Babajanians (2019)

February 5, 2019

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

KEY

C =  clinician

MtF = male to female

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

Source:   Babajanians, T. (2019.) Giving voice to gender expression. The ASHA Leader, 24(2), 54-63.

 

Reviewer(s):  pmh

 

Date:   February 3, 2019

 

Overall Assigned Grade:  no assigned grade because there was no supporting data

 

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

 

Take Away:  This brief article provided guidance in the treatment of male-to-female (MtF) voice. The author provided a brief overview of intake strategies, assessment, and treatment. In addition, other resources that are available electronically were cited. While the recommended guidelines involved a holistic approach including several aspects of communication, this blog review is only concerned with targets associated with prosody. The author also discussed issues concerned with vocal feminization surgery.

 

  1. Was there a review of the literature supporting components of the intervention?No

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Not Applicable (NA)

 

  1. Was the intervention based on clinically sound clinical procedures? Yes

 

  1. Did the author provide a rationale for components of the intervention? Yes

 

  1. Description of outcome measures:

∞    Are outcome measures suggested?  Yes

 

∞  The  following are outcome measures derived from the article.

  • Outcome #1: To produce a forward focused resonance with elevated pitch
  • Outcome #2: “Vocal health through a custom vocal hygiene plan and daily practice of vocal function exercises” (p. 57) thereby increasing the pitch range
  • Outcome #3: Establishment of “feminine speech pattern” (p. 59)

 

  1. Was generalization addressed? Yes. The author assigned regular and intensive homework to clients to facilitate generalization.

 

  1. Was maintenance addressed?

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe a strategy for working with MtF transgender voices including intensive practice and communication counseling

POPULATION:  Transgender (MtF); Adults

MODALITY TARGETED: production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, loudness, duration, and concordance

DOSAGE: 1 to 2 sessions a week for 10 weeks; intensive homework included in the treatment plan

ADMINISTRATOR:  SLP

STIMULI:

MAJOR COMPONENTS:

 

  • The author presented a holistic approach to working with MtF transgender clients involving direct intervention, counseling, and targets from multiple aspects of communication (e.g., articulation, prosody, voice/resonance, nonverbal communication.)This summary only focuses on the prosody targets.

 

  • Outcome #1:To produce a forward focused resonance with elevated pitch

– Increase the tactile sensation of producing speech in the front of the mouth

  • Practice humming
  • Produce of words and phrases that start with /m/.
  • Encourage good posture and breathing which to facilitated elevation of

the larynx.

 

  • Outcome #2:“Vocal health through a custom vocal hygiene plan and daily practice of vocal function exercises” (p. 57) thereby increasing the pitch range

– Use of contracting and expanding exercises.

–  Consider eliminating smoking and the consumption of dairy to reduce throat clearing

 

  • Outcome #3:Establishment of “feminine speech pattern” (p. 59)

∞  Prosodic targets include

– Increased breathiness

– Decreased loudness

– Easy onsets

–  Longer duration of vowels

–  Decreased rate of speech.

 

  • The author encourages her clients to complete several tasks as daily homework, such as

–  practicing exercises 2 times a day (on arising and before going to bed)

===============================================================

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Clark (2016)

January 30, 2019

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

KEY

C =  clinician

FtM =  Female to Male

MtF =  Male to Female

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

TG =  transgender

Source: Clark, C. J. (2016.) Voice and communication therapy for the transgender or transsexual client: Service delivery and treatment options. Graduate Independent Studies- Communication Sciences and Disorders.  Paper 2.  h8p://ir.library.illinoisstate.edu/giscsd/2

Reviewer(s):  pmh

 

Date:  January 25, 2019

 

Overall Assigned Grade:__not graded due to lack of supportingdata

 

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention/interpretations. [

 

Take Away:  [This graduate paper contains 2 pamphlets:  one for transgender  (TG) consumers who are seeking speech/voice therapy and one for speech-language pathologists (SLPs) wishing to work with TG individuals. Both pamphlets provide background information and definitions of important terms. For the TG consumer, the author also highlights issues such as finding an SLP, what expect when visiting the SLP, common assessment and treatment practices, as well as common concerns. While the SLP pamphlet also contains information about assessment and treatment it is geared to the professional. The SLP pamphlet also alterts SLPs to social-cultural issues to help clinicians work more efficiently and sensitively with their clients. The pamphlets were concerned with several aspects of communication. This review only focuses on outcomes related to prosody.

 

  1. Was there a review of the literature supporting components of the intervention?Yes

 

  • Thetype of review was Narrative Review which is traditional review of the literature in which an author surveys a topic but does not provide evidence of a priori criteria for literature selection and analysis.

 

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Yes, for a good part of the intervention.
  2. Was the intervention based on clinically sound clinical procedures? Yes

 

 

  1. Did the author provide a rationale for components of the intervention? Yes

 

 

  1. Description of outcome measures:

 

–  Are outcome measures implied?  Yes

 

–  The following prosodic outcomes were derived from the pamphlets as examples of suitable prosodic outcomes for Female to Male (FtM ) Clients:

 

PITCH OUTCOMES

  • Outcome #1: Improve overall vocal health such as reducing vocal tension to minimize damage from previous “self therapy”

 

  • Outcome #2: Lower speaking fundamental frequency (i.e., pitch) safely to the typical male range 100-150 Hz. (This may even be needed after hormone therapy.)

 

  • Outcome #3: To facilitate lower pitch, increase the use of abdominal/diaphragmatic breathing

 

  • Outcome #4: Increase speaking rate

 

  • Outcome #5: Increase vocal intensity/loudness

 

  • Outcome #6: Decrease the duration of select sounds

 

–  The following prosodic outcomes were derived from the pamphlets as examples of suitable prosodic outcomes for Male to Female (MtF) Clients:

 

  • Outcome #7: Increase speaking fundamental frequency (i.e., pitch.)

 

  • Outcome #8: To facilitate increasing pitch, decrease muscle tension

 

  • Outcome #9: Decrease vocal intensity/loudness

 

  • Outcome #10: Decrease speaking rate

 

  • Outcome #11: Increase the duration of vowels.

 

  • Outcome #12: Increase articulatory precision/overarticulation (concordance)

 

 

  1. Was generalization addressed? Yes.  The author suggested that several of the outcomes be observed in conversational speech.

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To present pamphlets for potential transgender clients and clinicians working with transgender clients describing concerns, assessment, and treatment of  speech/communication skills.

 

POPULATION: Transgender adults

 

MODALITY TARGETED:  Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pitch, loudness, rate, pause, duration, concordance

 

DOSAGE: Not provided

 

ADMINISTRATOR:  SLP

 

 

MAJOR COMPONENTS:

 

  • The author described strategies for treating several of the outcome. The recommendations are listed with the targeted outcome.

 

∞ For FtM Clients:

 

  • Outcome #1: Improve overall vocal health such as reducing vocal tension to minimize damage from previous “self therapy”

 

  • Outcome #2: Lower speaking fundamental frequency (i.e., pitch) safely to the typical male range 100-150 Hz. (This may even be needed after hormone therapy.)

– Use vocal exercises to lower pitch

 

  • Outcome #3: To facilitate lower pitch, increase the use of abdominal/diaphragmatic breathing

– The author warned that overuse of easy onsets may increase the perception of feminine speech patterns.

 

  • Outcome #4: Increase speaking rate

– Target oral reading

– Decrease pausing during conversation

 

  • Outcome #5: Increase vocal intensity/loudness

– Target oral reading

 

  • Outcome #6: Decrease the duration of select sounds

     –  No specific recommendations provided.

 

∞  For MtF Clients:

 

  • Outcome #7: Increase speaking fundamental frequency (i.e., pitch.)

– The clinician should identify a safe speaking fundamental frequency that does not tax the client’s physiology

 

  • Outcome #8: To facilitate increasing pitch, decrease muscle tension

– Use tactile and visual cues, relaxation exercises, yawn-sigh techniques,

– Encourage softer, breather phonation

–  Move from isolated sounds, to sentences, to conversation

 

  • Outcome #9: Decrease vocal intensity/loudness

– Clinician explains the difference between the client’s current level and the targeted level.

– Target self-awareness

 

  • Outcome #10: Decrease speaking rate

– Clinician explains the difference between the client’s current level and the targeted level.

– Target self-awareness

 

  • Outcome #11: Increase the duration of vowels.

     –  No specific recommendations provided.

 

  • Outcome #12: Increase articulatory precision/overarticulation (concordance)

–  Replace hard glottal attacks with easy onsets

–  Increase articulatory precision using light contacts and delicate contacts wit articulatory.

–  Move from isolated sounds, to words, to phrases, to sentences, to conversation.


Sousa (2017)

June 1, 2018

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  A summary of the intervention can be found by scrolling about one-half of the way down this page.

KEY

ASD =  autism spectrum disorder

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist 

Source:  Sousa, M. S. S. (2017).  Prosodic exercises for children with ASD via virtual therapy. Thesis in Electrical and Computer Engineering, Técnico Lisboa (Portugal).  Retrieved from Semantic Scholar (https://www.semanticscholar.org/paper/Prosodic-exercises-for-children-with-ASD-via-Sousa-Trancoso/800334b2054586baaa055b01f08c2932df93eb77) 

Reviewer(s):  pmh

Date:  May 31.2018 

Overall Assigned Grade for Evidence (because there are no supporting data, the highest grade will be F, ):  The grade of F should not be interpreted as an evaluation of the intervention described in this paper or the quality of the paper itself. It merely reflects the quality of the support for the intervention. Because there were no data, the grade is F.

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

Take Away:  The author detailed the strategies for developing a mobile phone-based prosodic intervention for young Portuguese speaking children diagnosed with autism spectrum disorder (ASD.) The author described methods for assessing the quality of the auditory stimuli used in the treatment and for evaluating acoustically imitations produced during the intervention by the children with ASD. The author consulted the existing literature as well as “therapists”  to identify important learning strategies and targets. Although this mobile-phone prosodic intervention was not administered, it does have potential as a model for future development.

  1. Was there a review of the literature supporting components of the intervention?Yes
  • Narrative Review

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Yes

  

  1. Was the intervention based on clinically sound clinical procedures? Yes

 

  1. Did the author(s) provide a rationale for components of the intervention? Yes

 

  1. Description of outcome measures:

–  Are outcome measures suggested?  Yes

  • Outcome #1: Discrimination of same and different using visual stimuli

 

  • Outcome #2: Discrimination of nonspeech auditory stimuli (affirmation versus question; pleasure versus displeasure) that differ only in intonation

 

  • Outcome #3: Discrimination of single words as representing pleasure or displeasure affective states

 

  • Outcome #4: Discriminate low versus high pitches in single words

 

  • Outcome #5: Identification of the direction of the pitches of 2 syllable productions

 

  • Outcome #6: Imitate intonation of single words

  

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

  

SUMMARY OF INTERVENTION

 

PURPOSE: to develop an Android application for teaching the comprehension and production of intonation

POPULATION:  Autism Spectrum Disorder; children

MODALITY TARGETED: comprehension, production (imitation)

 ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, intonation

OTHER TARGETS:  concepts of same/different

DOSAGE: not applicable because the program was not administered

ADMINISTRATOR:  mobile phones? (this is virtual therapy)

MAJOR COMPONENTS:

  • This intervention was developed to fulfill the thesis requirement for the Master of Science in Electrical and Computer Engineering at Ténico Lisboa (Portugal.)

 

  • Several tasks were developed for nonreading children to use on Android phones including

–  2 activities to teach the concept of same/different

– one activity to teach the discrimination of single words as being same or different when they could differ only by intonation patterns representing question/affirmation  or pleasure/displeasure.

–  one activity to teach the imitation of single words that differed only by intonation patterns representing question/affirmation  or pleasure/displeasure.

– one activity to teach the identification of pleasure/displeasure affective states of single words.

– one activity to teach the identification of high versus low pitches on auditory stimuli (initially nonspeech sounds, moving to speech sounds)

– one activity to teach the identification of sequences of pitches produced on sounds (e.g., high-high, low-low, high-low, etc.)

 

=========================================================

 


Hancock et al. (2017)

December 12, 2017

 

 

EBP THERAPY ANALYSIS

Treatment Groups

 

Note: Scroll about two-thirds of the way down the page to read the summary of the procedures.

 Key:

C = Clinician

CPP = cepstral peak prominence

EBP = evidence-based practice

F0 = fundamental frequency

Hz = Hertz

JITT = jitter

MaxF0 = Maximum fundamental frequency

MF0 = minimum fundamental frequency

Min-max F0 = change in fundamental frequency

NA = not applicable

NHR = noise-to-harmonic levels

P = Patient or Participant

PFR = Phonation frequency range

pmh = Patricia Hargrove, blog developer

SHIM = shimmer

ST = semitones

SLP = speech–language pathologist

Trans men = individuals who had been assigned as female sex at birth but who identified as male

WNL = within normal limits

 

 

SOURCE: Hancock, A. B., Childs, K. D., & Irwig, M. (2017.) Trans male voice in the first year of testosterone treatment: Make no assumptions. Journal of Speech, Language, and Hearing Research, 60, 2472-2482.

 

REVIEWER(S): pmh

 

DATE: December 11, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible grade based on the design of the investigation was C+, Prospective, Single Group with Pre and Post Testing.)

 

TAKE AWAY: The investigators explored the changes in fundamental frequency, pitch range, voice quality, and perceptions of effectiveness of hormone therapy administered to transgender males. Although there was individual variation, overall participants tended to produce lower pitch levels indicating a deepening of their voices.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Single Group with Pre- and Post-Testing

                                                                                                          

  • What was the level of support associated with the type of evidence?

Level = _ C+___

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? Not Applicable (NA), there was only one group.

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No
  • from clinicians? No
  • from analyzers? No

                                                                    

 

  1. Were the groups adequately described? Yes, if one includes the baseline data a descriptors

 

           How many Ps were involved in the study?

  • total # of Ps: 7
  • # of groups: 1
  • List names of groups and the # of participants (Ps) in each group:

     – Trans men (individuals who had been assigned as female sex at birth but who identified as male.)

 

– CONTROLLED CHARACTERISTICS

  • gender: trans men
  • previous and current voice therapy: None
  • smokers/nonsmokers: 6 nonsmokers; 1 smoked 1 -7 cigarettes a day
  • medications: none of the Ps had used testosterone

 

– DESCRIBED CHARACTERISTICS

  • age: 18 to 39 years
  • ethnic/racial background: Black (2), Racially mixed (3), White (2)
  • professional singer?: none

 

–   Were the groups similar before intervention began? NA, there was only one group.

                                                         

– Were the communication problems adequately described? Yes

 

  • other: baseline data describes jitter (JITT), shimmer (SHIM), noise-to-harmonic levels (NHR), cepstral peak prominence (CPP), fundamental frequency (F0), minimum fundamental frequency (MF0), change in fundamental frequency (Min-max F0), Phonation frequency range (PFR), Habitual pitch level. Only some of these measures were atypical for some of the participants (Ps.)

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

– Did each of the groups maintain at least 80% of their original members? Yes

                                                               

– Were data from outliers removed from the study? No

 

 

  1. Were the groups controlled acceptably? NA. there was only one group.

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– OUTCOMES

 

  • OUTCOME #1: Percentage Jitter (JITT)
  • OUTCOME #2: Percentage Shimmer (SHIM)
  • OUTCOME #3: Noise-to-harmonic ration (NHR)
  • OUTCOME #4: Minimum fundamental frequency (MF0)
  • OUTCOME #5: Cepstral peak prominence (CPP)
  • OUTCOME #6: Maximum fundamental frequency (MaxF0)
  • OUTCOME #7: Change in fundamental frequency from minimum to maximum pitch (Min-Max F0)
  • OUTCOME #8: Phonation frequency range (PFR) in Hertz (Hz) and semitones (ST)
  • OUTCOME #9: Habitual pitch level
  • OUTCOME #10: Self –perception of “maleness” of voice
  • OUTCOME #11: Self-perception that P’s voice reflects true self
  • OUTCOME #12: Self-perception of error required to produce voice they way P wants it to sound.

 

– The following outcome measures were subjective:

 

  • OUTCOME #10: Self –perception of “maleness” of voice
  • OUTCOME #11: Self-perception that P’s voice reflects true self
  • OUTCOME #12: Self-perception of error required to produce voice they way P wants it to sound.

 

The following outcome measures were objective:

 

  • OUTCOME #1: Percentage Jitter (JITT)
  • OUTCOME #2: Percentage Shimmer (SHIM)
  • OUTCOME #3: Noise-to-harmonic ration (NHR)
  • OUTCOME #4: Minimum fundamental frequency (MF0)
  • OUTCOME #5: Cepstral peak prominence (CPP)
  • OUTCOME #6: Maximum fundamental frequency (MaxF0)
  • OUTCOME #7: Change in fundamental frequency from minimum to maximum pitch (Min-Max F0)
  • OUTCOME #8: Phonation frequency range (PFR) in Hertz (Hz) and semitones (ST)
  • OUTCOME #9: Habitual pitch level

                                         

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? No
  • Intraobserver for analyzers?
  • Treatment fidelity for clinicians? No _x__     Unclear ____
  • If yes, describe

 

  1. What were the results?

 

∞ What level of significance was required to claim significance? NA. For the most part, the results were presented descriptively; that is, inferential statistics were not used. However, there were some correlational statistics but they will not be described here. To signify significant change, the investigators noted if the 12 month results 2 standard deviations from the 2 baseline data points.

 

PRE AND POST TREATMENT ANALYSES

 

 

  • OUTCOME #1: Percentage Jitter (JITT3

– At 12 months, variable results: some Ps JITT increased above threshold and for others threshold decreased.

 

  • OUTCOME #2: Percentage Shimmer (SHIM)

3 additional Ps produced SHIM beyond threshold at 12 months

 

  • OUTCOME #3: Noise-to-harmonic ration (NHR)

2 Ps were above threshold at baseline; all Ps were below threshold at 12 months.

 

  • OUTCOME #4: Minimum fundamental frequency (MF0)

Ps’ MF0s were closer to the predicted mean for mean (123 Hz) at the 12 month data collection.

– All Ps’ MF0s were significantly lower than the baseline.

 

  • OUTCOME #5: Cepstral peak prominence (CPP)

– CPP was within normal limits (WNL) for all Ps at baseline and at 12 months.

 

  • OUTCOME #6: Maximum fundamental frequency (MaxF0)

– For 5 of 7 Ps, the change from baseline to 12 months was significantly lower.

 

  • OUTCOME #7: Change in fundamental frequency from minimum to maximum pitch (Min-Max F0)

At 12 months, this measures was WNL.

 

  • OUTCOME #8: Phonation frequency range (PFR) in Hertz (Hz) and semitones (ST)

– For all Ps, the lowest and highest notes decreased from baseline to 12 months but there was variability in the individual Ps’ amount of decrease.

 

  • OUTCOME #9: Habitual pitch level

– One P produced a significant decrease in habitual pitch and one P produced a significant increase.

 

  • OUTCOME #10: Self –perception of “maleness” of voice

Self-perception of male gender of all Ps’ voices increased.

 

  • OUTCOME #11: Self-perception that P’s voice reflects true self

Self-perception that Ps’ voices reflected their true selves increased.

 

  • OUTCOME #12: Self-perception of effort required to produce voice they way P wants it to sound.

3 of the Ps never reported experiencing effort in producing their voices in the way they wanted at baseline or at 12 months.

– 4 of the Ps reported experiencing decreased effort in producing their voices in the way they wanted from baseline to12 months.

 

 

 

∞ What was the statistical test used to determine significance? Place xxx after any statistical test that was used to determine significance.

 

  • Spearman Rho
  • To signify significant change, the investigators noted if the 12 month data was 2 standard deviations from the 2 baseline data points.

 

Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceNA

 

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation.
  • Ps were assessed at baseline (prior to hormone treatment) and 3 months, 6 months, 9 months, and 12 months into the hormone treatment.
  • The baseline consisted of 2 sessions. All other testing periods involved only one session.
  • Following baseline, Ps, who were treated by the same endocrinologist, initiated hormone treatment (serum testosterone and estradiol.)
  • Ps enrolled in neither voice therapy or voice lessons during the intervention.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To measure the changes associated with the hormone therapy with transgender males.

 

POPULATION: Transgender Males; Adults

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch (level and range)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality

 

OTHER TARGETS: self- perception of effectiveness

 

DOSAGE: Ps were monitored every 2 weeks. All Ps started at 50 mg and the physician increased dose levels at needed based on clinical data and testosterone levels.

 

ADMINISTRATOR: endocrinologist

 

MAJOR COMPONENTS:

 

  • Under the direction of the same endocrinologist, all Ps were administered either testosterone enanthate or cypionate.

 

 

_______________________________________________________________

 


Diekema (2016)

March 23, 2017

ANALYSIS GUIDELINES

Comparison Research

 

KEY: 

CS = Clear Speech

eta = partial eta squared

f = female

fo = fundamental frequency

m = male

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

PD = Parkinson Disease

pmh = Patricia Hargrove, blog developer

S = segment

SD = standard deviation

SLP = speech-language pathologist

ST = semitones

 

SOURCE: Diekema, E. (2016). Acoustic Measurements of Clear Speech Cue Fade in Adults with Idiopathic Parkinson Disease. (Electronic Thesis or Dissertation). Bowling State University, Bowling Green, OH. Retrieved from https://etd.ohiolink.edu/

 

REVIEWER(S): pmh

 

DATE: March 17, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: Not graded. This investigation is not classified as an intervention study; rather it is an investigation of learning behavior in adults with Parkinson Disease (PD.)

 

TAKE AWAY: This investigation is not classified as an intervention study; rather it is an investigation of learning behavior in adults with Parkinson Disease (PD.) The results, however, can inform therapeutic practice. Speech samples of 12 adults with PD were recorded while they read aloud part of the Rainbow Passage following cues to use Clear Speech (CS) to explore whether the selected prosodic changes would be maintained after the CS cue. The results indicated that improvements in the following measures decreased throughout the passage suggesting that the gains from CS cues were not maintained: speech rate, articulation rate, percent pause time, fo variability, and intensity throughout the passage. However, gains in the following measures were maintained throughout the passage: intensity associated with word stress and mean fo . The investigator suggested that when using CS with adults with PD, clinicians should consider modifications to enhance the cues effectiveness over time.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of design? Retrospective, Single Group with Multiple Measurements of Selected Outcomes

 

  • What was the focus of the research? Clinically Related

                                                                                                           

  • What was the level of support associated with the type of evidence? Level = not graded.

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there were 2 or more groups, were participants randomly assigned to groups? Not Applicable (NA), there was only one group.

                                                                   

 

  1. Were experimental conditions concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from administrators of experimental conditions? No

                                                                    

  • from analyzers/judges? No

                                                                    

 

  1. Was the group adequately described? No

 

– How many participants were involved in the study?

 

  • total # of Ps: 12
  • # of groups: 1:
  • Did the group maintain membership throughout the investigation? Yes

 

 

CONTROLLED CHARACTERISTICS

  • diagnosis: idiopathic PD • gender:

 

DESCRIBED CHARACTERISTICS

  • age: 55- 84 years (mean = 73 years)
  • gender: 6m; 6f
  • medication: All Ps were receiving medications

 

  • Were the groups similar? NA, there was only one group

 

  • Were the communication problems adequately described? No

 

  • disorder type: dysarthria associated with PD

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups?

                                                               

  • Experimental Conditions? No

 

  • Criterion/Descriptive Conditions? Yes

 

  • Outcomes were for measured for the 5 segments of the read aloud versions of the Rainbow Passage of approximately 25 syllables each:

– Segment (S) 1

– S2

– S3

– S4

– S5

 

 

  1. Were the groups controlled acceptably? NA, there was only one group.

 

 

  1. Were dependent measures appropriate and meaningful? Yes

                                                                                                             

– OUTCOMES

 

  • OUTCOME #1: Average speech rate
  • OUTCOME #2: Average articulation rate
  • OUTCOME #3: Percent pause time
  • OUTCOME #4: Average fundamental frequency (fo) in semitones (ST) for the segment
  • OUTCOME #5: Average fo comparison (difference) for beginning (S1) and end (S5) of passage
  • OUTCOME #6: Coefficient of variation of fo for each segment
  • OUTCOME #7: Standard deviation (SD) in ST for each segment
  • OUTCOME #8: Differences in intensity between the first “rain” and first “bow” and last “rain” and “bow” for each participant (P)
  • OUTCOME #9: Difference in intensity from beginning to end of the Rainbow Passage (i.e., S1 “rain” versus S5 “rain” and S1 “bow” versus S5 “bow”)

 

None of the dependent measures were subjective.

 

– All of the dependent/ outcome measures were objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers?   No

 

  • Intraobserver for analyzers? No

 

  • Treatment or test administration fidelity for investigator? No

 

 

  1. Description of design:
  • The investigator analyzed pre-existing speech samples of 12 Ps diagnosed with PD.
  • The samples consisted of segments of the Rainbow Passage which the Ps had been directed to read aloud as if listeners where having trouble with understanding or hearing.
  • To analyze the samples, the investigator divided the passage into 5 segments of 25 syllables each with the exception of S5 that had 26 syllables. (The purpose of the segmentation was to enable the investigator to answer her question regarding the fading of the effectiveness of CS cues. Fading would be indicated by changes in the acoustic outcome measures over the 5 segments.)
  • Although there were an equal number of syllables in each segment, there were an unequal number of natural pauses in the segments:

– S1 = 2 pauses

– S2 = 1 pause

– S3 = 2 pauses

– S4 = 3 pauses

– S5 = 1 pause

 

  1. What were the results of the statistical (inferential) testing?

 

  • RESULTS:

 

 

  • OUTCOME #1: Average speech rate

– With the exception of S4, speech rate increased as the Ps progressed through the passage (i.e., there were significant difference among segments.)

     – From S1 to S5 across all Ps, there was an average increase in speech rate of 22%.

   – This suggests that the CS cue faded.

 

  • OUTCOME #2: Average articulation rate

– With the exception of S4, articulation rate increased as the Ps progressed through the passage (i.e., there were significant difference among segments.)

     – From S1 to S5 across all Ps, there was an average increase in speech rate of 18%.

   – This suggests that the CS cue faded.

 

  • OUTCOME #3: Percent pause time

     – Although there was a significant difference among the segments, the changes in pause time were not consistent. (This could be because of the differences in the number of natural pauses in the segments.)

     – The comparisons that were significant included

  • S1 (2 pauses) versus S4 (3 pauses)
  • S2 (1 pause) versus S4 (3 pauses)
  • S3 (2 pauses) versus S5 (1 pause)
  • S4 (3 pauses) versus S5 (1 pause)

   – This suggests that the CS cue faded.

 

  • OUTCOME #4: Average fundamental frequency (fo) in semitones (ST) for the segment

– The average fo (in ST) tended to decrease as Ps progressed through the passage but the investigator noted that the change in ST was only 1 ST and was unlikely to be perceivable.

   – This suggests that the CS cue was maintained.

 

  • OUTCOME #5: Average fo comparison (difference) for beginning (S1) and end (S5) of passage

– The average fo (in semitones) decreased in S1 compared to S5 but the investigator noted that the change in ST was only 1 ST and was unlikely to be perceivable

   – This suggests that the CS cue was maintained.

 

  • OUTCOME #6: Coefficient of variation of fo for each segment

     – Although Ps patterns of fo variation did not change in a linear manner. The highest variation was in S1 and the smallest was in S5.

   – This suggests that the CS cue faded.

  • OUTCOME #7: Standard deviation (SD) in ST for each segment

     – Ps patterns of fo variation were more linear than for Outcome #6.

     – The variation tended to decrease from S1 to S5.

   – This suggests that the CS cue faded.

 

  • OUTCOME #8: Differences in intensity between the first “rain” and first “bow” and last “rain” and “bow” for each participant (P) [i.e., stress related intensity]

– There were no significant differences for these comparisons suggesting the original CS cue was maintained (i.e., it did not fade.)

 

  • OUTCOME #9: Difference in intensity from beginning to end of the Rainbow Passage (i.e., S1 “rain” versus S5 “rain” and S1 “bow” versus S5 “bow”) [i.e., intensity throughout the sample]

     Overall, there were significant difference in the first and last productions of “rain” and the first and last productions of “bow.”

   – This suggests that the CS cue faded.

 

– What were the statistical tests used to determine significance?

  • t-test
  • ANOVA
  • MANOVA
  • Bonferroni correction

 

– Were effect sizes provided? Yes, but since this is not an intervention study, it will not be reported in this review.

 

– Were confidence interval (CI) provided? No

 

 

  1. Summary of correlational results: NA

 

 

  1. Summary of descriptive results: Qualitative research NA

 

 

  1. Brief summary of clinically relevant results:
  • The strength of the CS cue was maintained only for measures of intensity associated with word stress and mean fo throughout the 5 segments of the Rainbow Passage (Outcomes 4, 5, and 8.)
  • For the following measures, the strength of the CS cue faded during the reading of the Rainbow Passage: speech rate, articulation rate, percent pause time, fo variability, and intensity throughout the passage (Outcomes 1, 2, 3, 6, 7, and 9.)
  • The investigator suggested that when using CS with adults with PD, clinicians should consider modifications to enhance the cues temporal effectiveness.

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: no grade, this is an not an intervention investigation.

 

 

 

 


Lee & Son (2005)

December 7, 2015

EBP THERAPY ANALYSIS

Treatment Groups

 

 

Note: Scroll about two-thirds of the way down the page to read the summary of the procedure(s).

 

Key:

C = Clinician

EBP = evidence-based practice

GRBAS Scale = Grade, Rough, Breathiness, Asthenic, Strained Scale

MTD = muscle tension dysphonia

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SFo = speaking fundamental frequency

SLP = speech–language pathologist

 

 

SOURCE: Lee, E-K, & Son, Y-I. (2005). Muscle tension dysphonia in children: Voice characteristics and outcome of voice therapy. International Journal of Pediatric Otorhinolaryngology, 69, 911-917. doi: 10.1016/j.ijporl.2005.01.030

 

REVIEWER(S): pmh

 

DATE: December 5, 2015

 

ASSIGNED GRADE FOR OVERALL QUALITY: C- (The highest possible grade based on the design is C.)

 

TAKE AWAY: Korean speaking children with muscle tension dysphonia (MTD) received therapy targeting awareness, relaxation, breathing, phonation, and homework. The results of this retrospective, descriptive, single group investigation revealed that children with a diagnosis of MTD are amenable to intervention and that marked progress was noted in voice quality and pitch as well as in reducing hypercontraction.

 

 

  1. What type of evidence was identified?

                                                                                                           

– What was the type of evidence? Retrospective, Single Group with Pre- and Post-Testing

                                                                                                           

– What was the level of support associated with the type of evidence? Level = C

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? Not Applicable (NA), there was only one group.
  • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched? NA

                                                                    

 

  1. Was administration of intervention status concealed?
  • from participants? No
  • from clinicians? No
  • from analyzers? No

                                                                    

 

  1. Was the group adequately described? Yes

 

– How many Ps were involved in the study?

 

  • total # of Ps: 8; records were examined for 8 consecutive male children with MTD
  • # of groups: 1

 

– The P characteristics that were controlled (i.e., inclusion/exclusion criteria) included

  • age: children
  • gender: all male

 

– The P characteristics were described included

  • age: 4.2 to 12.2 years, mean = 7.5 years
  • Onset: 4 months previous to several years (see Table 1)
  • Previous intervention: no previous voice therapy; no previous medication for the voice symptoms
  • Associated medical findings: vocal nodules (7 participants, P); post upper respiratory infection (2Ps)
  • Comorbid communication problems: articulation disorder (1P); dysfluency (1P)

 

– Were the groups similar before intervention began? NA

                                                         

– Were the communication problems adequately described? Yes

  • disorder type: voice problem, MTD
  • functional level: A speech-language pathologist (SLP) perceptually rated Ps using the Grade, Rough, Breathiness, Asthenic, Strained (GRBAS) Scale. The following voice problems were noted:

– severe hoarseness – all Ps

– strained voice – all Ps

– breathiness – all Ps to varying degrees

– pitch problems – 6 Ps (e.g., diplophonia, high/low pitch, pitch breaks)

– phonation breaks – 2 Ps

– aphonia – 2 Ps

  • other

– vocal nodules—7Ps

– false vocal fold approximation

– decreased vibration of true vocal folds

– incomplete glottal closure

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did the group maintain at least 80% of their original members? Yes

                                                               

  • Were data from outliers removed from the study? No, but some data were lost due to technical or procedural issues.

 

 

  1. Were the groups controlled acceptably? NA

                                                                                                             

 

  1. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

– The outcomes (dependent variables) were

 

PERCEPTUAL OUTCOMES

  • OUTCOME #1: Improved performance on the Grade portion of the GRBAS scale
  • OUTCOME #2: Improved performance on the Rough portion of the GRBAS scale
  • OUTCOME #3: Improved performance on the Breathiness portion of the GRBAS scale
  • OUTCOME #4: Improved performance on the Asthenic portion of the GRBAS scale
  • OUTCOME #5: Improved performance on the Strained portion of the GRBAS scale

 

ACOUSTIC OUTCOMES

  • OUTCOME #6: Improved speaking fundamental frequency (SFo)
  • OUTCOME #7: Reduced rate of jitter
  • OUTCOME #8: Reduced rate of shimmer
  • OUTCOME #9: Reduced noise to harmonic ratio (NHR)

 

STROBOSCOPIC OUTCOME

  • OUTCOME #10: Improved vocal fold function/status

 

– The subjective outcome measures were

 

PERCEPTUAL OUTCOMES

  • OUTCOME #1: Improved performance on the Grade portion of the GRBAS scale
  • OUTCOME #2: Improved performance on the Rough portion of the GRBAS scale
  • OUTCOME #3: Improved performance on the Breathiness portion of the GRBAS scale
  • OUTCOME #4: Improved performance on the Asthenic portion of the GRBAS scale
  • OUTCOME #5: Improved performance on the Strained portion of the GRBAS scale

 

STROBOSCOPIC OUTCOME

  • OUTCOME #10: Improved vocal fold function/status

 

The objective outcome measures were

 

ACOUSTIC OUTCOMES

  • OUTCOME #6: Improved speaking fundamental frequency (SFo)
  • OUTCOME #7: Reduced rate of jitter
  • OUTCOME #8: Reduced rate of shimmer
  • OUTCOME #9: Reduced noise to harmonic ratio (NHR)

                                         

 

  1. Were reliability measures provided?
  • Interobserver for analyzers? No
  • Intraobserver for analyzers? No
  • Treatment fidelity for clinicians? No

 

 

  1. What were the descriptive results (i.e., there was no statistical analysis)?

 

– Summary Of Important Results

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

PERCEPTUAL OUTCOMES—Descriptive Results Only

  • OUTCOME #1: Improved performance on the Grade portion of the GRBAS scale – Marked improvement noted
  • OUTCOME #2: Improved performance on the Rough portion of the GRBAS scale—Improvement noted
  • OUTCOME #3: Improved performance on the Breathiness portion of the GRBAS scale—Improvement noted
  • OUTCOME #4: Improved performance on the Asthenic portion of the GRBAS scale—Improvement noted
  • OUTCOME #5: Improved performance on the Strained portion of the GRBAS scale– Marked improvement noted

 

ACOUSTIC OUTCOMES—Descriptive Results Only

  • OUTCOME #6: Improved speaking fundamental frequency (SFo) — Low or high pitch returned to normal range; P using 2 pitches converted to a single stable pitch.
  • OUTCOME #7: Reduced rate of jitter—6Ps of the 7Ps with complete data reduced rate of jitter; investigators described jitter as being stabilized
  • OUTCOME #8: Reduced rate of shimmer–5Ps of the 7Ps with complete data reduced rate of shimmer; investigators described shimmer as being stabilized
  • OUTCOME #9: Reduced noise to harmonic ratio (NHR)– 6P of the 7Ps with complete data reduced rate of shimmer; investigators described NHR as being stabilized

 

STROBOSCOPIC OUTCOME—Descriptive Results Only

  • OUTCOME #10: Improved vocal fold function/status —4P of the 4Ps with complete data presented with improved vocal fold function/status; investigators described reduced anterioposterior contraction and reduction in nodule siz2

 

– What was the statistical test used to determine significance? NA, there were no statistical analyses

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceNA, no measures of clinical significance were reported.

 

 

  1. Were maintenance data reported? Yes
  • The investigators contacted the parents of 5 the Ps 2 ½ years after the completion of the intervention via the phone.
  • The parents reported that

– voice quality continued to be unstrained (5Ps)

– no abnormally high or low SFo (5Ps)

– no pitch or phonation breaks (5Ps)

– breathy voice quality continued to be reduced (4Ps)

– multiple voice abuse episodes (1P)

 

 

  1. Were generalization data reported? Yes. The investigators focused part of treatment on carrying over what was learned in therapy to outside the clinic. Therefore, the maintenance data (item #11) could also be considered generalization data.

 

 

  1. Describe briefly the experimental design of the investigation.
  • Investigators reviewed files until they identified 8 consecutive Korean speaking children who had been diagnosed with MTD, received intervention, and had been assessed pre and post intervention with a battery of perceptual, acoustic, and stroboscopic measures.
  • The intervention targeted awareness, relaxation, breathing, and phonation as well as assigned homework.
  • The investigators interviewed by phone the parents of 5Ps 2 ½ years after the end of intervention to assess maintenance.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C-

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of an intervention for MTD in children.

 

POPULATION: Muscle tension dystonia (MTD), Voice problems; Children

 

MODALITY TARGETED: expressive

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality (hoarseness, roughness, aphonia, diplophonia, etc.)

 

DOSAGE: 1 or 2 times a week, 30 minute sessions, for 1 to 2 ½ months

 

ADMINISTRATOR: SLP with homework by family

 

MAJOR COMPONENTS:

 

  • Intervention involved targeting awareness, relaxation, breathing, phonation, and encouraging family involvement at home (homework)

 

  • AWARENESS:

– The clinician (C) worked with the P and his family to develop an awareness of his voice problem(s) by reviewing recordings of the P’s speech.

– C worked with P so that he was able to identify voice problems on recordings.

– C described vocal abuse and good vocal hygiene.

 

  • RELAXATION:

– C described excessive muscle tension and provided visual and kinesthetic feedback to the P.

– C provided manual circumlaryngeal massage to the P.

 

  • BREATHING:

– C provided respiration training.

 

  • PHONATION:

– C directed P to hum and then feel the vibrations in his nose and neck.

– C instructed P to practice vocalizing vowels preceded by /h/ by

  • sighing,
  • producing the vowel, and
  • noting the easy-onset of the /h/ as opposed to his habitual harsh onset.

– C gradually increased the length and complexity of utterances.

– C encouraged P to self-monitor.

– C engaged P in role playing.

 

  • HOMEWORK:

– C encouraged family members to attend sessions.

– C asked family members to monitor P’s behavior and to complete homework assignments.

– The homework assignments included practicing skills used in therapy to communication outside the clinic.

 

 


De Letter et al. (2007)

May 25, 2015

EBP THERAPY ANALYSIS

Treatment Groups

 

Note: Scroll about two-thirds of the way down the page to read the summary of the procedure(s).

 

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

PD = Parkinson’s disease

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: De Letter, M., Santens, P., Estercam, I., Van Maele, G., De Bodt, M., Boon, P., & Van Borsel, J. (2007). Levodopa induced modifications of prosody and comprehensibility in advanced Parkinson’s disease as perceived by professional listeners. Clinical Linguistics and Phonetics, 21, 783-791.

REVIEWER(S): pmh

 

DATE: May 22, 2015

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible grade, based on the design of the investigation, was C+.)

 

TAKE AWAY: This was not an intervention study; rather, it is classified as a clinically related investigation. Speakers of Dutch from Belgium with Parkinson’s disease (PD) were measured off (Pre-test) and on (Post Test) the medication Levodopa. Participants (Ps) produced significantly better pitch, loudness, and comprehensibility while using Levodopa. There was not a significant change in speaking rate on and off Levodopa conditions.

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Single Group with Pre- and Post-Testing
  • What was the level of support associated with the type of evidence? Level = C+

                                                                                                           

  1. Group membership determination:
  • Were participants randomly assigned to groups? Not applicable (NA), there was only one group.
  1. Was administration of intervention status concealed?
  • from participants? No
  • from clinicians? No
  • from analyzers? Yes ß

                                                                    

 

  1. Was the group adequately described? Yes

How many participants were involved in the study?

  • total # of participant: 10
  • # of groups: 1
  • # of participants in each group: 10 participants (Ps) in the one group
  • List names of group: Ps with Parkinson’s disease (PD) were evaluated without (pretesting) and with (post testing) Levodopa.

 

The following variables were described:

  • age: 63 -80 years; mean 68 years
  • gender: 5m; 5f
  • cognitive skills: A psychiatrist administered a variety of tests and evaluated all Ps’ cognitive skills; none of the Ps were judged to be impaired.
  • therapy: None of the Ps were enrolled in speech therapy at the time of the investigation. No one was involved with deep brain stimulation and/or lesioning.
  • co-morbidity: No comorbidity was identified using neuroimaging and clinical judgment
  • medication: All Ps had been prescribed Levodopa previous to the investigation. Most of the Ps also were prescribed other medication(s) but none of the medication interfered with muscle movement.
  • diagnosis: advanced PD

 

– Were the groups similar before intervention began? NA, there was only one group.

                                                         

– Were the communication problems adequately described? No

  • disorder type: hypokinetic dysarthria

 

 

  1. Was membership in groups maintained throughout the study?
  • Did the group maintain at least 80% of their original members? Yes
  • Were data from outliers removed from the study? No

 

  1. Were the groups controlled acceptably? NA, there was only one group.

                                                                                                             

 

  1. Were the outcomes measure appropriate and meaningful?

– The outcomes (dependent variables) were

  • OUTCOME #1: Improved ratings of pitch on a 10 point scale from a read passage
  • OUTCOME #2: Improved ratings of loudness on a 10 point scale from a read passage
  • OUTCOME #3: Improved ratings of speaking rate on a 10 point scale from a read passage
  • OUTCOME #4: Improved ratings of comprehensibility on a 10 point scale from a read passage

All the outcome measures are subjective,

– None ofthe outcome measures are objective. None

                                         

 

  1. Were reliability measures provided?

– Interobserver for analyzers? Yes. Overall Interobserver reliability for all Ps and all outcomes was 0.78.

 

Intraobserver for analyzers?

 

–  Treatment fidelity for clinicians? No

 

 

  1. What were the results of the statistical (inferential) testing.

PRE (without medications) VS POST (with Levadopa) TREATMENT:

  • OUTCOME #1: Improved ratings of pitch on a 10 point scale from a read passage: With Levodopa was significantly better (p < 0.01) than without Levodopa.
  • OUTCOME #2: Improved ratings of loudness on a 10 point scale from a read passage: With Levodopa was significantly better ( p < 0.01) than without Levodopa.
  • OUTCOME #3: Improved ratings of speaking rate on a 10 point scale from a read narrative No significant differences
  • OUTCOME #4: Improved ratings of comprehensibility on a 10 point scale from a read narrative With Levodopa was significantly better ( p = 0.01) than without Levodopa.

– What was the statistical test used to determine significance? Wilcoxon

 

– Were confidence interval (CI) provided? No

 

           

  1. What is the clinical significance? Not provided

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

           

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE: To investigate the effectiveness of the medication Levodopa on the perception of pitch, loudness, rate, and comprehensibility of read passages of Ps with PD.

POPULATION: PD; adults

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, loudness, rate

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: comprehensibility

 

DOSAGE: Single dosage of Levodopa.

 

ADMINISTRATOR: medical professional

 

MAJOR COMPONENTS:

  • In the pre condition, Ps had been off their medication for 12 hours. They reviewed a 182 syllable passage in Dutch prior to reading it aloud for audiorecording.
  • After the audiorecording, Ps were administered their regular dosage of Levodopa.
  • The Ps then waited one hour and re-read the same 182 syllable passage aloud for audiorecording.
  • Four speech-language pathologists (SLPs) listened to the audiorecodings. The audiorecordings for each of the Ps were randomized with respect to whether the sample was of the speaker with or without the Levodopa.
  • The SLPs rated each audiorecording for the following characteristics on a 10 point scale: pitch, loudness, rate, and comprehensibility.