A Study Of The Effect Of Auditory Feedback On Voice In Patients With Stage 1-3 Parkinson's Disease

The report of the 19 th National Congress of the Communist Party of China in 2017 stated in the“carrying out the Healthy China initiative” that “as we respond proactively to population aging,we will provide integrated elderly care and medical services,and accelerate the development of old-age programs and industries”.With the advent of an aging society,the health problems of the elderly have become increasingly important.Parkinson's disease is a common neurodegenerative disease in the elderly.Because of its high morbidity,prevalence and disability rate,Parkinson's disease has become an important disease that seriously threatens the health and quality of life of the elderly.Therefore,researchers all over the world should pay attention to the research on early detection,diagnosis and therapy for Parkinson's disease.Speech communication is an indispensable part of daily life.Speech disorders in Parkinson's disease patients will inevitably affect communication and reduce their quality of life.While the improvement of patients' quality of life and the final return of patients to society are the functions and purposes of rehabilitation.Foreign research shows that only 3% to 4% of the patients currently undergo speech therapy,mainly because of the poor aftereffects and long-term effects of speech therapy.While the voice function as an important aspect of speech functions,the importance of its assessment and therapy is self-evident.On the other hand,auditory disorders as non-motor symptoms in patients do not give rise to researchers the same attention as the study of olfactory disorders.Brainstem auditory evoked potentials in Parkinson's disease are widely studied in China.However,there is still a lack of other objective audiometry and subjective audiometry,especially for speech audiometry which is more important in daily life.Speech production and speech perception mutally influence and interact with each other to accomplish the purpose of communication.The role of the auditory system in the process of speech production is mainly reflected in the online control and adjustment by auditory feedback.The role of the speech motor system in speech perception is that it is activated when speech is perceived,and adjusts the function of speech perception.At present,there are few studies on the effect of auditory feedback on voice function in patients with Parkinson's disease.From what is stated above,we study the effect of auditory feedback on voice of Parkinson's disease patients,and propose more effective and pertinent precision rehabilitation practice recommendations for the rehabilitation of voice disorders.The study consists of three parts.The specific research methods and results are as follows:The first part is the study of the characteristics of auditory function.Firstly,puretone audiometry and speech audiometry were performed on 17 male and 15 female patients with stage 1-3 Parkinson's disease and 15 male and 17 female normal controls.Pure-tone audiometry results showed that the patients had more severe low-frequency,mid-frequency and high-frequency hearing loss than the controls,especially at high frequencies.Male patients had more severe high-frequency hearing loss than female,and female patients may have more severe low-frequency hearing loss than male.Speech audiometry results showed that the speech recognition threshold was significantly higher in patients than in controls.From the longitudinal comparison of the three hearing levels of 70 dB HL,50 dB HL and 30 dB HL,as the level of hearing reduced,the speech recognition score of initials,finals and tones decreased respectively.In addition to the controls' finals recognition score of 70 dB HL,both the patients and the controls showed tones recognition score > finals recognition score > initials recognition score at the same hearing level.The patients' initials recognition score was more dependent on the hearing levels than the finals and tones.Secondly,there were 10 patients with stage 1-3 Parkinson's disease and 10 normal controls,with 5 males and 5 females in each group were involved with method of constant stimulation to study pitch differenz limen,loudness differenz limen and delay reiz limen.The results indicated that the patients' pitch differenz limen,loudness differenz limen and delay reiz limen range were 18.00-126.83 Hz,1.08-6.00 dB HL,and 54.35-317.86 ms,and the controls' pitch differenz limen,loudness differenz limen and delay reiz limen range were 9.85-137.62 Hz,1.19-7.65 dB HL,and 52.08-407.14 ms.The purpose of the sensory threshold study was to obtain preliminary threshold of the patients and controls,not the difference between them.The results also provided data support for transformed auditory feedback experiments with transformation range parameters.The second part is the study of the characteristics of voice function.By using the Voice Handicap Index,a subjective assessment of voice was performed on 15 male and 15 female patients with stage 1-3 Parkinson's disease and 14 male and 14 female normal controls.Meanwhile,“Dr.Speech-1c” and “Dr.Voice-1”were applied to analyze their voice acoustic signal and electric glottis signal.The results showed that the subjective assessment and objective measurement were all important methods for voice disorders,and they were complementary and indispensable.Acoustic measurements of the voice indicated that the patients' fundamental frequency tremor,amplitude tremor and standard deviation of the fundamental frequency were significantly higher than the controls.There was no obvious abnormality in the patients' electric glottis measurements.This is an objective measurement of the characteristics of voice disorders,providing a new auxiliary examination and diagnosis pathway for early detection and diagnosis of Parkinson's disease.The third part is the study of the effect of auditory feedback on voice.Two procedures named “calibration” and “transformation” were generated based on the MATLAB R2016 b to carry out the frequency-altered auditory feedback(semitone and whole tone),loudness-altered auditory feedback(6dB and 12 d B),Lombard experiment(speech-spectrum noise and speech masking)and delayed auditory feedback(200ms and 400ms)of 8 male and 7 female patients with stage 1-3 Parkinson's disease and 8 male and 7 female normal controls.The results of frequency-altered auditory feedback showed that the patients were more sensitive to semitone and ascent fundamental frequency alteration.Semitone should be used as the initial pitch interval for therapy,and ascent auditory feedback should be enhanced.The results of loudness-altered auditory feedback showed that the patients were more sensitive to 6 dB amplitude and increase intensity alteration.6 dB should be chosen as the initial intensity amplitude for therapy,and increase intensity auditory feedback should be enhanced.The results of Lombard experiment indicated that the standard deviation of intensity and the amplitude perturbation reduced under the masking of speech-spectrum noise,while both of them increased under speech masking.This situation indicated that speech masking had a greater effect on the vocal cord amplitude.The decrease extent for habitual and the standard deviation of the foundmental frequency in the controls under speech masking was less than that of the speech-spectrum noise,indicating that the controls had a greater response to the speech-spectrum noise than the patients,in other words,the controls were more able to adapt to the changes of the voice by speech masking.The results of delayed auditory feedback showed that the acoustic signal of the voice was not affected by the patients' and the controls' auditory feedback with 200 ms and 400 ms delay.Combined with the results of other studies,it was concluded that the 200 ms delay effect reported may be reflected in the influence on speech fluency,and it did not affect the pronunciation of /?/.The innovative results of this study and its theoretical and practical implications are:(1)The fundamental frequency tremors,amplitude tremors,and standard deviation of the fundamental frequency reported for the first time in this study are significantly increased in patients with stage 1-3 Parkinson's disease through objective acoustics measurements of the characteristics of voice disorders.Combined with the current proposals of Parkinson's disease diagnosis and their limitations,we believe that the objective acoustic measurement and analysis of the characteristics of patients with voice disorders can be an important auxiliary examination item for early diagnosis.(2)In the absence of reports of pure-tone audiometry and speech audiometry in patients with Parkinson's disease in our country,this study performed subjective audiometry.Combined with previous reports of brainstem auditory evoked potentials,it is confirmed that there are indeed obvious auditory disorders in patients,suggesting that aural rehabilitation and voice and speech rehabilitation must pay attention to auditory disorders.(3)To determine the ranges of frequency alteration,intensity alteration and delay,we propose the method of constant stimulation to study pitch differenz limen,loudness differenz limen and delay reiz limen of the patients with Parkinson's disease in psychophysics for the first time.The feedback should first be able to be captured with the changes of auditory information,and then the subjects make corresponding acoustic adjustments.So this study is more evidence-based than others.(4)Two procedures named “calibration” and “transformation” were generated based on the MATLAB R2016 b to accomplish the purposes of frequency alteration,intensity alteration,noise addition and delay.We have changed the processing mode of the previous research on the linear change of the fundamental frequency,and in the specific implementation stage we propose four kinds of auditory feedback “manual,unordered and simultaneous”in order to get close to daily life.In the audio analysis part,“Dr.Speech-1c” and “Dr.Voice-1”were applied to comprehensively evaluate the effect of single-attribute parametric transformation on the pitch,loudness and tone quality of vioce,which is more in line with linguistic features.So this study has a certain reference significance for future study.(5)The study of the effect of auditory feedback on voice provides a new idea and approach for the therapy of voice and speech disorders in patients with Parkinson's disease and other patients with voice and speech disorders by using auditory feedback.More precise frequency and intensity alterations have been proposed for tonality and loudness assessment and therapy.The principle and method could supply precision rehabilitation for the patients' voice and speech disorders according to precision assessment and precision therapy.