A serious game for speech training in dysarthric speakers with Parkinson's disease: Exploring therapeutic efficacy and patient satisfaction

Background: The increasing need for speech therapy due to our ageing population raises the demand on therapeutical resources. To meet this demand, innovative delivery of speech training is required. eHealth applications may provide a solution, as intensified and prolonged training is only possible and affordable in patients' home environment.

Aims: This study explores the effects on speech intelligibility of game-based speech training that provides automatic feedback on loudness, pitch and pronunciation. Additionally, we investigate how satisfied patients are with the game-based speech training and how they experience the automatic feedback. Furthermore, patients' preferences for game-based speech training compared with face-to-face training are explored.

Methods and procedures: Eight adult dysarthric speakers with Parkinson's disease (PD) completed a 4-week game-based speech training in their home environment. For each speaker, 24 speech utterances were audio recorded 4 weeks before (T1), immediately before (T2) and immediately after (T3) the training. All speech samples were rated on speech intelligibility by 10 untrained listeners, by comparing them with the corresponding utterances realized by a healthy speaker. Changes over time were analysed using a linear mixed-effects analysis. Patient satisfaction with the game and the automatic feedback was assessed using a questionnaire. The preferences of patients were collected using a paired comparisons procedure in which the patients were asked whether they would prefer game-based or face-to-face speech training in four hypothetical scenarios with different hypothesized levels of speech improvement.

Outcomes and results: While there was no significant difference in speech intelligibility ratings between T1 and T2, we did find one between T2 and T3. At T3, speech intelligibility was rated higher than at T2, indicating positive effects of the game-based speech training. Patients generally seemed satisfied with the game as average ratings were above 7 on a 10-point rating scale. Generally, patients agreed with the automatic feedback and could use it to positively change the way they spoke. Patients prefer the training that provides the highest hypothetical improvement, and thus do not prefer face-to-face above game-based therapy.

Conclusions and implications: The results of this study suggest that dysarthric speakers due to PD see game-based speech therapy as a valid alternative for face-to-face therapy and that it leads to an average improvement in speech intelligibility. For an optimal effect and user satisfaction it should preferably not be used in isolation but in combination with face-to-face training. In this manner, the strengths of both therapeutic deliveries can be harnessed.

What this paper adds: What is already known on this subject Dysarthric speech in patients with PD is known to benefit from intensified and long-term speech therapy. The increasing need for speech therapy due to our ageing population raises the demand on therapeutical resources making highly frequent and long-term therapy difficult. eHealth provides the opportunity to intensify and prolong speech training in patients' home environment. A drill-and-practice method was employed and investigated in a web-based speech application, indicating positive effects on speech intelligibility. However, participants indicated a lack of variation in exercises making the training less enjoyable. Other research showed that serious games can increase enjoyment during training. What this paper adds to existing knowledge The results of this study show that it is possible to develop a serious game that can be successfully used for speech training by patients with dysarthria due to PD. Comparing speech intelligibility ratings before and after training, we observed significant improvements in speech intelligibility ratings. Patients generally agree with the automatic feedback and can use it to positively change the way they speak. Average ratings were above 7 on a 10-point scale, indicating that patients are satisfied with the game. Patients prefer the type of training (game based or face to face) that provides the highest hypothetical improvement. What are the potential or actual clinical implications of this work? The results of this study suggest that game-based speech training can improve speech intelligibility in patients. This indicates that it can be considered a suitable approach in the treatment of patients with dysarthria due to PD. Patients do not prefer game-based training above face-to-face training in all scenarios. For that reason, for every patient one should carefully consider how to optimally combine game-based and face-to-face training.