Disorders of communication

The encoding of speech modes in motor speech disorders: whispered versus normal speech in apraxia of speech and hypokinetic dysarthria

Speakers with motor speech disorders (MSD) present challenges in speech production, one of them being the difficulty to adapt their speech to different modes. However, it is unclear whether different types of MSD are similarly affected when it comes to adapting their speech to various communication contexts. This study investigates the encoding of speech modes in individuals with AoS following focal brain damage and in individuals with hypokinetic dysarthria (HD) secondary to Parkinson's disease. Participants with mild-to-moderate MSD and their age-matched controls performed a delayed production task of pseudo-words in two speech modes: normal and whispered speech. While overall accuracy did not differ significantly across speech modes, participants with AoS exhibited longer response latencies for whispered speech, reflecting difficulties in the initiation of utterances requiring an unvoiced production. In contrast, participants with HD showed faster response latencies for whispered speech, indicating that this speech mode is easier to encode/control for this population. Acoustic durations followed these same trends, with participants with AoS showing greater lengthening for whispered speech as compared to controls and to participants with HD, while participants with HD exhibited milder lengthening. Contrary to the predictions of speech production models, suggesting that speech mode changes might be particularly difficult in dysarthria, the present results suggest that speech mode adaptation rather seems particularly costly for participants with AoS.

The Radboud dysarthria assessment: validity and reliability of the Arabic version

PURPOSE

To cross-culturally adapt and validate the Radboud Dysarthria Assessment (RDA) and the speech component of the Radboud Oral Motor inventory for Parkinson's disease (ROMP-speech) into the Arabic language among Lebanese subjects with dysarthria.

MATERIALS AND METHODS

This study included 50 participants with dysarthria. The Arabic versions of the RDA (A-RDA) and the ROMP-speech (A-ROMP-speech) were administered in addition to the Arabic Speech Intelligibility test, the Lebanese Voice Handicap Index-10 (VHI-10lb) and semantic verbal fluency tasks. The maximum performance tasks were analyzed using the Praat software. The A-RDA qualitative recording form and the A-ROMP-speech were assessed for construct validity and internal consistency. The convergent validity of the maximum performance tasks, the severity scale, and the A-ROMP-speech were evaluated.

RESULTS

Exploratory factor analysis of the qualitative recording form extracted 3 factors explaining 82.973% of the total variance, and it demonstrated high internal consistency (α = 0.912). The maximum performance tasks of the RDA correlated significantly with the corresponding Praat scores. The severity scale and the A-ROMP-speech correlated fairly to strongly with the Arabic Speech Intelligibility test (rs=-0.695 and -0.736, p < 0.001) and the VHI-10lb (r = 0.539 and 0.640, p < 0.001).

CONCLUSION

The A-RDA and the A-ROMP-speech are valid and reliable dysarthria tools among Lebanese subjects.

Improving the Efficiency of Dysarthria Voice Conversion System Based on Data Augmentation

Dysarthria, a speech disorder often caused by neurological damage, compromises the control of vocal muscles in patients, making their speech unclear and communication troublesome. Recently, voice-driven methods have been proposed to improve the speech intelligibility of patients with dysarthria. However, most methods require a significant representation of both the patient's and target speaker's corpus, which is problematic. This study aims to propose a data augmentation-based voice conversion (VC) system to reduce the recording burden on the speaker. We propose dysarthria voice conversion 3.1 (DVC 3.1) based on a data augmentation approach, including text-to-speech and StarGAN-VC architecture, to synthesize a large target and patient-like corpus to lower the burden of recording. An objective evaluation metric of the Google automatic speech recognition (Google ASR) system and a listening test were used to demonstrate the speech intelligibility benefits of DVC 3.1 under free-talk conditions. The DVC system without data augmentation (DVC 3.0) was used for comparison. Subjective and objective evaluation based on the experimental results indicated that the proposed DVC 3.1 system enhanced the Google ASR of two dysarthria patients by approximately [62.4%, 43.3%] and [55.9%, 57.3%] compared to unprocessed dysarthria speech and the DVC 3.0 system, respectively. Further, the proposed DVC 3.1 increased the speech intelligibility of two dysarthria patients by approximately [54.2%, 22.3%] and [63.4%, 70.1%] compared to unprocessed dysarthria speech and the DVC 3.0 system, respectively. The proposed DVC 3.1 system offers significant potential to improve the speech intelligibility performance of patients with dysarthria and enhance verbal communication quality.

Episodic stuttering as the presenting manifestation of acute ischemic stroke: A case report and systematic literature review

BACKGROUND

Acquired episodic stuttering in adulthood represents a rare condition, which has been infrequently described in the literature.

CASE PRESENTATION

We describe the case of a 62-year-old male who presented to the emergency room with three episodes of new-onset brief isolated stuttering with no other speech impairment or associated focal neurologic deficits. His brain magnetic resonance imaging was notable for the presence of a small acute ischemic stroke involving the left precuneus cortex.

SYSTEMATIC LITERATURE REVIEW

We performed a systematic literature review to evaluate the association between stroke and acquired neurogenic stuttering. The evidence published to this date suggests that the underlying pathophysiology of acquired stutter does not localize to an isolated or focal region. The development of stuttering secondary to strokes may be the result of a disruption at any level in a cortico-striato-cortical integrative pathway mediating speech execution.

CONCLUSION

Here we aimed to emphasize the importance of carefully evaluating new-onset recurrent episodic stuttering to rule out an underlying stroke or another neurogenic etiology. We provide a comprehensive review of acquired stuttering, its differential diagnosis, and its evaluation.

A Slip Between the Brain and the Lip: Working Memory and Cognitive-Communication Disorders

The relationship between working memory and speech has been a topic of intense research interest and investigation for many years. Memory studies have found that the active processing of working memory is required for language comprehension and speech production. Though there are studies that discuss the capacity of working memory, the processing of verbal stimuli into verbal memory remains unclear. Therefore, it is essential to understand the functioning of the working memory and how it processes verbal information. As working memory is intricately linked with communication, any deficits in working memory could cause communication disorders. Also, the disruption in the storage and retrieval of verbal memory could cause a disturbance in the speech pattern. To this point, this review elaborates on the active processing of working memory and its role in communication. Further, by studying the deficits in working memory that could cause cognitive-communication disorders such as apraxia of speech, dementia, and dysarthria, this article highlights the importance of verbal memory in speech.

A Digital Telehealth System to Compute the Myasthenia Gravis Core Examination Metrics

Background

Telemedicine practice for neurological diseases has grown significantly during the COVID-19 pandemic.Telemedicine offers an opportunity to assess digitalization of examinations and enhances access to modern computer vision and artificial intelligence processing to annotate and quantify examinations in a consistent and reproducible manner. The Myasthenia Gravis Core Examination (MG-CE) has been recommended for the telemedicine evaluation of patients with myasthenia gravis.

Objective

We aimed to assess the ability to take accurate and robust measurements during the examination, which would allow improvement in workflow efficiency by making the data acquisition and analytics fully automatic and thereby limit the potential for observation bias.

Methods

We used Zoom (Zoom Video Communications) videos of patients with myasthenia gravis undergoing the MG-CE. The core examination tests required 2 broad categories of processing. First, computer vision algorithms were used to analyze videos with a focus on eye or body motions. Second, for the assessment of examinations involving vocalization, a different category of signal processing methods was required. In this way, we provide an algorithm toolbox to assist clinicians with the MG-CE. We used a data set of 6 patients recorded during 2 sessions.

Results

Digitalization and control of quality of the core examination are advantageous and let the medical examiner concentrate on the patient instead of managing the logistics of the test. This approach showed the possibility of standardized data acquisition during telehealth sessions and provided real-time feedback on the quality of the metrics the medical doctor is assessing. Overall, our new telehealth platform showed submillimeter accuracy for ptosis and eye motion. In addition, the method showed good results in monitoring muscle weakness, demonstrating that continuous analysis is likely superior to pre-exercise and post-exercise subjective assessment.

Conclusions

We demonstrated the ability to objectively quantitate the MG-CE. Our results indicate that the MG-CE should be revisited to consider some of the new metrics that our algorithm identified. We provide a proof of concept involving the MG-CE, but the method and tools developed can be applied to many neurological disorders and have great potential to improve clinical care.

Congenital unilateral lower lip palsy: a case-based review

BACKGROUND

Congenital unilateral lower lip palsy (CULLP), also referred to as congenital asymmetric crying facies (ACF), is a rare condition that causes pronounced depression of the unaffected lower lip when crying, despite symmetric appearance of the mouth and lips at rest. Unlike the acquired form of ACF, CULLP is idiopathic and often involves permanent defect.

METHODS AND RESULTS

We present a case-based review of CULLP, including a thorough analysis of the relevant literature and a discussion of the exemplary case of 5-year-old patient presenting with unilateral facial asymmetry resulting from left-sided facial weakness. The patient was diagnosed with ACF at birth, and documentation from a previous neurologic consultation specifies the root cause of the asymmetry as developmental aplasia of the left depressor anguli oris muscle (DAOM). However, there is no record of electrodiagnostic testing or B-scan ultrasound imaging that would support this conclusion, and the patient's dysarthric speech may suggest lower motor neuron involvement. Botox chemodenervation of the right, unaffected side was recommended to deanimate the contralateral lower lip and achieve facial symmetry, in addition to potentially resolving some of the patient's speech difficulties.

CONCLUSIONS

There are several approaches, both surgical and non-surgical, to the management and correction of CULLP. These include weakening the muscles of the contralateral side or increasing muscular tension on the ipsilateral side, referred to as deanimation and reanimation procedures, respectively.

Dysarthria detection based on a deep learning model with a clinically-interpretable layer

Studies have shown deep neural networks (DNN) as a potential tool for classifying dysarthric speakers and controls. However, representations used to train DNNs are largely not clinically interpretable, which limits clinical value. Here, a model with a bottleneck layer is trained to jointly learn a classification label and four clinically-interpretable features. Evaluation of two dysarthria subtypes shows that the proposed method can flexibly trade-off between improved classification accuracy and discovery of clinically-interpretable deficit patterns. The analysis using Shapley additive explanation shows the model learns a representation consistent with the disturbances that define the two dysarthria subtypes considered in this work.

Validation and cross-linguistic adaptation of the Frenchay Dysarthria Assessment (FDA-2) speech intelligibility tests: Hebrew version

'Dysarthria' is a group of motor speech disorders resulting from a disturbance in neuromuscular control. Most individuals with dysarthria cope with communicative restrictions due to speech impairments and reduced intelligibility. Thus, language-sensitive measurements of intelligibility are important in dysarthria neurological assessment. The Frenchay Dysarthria Assessment, 2nd edition (FDA-2), is a validated tool for the identification of the nature and patterns of oro-motor movements associated with different types of dysarthria. The current study conducted a careful culture- and linguistic-sensitive adaption of the two intelligibility subtests of the FDA-2 to Hebrew (words and sentences) and performed a preliminary validation with relevant clinical populations. First, sets of Hebrew words and sentences were constructed, based on the criteria defined in FDA-2, as well as on several other factors that may affect performance: emotional valence, arousal and familiarity. Second, the new subtests were validated in healthy older adults (n = 20), and in two clinical groups (acquired dysarthria, n = 15; and developmental dysarthria, n = 19). Analysis indicated that the new subtests were found to be specific and sensitive, valid and reliable, as scores significantly differ between healthy older adults and adults with dysarthria, correlated with other subjective measures of intelligibility, and showed high test-retest reliability. The words and sentences intelligibility subtests can be used to evaluate speech disorders in various populations of Hebrew speakers, thus may be an important addition to the speech-language pathologist's toolbox, for clinical work as well as for research purposes. WHAT THIS PAPER ADDS: What is already known on the subject 'Dysarthria' is a group of disorders reflecting impairments in the strength, speed and precision of movements required for adequate control of the various speech subsystems. Reduced speech intelligibility is one of the main consequences of all dysarthria subtypes, irrespective of their underlying cause. Indeed, most individuals with dysarthria cope with communicative restrictions due to speech impairments. Thus, language-sensitive measurements of intelligibility are important in dysarthria assessment. The FDA-2's words and sentences subtests present standardized and validated tools for the identification of the nature and patterns of oro-motor movements associated with different types of dysarthria. What this paper adds to existing knowledge The lack of assessment tools in Hebrew poses challenges to clinical evaluation as well as research purposes. The current study conducted a careful culture- and linguistic-sensitive adaption of the FDA-2 intelligibility subtests to Hebrew and performed a preliminary validation with relevant clinical populations. First, sets of Hebrew words and sentences were constructed, based on the criteria defined in FDA-2, as well as on several other factors that may affect performance: emotional valence, arousal and familiarity. Second, the new subtests were validated in healthy older adults (n = 20), and in two clinical groups (adults with acquired dysarthria, n = 15; and young adults with developmental dysarthria, n = 19). What are the potential or actual clinical implications of this work? Analyses indicated that the new word and sentence subtests are specific, sensitive, valid and reliable. Namely, (1) they successfully differentiate between healthy individuals and individuals with dysarthria; (2) they correlate with other subjective measures of intelligibility; and (3) they show high test-retest reliability. The words and sentences intelligibility subtests can be used to evaluate speech disorders in various populations of Hebrew speakers. Thus, they may be an important addition to the speech-language pathologist's toolbox, for clinical and research purposes. The methods described here can be emulated for the adaptation of speech assessment tools to other languages.

Deep learning applications in telerehabilitation speech therapy scenarios

Nowadays, many application scenarios benefit from automatic speech recognition (ASR) technology. Within the field of speech therapy, in some cases ASR is exploited in the treatment of dysarthria with the aim of supporting articulation output. However, in presence of atypical speech, standard ASR approaches do not provide any reliable result in terms of voice recognition due to main issues, including: (i) the extreme intra and inter-speakers variability of the speech in presence of speech impairments, such as dysarthria; (ii) the absence of dedicated corpora containing voice samples from users with a speech disability to train a state-of-the-art speech model, particularly in non-English languages. In this paper, we focus on isolated word recognition for native Italian speakers with dysarthria and we exploit an existing mobile app to collect audio data from users with speech disorders while they perform articulation exercises for speech therapy purposes. With this data availability, a convolutional neural network has been trained to spot a small number of keywords within atypical speech, according to a speaker dependent method. Finally, we discuss the benefits of the trained ASR system in tailored telerehabilitation contexts intended for patients with dysarthria who can follow treatment plans under the supervision of remote speech language pathologists.

An Update on the Measurement of Motor Cerebellar Dysfunction in Multiple Sclerosis

Multiple sclerosis (MS) is a progressive disease that often affects the cerebellum. It is characterised by demyelination, inflammation, and neurodegeneration within the central nervous system. Damage to the cerebellum in MS is associated with increased disability and decreased quality of life. Symptoms include gait and balance problems, motor speech disorder, upper limb dysfunction, and oculomotor difficulties. Monitoring symptoms is crucial for effective management of MS. A combination of clinical, neuroimaging, and task-based measures is generally used to diagnose and monitor MS. This paper reviews the present and new tools used by clinicians and researchers to assess cerebellar impairment in people with MS (pwMS). It also describes recent advances in digital and home-based monitoring for people with MS.

Cross-cultural adaptation into Italian and validation of the Frenchay dysarthria assessment - 2

BACKGROUND

A comprehensive evaluation of dysarthria is required to make an accurate differential diagnosis with other communication disorders and plan effective rehabilitation programs. The Frenchay Dysarthria Assessment-2 (FDA-2) is a valid, reliable and widely used protocol for the assessment of dysarthria. An Italian version of the FDA-2 is currently lacking.

AIM

To perform a cross-cultural adaptation of the FDA-2 in Italian and to validate the Italian version of the FDA-2.

DESIGN

Validation study.

SETTING

Inpatient rehabilitation center.

POPULATION

69 patients with dysarthria and 112 healthy controls.

METHODS

The FDA-2 was translated and cross-culturally adapted to Italian. The validation study was carried out in 4 steps: (1) 42 audio-recorded samples of FDA-2 items from 11 patients with dysarthria were independently assessed by 7 speech and language pathologists for interrater reliability and re-assessed after 6 weeks for intrarater reliability; (2) 11 patients were simultaneously assessed by 3 speech and language therapists for interrater reliability of the whole Italian version of the FDA-2 and re-assessed within 24 hours for test-retest reliability; (3) the Italian version of the FDA-2 was administered to 112 healthy volunteers to gain normative data; (4) 49 patients with different types of dysarthria were assessed using the Italian version of the FDA-2, the Therapy Outcome Measure impairment scale and the Robertson Profile for the validity analysis.

RESULTS

Interrater and intrarater reliability ranged from good to excellent (ICC >0.75) except for 3 audio-recorded items. The overall protocol demonstrated excellent (ICC >0.9) inter-rater and test-retest reliability for all the sections and the total score. Normative data were gained for 6 age groups. For the validity analysis, a statistically significant difference was found between dysarthric patients and healthy subjects for all sections and the total score. The FDA-2 significantly correlated to the therapy outcome measure (r=0.75) and the Robertson Profile (r=0.81).

CONCLUSIONS

The Italian version of the FDA-2 yield satisfactory reliability and validity, comparable to the psychometric properties of the original version.

CLINICAL REHABILITATION IMPACT

Speech and language pathologists can rely on a valid and reliable tool in Italian for the assessment of dysarthria in both clinical and research practice.

Feasibility of a Telerehabilitation Adaptation of the Be Clear Speech Treatment Program for Non-Progressive Dysarthria

This study evaluated the feasibility and outcomes of a telerehabilitation adaptation of the Be Clear speech treatment program for adults with non-progressive dysarthria to determine clinical delivery viability and future research directions. Treatment effects on speech clarity, intelligibility, communication effectiveness, and participation, as well as psychosocial outcomes in 15 participants with non-progressive dysarthria, were explored. Intervention involved daily 1-h online sessions (4 days per week for 4 weeks, totalling 16 sessions) and daily home practice. Outcome measures were obtained at baseline (PRE), post-treatment (POST), and 12 weeks following treatment (FUP). Feasibility measures targeting participant satisfaction, treatment adherence and fidelity, and technical viability were also employed. The programme was feasible concerning technical viability and implementation, treatment adherence and fidelity. High levels of participant satisfaction were reported. Increases in overall ratings of communication participation and effectiveness were identified at POST and FUP. Reductions in speech rate were identified at FUP. Improvements in aspects of lingual and laryngeal function were also noted after treatment. Over time, improvements relating to the negative impact of dysarthria were identified. Naïve listeners perceived negligible changes in speech clarity following treatment. Online delivery of the Be Clear speech treatment program was feasible, and some positive speech benefits were observed. Due to the small sample size included in this research, statistically significant findings related to speech outcomes must be interpreted with caution. An adequately powered randomised controlled trial of Be Clear online is warranted to evaluate treatment efficacy.

Pharyngoplasty for Speech Disorders Following Brain Injury

INTRODUCTION

Dysarthria is one of the commonest neurological speech disorders resulting from brain injury. However, hypernasality commonly co-exists in this subgroup of patients and is commonly overlooked. The authors aim to investigate the merit of surgery in improving hypernasality and speech intelligibility in patients with a mixed pattern of dysarthria and hypernasality secondary to brain injury.

MATERIALS AND METHODS

Data was collected from the regional plastic surgery unit over a 10-year period. All patients who underwent a pharyngoplasty for speech improvement following total brain injury from either a traumatic injury or a cerebrovascular accident were included. Patients were followed up post-operatively to assess; improvement in speech rehabilitation, complications and the need for surgical revision.

RESULTS

Six patients had a pharyngoplasty for speech improvement. Either a Hynes or Jackson pharyngoplasty was performed, with one patient requiring a hemi-pharyngoplasty. Post-operatively, 1 patient experienced self-limiting sleep apnea which resolved within 1 month. One patient developed obstructive symptoms and required revision. Overall, 83% of patients had clear improvement in speech intelligibility and articulation.

CONCLUSIONS

The authors have shown that surgical intervention, in the form of a pharyngoplasty, is an effective method of improving speech intelligibility and articulation, by improving hypernasality and restoring communication in this cohort of patients. The aim of this paper is to highlight this option to colleagues and to heighten the awareness that many patients with a total brain injury have a mixed pattern of speech disturbance and not solely the dysarthria that is attributed to this condition.

Isolated dysarthria due to hypoglossal palsy caused by supratentorial ischemic stroke: Radiological and electropsyological analysis

OBJECTIVES

Isolated dysarthria caused by stroke is a rare condition and generally seen in infratentorial lesions, especially in cerebellar lesions. Isolated dysarthria associated with supratentorial ischemic lesions are also very rare and, these conditions were shown in only a few cases. In this study, six patients characterized by IHP due to supratentorial ischemic lesions are presented.

PATIENTS AND METHODS

Physical examinations of patients were done by two different neurologists. The risk factors for stroke were determined. Localisations of lesions were identified by using magnetic resonance images(MRI). Corticolingual tract affection without sensorial and other corticospinal tract involvement was confirmed using Somatosensory evoked potentials(SEPs) and Transcranial Magnetic Stimulation(TMS).

RESULTS

Unilateral lingual paresis was detected in all of the patients. The lesions were demonstrated on MRI slices. All lesions were on the same localization. The affection of the corticolingual tract without any other motor and sensory tract involvement was proven electrophysiologically.

CONCLUSION

Corticospinal and corticobulbar fibers are very close to each other. Therefore common involvement is expected in cerebrovascular diseases. However, six patients with IHP caused by supratentorial ischemic lesions were reported in this study. Thus, a possible map of the corticolingual tract was drawn.

Development of the German Speech Intelligibility Index for the treatment of oral cancer patients

OBJECTIVES

This study aimed at 1) adapting the well-established Speech Handicap Index (SHI) to German, 2) testing the suitability of the instrument for assessing speech-related quality of life, 3) comparing it to the German Voice-Handicap-Index (VHI), in order to support treatment of oral cancer patients who experience posttreatment speech difficulties that affect their quality of life.

MATERIAL AND METHODS

Participants completed a web-based survey that employed a 2 (experienced problem: speech/articulation-related vs. voice-related) x 2 (SHI vs. VHI) between-subject experimental design, enabling it to distinguish between the experiences of voice and intelligibility impairments, and to determine the discriminatory ability of the two instruments.

RESULTS

The German SHI reliably assessed speech intelligibility and articulation-related Quality of life. While voice impairments were equally well assessed by both, VHI: M 2.48, SD 0.65; SHI: M 2.52, SD 0.63; only the latter appropriately registered intelligibility handicap in speech impairments (VHI: M 2.05, SD 0.70; SHI: 2.68, SD 0.73). The responsivity of the SHI in capturing the experienced handicap was significantly greater in the speech/articulation-impairment condition (p = .001).

CONCLUSION

The German SHI is a reliable and responsive measure for speech intelligibility and articulation-related quality of life that should be chosen in preference to the VHI.

Early detection and tracking of bulbar changes in ALS via frequent and remote speech analysis

Bulbar deterioration in amyotrophic lateral sclerosis (ALS) is a devastating characteristic that impairs patients' ability to communicate, and is linked to shorter survival. The existing clinical instruments for assessing bulbar function lack sensitivity to early changes. In this paper, using a cohort of N = 65 ALS patients who provided regular speech samples for 3-9 months, we demonstrated that it is possible to remotely detect early speech changes and track speech progression in ALS via automated algorithmic assessment of speech collected digitally.

Rehabilitation from meningioma

This chapter discusses the complex process of acute rehabilitation of patients after meningioma. Acute inpatient rehabilitation after meningioma utilizes an interdisciplinary approach to provide comprehensive rehabilitation through a team of physical, occupational, and speech therapists, nurses, doctors, recreational therapists, neuropsychologists, case managers and social workers, all of whom specialize in providing rehabilitation care. The prognosis of rehabilitation outcomes in this population is similar to that of the stroke population, and patients benefit from rehabilitation to maximize function in the setting of ongoing treatment. Common functional deficits include speech, cognitive, motor, and visual deficits. Medical complications include heterotopic ossification, venous thromboembolism, bowel and bladder complications, and pain. Patients must also be managed for behavioral complications such as agitation and maintenance of the sleep-wake cycle. The wide variety of functional outcomes following meningioma diagnosis and treatment necessitates a flexible rehabilitation course including testing for deficits, monitoring of outcomes, and ongoing therapy support.

Considerations on Effective Feedback in Computerized Speech Training for Dysarthric Speakers

Introduction: In this article, we consider the role of feedback in computerized speech training for patients with dysarthric speech due to acquired neurological disorders such as Parkinson's disease and stroke. Methods: Based on literature from different fields, we review several issues that play a role when designing feedback for computerized speech training, including serious games. Results: Which speech dimensions (e.g., articulation, loudness) to target in computerized speech feedback, and at what level of detail to provide the feedback, depend on the focus of the specific speech therapy and the technical feasibility of providing reliable speech feedback. Furthermore, feedback that provides knowledge of results generally appears equally effective as knowledge of performance feedback, and is more easily provided in computerized speech training systems. Implicit feedback can be more motivating than explicit feedback (e.g., in serious games), but may be harder to understand. Multimodal feedback is preferred over unimodal feedback to ensure that the feedback message is optimally perceived. Mild negative task-oriented feedback can enhance effort but should be balanced with positive feedback, such as feedback referring to patients' progress. Finally, a balance should be found between the motivational advantages of high-frequency immediate feedback (e.g., in serious games) and the advantages of low-frequency and delayed feedback in preventing patients from becoming dependent on augmented feedback. Conclusions: Several aspects play a role in designing feedback for computerized speech training for dysarthric speakers. Decisions on these aspects should be made carefully, accounting for the specific characteristics of the patient group that is targeted, the focus of the specific speech therapy, and the technological possibilities that are available.

Speech-Language Pathology Evaluation and Management of Hyperkinetic Disorders Affecting Speech and Swallowing Function

Background

Hyperkinetic dysarthria is characterized by abnormal involuntary movements affecting respiratory, phonatory, and articulatory structures impacting speech and deglutition. Speech–language pathologists (SLPs) play an important role in the evaluation and management of dysarthria and dysphagia. This review describes the standard clinical evaluation and treatment approaches by SLPs for addressing impaired speech and deglutition in specific hyperkinetic dysarthria populations.

Methods

A literature review was conducted using the data sources of PubMed, Cochrane Library, and Google Scholar. Search terms included 1) hyperkinetic dysarthria, essential voice tremor, voice tremor, vocal tremor, spasmodic dysphonia, spastic dysphonia, oromandibular dystonia, Meige syndrome, orofacial, cervical dystonia, dystonia, dyskinesia, chorea, Huntington’s Disease, myoclonus; and evaluation/treatment terms: 2) Speech–Language Pathology, Speech Pathology, Evaluation, Assessment, Dysphagia, Swallowing, Treatment, Management, and diagnosis.

Results

The standard SLP clinical speech and swallowing evaluation of chorea/Huntington’s disease, myoclonus, focal and segmental dystonia, and essential vocal tremor typically includes 1) case history; 2) examination of the tone, symmetry, and sensorimotor function of the speech structures during non-speech, speech and swallowing relevant activities (i.e., cranial nerve assessment); 3) evaluation of speech characteristics; and 4) patient self-report of the impact of their disorder on activities of daily living. SLP management of individuals with hyperkinetic dysarthria includes behavioral and compensatory strategies for addressing compromised speech and intelligibility. Swallowing disorders are managed based on individual symptoms and the underlying pathophysiology determined during evaluation.

Discussion

SLPs play an important role in contributing to the differential diagnosis and management of impaired speech and deglutition associated with hyperkinetic disorders.

Poststroke Communication Disorders and Dysphagia

Communication and swallowing disorders are common after stroke. Targeted surveillance followed by prompt evaluation and treatment is of paramount importance. The overall goals of rehabilitation for impaired swallowing and communication and swallowing deficits may differ based on the specific deficits caused by the stroke but the main goal is always to improve the patient's everyday interpersonal interactions and optimize participation in society. Fortunately, therapeutic or compensatory interventions can decrease the effects that communication and swallowing deficits have on the quality of life of stroke survivors.

Neuroanatomical foundations of naming impairments across different neurologic conditions

The ability to name objects or abstract entities is an essential feature of speech and language, being commonly considered a central component of normal neurologic function. For this reason, the bedside testing of naming performance is part of the neurologic examination, especially since naming impairments can signify the early onset of a progressive disease or the occurrence of a more established problem. Modern neuroscience research suggests that naming relies on specific and distributed networks that operate in concert to support various processing stages, spanning from object recognition to spoken words. Likewise, studies evaluating the types of naming impairments in patients with neurologic conditions have contributed to the understanding of acquired forms of naming impairments and the underlying stages during normal language processing. In this article, we review the neurobiological mechanisms supporting naming, with a focus on the clinical application of these concepts. We provide an overview of the stages of cognitive processing that are hypothesized to support naming. For each stage, we explore the evidence revealing its neural basis, drawing parallels to clinical syndromes that commonly disrupt each stage. We review the patterns of naming impairment across various neurologic conditions, including classic language disorders, such as poststroke aphasia or primary progressive aphasia, as well as other diseases where language impairments may be subtle but helpful for the appropriate diagnosis. In this context, we provide a structured and practical guide for the bedside naming assessments rooted in modern neuroscience, aimed at supporting the evaluation and diagnosis of neurologic conditions that affect language.

The integrative role of the sigh in psychology, physiology, pathology, and neurobiology

"Sighs, tears, grief, distress" expresses Johann Sebastian Bach in a musical example for the relationship between sighs and deep emotions. This review explores the neurobiological basis of the sigh and its relationship with psychology, physiology, and pathology. Sighs monitor changes in brain states, induce arousal, and reset breathing variability. These behavioral roles homeostatically regulate breathing stability under physiological and pathological conditions. Sighs evoked in hypoxia evoke arousal and thereby become critical for survival. Hypoarousal and failure to sigh have been associated with sudden infant death syndrome. Increased breathing irregularity may provoke excessive sighing and hyperarousal, a behavioral sequence that may play a role in panic disorders. Essential for generating sighs and breathing is the pre-Bötzinger complex. Modulatory and synaptic interactions within this local network and between networks located in the brainstem, cerebellum, cortex, hypothalamus, amygdala, and the periaqueductal gray may govern the relationships between physiology, psychology, and pathology. Unraveling these circuits will lead to a better understanding of how we balance emotions and how emotions become pathological.