1- How do I sound to me? Perceived changes in communication in Parkinson's disease: A Critique
Purpose of the Study
The prime purpose of this heading-01 is to discuss Perceived changes in communication in Parkinson's disease in a concise way.
Parkinson's disease (PD) is associated with impairments in movement which are often a primary concern for those affected. However, PD can also have a harmful effect on communication and certain aspects of language perception, although the nature of these problems is still being studied.
Miller, et al (2008) mentions that during communication, motor difficulties in PD usually cause restrictions in the ability to express nonverbal meanings through the face and voice. These changes impede how well Parkinsonian speakers communicate their emotions and attitudes through these important communication channels, presenting a barrier to effective communication and self-expression. Due to these limitations in expressive communication, sometimes people think that the personality traits of individuals with PD have changed and often they are perceived as more "negative".
In addition to problems with expression, there is evidence that PD impacts negatively on the ability to comprehend emotion expressions, especially when conveyed by the voice. Our research suggests that disease affecting the basal ganglia is frequently associated with deficits for understanding sentence-level prosody (speech tone), such as when judging the emotional tone of sentences (Miller, et al, 2008). We have observed these deficits in patients in the relatively early stages of PD (Hoehn & Yahr stages 1-3) who were not depressed and were not showing any evidence of intellectual decline. We have hypothesized that the basal ganglia are directly implicated in a functional brain network for deriving knowledge about emotions (and perhaps other features) through prosody, although more research needs to be conducted in this area.
Communication changes are almost inevitable for people with Parkinson's disease (PD). Around 80-90% experience voice changes; 45-50% show alterations in articulation. The perceptual, acoustic and kinematic changes associated with speech and voice deterioration have been described in detail. Language changes have received less attention (Miller, et al, 2008).
Perceptually, speech is typified as monopitched, monoloud, imprecise and dysfluent. Associated acoustic changes point to altered voice fundamental frequency (Fo), reduced variability of Fo, decreased sound intensity, lower harmonics-to-noise ratio and spectral distortions for many consonant types. Physiological and kinematic studies link acoustic findings to reductions in movement strength, endurance, peak velocity and amplitude.
Notably absent from this standard characterisation is the perspective of the individual who experiences these changes. Small-scale studies have endeavoured to capture a patient-centred view through questionnaires. Speakers with PD have been included in more general studies of the impact of dysarthria. Apart from the comparatively small scale of most of this work and that PD was not always the specific centre of attention, an added drawback of several studies is that changes in communication as a result of speech-language factors have been poorly separated from the broader consequences for communication of physical and lifestyle change.
2- 'A stony road... a 19 year journey': 'Bridging' through late-stage Parkinson's disease: A Critique