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Allison KM, Yunusova Y, Green JR. Shorter Sentence Length Maximizes Intelligibility and Speech Motor Performance in Persons With Dysarthria Due to Amyotrophic Lateral Sclerosis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:96-107. [PMID: 31072158 PMCID: PMC6503867 DOI: 10.1044/2018_ajslp-18-0049] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 07/10/2018] [Accepted: 07/28/2018] [Indexed: 05/16/2023]
Abstract
Purpose The purpose of this study was to investigate the effect of sentence length on intelligibility and measures of speech motor performance in persons with amyotrophic lateral sclerosis (ALS) and to determine how these effects were influenced by dysarthria severity levels. Method One hundred thirty-one persons with ALS were included in this study, stratified into 4 dysarthria severity groups. All participants produced sentences from 5 to 15 words in length. Intelligibility, speaking rate, and measures of speech pausing behavior (i.e., total speech duration, total pause duration, and mean speech event duration) were measured for each sentence. Linear mixed-effects models were used to determine the effect of sentence length on speech measures for speakers at different dysarthria severity levels. Results Results showed that speech intelligibility significantly declined at longer sentence lengths only for the speakers with ALS who had more advanced dysarthria symptoms; however, speakers with mild-to-severe dysarthria showed significant declines in speaking rate and speech pausing behavior at longer sentence lengths. Conclusions Findings suggest that producing shorter sentences may help maximize intelligibility for speakers with moderate-to-severe dysarthria secondary to ALS and may be a beneficial compensatory strategy for preserving motor effort for all speakers with dysarthria secondary to ALS.
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Affiliation(s)
- Kristen M. Allison
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Bioscience and Technology Program, Harvard Medical School, Boston, MA
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Yunusova Y, Plowman EK, Green JR, Barnett C, Bede P. Clinical Measures of Bulbar Dysfunction in ALS. Front Neurol 2019; 10:106. [PMID: 30837936 PMCID: PMC6389633 DOI: 10.3389/fneur.2019.00106] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/28/2019] [Indexed: 12/31/2022] Open
Abstract
Bulbar impairment represents a hallmark feature of Amyotrophic Lateral Sclerosis (ALS) that significantly impacts survival and quality of life. Speech and swallowing dysfunction are key contributors to the clinical heterogeneity of ALS and require well-timed and carefully coordinated interventions. The accurate clinical, radiological and electrophysiological assessment of bulbar dysfunction in ALS is one of the most multidisciplinary aspects of ALS care, requiring expert input from speech-language pathologists (SLPs), neurologists, otolaryngologists, augmentative alternative communication (AAC) specialists, dieticians, and electrophysiologists—each with their own evaluation strategies and assessment tools. The need to systematically evaluate the comparative advantages and drawbacks of various bulbar assessment instruments and to develop integrated assessment protocols is increasingly recognized. In this review, we provide a comprehensive appraisal of the most commonly utilized clinical tools for assessing and monitoring bulbar dysfunction in ALS based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) evaluation framework. Despite a plethora of assessment tools, considerable geographical differences exist in bulbar assessment practices and individual instruments exhibit considerable limitations. The gaps identified in the literature offer unique opportunities for the optimization of existing and development of new tools both for clinical and research applications. The multicenter validation and standardization of these instruments will be essential for guideline development and best practice recommendations.
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Affiliation(s)
- Yana Yunusova
- Department of Speech Language Pathology, University of Toronto, Toronto, ON, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Volcal Tract Visualization Lab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Emily K Plowman
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, United States
| | - Jordan R Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, United States.,Speech and Hearing Biosciences and Technology Program, Harvard University, Cambridge, MA, United States
| | - Carolina Barnett
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Peter Bede
- Computational Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
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53
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Pattee GL. Caring for the ALS patient today: Are we under-utilizing our available clinical tools? Muscle Nerve 2019; 59:149-151. [DOI: 10.1002/mus.26362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 09/19/2018] [Accepted: 10/16/2018] [Indexed: 11/09/2022]
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54
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Chiaramonte R, Di Luciano C, Chiaramonte I, Serra A, Bonfiglio M. Multi-disciplinary clinical protocol for the diagnosis of bulbar amyotrophic lateral sclerosis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2017.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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55
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Utianski RL, Botha H, Duffy JR, Clark HM, Martin PR, Butts AM, Machulda MM, Whitwell JL, Josephs KA. Rapid rate on quasi-speech tasks in the semantic variant of primary progressive aphasia: A non-motor phenomenon? THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2018; 144:3364. [PMID: 30599666 PMCID: PMC6296908 DOI: 10.1121/1.5082210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/16/2018] [Accepted: 11/17/2018] [Indexed: 06/09/2023]
Abstract
This study examined the rate of producing alternating motion rates, sequential motion rates (SMRs), and repeated words in 27 individuals with the semantic variant of Primary Progressive Aphasia (svPPA). Only the rate of producing SMRs was significantly elevated in svPPA compared to controls. This may be associated with concomitant neuropsychiatric symptoms in svPPA, as correlation analysis showed a relationship between increased SMR rate and the Neuropsychiatric Inventory Questionnaire, which documented anxiety and disinhibition. Future studies will assess these findings in a larger cohort and work to better understand if this phenomenon is a manifestation of behavioral and/or motor changes.
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Affiliation(s)
- Rene L Utianski
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55902, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55902, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55902, USA
| | - Heather M Clark
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55902, USA
| | - Peter R Martin
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota 55902, USA
| | - Alissa M Butts
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota 55902, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota 55902, USA
| | | | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55902, USA
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56
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Christidi F, Karavasilis E, Rentzos M, Kelekis N, Evdokimidis I, Bede P. Clinical and Radiological Markers of Extra-Motor Deficits in Amyotrophic Lateral Sclerosis. Front Neurol 2018; 9:1005. [PMID: 30524366 PMCID: PMC6262087 DOI: 10.3389/fneur.2018.01005] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/06/2018] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is now universally recognized as a complex multisystem disorder with considerable extra-motor involvement. The neuropsychological manifestations of frontotemporal, parietal, and basal ganglia involvement in ALS have important implications for compliance with assistive devices, survival, participation in clinical trials, caregiver burden, and the management of individual care needs. Recent advances in neuroimaging have been instrumental in characterizing the biological substrate of heterogeneous cognitive and behavioral deficits in ALS. In this review we discuss the clinical and radiological aspects of cognitive and behavioral impairment in ALS focusing on the recognition, assessment, and monitoring of these symptoms.
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Affiliation(s)
- Foteini Christidi
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratios Karavasilis
- Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Rentzos
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Evdokimidis
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Peter Bede
- Computational Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
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57
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Theme 14 Palliative care and decision making. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:375-388. [DOI: 10.1080/21678421.2018.1510584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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58
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Rong P, Yunusova Y, Richburg B, Green JR. Automatic extraction of abnormal lip movement features from the alternating motion rate task in amyotrophic lateral sclerosis. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 20:610-623. [PMID: 30253671 PMCID: PMC6449219 DOI: 10.1080/17549507.2018.1485739] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/03/2018] [Accepted: 06/04/2018] [Indexed: 05/19/2023]
Abstract
Purpose: With the long-term goal to develop a clinically feasible tool for assessing articulatory involvement in ALS, we designed an algorithmic approach to automatically extract lip movement features during an alternating motion rate (AMR) task and assessed their efficacy for detecting and monitoring articulatory involvement in amyotrophic lateral sclerosis (ALS). Method: Twenty three spatial, temporal, and spatiotemporal AMR features were extracted from 161 samples of lip movements (139 from participants with ALS; 22 from neurologically-intact participants). The diagnostic value of these features was assessed based on their (1) sensitivity for detecting early bulbar motor involvement, and (2) associations with accepted clinical measures of bulbar disease progression. Result: Among all AMR features, two temporal features were the most affected - temporal variability and syllable frequency, which (1) showed large changes during early disease stages and (2) predicted the progression of bulbar motor involvement and speech intelligibility decline. Spatial features were in general, less sensitive to early bulbar motor involvement. Conclusions: The findings provided preliminary support for the algorithmic approach to quantifying articulatory features predictive of bulbar motor and speech decline in ALS. The differential disease effects on spatial and temporal AMR features might shed light on the mechanism of articulatory involvement during ALS progression.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, University of Kansas, 100 Sunnyside Avenue, Lawrence, KS 66045
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5
| | - Brian Richburg
- Department of Communication Sciences & Disorders, MGH Institute of Health Professions, 36 First Avenue, Boston, MA 02129
| | - Jordan R. Green
- Department of Communication Sciences & Disorders, MGH Institute of Health Professions, 36 First Avenue, Boston, MA 02129
- Harvard Medical School, Speech and Hearing Biosciences and Technology Program, 1350 Massachusetts Avenue, Suite 350, Cambridge, MA 02138-3654
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59
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Smith KM, Caplan DN. Communication impairment in Parkinson's disease: Impact of motor and cognitive symptoms on speech and language. BRAIN AND LANGUAGE 2018; 185:38-46. [PMID: 30092448 DOI: 10.1016/j.bandl.2018.08.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 07/21/2018] [Accepted: 08/02/2018] [Indexed: 06/08/2023]
Abstract
Communication impairment is common in Parkinson's disease (PD) and may have both motor speech control and cognitive-linguistic underpinnings. The neurobiology of communication impairment in PD is poorly understood, and work is needed to disentangle the relative contributions of motor and cognitive dysfunction. In clinical practice, cognitive-linguistic impairments are often overlooked despite the large body of research on this topic in neurocognitive and linguistics literature. In this review, we will discuss the roles of motor speech changes, cognitive and linguistic impairment, and other related functions in the communication disabilities of individuals with PD. We will describe the various types of communication difficulties in PD and tools for measuring these symptoms. We will discuss specific deficits that may further understanding of the neurobiology of communication impairment in PD, including voice and speech acoustic changes, linguistic processing and production difficulties, and pausing. We will emphasize the importance of an interdisciplinary approach and the patient perspective on daily communication in guiding future research.
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Affiliation(s)
- Kara M Smith
- University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - David N Caplan
- Massachusetts General Hospital, 175 Cambridge Street, Boston, MA 02114, USA.
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60
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Green JR, Allison KM, Cordella C, Richburg BD, Pattee GL, Berry JD, Macklin EA, Pioro EP, Smith RA. Additional evidence for a therapeutic effect of dextromethorphan/quinidine on bulbar motor function in patients with amyotrophic lateral sclerosis: A quantitative speech analysis. Br J Clin Pharmacol 2018; 84:2849-2856. [PMID: 30152872 PMCID: PMC6256051 DOI: 10.1111/bcp.13745] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/23/2018] [Accepted: 08/16/2018] [Indexed: 12/28/2022] Open
Abstract
Aims A recent double‐blind placebo‐controlled crossover 70‐day trial demonstrated that a fixed combination of dextromethorphan and quinidine (DM/Q) improves speech and swallowing function in most patients with amyotrophic lateral sclerosis. In this study, a subset of participants, many of whom did not substantially improve while on DM/Q, were re‐evaluated using computer‐based speech analyses and expert clinician ratings of the overall severity of speech impairment. Methods Speech samples were recorded from the subset of 10 patients at four visits made at approximately 30‐day intervals. The recordings were analysed by automated computer‐based analysis of speech pausing patterns. Severity of speech impairment was rated by three experienced speech‐language pathologists using direct magnitude estimation. Scores on patient‐reported and clinician‐administered scales of bulbar motor involvement were obtained at each visit. Results The effects of DM/Q were detected on several of the objective speech measures, including total pause duration (s) (Cohen's d = 0.73, 95% confidence interval (CI) –1.70, 0.24), pause time (%) (d = 0.77, 95% CI –1.75, 0.21), and mean speech event duration (s) (d = 0.52, 95% CI –0.44, 1.47), but not on clinician ratings of speech or the speech components of the self‐report or clinician‐administered scales. Conclusions These findings suggest that even patients with modest improvement while on DM/Q may experience quantifiable improvements in speech when assessed using sensitive and objective measures. This study provides additional evidence of the positive impact of DM/Q on one or more of the neural systems that control bulbar motor function and production of speech.
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Affiliation(s)
- Jordan R Green
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Charlestown, MA, USA.,Program in Speech and Hearing Bioscience and Technology Program, Division of Medical Sciences, Harvard University, Boston, MA, USA
| | - Kristen M Allison
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Charlestown, MA, USA.,Department of Communication Sciences and Disorders, Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Claire Cordella
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Charlestown, MA, USA.,Program in Speech and Hearing Bioscience and Technology Program, Division of Medical Sciences, Harvard University, Boston, MA, USA
| | - Brian D Richburg
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Charlestown, MA, USA
| | - Gary L Pattee
- Department of Neurology, University of Nebraska Medical College, Omaha, NE, USA
| | - James D Berry
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Eric A Macklin
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Erik P Pioro
- Department of Neurology, Cleveland Clinic Neuromuscular Center, Cleveland, OH, USA
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61
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Feenaughty L, Tjaden K, Weinstock-Guttman B, Benedict RHB. Separate and Combined Influence of Cognitive Impairment and Dysarthria on Functional Communication in Multiple Sclerosis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1051-1065. [PMID: 30054632 PMCID: PMC6195026 DOI: 10.1044/2018_ajslp-17-0174] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/16/2018] [Indexed: 05/15/2023]
Abstract
PURPOSE Dysarthria is a consequence of multiple sclerosis (MS) that can co-occur with cognitive impairment. Clinical management thus requires understanding the separate and combined effects of dysarthria and cognitive impairment on functional communication in MS. This study compared perceptual measures of intelligibility and speech severity that capture functional communication deficits for 4 operationally defined groups with MS. The relationship between communication participation and perceptual measures was also examined. METHOD Forty-eight adults with MS and 12 healthy controls participated. Cognitive testing and dysarthria diagnosis determined group assignment: (a) MS with cognitive impairment (MSCI), (b) MS with a diagnosis of dysarthria and no cognitive impairment (MSDYS), (c) MS with dysarthria and cognitive impairment (MSDYS + CI), and (d) MS without dysarthria or cognitive impairment (MS). Sentence Intelligibility Test scores, scaled speech severity obtained from the "Grandfather Passage," and Communication Participation Item Bank (CPIB) scores were analyzed. RESULTS Sentence Intelligibility Test scores approached 100% for all groups. Speech severity was greater for the MSDYS + CI and MSDYS groups versus controls. CPIB scores were greatest for the MSDYS + CI group and were not significantly correlated with either perceptual measure. CONCLUSIONS The CPIB and speech severity were sensitive to aspects of communication problems for some groups with MS not reflected in a measure of sentence intelligibility. Findings suggest the importance of employing a variety of measures to capture functional communication problems experienced by persons with MS.
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Affiliation(s)
- Lynda Feenaughty
- Department of Communicative Disorders and Sciences, University at Buffalo, New York
| | - Kris Tjaden
- Department of Communicative Disorders and Sciences, University at Buffalo, New York
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62
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Smith RA, Macklin EA, Myers KJ, Pattee GL, Goslin KL, Meekins GD, Green JR, Shefner JM, Pioro EP. Assessment of bulbar function in amyotrophic lateral sclerosis: validation of a self-report scale (Center for Neurologic Study Bulbar Function Scale). Eur J Neurol 2018; 25:907-e66. [PMID: 29577526 PMCID: PMC6005752 DOI: 10.1111/ene.13638] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/19/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Impaired bulbar functions of speech and swallowing are among the most serious consequences of amyotrophic lateral sclerosis (ALS). Despite this, clinical trials in ALS have rarely emphasized bulbar function as an endpoint. The rater-administered Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) or various quality-of-life measures are commonly used to measure symptomatic benefit. Accordingly, we sought to evaluate the utility of measures specific to bulbar function in ALS. METHODS We assessed bulbar functions in 120 patients with ALS, with clinicians first making direct observations of the degree of speech, swallowing and salivation impairment in these subjects. Clinical diagnosis of bulbar impairment was then compared with ALSFRS-R scores, speech rate, time to swallow liquids and solids, and scores obtained when patients completed visual analog scales (VASs) and the newly-developed 21-question self-administered Center for Neurologic Study Bulbar Function Scale (CNS-BFS). RESULTS The CNS-BFS, ALSFRS-R, VAS and timed speech and swallowing were all concordant with clinician diagnosis. The self-report CNS-BFS and ALSFRS-R bulbar subscale best predicted clinician diagnosis with misclassification rates of 8% and 14% at the optimal cut-offs, respectively. In addition, the CNS-BFS speech and swallowing subscales outperformed both the bulbar component of the ALSFRS-R and speech and swallowing VASs when correlations were made between these scales and objective measures of timed reading and swallowing. CONCLUSIONS Based on these findings and its relative ease of administration, we conclude that the CNS-BFS is a useful metric for assessing bulbar function in patients with ALS.
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Affiliation(s)
| | - E. A. Macklin
- Biostatistics CenterMassachusetts General HospitalBostonMA
- Department of MedicineHarvard Medical SchoolBostonMA
| | | | - G. L. Pattee
- Department of NeurologyUniversity of Nebraska Medical CollegeLincolnNE
| | - K. L. Goslin
- Providence ALS Center, Providence Brain and Spine InstituteProvidenceOR
| | - G. D. Meekins
- Department of NeurologyUniversity of Minnesota School of MedicineMinneapolisMN
| | - J. R. Green
- Communication Sciences and DisordersMassachusetts General Hospital Institute of Health ProfessionsBostonMA
- Speech & Hearing Bioscience and Technology ProgramHarvard Medical SchoolBostonMA
| | - J. M. Shefner
- Department of NeurologyBarrow Neurological InstitutePhoenixAR
| | - E. P. Pioro
- Department of NeurologyCleveland Clinic Neuromuscular CenterClevelandOHUSA
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63
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Silent pauses in aphasia. Neuropsychologia 2018; 114:41-49. [DOI: 10.1016/j.neuropsychologia.2018.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/05/2018] [Accepted: 04/05/2018] [Indexed: 12/14/2022]
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64
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Chiaramonte R, Di Luciano C, Chiaramonte I, Serra A, Bonfiglio M. Multi-disciplinary clinical protocol for the diagnosis of bulbar amyotrophic lateral sclerosis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 70:25-31. [PMID: 29699694 DOI: 10.1016/j.otorri.2017.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/21/2017] [Accepted: 12/08/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND OBJECTIVES The objective of this study was to examine the role of different specialists in the diagnosis of amyotrophic lateral sclerosis (ALS), to understand changes in verbal expression and phonation, respiratory dynamics and swallowing that occurred rapidly over a short period of time. MATERIALS AND METHODS 22 patients with bulbar ALS were submitted for voice assessment, ENT evaluation, Multi-Dimensional Voice Program (MDVP), spectrogram, electroglottography, fiberoptic endoscopic evaluation of swallowing. RESULTS In the early stage of the disease, the oral tract and velopharyngeal port were involved. Three months after the initial symptoms, most of the patients presented hoarseness, breathy voice, dysarthria, pitch modulation problems and difficulties in pronunciation of explosive, velar and lingual consonants. Values of MDVP were altered. Spectrogram showed an additional formant, due to nasal resonance. Electroglottography showed periodic oscillation of the vocal folds only during short vocal cycle. Swallowing was characterized by weakness and incoordination of oro-pharyngeal muscles with penetration or aspiration. CONCLUSIONS A specific multidisciplinary clinical protocol was designed to report vocal parameters and swallowing disorders that changed more quickly in bulbar ALS patients. Furthermore, the patients were stratified according to involvement of pharyngeal structures, and severity index.
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Affiliation(s)
- Rita Chiaramonte
- Department of Physical Medicine and Rehabilitation, University of Catania, 95125 Catania, Italy.
| | - Carmela Di Luciano
- Department for Health activities and Epidemiologic Observatory, Sicily Region, Italy
| | | | - Agostino Serra
- Departments of Otolaryngology, University of Catania, 95125 Catania, Italy
| | - Marco Bonfiglio
- Department for Health activities and Epidemiologic Observatory, Sicily Region, Italy
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65
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Makkonen T, Ruottinen H, Puhto R, Helminen M, Palmio J. Speech deterioration in amyotrophic lateral sclerosis (ALS) after manifestation of bulbar symptoms. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:385-392. [PMID: 29159848 DOI: 10.1111/1460-6984.12357] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 09/18/2017] [Accepted: 10/11/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The symptoms and their progression in amyotrophic lateral sclerosis (ALS) are typically studied after the diagnosis has been confirmed. However, many people with ALS already have severe dysarthria and loss of adequate speech at the time of diagnosis. Speech-and-language therapy interventions should be targeted timely based on communicative need in ALS. AIMS To investigate how long natural speech will remain functional and to identify the changes in the speech of persons with ALS. METHODS & PROCEDURES Altogether 30 consecutive participants were studied and divided into two groups based on the initial type of ALS, bulbar or spinal. Their speech disorder was evaluated on severity, articulation rate and intelligibility during the 2-year follow-up. OUTCOME & RESULTS The ability to speak deteriorated to poor and necessitated augmentative and alternative communication (AAC) methods with 60% of the participants. Their speech remained adequate on average for 18 months from the first bulbar symptom. Severity, articulation rate and intelligibility declined with nearly all participants during the study. To begin with speech deteriorated more in the bulbar group than in the spinal group and the difference remained during the whole follow-up with some exceptions. CONCLUSIONS & IMPLICATIONS The onset of bulbar symptoms indicated the time to loss of speech better than when assessed from ALS diagnosis or the first speech therapy evaluation. In clinical work, it is important to take the initial type of ALS into consideration when determining the urgency of AAC measures as people with bulbar-onset ALS are more susceptible to delayed evaluation and AAC intervention.
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Affiliation(s)
- Tanja Makkonen
- Department of Neurology and Rehabilitation, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Hanna Ruottinen
- Department of Neurology and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Riitta Puhto
- Department of Neurology and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Mika Helminen
- Science Center, Tampere University Hospital, Tampere, Finland
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Johanna Palmio
- Neuromuscular Research Center, University of Tampere and, Tampere University Hospital, Tampere, Finland
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66
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Allison KM, Yunusova Y, Campbell TF, Wang J, Berry JD, Green JR. The diagnostic utility of patient-report and speech-language pathologists' ratings for detecting the early onset of bulbar symptoms due to ALS. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:358-366. [PMID: 28355886 PMCID: PMC5530595 DOI: 10.1080/21678421.2017.1303515] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/14/2017] [Accepted: 02/28/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed to determine the diagnostic utility of clinician speech ratings and patient self-report for detecting early bulbar changes associated with amyotrophic lateral sclerosis (ALS), compared to instrumentation-based speech measures. METHODS Thirty-six individuals with ALS and 17 healthy control participants were included. Patients' awareness of early bulbar motor involvement was assessed using self-reported scores on the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R). Clinicians' detection of early bulbar motor involvement was assessed through perceptual speech ratings by two experienced speech-language pathologists. Participants with ALS were grouped as 'bulbar pre-symptomatic' or 'bulbar symptomatic' based on self-report and clinician ratings, and compared to healthy controls on six instrumentation-based speech measures. ROC analysis was used to compare the sensitivity and specificity of perceptual and instrumentation-based measures for detecting bulbar changes in pre-symptomatic individuals. RESULTS Early bulbar changes that were documented using instrumentation-based measures were undetected by both patients and clinicians. ROC analyses indicated that instrumentation-based measures outperformed clinicians' scaled severity ratings, and that percent pause time was the best measure for differentiating healthy controls from bulbar pre-symptomatic individuals with ALS. CONCLUSIONS Findings suggested that instrumentation-based measures of speech may be necessary for early detection of bulbar changes due to ALS.
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Affiliation(s)
- Kristen M. Allison
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, United States
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
| | - Thomas F. Campbell
- Callier Center for Communication Disorders, University of Texas at Dallas, Dallas, TX, United States
| | - Jun Wang
- Callier Center for Communication Disorders, University of Texas at Dallas, Dallas, TX, United States
| | - James D. Berry
- MDA ALS Clinic, Massachusetts General Hospital, Boston, MA, United States
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, United States
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Poole ML, Brodtmann A, Darby D, Vogel AP. Motor Speech Phenotypes of Frontotemporal Dementia, Primary Progressive Aphasia, and Progressive Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:897-911. [PMID: 28289749 DOI: 10.1044/2016_jslhr-s-16-0140] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/11/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Our purpose was to create a comprehensive review of speech impairment in frontotemporal dementia (FTD), primary progressive aphasia (PPA), and progressive apraxia of speech in order to identify the most effective measures for diagnosis and monitoring, and to elucidate associations between speech and neuroimaging. METHOD Speech and neuroimaging data described in studies of FTD and PPA were systematically reviewed. A meta-analysis was conducted for speech measures that were used consistently in multiple studies. RESULTS The methods and nomenclature used to describe speech in these disorders varied between studies. Our meta-analysis identified 3 speech measures which differentiate variants or healthy control-group participants (e.g., nonfluent and logopenic variants of PPA from all other groups, behavioral-variant FTD from a control group). Deficits within the frontal-lobe speech networks are linked to motor speech profiles of the nonfluent variant of PPA and progressive apraxia of speech. Motor speech impairment is rarely reported in semantic and logopenic variants of PPA. Limited data are available on motor speech impairment in the behavioral variant of FTD. CONCLUSIONS Our review identified several measures of speech which may assist with diagnosis and classification, and consolidated the brain-behavior associations relating to speech in FTD, PPA, and progressive apraxia of speech.
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Affiliation(s)
- Matthew L Poole
- Centre for Neuroscience of Speech, The University of Melbourne, Victoria, AustraliaEastern Cognitive Disorders Clinic, Monash University, Melbourne, Victoria, Australia
| | - Amy Brodtmann
- Eastern Cognitive Disorders Clinic, Monash University, Melbourne, Victoria, AustraliaFlorey Institute for Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - David Darby
- Eastern Cognitive Disorders Clinic, Monash University, Melbourne, Victoria, AustraliaFlorey Institute for Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Victoria, AustraliaEastern Cognitive Disorders Clinic, Monash University, Melbourne, Victoria, AustraliaDepartment of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
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Czarzasta J, Habich A, Siwek T, Czapliński A, Maksymowicz W, Wojtkiewicz J. Stem cells for ALS: An overview of possible therapeutic approaches. Int J Dev Neurosci 2017; 57:46-55. [PMID: 28088365 DOI: 10.1016/j.ijdevneu.2017.01.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 01/06/2017] [Accepted: 01/06/2017] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is an unusual, fatal, neurodegenerative disorder leading to the loss of motor neurons. After diagnosis, the average lifespan ranges from 3 to 5 years, and death usually results from respiratory failure. Although the pathogenesis of ALS remains unclear, multiple factors are thought to contribute to the progression of ALS, such as network interactions between genes, environmental exposure, impaired molecular pathways and many others. The neuroprotective properties of neural stem cells (NSCs) and the paracrine signaling of mesenchymal stem cells (MSCs) have been examined in multiple pre-clinical trials of ALS with promising results. The data from these initial trials indicate a reduction in the rate of disease progression. The mechanism through which stem cells achieve this reduction is of major interest. Here, we review the to-date pre-clinical and clinical therapeutic approaches employing stem cells, and discuss the most promising ones.
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Affiliation(s)
- Joanna Czarzasta
- Department of Pathophysiology, Faculty of Medical Sciences, University of Warmia and Mazury, Olsztyn, Poland.
| | - Aleksandra Habich
- Department of Neurology and Neurosurgery, Faculty of Medical Sciences, University of Warmia and Mazury, Olsztyn, Poland
| | - Tomasz Siwek
- Department of Neurology and Neurosurgery, Faculty of Medical Sciences, University of Warmia and Mazury, Olsztyn, Poland
| | - Adam Czapliński
- Department of Neurology and Neurosurgery, Faculty of Medical Sciences, University of Warmia and Mazury, Olsztyn, Poland; Neurocentrum Bellevue, Neurology, Zurich, Switzerland
| | - Wojciech Maksymowicz
- Department of Neurology and Neurosurgery, Faculty of Medical Sciences, University of Warmia and Mazury, Olsztyn, Poland
| | - Joanna Wojtkiewicz
- Department of Pathophysiology, Faculty of Medical Sciences, University of Warmia and Mazury, Olsztyn, Poland; Laboratory of Regenerative Medicine, University of Warmia and Mazury, Olsztyn, Poland; Foundation for nerve cells regeneration, Olsztyn, Poland
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Rong P, Yunusova Y, Wang J, Zinman L, Pattee GL, Berry JD, Perry B, Green JR. Predicting Speech Intelligibility Decline in Amyotrophic Lateral Sclerosis Based on the Deterioration of Individual Speech Subsystems. PLoS One 2016; 11:e0154971. [PMID: 27148967 PMCID: PMC4858181 DOI: 10.1371/journal.pone.0154971] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/21/2016] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To determine the mechanisms of speech intelligibility impairment due to neurologic impairments, intelligibility decline was modeled as a function of co-occurring changes in the articulatory, resonatory, phonatory, and respiratory subsystems. METHOD Sixty-six individuals diagnosed with amyotrophic lateral sclerosis (ALS) were studied longitudinally. The disease-related changes in articulatory, resonatory, phonatory, and respiratory subsystems were quantified using multiple instrumental measures, which were subjected to a principal component analysis and mixed effects models to derive a set of speech subsystem predictors. A stepwise approach was used to select the best set of subsystem predictors to model the overall decline in intelligibility. RESULTS Intelligibility was modeled as a function of five predictors that corresponded to velocities of lip and jaw movements (articulatory), number of syllable repetitions in the alternating motion rate task (articulatory), nasal airflow (resonatory), maximum fundamental frequency (phonatory), and speech pauses (respiratory). The model accounted for 95.6% of the variance in intelligibility, among which the articulatory predictors showed the most substantial independent contribution (57.7%). CONCLUSION Articulatory impairments characterized by reduced velocities of lip and jaw movements and resonatory impairments characterized by increased nasal airflow served as the subsystem predictors of the longitudinal decline of speech intelligibility in ALS. Declines in maximum performance tasks such as the alternating motion rate preceded declines in intelligibility, thus serving as early predictors of bulbar dysfunction. Following the rapid decline in speech intelligibility, a precipitous decline in maximum performance tasks subsequently occurred.
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Affiliation(s)
- Panying Rong
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, United States of America
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| | - Jun Wang
- Department of Bioengineering, University of Texas at Dallas, Richardson, Texas, United States of America
- Callier Center for Communication Disorders, University of Texas at Dallas, Richardson, Texas, United States of America
| | - Lorne Zinman
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Gary L. Pattee
- Neurology Associates, P.C., Lincoln, Nebraska, United States of America
| | - James D. Berry
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Bridget Perry
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, United States of America
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, United States of America
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