stathopoulos, Ph.D. Joan E. Sussman, Ph.D. Kelly Richardson, M.A., Devan DeCicco, M.A., Jennifer Kamphaus, B.A., Katrina Fulcher, M.A., University at Buffalo Jessica E. Huber, Ph.D. Meghan Darling, M.S. Purdue University Contact: stathop@buffalo.edu Contact: jhuber@purdue.edu

2 Problem Parkinson s disease (PD) results in impaired speech and voice production including hypophonia, rate changes, and articulatory imprecision Hypophonia is reduced vocal intensity; perceptually, it s soft sounding voice

3 Purpose The goal of the current study is to examine the interrelated function of the laryngeal and respiratory systems, while individuals with PD naturally increase their vocal intensity in a condition of background noise First: to investigate whether speakers with hypophonia secondary to PD would increase their sound pressure levels (SPLs) when speaking in noise (Lombard Effect) Second: to examine the effects of increased vocal intensity on underlying laryngeal and respiratory mechanisms

4 Respiratory Strategies for Increasing Vocal Intensity Typical speakers use a combination of respiratory static recoil and muscular forces synergistically to maintain a steady, pressurized airstream for speech production Typical speakers inhale to higher lung and rib cage volumes to take advantage of greater elastic recoil forces, thus reducing the effort required to produce higher subglottal air pressure Finnegan, Luschei, & Hoffman, 2000; Hixon, Goldman, & Mead, 1973; Huber, 2007; Huber, Chandrasekaran, & Wolstencroft, 2005; Stathopoulos & Sapienza, 1993; Stathopoulos & Sapienza, 1997; Winkworth & Davis, 1997

5 Speakers with PD have Respiratory Support Problems Individuals with Parkinson s disease (PD) have been shown to exhibit: Loss of muscle function Decreased rib cage and abdominal support Breakdown in the synergistic movement of rib cage &abdomen Increased paradoxing Shortened utterance lengths Difficulty planning in advance to support longer utterances Bunton, 2005; Darley, Aronson, & Brown, 1975; Duffy, 2005; Huber & Darling, 2011; Huber, Stathopoulos, Ramig, & Lancaster, 2003; Sadagopan & Huber, 2007; Solomon & Hixon, 1993

6 Laryngeal/Respiratory Mechanisms Interact to Increase Vocal Intensity The larynx is not just a passive appendage through which gases are inspired or expired but a complex organ performing subtle and well coordinated functions in relation to respiratory airflow during both inspiration and expiration (Brancatisano, p , 1996) Laryngeal contribution to increased vocal intensity is achieved through changes to glottal configuration and/or resistance Adjustments in vocal intensity are regulated by simultaneous changes to both the respiratory and laryngeal components of the speech system Holmberg, Hillman, & Perkell, 1988; Isshiki, 1964; Stathopoulos & Sapienza, 1997; Titze, 1994

7 Laryngeal Configuration in Individuals with PD The presence of decreased adduction (e.g., vocal fold bowing), increased glottal opening, and asymmetric vibratory patterns during phonation have been confirmed by videostroboscopic studies Changes to the laryngeal mechanism are thought to impact the ability of individuals with PD to produce high intensity speech Dromey, Ramig, & Johnson, 1995; Dromey, 1996; Hanson, Gerratt, & Ward, 1984; Perez, Ramig, Smith, & Dromey, 1996; Ramig, Dromey, Perez, & Samandari, 1995

The Lombard Effect to Cue Increases in Vocal Intensity Behavioral therapies (e.g.

require the participant to remember specific instructions The speaker responds to

multitalker babble noise in one ear during speech The noise causes the participant to

8 The Lombard Effect to Cue Increases in Vocal Intensity Behavioral therapies (e.g., LSVT ) require active cognitive participation; whereas, natural cueing does not require the participant to remember specific instructions The speaker responds to stimuli in their environment in an automatic, involuntary way The SpeechVive TM played multitalker babble noise in one ear during speech The noise causes the participant to speak louder and more clearly due to the Lombard effect (Garnier, Dohen, Lævenbruck, Welby, & Bailly, 2006)

9 Hypotheses: There will be an increase in vocal intensity when participants with PD speak in noise (Lombard Effect). The increases in vocal intensity will be accomplished by simultaneous response from the respiratory and laryngeal mechanisms to increase: Subglottal pressure Vocal fold adduction Glottal resistance

10 Methods The following dependent measures were made to reflect the underlying respiratory and laryngeal mechanisms to increase SPL It was predicted that: Estimated subglottal air pressure (Ps) would increase Peak-to-peak glottal airflow would increase Maximum flow declination rate (MFDR) would increase Minimum glottal airflow would decrease Open quotient (OQ) would decrease Lung volume initiations, terminations & excursions would increase Rib cage volume initiations, terminations, & excursions would increase Abdominal volume initiations & terminations would decrease & abdominal excursions would increase

11 Participants 33 adults with PD 6 women, mean age (7.82) years 27 men, mean age (10.05) years Hoehn & Yahr movement Stage II-IV (mild-severe) with predominantly III-IV (mild to severely disabling but still able to stand or walk unassisted) Mild to severe speech impairments, with predominantly moderate-severe impairment

12 Speech Tasks Respiratory Function: two-minute monologue on topic of choice Estimated intraoral air pressure: sentence production Buy pop or pop a papa at a slow rate, in a monotone voice and at a comfortable loudness Estimated laryngeal airflow: sustained /a/ for five seconds at a comfortable loudness level After: Smitheran and Hixon (1981) for making measures of estimated P s

13 Statistical Analysis Repeated measures analyses of variance (ANOVAs) were used to examine whether the dependent variables significantly changed when the participants spoke at: higher vocal intensity vs. comfortable intensity level

14 Results: Comfortable vs. High Vocal Intensity Significant Differences Non-Significant SPL Subglottal air pressure Max flow declination rate Minimum glottal airflow LVI, LVT RCVI, RCVT ABVI,ABVT Peak to peak airflow Open quotient (OQ) Utterance length LVE RCVE ABVE

15 Mean data from the present speakers with PD show that speaking in noise while wearing the SpeechVive TM elicits both higher SPLs and Ps SPL P S Sound Pressure Level (db) Comf High Subglottal Pressure (cmh2o) Comf High

16 Increased MFDR reflects a narrowing of the airflow waveform and indicates improved acoustic/aerodynamic efficiency 550 MFDR Maximum Flow Declination Rate (l/s/s) Comf High

17 Minimum Glottal Air Flow Speakers with PD decreased their minimum flows during the closed portion of the vibratory cycle Implies that they obtained some improved adduction Changes to the intrinsic muscles of the larynx as a result of age are likely to affect adductory forces Minimum Flow (l/s) Comf High Makes it more difficult to change OQ 0

18 Lung Volume at Utterance Initiation and Termination Speakers with PD shifted to higher lung volume (LV) ranges (and RC volumes; not shown) High LV takes advantage of higher recoil pressures to help generate higher vocal intensity Lung Volume (%VC) Comf High This moved their lung 5 volumes closer to those for elderly adults in noise 0 EEL OC PD

19 Many of the speakers with PD had poor abdominal support for speech. e.g., the abdominal position at utterance initiation indicated that the diaphragm displaced the abdominal wall outward RC and AB positions in x-y Display Rib Cage Volume EEL Abdominal Volume -0.4

20 Utterance Length No changes in utterance length when the individuals spoke at higher SPL respiratory and laryngeal mechanisms of speakers were able to maintain utterance length at high Syllables Per Breath Group SPL 9.9 Comf High

21 Summary Mean data from the present speakers with PD show that speaking in noise while wearing the SpeechVive TM elicits both higher SPLs and Ps Participants were able to improve their underlying physiologic support Interaction of both the respiratory and laryngeal mechanisms allowed speakers with PD to increase their vocal intensity: Improved vocal fold adduction Sharpened the glottal airflow waveform; provided configuration to increase vocal intensity Improved use of higher lung and rib cage volumes to take advantage of recoil pressures to generate higher Ps and vocal intensities Significantly increased values of ABVI and ABVT indicate larger abdominal volumes, speakers with PD have less abdominal support at higher vocal intensity

22 SpeechVive Off SpeechVive On Male, 68 years old Hoehn and Yahr Scale: II mild-moderate Visual Analogue speech severity: 10% mild Speech Dimension Rating Scale: mildly hypophonic SPL increase: 8 db Ps increase: 2.8 cmh 2 O

23 Acknowledgements University at Buffalo Lab Staff Adrienne Ricchiazzi Molly Dinnen-Carey Purdue Lab Staff: Sandy Synder Ashley Guss Nicole Herndon Meghan Moran Elizabeth Morgan Taylor Remick Zeina Saba Jessica Shockey Sheena Srivastava Malinda Troyer Jillian Wendel Jennifer Cohen Laurel Donaldson Jaime Doolittle Melissa Johnson Funding: NIH NIDCD R01: 5R01DC9409 NIH NIDCD Supplement AMI Purdue Indiana CTSI Special Thanks to: Jim Jones and Kirk Foster for designing the electronics and building the SpeechViveTM devices Lata Krishnan, Ph.D., CCC- A, Christine Stocking, Au.D., JoAnn Hammer, Au.D., Susan Roberts, Au.D. for completing all the hearing examinations Beth Levendoski, CCC-SLP, Kitty Kubat, CCC-SLP, and Carol Sellers, CCC-SLP for assistance with data collection Team at AMIPurdue for their assistance in the development of SpeechViveTM

24 Glottal Airflow Measures Peak to Peak Airflow Minimum Airflow

26 Respiratory Function Measures EEL

Jessica E. Huber, Ph.D. Associate Professor Purdue University

Jessica E. Huber, Ph.D. Associate Professor Purdue University jhuber@purdue.edu Funding: National Institutes of Health, NIDCD (R01 DC9409) National Institutes of Health, NIDCD (R03 DC05731) Research Support