Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Health and Rehabilitation Sciences

Supervisor

Page, Allyson D.

Abstract

Hypophonia is one of the most prevalent speech impairments in hypokinetic dysarthria. Unfortunately, behavioral interventions for hypophonia often fail to generalize beyond the clinic. An alternative approach to management is the use of speech amplification devices. This study evaluated how 17 individuals with hypophonia (HP) and their primary communication partners (PCPs) rated communicative participation across three, one-week device trial periods at home. Amplification devices included: a wired belt pack amplifier, wireless stationary amplifier, and personal FM system. Patient-reported outcome measures included the CES, VAPP and PIADS. Results indicated HPs rated participation higher following device use in comparison no device. Further, HP and PCPs rated these measures similarly suggesting PCPs can be used reliably as proxies. Finally, the FM system produced the overall highest VAPP ratings and second highest CES ratings. This study will serve to inform evidence-based prescription of speech amplification devices from a multi-dimensional approach for individuals with hypophonia.

Summary for Lay Audience

Hypophonia, or reduced speech loudness, is one of the primary speech features of Parkinson’s disease. Estimates suggest that hypophonia is present in approximately 42-49% of individuals with hypokinetic dysarthria. Hypophonia can hinder verbal communication in social contexts and can be a disabling aspect of Parkinson’s disease, affecting communicative participation. Communicative participation is defined as taking part in life situations where knowledge, information, ideas, or feelings are exchanged. It may take the form of speaking, listening, reading, writing or nonverbal means of communication. Speech treatment for hypophonia typically aims to increase speech loudness. Unfortunately, behavioral speech interventions for hypophonia often fail to generalize beyond the clinic. An alternative approach to management is the use of speech amplification devices. The present study is part of a larger study that explored the performance of three speech amplification devices across the parameters of speech-to-noise ratio and speech intelligibility. What remains unexplored is an evaluation of these amplification devices from the perspective of communicative participation. This study evaluated how individuals with hypophonia and their primary communication partners rated communicative participation: 1) before and after experience with an amplification device, and 2) across three different amplification devices following trial periods outside of the laboratory. Amplification devices included a wired belt pack amplifier, a wireless stationary amplifier, and a two-way personal communication system. Seventeen participants with hypophonia and their primary communication partners participated in a study in which they tested the three speech amplification devices in a laboratory environment as well as during one-week trial periods at home. Outcome measures included the Communicative Effectiveness Survey (CES) and the Voice Activity and Participation Profile (VAPP). Results indicated participants with hypophonia rated participation higher following device use in comparison to no device. Further, both groups rated these measures similarly across device conditions suggesting primary communication partners can be used reliably as proxies, if required. Finally, the two-way personal communication system emerged as the amplification device producing the overall highest VAPP ratings and second highest CES ratings. The current study complements previous acoustic and perceptual efficacy data that will inform evidence-based prescription of amplification devices from a multi-dimensional approach.

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