Voice loudness, self-assessment, and auditory-sensory feedback in voice production in Parkinson’s disease
Parkinson’s disease (PD) often causes decreased voice loudness. Several studies suggest that this may be due to impaired auditory feedback for the own voice regulation (Huang et al., 2019; see also Guenther et al., 2006). Furthermore, individuals with PD (IwPD) may not fully recognize their vocal issues, making patient reported outcome measures (PROMs) less effective to diagnose their speech and voice difficulties. Despite this, voice self-assessment is still the most used method for diagnosis of vocal impairments in clinical settings. In order to gain insight into the mechanisms of voice loudness feedback in IwPD, three studies were conducted. In Study 1, we compared the validity of the VoiSS PROMs scale for detecting voice dysfunction in a group of IwPD and a group of individuals with General Voice Disorders (GVD). In Study 2, we employed acoustic speech analysis to investigate whether a group of individuals with IwPD exhibited difficulties in adapting their voice intensity to specific situations where they received auditory feedback that was manipulated. In Study 3, we used the Motor-Induced Suppression (MIS) method to observe N1 and P2 responses to the own voice, thus exploring possible differences between IwPD and healthy individuals in their electrophysiological responses associated to voice feedback mechanisms. Our results suggest that IwPD report fewer vocal symptoms than GVD in VoiSS (although they present voice dysfunctions, in clinical examinations and acoustic analysis of their voice). IwPD also show less adaptation to changes in the own voice, such as an increased amplitude after phonation, and have compromised suppression mechanisms affecting ERP amplitudes.
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