Hypokinetic dysarthria is a highly prevalent and functionally disabling communication disorder in Parkinson's disease (PD), encompassing hypophonia, imprecise articulation, and festinating speech. Music-supported vocal rehabilitation-operationalized through the Accent Method (AM), a rhythm- and breathing-based voice therapy approach grounded in hierarchical respiratory-phonatory-prosodic coordination-offers a theoretically grounded mechanism for addressing PD dysarthria by exploiting the well-documented facilitatory effect of external rhythmic auditory cueing on motor control in PD. Despite widespread clinical use of the AM in Scandinavian centers, rigorous controlled evidence for its effects on voice intensity and speech performance in PD remains limited. Prospective, parallel-group, randomized controlled trial comparing a structured, four-phase PD-adapted AM protocol with an active nonspecific control program (vocal hygiene and general breathing exercises) over 20 weeks. Ninety-two adults with idiopathic PD (Hoehn and Yahr stages 2-3) were randomized to music-supported AM rehabilitation (n = 46) or active control (n = 46). Blinded assessors evaluated outcomes at baseline and at 6, 12, and 20 weeks. Primary outcome: Voice Handicap Index-30 (VHI-30). Secondary outcomes: GRBAS perceptual dysphonia scale, sound pressure level (SPL), maximum phonation time (MPT), acoustic parameters (jitter, shimmer, fundamental frequency [F0]), speech intelligibility rated by blinded naive listeners, UPDRS speech sub-item, and PDQ-39 communication subscale. All between-group comparisons at 20 weeks favored music-supported AM rehabilitation (all P < 0.001, Bonferroni corrected; adjusted α = 0.005). VHI-30 improvement: -36.8 points (AM) vs. -9.4 points (Control); between-group difference 26.8 points (95% CI: 22.2-31.4; Cohen's d = 2.47). Voice intensity (SPL) improved by +14.8 dB in the AM group versus +4.3 dB in the control group-a nearly threefold greater improvement. Speech intelligibility improved from 67.4% to 84.6% in the AM group versus 68.1% to 73.4% in the control group (+17.2%-point between-group difference), representing a movement from clinically impaired intelligibility to near-functional communicative levels. Jitter normalized from 4.12 ± 0.98% to 1.04 ± 0.31% (AM) versus 4.08 ± 0.94% to 2.96 ± 0.77% (Control), and shimmer from 10.41 ± 2.37% to 3.18 ± 0.84% versus 10.28 ± 2.29% to 6.74 ± 1.61%. Effect sizes were large to very large across all domains (Cohen's d range: 1.41-2.47). Music-supported vocal rehabilitation using the PD-adapted Accent Method yields large, consistent, and clinically meaningful improvements in voice intensity, acoustic stability, speech intelligibility, and communication-related quality of life compared with an active nonspecific control program. These findings establish the AM as an evidence-based behavioral management option for PD-associated hypokinetic dysarthria. Head-to-head comparative trials against LSVT LOUD and SPEAK OUT! are the essential next step.

This study investigated whether different types of dysarthric speech (with comparable baseline intelligibility) are equally susceptible to background noise. Using intrinsically degraded speech from four individuals with dysarthria, each representing a distinct motor speech disorder subtype, we examined how intelligibility is impacted by masker type (stationary vs fluctuating noise) and signal-to-noise ratio (SNR). Ninety-five listeners completed a listening task with stationary speech-shaped noise or ecologically valid cafeteria noise, across multiple SNRs. Although all degraded signals showed intelligibility declines in noise, the extent and pattern of decline varied, suggesting that not all forms of pathological degradation interact with background noise in the same way. Notably, the typical intelligibility benefit associated with fluctuating maskers (i.e., masking release) was absent for all dysarthric signals. These findings reveal that equivalently intelligible but qualitatively different dysarthric signals do not respond uniformly to environmental challenges. The results have implications for models of speech perception, which must account for complex interactions between intrinsic (speaker-specific) and external (environmental) degradations, as well as for real-world communication and intervention strategies.

Automated analysis of speech and language provides a critical opportunity for developing a scalable tool for general medical settings to aid in psychiatric diagnosis and triage. In a cross-diagnostic highly comorbid sample, we evaluated the contribution of speech and language features to diagnostic classification through a hierarchical, dichotomous approach: first distinguishing healthy volunteers (HV) vs. participants with any psychiatric disorder (Split 1), then identifying those with serious mental illness (SMI) vs. other psychiatric disorders (Split 2). Speech was collected from 266 participants via picture description, verbal fluency, paragraph reading, and open-ended verbal journaling tasks. We extracted 640 interpretable features spanning acoustic, temporal, lexical, syntactic, discourse, and coherence domains. LightGBM models were trained with 5-fold cross-validation comparing all combinations of speech tasks, and SHAP values were plotted for feature importance. For Split 1, the best-performing model achieved F1=0.865 combining picture description and journaling tasks, with picture description alone reaching F1=0.830. For Split 2, performance was moderate (F1=0.626), with picture description also as the best single task. Top features for Split 1 included amplitude instability (shimmer) and restricted pitch variance; Split 2 was influenced by articulation rate and filled pauses. This study represents a novel classification approach in a naturalistic, clinically complex sample. Findings suggest that a brief, explainable speech-based assessment may be able to identify individuals who need further evaluation for psychiatric disorders. External validation, bias auditing, and deployment studies are warranted to assess clinical impact.

PurposeChildren with cleft conditions are at increased risk of language and speech disorders. Velopharyngeal dysfunction is a common sequela of palate repair, and children may develop cleft-type speech characteristics, with consequences in the academic, social, and ultimately employment, domains. Infants with certain speech behaviors are more likely to present with increased intelligibility at school age. These behaviors could be embedded into general language development strategies and taught to infants by their caregivers. This paper describes a study protocol investigating the effects of early language intervention strategies, as part of a caregiver-coached, group-based intervention in infants with cleft palate. The goal will be measured by changes in comprehension and expression, as well as the ratio of word to gesture use, attempts at oral plosive sounds, number of phonemes, and frequency and shape of babbling.MethodsWe will recruit up to 40 infants with cleft palate, plus their caregivers. Infants should be aged between 6 and 15 months. Families will attend a total of 12 sessions over 6 weeks and will complete demographic and communication-based questionnaires. Caregiver confidence will also be measured.ResultsWe hypothesize that, in addition to increasing the number of words or concepts that the infant can comprehend and express, there will be an increase in the specific speech behaviors that will be targeted in this intervention.ConclusionIf the study hypotheses are confirmed, these findings will provide support to better equip families with strategies to support speech and language development in the first 15 months of life.

Preoperative speech deficits in children with posterior fossa tumours (PFTs) may be linked to postoperative speech impairment (POSI), a hallmark of posterior fossa syndrome, yet this relationship remains underexplored. POSI is characterized by mutism or markedly reduced speech that resolves within weeks to months but often leaves persistent motor-speech deficits. Most existing literature has focused on postoperative outcomes, with limited attention to preoperative speech function. We therefore systematically investigated this association by analyzing perceptible motor-speech features in a large cohort of patients scheduled for surgery within the European Study of Cerebellar Mutism Syndrome. We included data from 135 children which formed three age-and sex- comparable groups: 16 patients who later developed POSI, 11 were mute and five had severely reduced speech (3;9-14;4 years), 62 patients with habitual speech (3;2-17;11 years), and 57 healthy controls (3;0-18;1 years). Patients were Italian-, Dutch-, and English-speaking, while controls were Dutch- and Italian-speaking. Four speech-language therapists rated participants' narrative recordings on 23 speech features (e.g., distorted vowels, imprecise consonants, stuttering, and hoarseness). Group comparisons revealed significant preoperative differences between the children who later developed POSI and the children with habitual speech in both hypernasality and in phonation-respiration (e.g., leaky, hoarse, and strained voice). In addition, patients who later developed POSI showed impairment compared to healthy controls in prosody (e.g., speech rate, excess and equal stress) and articulation (e.g., distorted vowels, imprecise consonants, sequencing errors). Patients with habitual speech differed from the controls in hypernasality and prosody. Moreover, age influenced the severity of articulatory and prosodic symptoms, with younger patients showing greater impairment. Children with PFT show signs of speech impairment preoperatively relative to healthy controls. When comparing patients, those later developing POSI show more severe impairments related to resonance and voice quality. This suggests possible differences in the degree to which speech-related underlying anatomical substrates were compromised, and these early differences may represent potential predictors of later POSI. These findings highlight the value of preoperative assessment for identifying children at a heightened risk of POSI, opening opportunities for prehabilitation - targeted early intervention in the form of speech therapy - to strengthen the speech-motor networks.

Pediatric speech sound disorders (SSDs) affect many young children and are commonly assessed through auditory-perceptual judgments and IPA transcription, which are limited by listener bias, variable interrater reliability, and difficulty attributing deviations at the phoneme level. We present a developmentally informed framework for pediatric vocal biomarker foundations that prioritizes age-aware, phoneme-resolved interpretability over utterance-level accuracy alone.