Vowel Articulation Index Research Articles

Variability in Vowel Space in Parkinson's Disease: Associations With Cognitive and Motor Impairment.

People with Parkinson's disease (PwP) typically experience impairments in vowel articulation; however, less is known about how this measure varies with speech task type and clinical characteristics such as cognitive impairment. We characterized vowel space in PwP with and without mild cognitive impairment (MCI) comparing performance across phonation, reading, and picture description tasks. We evaluated associations between vowel space and cognitive impairment, as well as motor symptom severity to elucidate the factors contributing to variability in this acoustic measure. PwP (n = 48) and age-matched controls (n = 15) performed sustained phonation of corner vowels, a reading passage, and a picture description task (Cookie Theft picture). PwP participants were classified as with normal cognition (PD-NC) or MCI (PD-MCI), and motor symptoms were assessed using the Movement Disorders Society Unified Parkingson's Disease Rating Scale Part III (MDS-UPDRS Part III). Vowel articulation index (VAI) for each task and mean difference in VAI between tasks was compared between the groups using linear mixed models adjusted for age, sex, and education. The impact of motor severity was assessed by additionally adjusting the model for MDS-UPDRS Part III score. In the adjusted mixed model, mean VAI was significantly lower in the PD-MCI group compared to the PD-NC group for all tasks. Within participants, adjusted mean differences demonstrated that all groups declined in VAI when sustained phonation was compared to either reading or picture description tasks. Adjustment for MDS-UPDRS Part III did not alter the results, suggesting no major association of motor impairment with vowel space variability within or between individuals or groups. Variability in vowel space is impacted by cognitive impairment and speech task in PwP. These findings are relevant to the further development of speech markers in PwP and other neurogenerative diseases that impact both cognitive and motor functions.

Acoustic Effects of Speaker Sex, Speech Sample, and Mandarin Tone on Vowel Production of Poststroke Spastic Dysarthria

Plain Language SummaryMandarin speakers with poststroke spastic dysarthria often have vowel production deficits that affect articulation and speech intelligibility. Vowel production is influenced by many factors. This study explored the acoustic effects of speaker sex, tones, and speech samples and their interactions on vowel production in Mandarin speakers with poststroke spastic dysarthria and confirmed the existence of these effects. We found that regardless of the speech samples or tones, there were the reduced range of articulatory movements, centralized vowel production, and prolonged vowel duration in dysarthria compared to healthy people. The most sensitive and useful analysis measures were the vowel articulation index and vowel duration. Specific influencing factors (speaker sex, speech sample, and tone) of vowel production need to be taken seriously by speech and language pathologists and considered in the assessment and rehabilitation.

Vowel articulation and intelligibility of speech in Spanish speakers with Parkinson's disease treated with deep brain stimulation of the subthalamic nucleus

Parkinson's disease (PD) can affect the intelligibility of speech. Although studies of vowel production are useful for measuring this impairment, they do not exist in Spanish speakers with the disease who have been treated with subthalamic nucleus deep brain stimulation (STN-DBS). STN-DBS is an effective treatment for the classic signs of PD, but with varied effects on speech. Data from two individuals with PD treated with STN-DBS were studied: one (P1) had impairment and the other (P2) had stable speech intelligibility after STN-DBS implantation. The triangular vowel space area (tVSA) and the vowel articulation index (VAI) were measured and compared before the implantation surgery, and at three, six and nine months after surgery. These measurements were compared with measurements of speech intelligibility (percentage of words correctly identified and degree of intelligibility). Both participants presented variations in measurements of vowel articulation after surgery. In P1, the reduction in the tVSA, but not the post-surgical change in the VAI, was consistent with reduced speech intelligibility. However, in P2, both measurements (tVSA and VAI) reflected stable speech intelligibility after surgery. Reduced speech intelligibility in Spanish speakers with PD after STN-DBS implantation may be reflected in a reduced tVSA.

Subclinical articulatory changes of vowel parameters in Korean amyotrophic lateral sclerosis patients with perceptually normal voices.

The available quantitative methods for evaluating bulbar dysfunction in patients with amyotrophic lateral sclerosis (ALS) are limited. We aimed to characterize vowel properties in Korean ALS patients, investigate associations between vowel parameters and clinical features of ALS, and analyze subclinical articulatory changes of vowel parameters in those with perceptually normal voices. Forty-three patients with ALS (27 with dysarthria and 16 without dysarthria) and 20 healthy controls were prospectively collected in the study. Dysarthria was assessed using the ALS Functional Rating Scale-Revised (ALSFRS-R) speech subscores, with any loss of 4 points indicating the presence of dysarthria. The structured speech samples were recorded and analyzed using Praat software. For three corner vowels (/a/, /i/, and /u/), data on the vowel duration, fundamental frequency, frequencies of the first two formants (F1 and F2), harmonics-to-noise ratio, vowel space area (VSA), and vowel articulation index (VAI) were extracted from the speech samples. Corner vowel durations were significantly longer in ALS patients with dysarthria than in healthy controls. The F1 frequency of /a/, F2 frequencies of /i/ and /u/, the VSA, and the VAI showed significant differences between ALS patients with dysarthria and healthy controls. The area under the curve (AUC) was 0.912. The F1 frequency of /a/ and the VSA were the major determinants for differentiating ALS patients who had not yet developed apparent dysarthria from healthy controls (AUC 0.887). In linear regression analyses, as the ALSFRS-R speech subscore decreased, both the VSA and VAI were reduced. In contrast, vowel durations were found to be rather prolonged. The analyses of vowel parameters provided a useful metric correlated with disease severity for detecting subclinical bulbar dysfunction in ALS patients.

A comparative study of automatic vowel articulation index and auditory-perceptual assessments of speech intelligibility in Parkinson’s disease

Purpose The purpose of this study was to analyse the relationship between automatic vowel articulation index (aVAI) and direct magnitude estimation (DME) among speakers with Parkinson’s disease (PD) and healthy controls. We further analysed the potential of aVAI to serve as an objective measure of speech impairment in the clinical setting. Method Speech samples from native Finnish speakers were utilised. Expert raters utilised DME to scale the intelligibility of speech samples. aVAI scores for PD speakers and healthy control speakers were analysed in relationship to DME speech intelligibility ratings and, among PD speakers, disease stage utilising nonparametric statistical analysis. Result Mean DME intelligibility ratings were lower among PD speakers compared to healthy controls. Mean aVAI scores were nearly the same between speaker groups. DME intelligibility ratings and aVAI were strongly correlated within the PD speaker group. aVAI and DME intelligibility ratings were moderately correlated with disease stage as measured by the Hoehn and Yahr scale. Conclusion aVAI was observed to be a promising tool for analysing vowel articulation in PD speakers. Further research is warranted on the application of aVAI as an objective measure of severity of speech impairment in the clinical setting, with varying patient populations and speech samples.

Vowel production: a potential speech biomarker for early detection of dysarthria in Parkinson's disease.

Our aim is to detect early, subclinical speech biomarkers of dysarthria in Parkinson's disease (PD), i.e., systematic atypicalities in speech that remain subtle, are not easily detectible by the clinician, so that the patient is labeled "non-dysarthric." Based on promising exploratory work, we examine here whether vowel articulation, as assessed by three acoustic metrics, can be used as early indicator of speech difficulties associated with Parkinson's disease. This is a prospective case-control study. Sixty-three individuals with PD and 35 without PD (healthy controls-HC) participated in this study. Out of 63 PD patients, 43 had been diagnosed with dysarthria (DPD) and 20 had not (NDPD). Sustained vowels were recorded for each speaker and formant frequencies were measured. The analyses focus on three acoustic metrics: individual vowel triangle areas (tVSA), vowel articulation index (VAI) and the Phi index. tVSA were found to be significantly smaller for DPD speakers than for HC. The VAI showed significant differences between these two groups, indicating greater centralization and lower vowel contrasts in the DPD speakers with dysarhtria. In addition, DPD and NDPD speakers had lower Phi values, indicating a lower organization of their vowel system compared to the HC. Results also showed that the VAI index was the most efficient to distinguish between DPD and NDPD whereas the Phi index was the best acoustic metric to discriminate NDPD and HC. This acoustic study identified potential subclinical vowel-related speech biomarkers of dysarthria in speakers with Parkinson's disease who have not been diagnosed with dysarthria.

Articulatory undershoot of vowels in isolated REM sleep behavior disorder and early Parkinson’s disease

Imprecise vowels represent a common deficit associated with hypokinetic dysarthria resulting from a reduced articulatory range of motion in Parkinson’s disease (PD). It is not yet unknown whether the vowel articulation impairment is already evident in the prodromal stages of synucleinopathy. We aimed to assess whether vowel articulation abnormalities are present in isolated rapid eye movement sleep behaviour disorder (iRBD) and early-stage PD. A total of 180 male participants, including 60 iRBD, 60 de-novo PD and 60 age-matched healthy controls performed reading of a standardized passage. The first and second formant frequencies of the corner vowels /a/, /i/, and /u/ extracted from predefined words, were utilized to construct articulatory-acoustic measures of Vowel Space Area (VSA) and Vowel Articulation Index (VAI). Compared to controls, VSA was smaller in both iRBD (p = 0.01) and PD (p = 0.001) while VAI was lower only in PD (p = 0.002). iRBD subgroup with abnormal olfactory function had smaller VSA compared to iRBD subgroup with preserved olfactory function (p = 0.02). In PD patients, the extent of bradykinesia and rigidity correlated with VSA (r = −0.33, p = 0.01), while no correlation between axial gait symptoms or tremor and vowel articulation was detected. Vowel articulation impairment represents an early prodromal symptom in the disease process of synucleinopathy. Acoustic assessment of vowel articulation may provide a surrogate marker of synucleinopathy in scenarios where a single robust feature to monitor the dysarthria progression is needed.

Speech Rate Mediated Vowel and Stop Voicing Distinctiveness in Parkinson's Disease.

Purpose The purpose of this study was to quantify changes in acoustic distinctiveness in two groups of talkers with Parkinson's disease as they modify across a wide range of speaking rates. Method People with Parkinson's disease with and without deep brain stimulation and older healthy controls read 24 carrier phrases at different speech rates. Target nonsense words in the carrier phrases were designed to elicit stop consonants and corner vowels. Participants spoke at seven self-selected speech rates from very slow to very fast, elicited via magnitude production. Speech rate was measured in absolute words per minute and as a proportion of each talker's habitual rate. Measures of segmental distinctiveness included a temporal consonant measure, namely, voice onset time, and a spectral vowel measure, namely, vowel articulation index. Results All talkers successfully modified their rate of speech from slow to fast. Talkers with Parkinson's disease and deep brain stimulation demonstrated greater baseline speech impairment and produced smaller proportional changes at the fast end of the continuum. Increasingly slower speaking rates were associated with increased temporal contrasts (voice onset time) but not spectral contrasts (vowel articulation). Faster speech was associated with decreased contrasts in both domains. Talkers with deep brain stimulation demonstrated more aberrant productions across all speaking rates. Conclusions Findings suggest that temporal and spectral segmental distinctiveness are asymmetrically affected by speaking rate modifications in Parkinson's disease. Talkers with deep brain stimulation warrant further investigation with regard to speech changes they make as they adjust their speaking rate.

Impact of Face Masks on Speech Acoustics and Vocal Effort in Healthcare Professionals.

We investigated speech acoustics and self-reported vocal symptoms in mask-wearing healthcare professionals. We hypothesized that there would be an attenuation of spectral energies and increase in vocal effort during masked speech compared to unmasked speech. Within and between subject quasi-experimental design. We prospectively enrolled 21 healthcare providers (13 cisgender female, 8 cisgender male; M=32.9 years; SD=7.9 years) and assessed acoustics and perceptual measures with and without a face mask in place. Measurements included: 1) acoustic Vowel Articulation Index (VAI); 2) cepstral and spectral acoustic measures; 3) traditional vocal measures (e.g., fundamental frequency, intensity); 4) relative fundamental frequency (RFF); and 5) self-reported ratings of vocal effort and dyspnea. During masked speech, there was a significant reduction in VAI, high-frequency information (>4 kHz), and RFF offset 10, as well as a significant increase in cepstral peak prominence and perceived vocal effort. Further analysis showed that high-frequency attenuation was more pronounced when wearing an N95 mask compared to a simple mask. Face masks pose an additional barrier to effective communication that primarily impacts spectral characteristics, vowel space measures, and vocal effort. Future work should evaluate how long-term mask use impacts vocal health and may contribute to vocal problems. 3 Laryngoscope, 132:391-397, 2022.

Kinematic and Acoustic Changes to Vowels and Diphthongs in Bite Block Speech.

Purpose We examined the effect of bite block insertion (BBI) on lingual movements and formant frequencies in corner vowel and diphthong production in a sentence context. Method Twenty young adults produced the corner vowels (/u/, /ɑ/, /æ/, /i/) and the diphthong /ɑɪ/ in sentence contexts before and after BBI. An electromagnetic articulograph measured the movements of the tongue back, middle, and front. Results There were significant decreases in the acoustic vowel articulation index and vowel space area following BBI. The kinematic vowel articulation index decreased significantly for the back and middle of the tongue but not for the front. There were no significant acoustic changes post-BBI for the diphthong, other than a longer transition duration. Diphthong kinematic changes after BBI included smaller movements for the back and middle of the tongue, but not the front. Conclusions BBI led to a smaller acoustic working space for the corner vowels. The adjustments made by the front of the tongue were sufficient to compensate for the BBI perturbation in the diphthong, resulting in unchanged formant trajectories. The back and middle of the tongue were likely biomechanically restricted in their displacement by the fixation of the jaw, whereas the tongue front showed greater movement flexibility.

Language-Independent Approach for Automatic Computation of Vowel Articulation Features in Dysarthric Speech Assessment

Imprecise vowel articulation can be observed in people with Parkinson's disease (PD). Acoustic features measuring vowel articulation have been demonstrated to be effective indicators of PD in its assessment. Standard clinical vowel articulation features of vowel working space area (VSA), vowel articulation index (VAI) and formants centralization ratio (FCR), are derived the first two formants of the three corner vowels /a/, /i/ and /u/. Conventionally, manual annotation of the corner vowels from speech data is required before measuring vowel articulation. This process is time-consuming. The present work aims to reduce human effort in clinical analysis of PD speech by proposing an automatic pipeline for vowel articulation assessment. The method is based on automatic corner vowel detection using a language universal phoneme recognizer, followed by statistical analysis of the formant data. The approach removes the restrictions of prior knowledge of speaking content and the language in question. Experimental results on a Finnish PD speech corpus demonstrate the efficacy and reliability of the proposed automatic method in deriving VAI, VSA, FCR and F2i/F2u (the second formant ratio for vowels /i/ and /u/). The automatically computed parameters are shown to be highly correlated with features computed with manual annotations of corner vowels. In addition, automatically and manually computed vowel articulation features have comparable correlations with experts' ratings on speech intelligibility, voice impairment and overall severity of communication disorder. Language-independence of the proposed approach is further validated on a Spanish PD database, PC-GITA, as well as on TORGO corpus of English dysarthric speech.

A Comprehensive Analysis of Age and Gender Effects in European Portuguese Oral Vowels

The knowledge about the age effects in speech acoustics is still disperse and incomplete. This study extends the analyses of the effects of age and gender on acoustics of European Portuguese (EP) oral vowels, in order to complement initial studies with limited sets of acoustic parameters, and to further investigate unclear or inconsistent results. A database of EP vowels produced by a group of 113 adults, aged between 35 and 97, was used. Duration, fundamental frequency (f0), formant frequencies (F1 to F3), and a selection of vowel space metrics (F1 and F2 range ratios, vowel articulation index [VAI] and formant centralization ratio [FCR]) were analyzed. To avoid the arguable division into age groups, the analyses considered age as a continuous variable. The most relevant age-related results included: vowel duration increase in both genders; a general tendency to formant frequencies decrease for females; changes that were consistent with vowel centralization for males, confirmed by the vowel space acoustic indexes; and no evidence of F3 decrease with age, in both genders. This study has contributed to knowledge on aging speech, providing new information for an additional language. The results corroborated that acoustic characteristics of speech change with age and present different patterns between genders.

Vowel articulation index and conversational spontaneous speech intelligibility in Parkinson's disease

Objective: In PD, Vowel Articulation Index (VAI) has been shown to be related to elicited speech intelligibility (ESI). VAI derives from F1 and F2 of the corner vowels /i/, /u/, and /a/, and is sensitive to mild hypokinetic dysarthria in PD. However, this effect has not been investigated in conversational spontaneous speech intelligibility (SSIC), which is the objective of this study.

Quantitative acoustic metrics of vowel production in mandarin-speakers with post-stroke spastic dysarthria

ABSTRACT Impairment of vowel production in dysarthria has been highly valued. This study aimed to explore the vowel production of Mandarin-speakers with post-stroke spastic dysarthria in connected speech and to explore the influence of gender and tone on the vowel production. Multiple vowel acoustic metrics, including F1 range, F2 range, vowel space area (VSA), vowel articulation index (VAI) and formant centralization ratio (FCR), were analyzed from vowel tokens embedded in connected speech produced. The participants included 25 clients with spastic dysarthria secondary to stroke (15 males, 10 females) and 25 speakers with no history of neurological disease (15 males, 10 females). Variance analyses were conducted and the results showed that the main effects of population, gender, and tone on F2 range, VSA, VAI, and FCR were all significant. Vowel production became centralized in the clients with post-stroke spastic dysarthria. Vowel production was found to be more centralized in males compared to females. Vowels in neutral tone (T0) were the most centralized among the other tones. The quantitative acoustic metrics of F2 range, VSA, VAI, and FCR were effective in predicting vowel production in Mandarin-speaking clients with post-stroke spastic dysarthria, and hence may be used as powerful tools to assess the speech performance for this population.

Stability, reliability, and sensitivity of acoustic measures of vowel space: A comparison of vowel space area, formant centralization ratio, and vowel articulation index.

Vowel space (VS) measurements can provide objective information on formant distribution and act as a proxy for vowel production. There are a number of proposed ways to quantify vowel production clinically, including vowel space area, formant centralization ratio, and vowel articulation index (VAI). The stability, reliability, and sensitivity of three VS measurements were investigated in two experiments. Stability was explored across three inter-recording intervals and challenged in two sensitivity conditions. Data suggest that VAI is the most stable measure across 30 s, 2 h, and 4 h inter-recording intervals. VAI appears the most sensitive metric of the three measures in conditions of fatigue and noise. These analyses highlight the need for stability and sensitivity analysis when developing and validating acoustic metrics, and underscore the potential of the VAI for vowel analysis.

Examining Acoustic and Kinematic Measures of Articulatory Working Space: Effects of Speech Intensity.

The purpose of this study was to examine the effect of speech intensity on acoustic and kinematic vowel space measures and conduct a preliminary examination of the relationship between kinematic and acoustic vowel space metrics calculated from continuously sampled lingual marker and formant traces. Young adult speakers produced 3 repetitions of 2 different sentences at 3 different loudness levels. Lingual kinematic and acoustic signals were collected and analyzed. Acoustic and kinematic variants of several vowel space metrics were calculated from the formant frequencies and the position of 2 lingual markers. Traditional metrics included triangular vowel space area and the vowel articulation index. Acoustic and kinematic variants of sentence-level metrics based on the articulatory-acoustic vowel space and the vowel space hull area were also calculated. Both acoustic and kinematic variants of the sentence-level metrics significantly increased with an increase in loudness, whereas no statistically significant differences in traditional vowel-point metrics were observed for either the kinematic or acoustic variants across the 3 loudness conditions. In addition, moderate-to-strong relationships between the acoustic and kinematic variants of the sentence-level vowel space metrics were observed for the majority of participants. These data suggest that both kinematic and acoustic vowel space metrics that reflect the dynamic contributions of both consonant and vowel segments are sensitive to within-speaker changes in articulation associated with manipulations of speech intensity.

ХАРАКТЕРИСТИКА РЕЧИ ДЕТЕЙ 6-7 ЛЕТ С РАССТРОЙСТВАМИ АУТИСТИЧЕСКОГО СПЕКТРА И СИНДРОМОМ ДАУНА

In this work, the data on the features of speech development in children with autism spectrum disorders (ASD) and with Down syndrome (DS) are presented. Methods of perceptual experiment and instrumental analysis were used. It is shown that in typically developing (TD) children the values of vowel articulation index of stressed vowels in words are maximal in comparison with the corresponding characteristic in children with ASD and children with DS. The words of children with ASD are characterized by high pitch values of words and stressed vowels as well as high values of vowel articulation index. The words of children with DS, besides high pitch values of words and stressed vowels noticed for children with ASD, had maximum duration of words and stressed vowels, low values of the vowel articulation index of stressed vowels. In children with DS, more types of consonant phonemes were not formed compared to children with ASD and TD ones; in addition, children with DS used consonants that do not exist in the Russian language.

Imprecise vowel articulation as a potential early marker of Parkinson's disease: Effect of speaking task

The purpose of this study was to analyze vowel articulation across various speaking tasks in a group of 20 early Parkinson's disease (PD) individuals prior to pharmacotherapy. Vowels were extracted from sustained phonation, sentence repetition, reading passage, and monologue. Acoustic analysis was based upon measures of the first (F1) and second (F2) formant of the vowels /a/, /i/, and /u/, vowel space area (VSA), F2i/F2u and vowel articulation index (VAI). Parkinsonian speakers manifested abnormalities in vowel articulation across F2u, VSA, F2i/F2u, and VAI in all speaking tasks except sustained phonation, compared to 15 age-matched healthy control participants. Findings suggest that sustained phonation is an inappropriate task to investigate vowel articulation in early PD. In contrast, monologue was the most sensitive in differentiating between controls and PD patients, with classification accuracy up to 80%. Measurements of vowel articulation were able to capture even minor abnormalities in speech of PD patients with no perceptible dysarthria. In conclusion, impaired vowel articulation may be considered as a possible early marker of PD. A certain type of speaking task can exert significant influence on vowel articulation. Specifically, complex tasks such as monologue are more likely to elicit articulatory deficits in parkinsonian speech, compared to other speaking tasks.

Impairment of vowel articulation as a possible marker of disease progression in Parkinson's disease.

PurposeThe aim of the current study was to survey if vowel articulation in speakers with Parkinson's disease (PD) shows specific changes in the course of the disease.Method67 patients with PD (42 male) and 40 healthy speakers (20 male) were tested and retested after an average time interval of 34 months. Participants had to read a given text as source for subsequent calculation of the triangular vowel space area (tVSA) and vowel articulation index (VAI). Measurement of tVSA and VAI were based upon analysis of the first and second formant of the vowels /α/, /i/and /u/ extracted from defined words within the text.ResultsAt first visit, VAI values were reduced in male and female PD patients as compared to the control group, and showed a further decrease at the second visit. Only in female Parkinsonian speakers, VAI was correlated to overall speech impairment based upon perceptual impression. VAI and tVSA were correlated to gait impairment, but no correlations were seen between VAI and global motor impairment or overall disease duration. tVSA showed a similar reduction in the PD as compared to the control group and was also found to further decline between first and second examination in female, but not in male speakers with PD.ConclusionsMeasurement of VAI seems to be superior to tVSA in the description of impaired vowel articulation and its further decline in the course of the disease in PD. Since impairment of vowel articulation was found to be independent from global motor function but correlated to gait dysfunction, measurement of vowel articulation might have a potential to serve as a marker of axial disease progression.

Intensive voice treatment (LSVT ®LOUD) for Parkinson's disease following deep brain stimulation of the subthalamic nucleus

Purpose Intensive voice therapy (LSVT ®LOUD) can effectively manage voice and speech symptoms associated with idiopathic Parkinson disease (PD). This small-group study evaluated voice and speech in individuals with and without deep brain stimulation of the subthalamic nucleus (STN-DBS) before and after LSVT LOUD, to determine whether outcomes for surgical subjects were comparable to non-surgical cohorts. Methods Eight subjects with PD (four with STN-DBS and four without) received LSVT LOUD four times a week for four weeks. Four additional subjects with PD remained untreated. Voice intensity (SPL), Vowel Articulation Index (VAI), the Voice Handicap Index (VHI), and a structured interview were evaluated before and after treatment and again six months later. Results Both treated groups showed significant increases in SPL from pre to post and six-month follow up. VAI was significantly higher for the treated groups compared to the untreated subjects at follow up. Several treated individuals had significant clinical improvement in VHI scores, particularly within the LSVT-DBS group. Treated individuals reported improvements in voice and speech in structured interviews; however, answers suggest more variable long-term maintenance within the LSVT-DBS group. The untreated group exhibited no significant changes in any measure throughout the study. Conclusions Results support LSVT LOUD for treating voice and speech in individuals with PD following STN-DBS surgery. However, modifications may be required to maintain functional improvements. Learning outcomes: As a result of this activity, the participant will be able to (1) describe how deep brain stimulation of the subthalamic nucleus may affect voice and speech in Parkinson disease; (2) describe the effects of intensive voice therapy (LSVT ®LOUD) on people with PD both with and without STN-DBS; (3) describe how individuals with STN-DBS maintained treatment effects over time.