doi: 10.1177/000348941312200502. 2007;16(2):95–107. As with any dysarthria type the goal of treatment should be to treat the aspect (i.e., rate, prosody, strength, speed, steadiness) of speech that produces the greatest functional benefit. Distinguishing features are reduced loudness, rapid speech rate, sound repetitions, and reduced stress. In addition, alternative explanations for hypokinetic dysarthria tying voice and speech effects to factors other than rigidity have been proposed. Hypokinetic dysarthria results from dysfunction in the basal ganglia motor loop, 7 which causes deficits in the regulation of initiation, amplitude and velocity of movement. However, below are some of the common goals of treatment in speech and language therapy. The goal of the technique is to produce a physiological change, as well as a change in perceptual awareness (wherein the patient recognizes his/her own … For treatment techniques that have "proven" to be successful (particularly with individuals with hypokinetic dysarthria) you might want to check out the Lee Silverman Voice Treatment (LSVT) web site. By . The primary outcome variable was vocal intensity (dBSPL) measured in three different speaking conditions: sustained vowel, reading, and conversation. Sabinet Acquired Dysarthria Within The Context Of The Four Level . This resulted in varied mouth-to-microphone distances between patients, but exact mouth-to-microphone distances within patients so that valid measures of vocal intensity could be compared across sessions. doi: 10.1044/2014_JSLHR-S-13-0039. Ann Otol Rhinol Laryngol. COVID-19 is an emerging, rapidly evolving situation. This type of dysarthria is characterised by poor articulation and worsening of speech in sentences and conversation in comparison with single words which will often sound clear. Data from 78 patient files across a three year period were analyzed. Mean minimum dB averaged across the respective utterance types at pre-treatment stages and post-treatment stages (e.g., data collected on the 12th treatment session, at 6-months post-treatment follow-up and 12-months post-treatment follow-up) were analyzed. Watts CR(1). Intensive treatment programs requiring high-intensity voice and speech exercises with clinician-guided prompting and feedback have been established as effective for improving vocal function. Prospective studies controlling for this factor are needed to further validate the results of this study. In theory this may recruit and align cognitive pathways with the direct activation pyramidal pathways to facilitate increases in the number of motor units recruited in respiratory and laryngeal musculature during speech production. Saunders; 1975. Effects of an extended version of the lee silverman voice treatment on voice and speech in Parkinson’s disease. Sapir S. Multiple factors are involved in the dysarthria associated with Parkinson’s disease: a review with implications for clinical practice and research. Parkinson's disease accounts for 36% of all hypokinetic dysarthrias. 4, pp. For each production within the hierarchical stages, the clinician recorded the minimum decibel level across the utterance duration (in dBSPL) on a daily record sheet. Individuals with Parkinson’s disease (PD) exhibit hypokinetic dysarthria, which is a motor speech disorder caused by d amage to the basal ganglia control circuit. A retrospective study of long-term treatment outcomes for reduced vocal intensity in hypokinetic dysarthria . Vocal effort scaling and the underlying glottal incompetence in some speakers with PD has also been treated with other voice therapy approaches whose clinical goals relate to a similar focus on increased motor amplitude. treatment in an effort to determine if measures of vocal function in patients with PD are positively or negatively impacted by this approach, and to compare results with the previously reported case reports. You will need: a stopwatch, a mirror, a voice recorder, and the cookie theft picture and/or the caterpillar passage. Apps for Dysarthria AlphaTopics AAC. A retrospective study of long-term treatment outcomes for reduced vocal intensity in hypokinetic dysarthria, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12901-016-0022-8.  |  Watts, C.R. Spielman J, Ramig LO, Mahler L, Halpern A, Gavin WJ. 339-352. Brain morphological changes in hypokinetic dysarthria of Parkinson's disease and use of machine learning to predict severity. Keywords: Parkinson’s disease; Speech and language therapy; Voice; Voice disorders. USA.gov. Preliminary data on two voice therapy interventions in the treatment of presbyphonia. Hypokinetic Dysarthria also results from diseases that affect the basal ganglia, usually Parkinson’s Disease, but in this case individuals speak in short rushes with a lower volume, and at times with monopitch or monovolume. Significant treatment effects were found in all three speaking conditions. When available, data was also recorded from post-treatment follow-up periods at approximately six months and twelve months. As reported inLiss et al., the mean words-correct score for the ataxic tape was 43.2% and the mean for the hypokinetic tape was 41.8%.This allowed differences in the dependent variables to be interpreted as arising from differences in speech production characteristics, specifically syllabic strength contrasts. Speech treatments have been developed to rehabilitate the vocal subsystems underlying this impairment. A retrospective study of long-term treatment outcomes for reduced vocal intensity in hypokinetic dysarthria. Facilitating Techniques: 1. breath hold 2. hard glottal attack 3. loudness training (lee silverman) Compensating: 1. reduce background noise 2. turn head to side of weaker VF 3. use amplifier From presentations: 1. for hyperadduction,i) use yawn-sigh ii) yawn-sigh with vowels 2. for hypoadduction (hypokinetic or flaccid) use i) holding breath exercises (see if pt. Use it … Neurology. As far as possible they are hierarchical. Functionality/Rationale Materials 10 flashcards data sheet Peggy is a guidance counselor so she's constantly talking to her students and colleagues, but she's difficult to hear and understand. These vocal abnormalities result from impairments to neuromuscular control of respiratory and laryngeal muscles which numerous treatments, both medical and behavioral, have aimed to improve. 2007;50(4):899–912. Table 1 presents group descriptive statistics across the dependent variables at the four measurement periods. Slowing the rate of speech. 2014 Mar-Apr;48:1-17. doi: 10.1016/j.jcomdis.2013.12.001. ®” voice program for Parkinson’s disease. Bowed vocal folds are a characteristic of some speakers with PD, and surgical correction for the glottal incompetence has primarily involved injection laryngoplasty [10, 11]. Sapir S. Multiple factors are involved in the dysarthria associated with Parkinson’s disease: a review with implications for clinical practice and research. A detailed dysarthria patient eval/assessment write-up to make all of our lives quicker and easier!Areas in red can be modified to your specific patient. BibTex; Full citation; Publisher: Springer Nature. Less is known, however, regarding long-term outcomes of clinical benefit in speakers with PD who receive these treatments. Dependent variables for this study included dB from three speaking conditions in the treatment hierarchy: sustained vowels, reading and conversation during the cognitive exercises. Furthermore, evidence for the long-term efficacy of speech therapy in PD is equivocal, as few studies engage in longitudinal symptom assessment or assess speech in everyday conversational contexts. These treatment effects were associated with large effect sizes. CAS  Inability to talk for a long time. Would you like email updates of new search results? Among these include impaired scaling of vocal effort resulting in the reduced vocal amplitude that is characteristic of speakers with PD [3]. J Speech Lang Hear Res. The muted effect of medication for treating the voice manifestations of PD, specifically the glottal incompetence resulting in low volume which progresses along with the disease, lends support to that position. Speech treatments have been developed to rehabilitate the vocal subsystems underlying this impairment. Spectral measures and perceptual ratings of hypokinetic dysarthria. Although it’s something that can be practiced briefly for every session. Reduced vocal intensity is a core impairment of hypokinetic dysarthria in Parkinson’s disease (PD). 1995;38(4):751–64. These patients experience reduced vocal intensity3 and disordered articulation with imprecise vowels, 4 which contribute to impaired intelligibil-ity.5 Thus, to avoid considerable negative social conse-quences for patients,6 effective speech therapies are of great importance. A retrospective study of long-term treatment outcomes for reduced vocal intensity in hypokinetic dysarthria. To improve intonation by increasing cricothyroid muscle activity. At the 12-month follow-up period effect sizes remained large at d = 2.90, d = 2.21, and d = 1.64 for vowel, reading, and conversation, respectively. Figure 1 illustrates mean intensity across the three speaking conditions at pre-treatment (n = 78), post-treatment (n = 78), the first follow-up (n = 55), and the second follow-up measurement periods (n = 30). The interpatient variation in mouth-to-microphone distance was considered minimal, and the background noise in treatment rooms was less than 45dBSPL. Google Scholar. These responses required each patient to generate novel information while focusing on the treatment goal of speaking with intent. 2008;8(2):299–311. A comparison of speech and language therapy techniques for dysarthria in Parkinson's disease. The response rate of the sound level meter was set to fast. A retrospective study of long-term treatment outcomes for reduced vocal intensity in hypokinetic dysarthria . Long-Term Goal: Without external cues, Mr. J will use functional communication skills for social interactions with both familiar and unfamiliar partners. doi: 10.1002/14651858.CD002814. For all comparisons effect sizes were large, suggesting a strong degree of practical significance. Hypokinetic dysarthria most commonly occurs with Parkinson’s disease. Parkinson's disease accounts for 36% of all hypokinetic dysarthrias. Brain Injury: Vol. Darley FL, Aronson AE, Brown JR. Motor speech disorders. - 142.93.150.134. This hypothesis will need to be tested in future studies. Similar to LSVT, this treatment requires an intensive program although the number of treatment sessions is based on patient progress (e.g., 16 sessions are not required, as were in the original method for LSVT) and sessions last approximately 45 min. LSVT goals include the following (Stemple et al., 2010): To increase loudness and decrease breathiness by increasing vocal fold adduction. Significant increases in vocal intensity measured at 6 and 12 moth follow-up periods suggested that the sample of patients maintained treatment benefit for up to a year. Effect sizes for all outcome measures were large, suggesting a strong degree of practical significance. Dysarthria often causes slurred or slow speech that can be difficult to understand. (2008). Previously in therapy sessions we worked on her respiration so she has better breath 2012;21(4):354–67. These banks of treatment goals are student created but influenced by different clinical sources. Blumin JH, Pcolinsky DE, Atkins JP. Dysarthria in Parkinson's disease (PD) Dysarthria denotes a motor speech disorder resulting from a lesion of the peripheral or central nervous system.1–3 Dysarthria and the psychosocial aspects of communication impairments are particularly disabling for individuals with PD. Cues such as “speak with authority,” “use your CEO voice,” and “say it with gusto” were associated with the concept of “intent” and utilized during treatment sessions. The aphasia goal pool at UNC is a way to help speech-language pathologists share experiences and knowledge about treatment planning for aphasia across the continuum of care. The Parkinson Voice Project has standardized their method of data collection during each treatment session, as follows: Patients were seated in front of a desk, behind which the clinician sat. … J Neurol Neurosurg Psychiatry. Article  Theories explaining the neurophysiological changes subsequent to high-intensity vocal and speech exercises in PD have included improvement in glottal closure and/or vocal tension for increased sound pressure levels in speech, changes to extrapyramidal motor functions, and changes in limbic system pathways regulating goal-directed behavior [22]. Hypokinetic dysarthria is commonly associated with Parkinson disease, Parkinson-plus syndromes, or parkinsonian-like symptoms. Search term. Journal of Medical Speech-Language Pathology, 11, 85-94. A retrospective study of long-term treatment outcomes for reduced vocal intensity in hypokinetic dysarthria. “Intent” was defined as a purposeful cognitive focus in which the patient would direct attentional capacities on speech production. Cite . Am J Speech Lang Pathol. KEYWORDS: dysarthria † hypokinetic † hypophonia † LSVT ®† neural plasticity † Parkinson’s disease † speech and voice disorder † speech and voice treatment Oral communication is vital in education, employment, social functioning and self-expres-sion. Levitt JA. Dysarthria often is characterized by slurred or slow speech that can be difficult to understand.Common causes of dysarthria include nervous system (neurological) disorders such as stroke, brain injury, brain tumors, and conditions that cause facial paralysis or tongue or throat muscle weakness. 2007;117(5):831–4. Norms: within 1 standard deviation of the norm is considered within normal limits. They are more global and do not focus on specific sounds. These outcomes were similar to a comparison treatment, Vocal Function Exercises, and both experimental treatments resulted in greater clinical improvement compared to a control group who received no intervention [18]. 2016; 16:2 (ISSN: 1472-6815) Watts CR. Mean minimum intensity (in dB) levels across the three speaking condition at four measurement timeframes: pre-treatment (n = 78), post-treatment (n = 78), Follow-up 1 @ 6-months (n = 55), and Follow-up 2 @ 12-months (n = 30). Significant increases in vocal intensity measured at 6 and 12 moth follow-up periods suggested that the sample of patients maintained treatment benefit for up to a year. As reported inLiss et al., the mean words-correct score for the ataxic tape was 43.2% and the mean for the hypokinetic tape was 41.8%.This allowed differences in the dependent variables to be interpreted as arising from differences in speech production characteristics, specifically syllabic strength contrasts. Statistically significant increases in vocal intensity were found at post-treatment, 6 months, and 12 month follow-up periods with intensity gains ranging from 5 to 17 dB depending on speaking condition and measurement period. Cell Tissue Res. long-term smoking, including passive; overweight; adverse heredity, genetic abnormalities (eg, narrowing of the heart vessels); frequent and deep stresses, hormonal disorders; viral, microbial, fungal infections (rubella, meningitis, aspergillosis, etc. Patients were asked to produce any utterance while facing the clinician (with mouth directed toward microphone head of sound level meter). This is the only form a dysarthria where you will see an increase in the rate of speech. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Try downloading instead. In this analysis there were significant treatment effects for sustained vowel (F[1,108] = 329.06, p < 0.001), reading (F[1,108] = 15.27, p < 0.001), and conversation (F[1,108] = 95.72, p < 0.001). Data for this study was collected from patient records of the clinical population at Parkinson Voice Project in Richardson, TX, who were treated between March 2011 and October 2014, who completed at least 12 treatment sessions and for whom pre-treatment and post-treatment data were recorded. Online ahead of print. Christopher R Watts Davies School of Communication Sciences & Disorders, Texas Christian University, TCU Box 297450, Fort Worth, TX 76129 USA. Less is known, however, regarding long-term outcomes of clinical benefit in speakers with PD who receive these treatments. … Enhance & clarify natural speech with this simple yet powerful augmentative communication app for dysarthria & aphasia. Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT): a pilot study. To improve voice quality by increasing stability of vocal fold vibration. By design, the phrases on the two dysarthria tapes were of equivalent intelligibility. El Sharkawi A, Ramig L, Logemann JA, Pauloski BR, Rademaker AW, Smith CH, et al. To improve voice quality by increasing stability of vocal fold vibration. 22, No. © 2021 Springer Nature Switzerland AG. Speech treatments have been developed to rehabilitate the vocal subsystems underlying this impairment. Speech treatments have been developed to rehabilitate the vocal subsystems underlying this impairment. Laryngeal electromyography in adults with Parkinson’s disease and voice complaints. Saunders; 1975. Mean years post-diagnosis onset at which treatment first began was 7.0 years. If they also have deficits in phonation because of a unilateral vocal fold weakness, then you can target both at the same time. Statistically significant increases in vocal intensity were found at post-treatment, 6 months, and 12 month follow-up periods with intensity gains ranging from 5 to 17 dB depending on speaking condition and measurement period. Ramig LO, Fox C, Sapir S. Speech treatment for Parkinson’s disease Expert Rev. This can be In all comparisons vocal intensity increased as a result of treatment. Guidelines for Speech Recording and Acoustic Analyses in Dysarthrias of Movement Disorders. 2014;57(5):1330–43. To compare treatment outcomes separate one-way multivariate analyses of variance (MANOVA) with repeated measures were applied to the pre-treatment and post-treatment data. Correspondence to Spastic dysarthria is caused by damage to the upper motor neurons. The classic clinical presentation of speech impairment in PD is characterized by a perceptually salient low volume and breathy voice quality, short rushes of speech, and imprecise articulation [2]. -, Braak H, Ghebremedhin E, Rub U, Bratzke H, Del Tredici K. Stages in the development of Parkinson’s disease-related pathology. 2001;71(4):493–8. These findings are supported by outcome studies reporting treatment outcomes within a few months post-treatment, in addition to prior studies that have reported long-term outcome results. Rusz J, Tykalova T, Ramig LO, Tripoliti E. Mov Disord. Gracco C, Marek K. Laryngeal eledromyographic findings in Parkinson’s disease. This theory links the basal ganglia mediation of physical effort sense to the reduced vocal effort and subsequent low volume characterizing speech patterns of speakers with PD. Article  Curr Opin Otolaryngol Head Neck Surg. PubMed  Hypokinetic Dysarthria in Parkinson’s Disease Abdul Haleem Butt 2012 Master Thesis Computer Engineering Nr: E4105D . Wiley K, Elandary S. SPEAK OUT!® a practical approach to treating Parkinson’s. The author has no financial disclosures to report associated with this research. Learn about the causes of dysarthria and the available treatment options here. of their disease,1 summarized under the term hypokinetic dysarthria2 or dysarthrophonia. Therapy for hypokinetic dysarthria focuses on increasing loudness, reducing speech rate, and improving articulation. Interestingly, the focus on increasing the amplitude of motor activity during LSVT has also been shown to improve articulation and swallowing abilities in some patients, reportedly due to carry-over effects in neuromotor abilities associated with structures and pathways tangentially trained in the LSVT exercises [15–17]. For the pre-treatment vs. post-treatment analysis, there was a significant main effect for measurement period (Pillai’s Trace = 0.793, F[3,152] = 193.7, p < 0.001) with a corresponding large effect size as calculated by partial eta squared (η2 = 0.793), which reflects the error variance between the three speaking conditions as a percent variance explained. BMC Ear, Nose and Throat Disorders Reports which document clinical outcomes from larger samples, both in retrospective and prospective designs, will better inform clinical practice and evidence-based application of treatment approaches. Hypokinetic Dysarthria in Parkinson’s Disease Abdul Haleem Butt 2012 Master Thesis Computer Engineering Nr: E4105D . See this image and copyright information in PMC. Among the physiological impairments resulting from Parkinson’s disease (PD) include the onset and progression of hypokinetic dysarthria. 22, No. Effect sizes for mean intensity change comparing pre-treatment to the 6-month follow-up period remained large at d = 3.46, d = 0.75, and d = 1.87 for vowel, reading, and conversation, respectively. Answer The prominent speech characteristics are reduced vocal loudness and vocal decay, meaning that over time there is a fading in the loudness. Philadelphia: Elsevier; 2005. Data was recorded from patient files that underwent at least 12 treatment sessions. This study did not include a rigid control over mouth-to-microphone distance, which is known to influence measurements of acoustic intensity. 2013;122(5):294–8.  |  Hypokinetic Dysarthria. Another related treatment focusing on vocal scaling, called “SPEAK OUT!®”, targets vocal effort by prompting patients to speak with “intent”, defined and modeled as a purposeful cognitive focus on increasing vocal loudness and intonation variability during speech [19]. 2004;318:121–34. Patients were asked to speak with “intent” for every production throughout the treatment hierarchy. All patients received a structured, intensive program of voice therapy focusing on speaking intent and loudness. The positive treatment outcomes experienced by the PD cohort in this study are consistent with treatment responses subsequent to other treatment approaches which focus on high-intensity, clinician guided motor learning for voice and speech production in PD. Speech FlipBook. Individuals with Parkinson’s disease (PD) exhibit hypokinetic dysarthria, which is a motor speech disorder caused by d amage to the basal ganglia control circuit. Due to the retrospective nature of the design treatment fidelity could not be assessed. Remacle M, Lawson G. Results with collagen injection into the vocal folds for medialization. Deane KH, Whurr R, Playford ED, Ben-Shlomo Y, Clarke CE. 2014;22(6):466–71. Each treatment session is structured with a hierarchy of speech, voice, and cognitive exercises progressing in the following manner: warm-up vocalizations → sustained vowel production → pitch glides → counting → reading → cognitive exercises. A retrospective study of long-term treatment outcomes for reduced vocal intensity in hypokinetic dysarthria. The author would like to thank Samantha Elandary and the clinicians at the Parkinson Voice Project in Richardson, TX for allowing IRB approved access to historical data. Collectively, the results of this study further support the notion that intensive speech and voice treatments focusing on vocal effort scaling are effective for increasing speaking intensity secondary to Parkinson’s disease. A retrospective study of long-term treatment outcomes for reduced vocal intensity in hypokinetic dysarthria . Google Scholar. Sinclair CF, Gurey LE, Brin MF, Stewart C, Blitzer A. Surgical management of airway dysfunction in Parkinson’s disease compared with Parkinson-plus syndromes. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Each patient whose file was included in this study received three treatment sessions per week and completed homework exercises for which they returned homework logs at the subsequent treatment session. A retrospective study of long-term treatment outcomes for reduced vocal intensity in hypokinetic dysarthria BMC Ear Nose Throat Disord. Curr Opin Otolaryngol Head Neck Surg. 2014;57(5):1330–1343. During treatment sessions, patients were cued by asking them to determine if prior utterances were produced with “intent” or not, and where appropriate “intent” was modeled for them by the clinician. DOI identifier: 10.1186/s12901-016-0022-8. Author information: (1)Davies School of Communication Sciences & Disorders, Texas Christian University, TCU Box 297450, Fort Worth, TX 76129 USA. The influence of speaking task on sound intensity and the differential influence of speaking task on response to treatment in patients with PD has also been demonstrated in prior studies [21]. Laryngeal findings in advanced Parkinson’s disease. The short-term efficacy of the Lee Silverman Voice Treatment (LSVT) and the short- and long-term efficacy of LSVT exercises combined with respiration treatment and physical therapy (Combination Treatment) were examined for a young man diagnosed with mixed hypokinetic-spastic dysarthria 20 months after sustaining a traumatic brain injury (TBI). Dysarthria is commonly reflected in multiple motor-speech systems; however, in many patients a single motor-speech system may be affected. The cognitive exercises focused on improving word retrieval and processing speed. Learn vocabulary, terms, and more with flashcards, games, and other study tools. This study investigated the effect of an intensive speech treatment focusing on rescaling of vocal effort to treat reduced vocal intensity due to hypokinetic dysarthria in PD. Start studying Hypokinetic Dysarthria. J Speech Lang Hear Res. Part of Springer Nature. , , Pathogenesis. These are not meant to be exhaustive but serve as examples of possible goals for patients with dysarthria and/or AOS. The authors reported significant improvements in participants’ perceptions of quality of life and perceived effort of voice production. DOI identifier: 10.1186/s12901-016-0022-8. Of the 22 who did not complete 12 treatments, reasons included (a) meeting treatment goals prior to 12 treatments or (b) illness or other life situations requiring withdrawal from treatment. Int J Lang Commun Disord. Wight S, Miller N. Lee Silverman voice treatment for people with Parkinson’s: audit of outcomes in a routine clinic. Collectively the statistical analyses revealed a significant treatment effect on vocal intensity measured at post-treatment, 6-month follow-up, and 12-month follow-up when compared to pre-treatment vocal intensity. Stathopoulos ET, Huber JE, Richardson K, Kamphaus J, DeCicco D, Darling M, Fulcher K, Sussman JE. Dromey C, Ramig LO, Johnson AB. J Speech Lang Hear Res. volume 16, Article number: 2 (2016) The dependent variable for all analyses was vocal intensity in decibels (dBSPL). Results: The results revealed no dominant theoretical framework for long-term goals, whereas short-term goals largely reflected a sensory-motor framework. Sapir (2014) has suggested that this model could explain why hypokinetic dysarthria is not sensitive to dopamine replacement therapy (cranial nerves are influenced by dopaminergic pathways, but do not directly utilize dopamine for neuronal communication) [3]. Interpret your findings using the Dysarthria Differential Diagnosis Tool. Speech treatments have been developed to rehabilitate the vocal subsystems underlying this … Duffy JR. Motor speech disorders: Substrates, differential diagnosis, and management. Theories regarding the underlying neurophysiological response to treatment will be discussed. Baker KK, Ramig LO, Luschei ES, Smith ME. 2015;50(2):215–25. Dysarthria treatment (i.e., speech therapy) depends on the specific type of speech disturbance, and is based on compensation, augmentation, or an exercise program (Berry et al., 1974). Although long-term treatment effects across all speaking conditions are not unequivocal among previously reported investigations, the significant 6-month and 12-month follow-up effects found in this study are consistent with prior studies investigating long-term treatment effects secondary to LSVT [21, 22]. PubMed  DOI identifier: 10.1186/s12901-016-0022-8. The positive treatment outcomes experienced by the PD cohort in this study are consistent with treatment responses subsequent to other treatment approaches which focus on high-intensity, clinician guided motor learning for voice and speech production in PD. In total, 147 long-term and 490 short-term goals were coded. In the pre-treatment vs. 12-month follow-up analysis there was a significant main effect for measurement period (Pillai’s Trace = 0.692, F[3,56] = 42.03, p < 0.001) with a corresponding large effect size (η2 = 0.685). NIH National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error, Mean minimum intensity (in dB) levels across the three speaking condition at four measurement timeframes: pre-treatment (. Dysarthria and the cookie theft picture and/or the caterpillar passage mirror, a mirror a!, Richardson K, Elandary S. SPEAK OUT! ® a practical approach to treating ’! 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