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Huang PK, Chen CK, Yu YH, Ho GM, Hsieh LC. Long-term voice outcomes of medialization thyroplasty with adjustable implant for unilateral vocal fold paralysis. Eur Arch Otorhinolaryngol 2024; 281:1371-1378. [PMID: 38085304 DOI: 10.1007/s00405-023-08367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/19/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Medialization thyroplasty (MT) using various implants has been employed as a corrective procedure for unilateral vocal fold paralysis (UVFP). A newly developed APrevent® vocal implant system (VOIS) offers an innovative solution with a finely adjustable design. This study aimed to investigate the long-term functional voice outcomes and benefits of postoperative adjustments in patients receiving MT using the VOIS-implant. METHODS This is a prospective case series study at single tertiary medical center. Fourteen adult patients diagnosed with UVFP received MT with the VOIS implant and were followed up for more than 1 year. Implant adjustment procedure by injecting 0.9% physiological saline solution was performed both during and after the surgery to optimize glottal closure and voice quality. Objective voice outcomes and acoustic parameters were assessed preoperatively and postoperatively at various timepoints. RESULTS Thirteen patients (93%) received intraoperative balloon adjustment, ranging from 0.05to 0.12 ml. Four patients underwent adjustments postoperatively and exhibited a positive trend towards immediately improving acoustic voice quality. Our long-term results demonstrated a notable improvement after the surgery in voice quality, with significant decreases in VHI-30 and improvements in perceptual parameters of GRBAS scale, acoustic measures such as jitter and signal-to-noise ratio (p < 0.001) and cepstral peak prominence smoothed in sustained vowel and short sentences. The voice outcomes remained stable more than 1 year follow-up. CONCLUSIONS Overall, MT with VOIS implantation provides a favorable long-term outcomes and stability in voice quality for patients with UVFP and also an effective tool for postoperative adjustment without major revision surgeries.
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Affiliation(s)
- Po-Kai Huang
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan
| | - Chin-Kuo Chen
- Department of Otolaryngology-Head and Neck Surgery, Communication Enhancement Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsuan Yu
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan
- Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei, Taiwan
| | - Guan-Min Ho
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan.
- Yomin ENT and Pediatric Clinic, Taipei, Taiwan.
- APrevent® Medical, Taipei, Taiwan.
| | - Li-Chun Hsieh
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan.
- Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei, Taiwan.
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan.
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Dragicevic DA, Dahl KL, Perkins Z, Abur D, Stepp CE. Effects of a Concurrent Working Memory Task on Speech Acoustics in Parkinson's Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:418-434. [PMID: 38081054 PMCID: PMC11001185 DOI: 10.1044/2023_ajslp-23-00214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/30/2023] [Accepted: 10/26/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE The purpose of this study was to determine the effect of a concurrent working memory task on acoustic measures of speech in individuals with Parkinson's disease (PD). METHOD Individuals with PD and age- and sex-matched controls performed a speaking task with and without a Stroop-like concurrent working memory task. Cepstral peak prominence, low-to-high spectral energy ratio, fundamental frequency (fo) standard deviation, articulation rate, pause duration, articulatory-acoustic vowel space, relative fo, mean voice onset time (VOT), and VOT variability were calculated for each condition. Mixed-model analyses of variance were performed to determine the effects of group, condition (presence of the concurrent working memory task), and their interaction on the acoustic measures. RESULTS All measures except for VOT variability, mean pause duration, and relative fo offset differed between people with and without PD. Cepstral peak prominence, articulation rate, and relative fo offset differed as a function of condition. However, no measures indicated disparate effects of condition as a function of group. CONCLUSION Although differentially impactful on limb motor function in PD, here a concurrent working memory task was not found to be differentially disruptive to speech acoustics in PD. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24759648.
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Affiliation(s)
| | - Kimberly L. Dahl
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Zoe Perkins
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Defne Abur
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Center for Language and Cognition Groningen, University of Groningen, the Netherlands
| | - Cara E. Stepp
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston University, MA
- Department of Otolaryngology—Head and Neck Surgery, Boston University School of Medicine, MA
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3
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Maffei MF, Green JR, Murton O, Yunusova Y, Rowe HP, Wehbe F, Diana K, Nicholson K, Berry JD, Connaghan KP. Acoustic Measures of Dysphonia in Amyotrophic Lateral Sclerosis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:872-887. [PMID: 36802910 PMCID: PMC10205101 DOI: 10.1044/2022_jslhr-22-00363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/25/2022] [Accepted: 12/01/2022] [Indexed: 05/25/2023]
Abstract
PURPOSE Identifying efficacious measures to characterize dysphonia in complex neurodegenerative diseases is key to optimal assessment and intervention. This study evaluates the validity and sensitivity of acoustic features of phonatory disruption in amyotrophic lateral sclerosis (ALS). METHOD Forty-nine individuals with ALS (40-79 years old) were audio-recorded while producing a sustained vowel and continuous speech. Perturbation/noise-based (jitter, shimmer, and harmonics-to-noise ratio) and cepstral/spectral (cepstral peak prominence, low-high spectral ratio, and related features) acoustic measures were extracted. The criterion validity of each measure was assessed using correlations with perceptual voice ratings provided by three speech-language pathologists. Diagnostic accuracy of the acoustic features was evaluated using area-under-the-curve analysis. RESULTS Perturbation/noise-based and cepstral/spectral features extracted from /a/ were significantly correlated with listener ratings of roughness, breathiness, strain, and overall dysphonia. Fewer and smaller correlations between cepstral/spectral measures and perceptual ratings were observed for the continuous speech task, although post hoc analyses revealed stronger correlations in speakers with less perceptually impaired speech. Area-under-the-curve analyses revealed that multiple acoustic features, particularly from the sustained vowel task, adequately differentiated between individuals with ALS with and without perceptually dysphonic voices. CONCLUSIONS Our findings support using both perturbation/noise-based and cepstral/spectral measures of sustained /a/ to assess phonatory quality in ALS. Results from the continuous speech task suggest that multisubsystem involvement impacts cepstral/spectral analyses in complex motor speech disorders such as ALS. Further investigation of the validity and sensitivity of cepstral/spectral measures during continuous speech in ALS is warranted.
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Affiliation(s)
- Marc F. Maffei
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Bioscience and Technology Program, Harvard University, Cambridge, MA
| | - Olivia Murton
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Hannah P. Rowe
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Farah Wehbe
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Kathleen Diana
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston
| | - Katharine Nicholson
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston
| | - James D. Berry
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston
| | - Kathryn P. Connaghan
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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Kim Y, Sidtis D, Sidtis JJ. Singing and Speaking Ability in Parkinson's Disease and Spinocerebellar Ataxia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:126-153. [PMID: 36608288 PMCID: PMC10023174 DOI: 10.1044/2022_jslhr-22-00274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/27/2022] [Accepted: 09/30/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE This study examined spontaneous, spoken-to-a-model, and two sung modes in speakers with Parkinson's disease (PD), speakers with cerebellar disease (CD), and healthy controls. Vocal performance was measured by intelligibility scores and listeners' perceptual ratings. METHOD Participants included speakers with hypokinetic dysarthria secondary to PD, those with ataxic dysarthria secondary to CD, and healthy speakers. Participants produced utterances in four vocal modes: spontaneous speech, spoken-to-a-model, sung-to-a-model, and spontaneous singing. For spoken-to-a-model and sung-to-a-model modes, written material was provided the model. For spontaneous singing, participants sang songs that they endorsed as familiar. DEPENDENT VARIABLES In Experiment I, listeners orthographically transcribed the audio samples of the first three vocal modes. In Experiment IIa, raters evaluated the accuracy of the pitch and rhythm of the spontaneous singing of familiar songs. Finally, familiar songs and sung-to-a-model utterances were rated on a competency scale by a second group of raters (Experiment IIb). RESULTS Results showed increases in intelligibility during the spoken-to-a-model mode compared with the spontaneous mode in both PD and CD groups. Singing enhanced the vocal output of speakers with PD more than in speakers with CD, as measured by percent intelligibility. PD participants' pitch and rhythm accuracy and competency in singing familiar songs was rated more favorably than those produced by CD participants. CONCLUSIONS The findings reveal a vocal task effect for spoken utterances in both groups. Sung exemplars, more impaired in CD, suggest a significant involvement of the cerebellum in singing. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21809544.
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Affiliation(s)
- Yoonji Kim
- Department of Speech, Language and Hearing Science, Temple University, Philadelphia, PA
- Geriatrics Division, The Nathan Kline Institute for Psychiatric Research at Rockland Psychiatric Center, Orangeburg, NY
| | - Diana Sidtis
- Geriatrics Division, The Nathan Kline Institute for Psychiatric Research at Rockland Psychiatric Center, Orangeburg, NY
- Department of Communicative Sciences and Disorders, New York University, NY
| | - John J. Sidtis
- Geriatrics Division, The Nathan Kline Institute for Psychiatric Research at Rockland Psychiatric Center, Orangeburg, NY
- Department of Psychiatry, New York University Langone School of Medicine, NY
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Kim GH, Lim DW, Kim JW, Park HJ, Lee YW. A Cepstral Analysis of Pathological Voice Quality in the Korean Population using Praat. J Voice 2022:S0892-1997(22)00319-8. [PMID: 36464574 DOI: 10.1016/j.jvoice.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/17/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES This study aimed to investigate the reference values for cepstral peak prominence (CPP) and smoothed CPP (CPPS) measured using Praat in Korean speakers with the normal, healthy and pathological voice. METHODS A total of 4,524 Korean participants with vocally healthy (n = 410) and dysphonic voices (n = 4,114) participated in this study. The speech task consisted of a sustained vowel /a/ and a sentence reading the Korean passage "Walk". CPP and CPPS values were quickly and automatically measured in sustained vowel and continuous speech tasks using Praat script. Furthermore, three veteran speech language pathologists (SLPs) scored the severity of dysphonia using the GRBAS scale (grade, roughness, breathiness, asthenia, strain) and Consensus Auditory Perceptual Evaluation of Voice (CAPE-V). RESULTS Three SLPs showed high inter- and intra-rater reliabilities (IRR) in auditory-perceptual (A-P) evaluation. Significant differences were confirmed in CPP and CPPS between the normally healthy and pathological voice groups for both voice tasks (P < 0.01). The measured values of CPP and CPPS varied depending on the laryngeal pathology. In the receiver operating characteristic (ROC) curve analysis, the CPP_Vowel (CPP_V), CPPS_V, CPP_Sentence (CPP_S), and CPPS_S cut-off values were <21.5, <12.0, <19.7, and <10.1, respectively. Through ROC curve analysis, it was confirmed that CPP and CPPS had excellent diagnostic accuracy in distinguishing disordered voice (area under the ROC: 0.951-0.966). CONCLUSION We investigated the reference values for CPP and CPPS measured with Praat for Korean speakers and confirmed that cepstral analysis is a promising tool for differentiating pathological voice.
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Affiliation(s)
- Geun-Hyo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Dong-Won Lim
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jae-Won Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do, South Korea
| | - Hee-June Park
- Department of Speech and Hearing Therapy, Catholic University of Pusan, Busan, Korea
| | - Yeon-Woo Lee
- Department of Speech-Language Pathology, Kosin University, Busan, South Korea.
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Terriza M, Navarro J, Retuerta I, Alfageme N, San-Segundo R, Kontaxakis G, Garcia-Martin E, Marijuan PC, Panetsos F. Use of Laughter for the Detection of Parkinson's Disease: Feasibility Study for Clinical Decision Support Systems, Based on Speech Recognition and Automatic Classification Techniques. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10884. [PMID: 36078600 PMCID: PMC9518165 DOI: 10.3390/ijerph191710884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 06/15/2023]
Abstract
Parkinson's disease (PD) is an incurable neurodegenerative disorder which affects over 10 million people worldwide. Early detection and correct evaluation of the disease is critical for appropriate medication and to slow the advance of the symptoms. In this scenario, it is critical to develop clinical decision support systems contributing to an early, efficient, and reliable diagnosis of this illness. In this paper we present a feasibility study for a clinical decision support system for the diagnosis of PD based on the acoustic characteristics of laughter. Our decision support system is based on laugh analysis with speech recognition methods and automatic classification techniques. We evaluated different cepstral coefficients to identify laugh characteristics of healthy and ill subjects combined with machine learning classification models. The decision support system reached 83% accuracy rate with an AUC value of 0.86 for PD-healthy laughs classification in a database of 20,000 samples randomly generated from a pool of 120 laughs from healthy and PD subjects. Laughter could be employed for the efficient and reliable detection of PD; such a detection system can be achieved using speech recognition and automatic classification techniques; a clinical decision support system can be built using the above techniques. Significance: PD clinical decision support systems for the early detection of the disease will help to improve the efficiency of available and upcoming therapeutic treatments which, in turn, would improve life conditions of the affected people and would decrease costs and efforts in public and private healthcare systems.
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Affiliation(s)
- Miguel Terriza
- Neuro-Computing & Neuro-Robotics Research Group, Complutense University of Madrid, 28040 Madrid, Spain
- Innovation Group, Institute for Health Research San Carlos Clinical Hospital (IdISSC), 28040 Madrid, Spain
| | - Jorge Navarro
- Department of Economic Structure, CASETEM Research Group, Faculty of Economy, University of Zaragoza, 50009 Zaragoza, Spain
| | - Irene Retuerta
- Independent Researchers, Affiliated to Bioinformation and Systems Biology Group, Aragon Health Sciences Institute (IACS-IIS Aragon), 50009 Zaragoza, Spain
| | - Nuria Alfageme
- Neuro-Computing & Neuro-Robotics Research Group, Complutense University of Madrid, 28040 Madrid, Spain
- Innovation Group, Institute for Health Research San Carlos Clinical Hospital (IdISSC), 28040 Madrid, Spain
| | - Ruben San-Segundo
- Speech Technology Group, Information Processing and Telecommunications Center, 28040 Madrid, Spain
| | - George Kontaxakis
- Biomedical Image Technologies Group, Information Processing and Telecommunications Center, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Elena Garcia-Martin
- Department of Ophthalmology, Miguel Servet University Hospital, 50009 Zaragoza, Spain
- Miguel Servet Ophthalmology Research Group (GIMSO), Aragon Health Research Institute (IIS Aragón), University of Zaragoza, 50009 Zaragoza, Spain
| | - Pedro C. Marijuan
- Independent Researchers, Affiliated to Bioinformation and Systems Biology Group, Aragon Health Sciences Institute (IACS-IIS Aragon), 50009 Zaragoza, Spain
| | - Fivos Panetsos
- Neuro-Computing & Neuro-Robotics Research Group, Complutense University of Madrid, 28040 Madrid, Spain
- Innovation Group, Institute for Health Research San Carlos Clinical Hospital (IdISSC), 28040 Madrid, Spain
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Walden PR, Rau S. Individual Voice Dimensions' Prediction of Overall Dysphonia Severity on Two Auditory-Perceptual Scales. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2759-2777. [PMID: 35868295 DOI: 10.1044/2022_jslhr-21-00689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Auditory-perceptual evaluation of dysphonic voice is an essential clinical activity that characterizes the nature of dysphonia and aids in planning its clinical management. Although there are multidimensional acoustic measures that correlate well with overall severity ratings, they tend to include measures that have only small or moderate correlations with individual voice characteristics frequently perceptually measured (e.g., breathiness or roughness). Given this difference between perceptual and acoustic measures, it is unclear how much individual voice characteristics contribute to a listener's perception of overall severity of dysphonia. PURPOSE The purpose of this study was to explore individual voice characteristics' relative contribution to the rating of overall dysphonia severity and to explore sex-related differences. METHOD Two hundred ninety-six voice samples were accessed from the Perceptual Voice Qualities Database. Roughness, breathiness, asthenia, strain, pitch, and loudness ratings from the Grade, Roughness, Breathiness, Asthenia, Strain and Consensus Auditory-Perceptual Evaluation of Voice scales were used to predict overall voice quality severity in linear regression with bootstrapped coefficients. RESULTS Roughness, breathiness, and strain were the strongest predictors of overall severity. Asthenia and, to a lesser extent, pitch were also significant predictors of overall severity. Loudness was not a significant predictor. There were several sex-related differences noted, as well as differences related to the scale used. CONCLUSIONS Breathiness, roughness, and strain were all important predictors of overall severity for all regressions. Clinicians should be aware of scale-related differences if they are using auditory-perceptual measures to choose voice therapy targets. Analyses accounting for perceptual strategy differences were recommended for future studies.
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Affiliation(s)
| | - Sydney Rau
- Department of Communication Sciences and Disorders, St. John's University, Queens, NY
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Kouba T, Illner V, Rusz J. Study protocol for using a smartphone application to investigate speech biomarkers of Parkinson's disease and other synucleinopathies: SMARTSPEECH. BMJ Open 2022; 12:e059871. [PMID: 35772829 PMCID: PMC9247696 DOI: 10.1136/bmjopen-2021-059871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Early identification of Parkinson's disease (PD) in its prodromal stage has fundamental implications for the future development of neuroprotective therapies. However, no sufficiently accurate biomarkers of prodromal PD are currently available to facilitate early identification. The vocal assessment of patients with isolated rapid eye movement sleep behaviour disorder (iRBD) and PD appears to have intriguing potential as a diagnostic and progressive biomarker of PD and related synucleinopathies. METHODS AND ANALYSIS Speech patterns in the spontaneous speech of iRBD, early PD and control participants' voice calls will be collected from data acquired via a developed smartphone application over a period of 2 years. A significant increase in several aspects of PD-related speech disorders is expected, and is anticipated to reflect the underlying neurodegeneration processes. ETHICS AND DISSEMINATION The study has been approved by the Ethics Committee of the General University Hospital in Prague, Czech Republic and all the participants will provide written, informed consent prior to their inclusion in the research. The application satisfies the General Data Protection Regulation law requirements of the European Union. The study findings will be published in peer-reviewed journals and presented at international scientific conferences.
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Affiliation(s)
- Tomáš Kouba
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Vojtěch Illner
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
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An Update on the Measurement of Motor Cerebellar Dysfunction in Multiple Sclerosis. THE CEREBELLUM 2022:10.1007/s12311-022-01435-y. [PMID: 35761144 PMCID: PMC9244122 DOI: 10.1007/s12311-022-01435-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 12/03/2022]
Abstract
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.
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Narayana S, Franklin C, Peterson E, Hunter EJ, Robin DA, Halpern A, Spielman J, Fox PT, Ramig LO. Immediate and long-term effects of speech treatment targets and intensive dosage on Parkinson's disease dysphonia and the speech motor network: Randomized controlled trial. Hum Brain Mapp 2022; 43:2328-2347. [PMID: 35141971 PMCID: PMC8996348 DOI: 10.1002/hbm.25790] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/16/2021] [Accepted: 01/07/2022] [Indexed: 11/07/2022] Open
Abstract
This study compared acoustic and neural changes accompanying two treatments matched for intensive dosage but having two different treatment targets (voice or articulation) to dissociate the effects of treatment target and intensive dosage in speech therapies. Nineteen participants with Parkinsonian dysphonia (11 F) were randomized to three groups: intensive treatment targeting voice (voice group, n = 6), targeting articulation (articulation group, n = 7), or an untreated group (no treatment, n = 6). The severity of dysphonia was assessed by the smoothed cepstral peak prominence (CPPS) and neuronal changes were evaluated by cerebral blood flow (CBF) recorded at baseline, posttreatment, and 7-month follow-up. Only the voice treatment resulted in significant posttreatment improvement in CPPS, which was maintained at 7 months. Following voice treatment, increased activity in left premotor and bilateral auditory cortices was observed at posttreatment, and in the left motor and auditory cortices at 7-month follow-up. Articulation treatment resulted in increased activity in bilateral premotor and left insular cortices that were sustained at a 7-month follow-up. Activation in the auditory cortices and a significant correlation between the CPPS and CBF in motor and auditory cortices was observed only in the voice group. The intensive dosage resulted in long-lasting behavioral and neural effects as the no-treatment group showed a progressive decrease in activity in areas of the speech motor network out to a 7-month follow-up. These results indicate that dysphonia and the speech motor network can be differentially modified by treatment targets, while intensive dosage contributes to long-lasting effects of speech treatments.
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Affiliation(s)
- Shalini Narayana
- Department of Pediatrics, Division of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Crystal Franklin
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA
| | | | - Eric J Hunter
- Department of Communicative Sciences and Disorders, Michigan State University, Lansing, Michigan, USA
| | - Donald A Robin
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, New Hampshire, USA
| | - Angela Halpern
- LSVT Global Inc, Tucson, Arizona, USA.,National Center for Voice and Speech and Department of Speech-Language and Hearing Sciences, University of Colorado-Boulder, Boulder, Colorado, USA
| | - Jennifer Spielman
- National Center for Voice and Speech and Department of Speech-Language and Hearing Sciences, University of Colorado-Boulder, Boulder, Colorado, USA.,Front Range Voice Care, Denver, Colorado, USA
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA.,Audie L. Murphy South Texas Veterans Administration Medical Center, San Antonio, Texas, USA
| | - Lorraine O Ramig
- LSVT Global Inc, Tucson, Arizona, USA.,National Center for Voice and Speech and Department of Speech-Language and Hearing Sciences, University of Colorado-Boulder, Boulder, Colorado, USA.,Columbia University, New York, New York, USA
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11
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Eshghi M, Connaghan KP, Gutz SE, Berry JD, Yunusova Y, Green JR. Co-Occurrence of Hypernasality and Voice Impairment in Amyotrophic Lateral Sclerosis: Acoustic Quantification. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4772-4783. [PMID: 34714698 PMCID: PMC9150680 DOI: 10.1044/2021_jslhr-21-00123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 05/31/2023]
Abstract
PURPOSE Hypernasality and atypical voice characteristics are common features of dysarthric speech due to amyotrophic lateral sclerosis (ALS). Existing acoustic measures have been developed to primarily target either hypernasality or voice impairment, and the effects of co-occurring hypernasality-voice problems on these measures are unknown. This report explores (a) the extent to which acoustic measures are affected by concurrent perceptually identified hypernasality and voice impairment due to ALS and (b) candidate acoustic measures of early indicators of hypernasality and voice impairment in the presence of multisystem involvement in individuals with ALS. METHOD Two expert listeners rated severity of hypernasality and voice impairment in sentences produced by individuals with ALS (n = 27). The samples were stratified based on perceptual ratings: voice/hypernasality asymptomatic, predominantly hypernasal, predominantly voice impairment, and mixed (co-occurring hypernasality and voice impairment). Groups were compared using established acoustic measures of hypernasality (one-third octave analysis) and voice (cepstral/spectral analysis) impairment. RESULTS The one-third octave analysis differentiated all groups; the cepstral peak prominence differentiated all groups except asymptomatic versus mixed, whereas the low-to-high spectral ratio did not differ among groups. Additionally, one-third octave analyses demonstrated promising speech diagnostic potential. CONCLUSIONS The results highlight the need to consider the validity of measures in the context of multisubsystem involvement. Our preliminary findings further suggest that the one-third octave analysis may be an optimal approach to quantify hypernasality and voice abnormalities in the presence of multisystem speech impairment. Future evaluation of the diagnostic accuracy of the one-third octave analysis is warranted.
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Affiliation(s)
- Marziye Eshghi
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, MA
| | - Kathryn P. Connaghan
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, MA
| | - Sarah E. Gutz
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Boston, MA
| | - James D. Berry
- Sean M. Healey and AMG Center for ALS, Department of Neurology, Massachusetts General Hospital, Boston
| | - Yana Yunusova
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute (KITE), University Health Network, Ontario, Canada
| | - Jordan R. Green
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, MA
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Boston, MA
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Šimek M, Rusz J. Validation of cepstral peak prominence in assessing early voice changes of Parkinson's disease: Effect of speaking task and ambient noise. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 150:4522. [PMID: 34972306 DOI: 10.1121/10.0009063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
Although the cepstral peak prominence (CPP) and its variant, the cepstral peak prominence smooth (CPPS), are considered to be robust acoustic measures for the evaluation of dysphonia, whether they are sensitive to capture early voice changes in Parkinson's disease (PD) has not yet been explored. This study aimed to investigate the voice changes via the CPP measures in the idiopathic rapid eye movement sleep behavior disorder (iRBD), a special case of prodromal neurodegeneration, and recently diagnosed and advanced-stage Parkinson's disease (AS-PD) patients using different speaking tasks across noise-free and noisy environments. The sustained vowel phonation, reading of passages, and monologues of 60 early stage untreated PD, 30 advanced-stage Parkinson's disease, 60 iRBD, and 60 healthy control (HC) participants were evaluated. Significant differences were found between the PD groups and controls in sustained phonation via the CPP (p < 0.05) and CPPS (p < 0.01) and the monologue via the CPP (p < 0.01), although neither the CPP nor CPPS measures were sufficiently sensitive to capture the possible prodromal dysphonia in the iRBD. The quality of the CPP and CPPS measures was influenced substantially by the addition of ambient noise. It was anticipated that the CPP measures might serve as a promising digital biomarker in assessing the dysphonia from the early stages of PD.
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Affiliation(s)
- Michal Šimek
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
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Improved Estimation of Parkinsonian Vowel Quality through Acoustic Feature Assimilation. ScientificWorldJournal 2021; 2021:6076828. [PMID: 34335114 PMCID: PMC8298151 DOI: 10.1155/2021/6076828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/17/2020] [Accepted: 06/30/2021] [Indexed: 02/06/2023] Open
Abstract
This paper investigated the performance of a number of acoustic measures, both individually and in combination, in predicting the perceived quality of sustained vowels produced by people impaired with Parkinson's disease (PD). Sustained vowel recordings were collected from 51 PD patients before and after the administration of the Levodopa medication. Subjective ratings of the overall vowel quality were garnered using a visual analog scale. These ratings served to benchmark the effectiveness of the acoustic measures. Acoustic predictors of the perceived vowel quality included the harmonics-to-noise ratio (HNR), smoothed cepstral peak prominence (CPP), recurrence period density entropy (RPDE), Gammatone frequency cepstral coefficients (GFCCs), linear prediction (LP) coefficients and their variants, and modulation spectrogram features. Linear regression (LR) and support vector regression (SVR) models were employed to assimilate multiple features. Different feature dimensionality reduction methods were investigated to avoid model overfitting and enhance the prediction capabilities for the test dataset. Results showed that the RPDE measure performed the best among all individual features, while a regression model incorporating a subset of features produced the best overall correlation of 0.80 between the predicted and actual vowel quality ratings. This model may therefore serve as a surrogate for auditory-perceptual assessment of Parkinsonian vowel quality. Furthermore, the model may offer the clinician a tool to predict who may benefit from Levodopa medication in terms of enhanced voice quality.
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Behrman A, Cody J, Chitnis S, Elandary S. Dysarthria treatment for Parkinson's disease: one-year follow-up of SPEAK OUT! ® with the LOUD Crowd ®. LOGOP PHONIATR VOCO 2021; 47:271-278. [PMID: 34338571 DOI: 10.1080/14015439.2021.1958001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION SPEAK OUT! with The LOUD Crowd is a standardized speech therapy program typically consisting of 12 one-on-one treatments and ongoing weekly group maintenance sessions for patients with dysarthria due to Parkinson's disease (PD). It is based upon the hypothesis that increased attention to speech, which is a goal-directed motor activity, may compensate for the impairment in automatic sequential motor behaviors often demonstrated in patients with PD. We present results on the 1-year response to treatment. METHODS Forty individuals with idiopathic PD received SPEAK OUT! delivered in 12 one-on-one 40-min treatment sessions 3 times per week for four consecutive weeks in addition to ongoing group maintenance sessions called The LOUD Crowd. Evaluations occurred 3 times at baseline, within one and six weeks after completion of the SPEAK OUT! sessions (N = 40) and 1-year later (N = 35). Assessments included mean speech intensity and intonation from reading and monolog, the voice quality acoustic measure called cepstral peak prominence (CPP), and scores on the voice-related quality of life questionnaire. RESULTS The significant improvements achieved in all outcome measures from baseline to completion of SPEAK OUT! were maintained 1-year later. Participation throughout the year in regular group maintenance sessions (The LOUD Crowd) was positively correlated with level of improvement at 1 year for all measures except patient perception of voice. CONCLUSIONS These long-term data contribute evidence of the effectiveness of this speech therapy program for improving communication for individuals with PD and emphasize the importance of regular and ongoing group sessions to sustain therapeutic gains.
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Affiliation(s)
- Alison Behrman
- Department of Speech-Language-Hearing Sciences, Lehman College
- City University of New York, Bronx, NY, USA
| | | | - Shilpa Chitnis
- Parkinson Voice Project, Richardson, TX, USA.,Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Hidalgo-De la Guía I, Garayzábal-Heinze E, Gómez-Vilda P, Martínez-Olalla R, Palacios-Alonso D. Acoustic Analysis of Phonation in Children With Smith-Magenis Syndrome. Front Hum Neurosci 2021; 15:661392. [PMID: 34149380 PMCID: PMC8209519 DOI: 10.3389/fnhum.2021.661392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Complex simultaneous neuropsychophysiological mechanisms are responsible for the processing of the information to be transmitted and for the neuromotor planning of the articulatory organs involved in speech. The nature of this set of mechanisms is closely linked to the clinical state of the subject. Thus, for example, in populations with neurodevelopmental deficits, these underlying neuropsychophysiological procedures are deficient and determine their phonation. Most of these cases with neurodevelopmental deficits are due to a genetic abnormality, as is the case in the population with Smith–Magenis syndrome (SMS). SMS is associated with neurodevelopmental deficits, intellectual disability, and a cohort of characteristic phenotypic features, including voice quality, which does not seem to be in line with the gender, age, and complexion of the diagnosed subject. The phonatory profile and speech features in this syndrome are dysphonia, high f0, excess vocal muscle stiffness, fluency alterations, numerous syllabic simplifications, phoneme omissions, and unintelligibility of speech. This exploratory study investigates whether the neuromotor deficits in children with SMS adversely affect phonation as compared to typically developing children without neuromotor deficits, which has not been previously determined. The authors compare the phonatory performance of a group of children with SMS (N = 12) with a healthy control group of children (N = 12) matched in age, gender, and grouped into two age ranges. The first group ranges from 5 to 7 years old, and the second group goes from 8 to 12 years old. Group differences were determined for two forms of acoustic analysis performed on repeated recordings of the sustained vowel /a/ F1 and F2 extraction and cepstral peak prominence (CPP). It is expected that the results will enlighten the question of the underlying neuromotor aspects of phonation in SMS population. These findings could provide evidence of the susceptibility of phonation of speech to neuromotor disturbances, regardless of their origin.
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Affiliation(s)
| | | | - Pedro Gómez-Vilda
- Center for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
| | | | - Daniel Palacios-Alonso
- Escuela Técnica Superior de Ingeniería Informática, Universidad Rey Juan Carlos, Madrid, Spain
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Monitoring Parkinson's disease progression based on recorded speech with missing ordinal responses and replicated covariates. Comput Biol Med 2021; 134:104503. [PMID: 34091382 DOI: 10.1016/j.compbiomed.2021.104503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/10/2021] [Accepted: 05/15/2021] [Indexed: 11/19/2022]
Abstract
Monitoring Parkinson's Disease (PD) progression is an important task to improve the life quality of the affected people. This task can be performed by extracting features from voice recordings and applying specifically designed statistical models, leading to systems that improve the ability of monitoring the progression of PD in an objective, remote, non-invasive, fast, and economically sustainable way. An experiment has been conducted with 36 subjects to study the progression of the PD over 4 years by using the Hoehn and Yahr (HY) scale and features extracted from the phonation of the vowel/a/. The collected dataset had many missing data, which should be addressed jointly with the non-decreasing nature of the disease and the within-subject variability due to the use of replicated features. In order to handle these issues, a Hidden Markov model for longitudinal data was designed and implemented by using a data augmentation scheme based on different latent variables. Markov chain Monte Carlo methods were used to generate from the posterior distribution. The proposed approach has been tested on simulated data, providing good accuracy rates in the context of a multiclass problem. It also has been applied to the real data obtained from the conducted experiment, providing imputed and predicted HY stages compatible with the progression of PD. The conducted experiment and the proposed approach contribute to fill a gap in the scientific literature on experiments and methodologies for tracking PD progression based on acoustic features and the HY scale. This would help to derive an expert system that can be integrated into the protocols of neurology units in hospital centers.
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Chiu YF, Neel A, Loux T. Exploring the Acoustic Perceptual Relationship of Speech in Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:1560-1570. [PMID: 33900806 DOI: 10.1044/2021_jslhr-20-00610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Auditory perceptual judgments are commonly used to diagnose dysarthria and assess treatment progress. The purpose of the study was to examine the acoustic underpinnings of perceptual speech abnormalities in individuals with Parkinson's disease (PD). Method Auditory perceptual judgments were obtained from sentences produced by 13 speakers with PD and five healthy older adults. Twenty young listeners rated overall ease of understanding, articulatory precision, voice quality, and prosodic adequacy on a visual analog scale. Acoustic measures associated with the speech subsystems of articulation, phonation, and prosody were obtained, including second formant transitions, articulation rate, cepstral and spectral measures of voice, and pitch variations. Regression analyses were performed to assess the relationships between perceptual judgments and acoustic variables. Results Perceptual impressions of Parkinsonian speech were related to combinations of several acoustic variables. Approximately 36%-49% of the variance in the perceptual ratings were explained by the acoustic measures indicating a modest acoustic perceptual relationship. Conclusions The relationships between perceptual ratings and acoustic signals in Parkinsonian speech are multifactorial and involve a variety of acoustic features simultaneously. The modest acoustic perceptual relationships, however, suggest that future work is needed to further examine the acoustic bases of perceptual judgments in dysarthria.
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Affiliation(s)
- Yi-Fang Chiu
- Department of Communication Sciences and Disorders, Saint Louis University, MO
| | - Amy Neel
- Department of Speech and Hearing Sciences, The University of New Mexico, Albuquerque
| | - Travis Loux
- Department of Epidemiology and Biostatistics, Saint Louis University, MO
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Behrman A, Cody J, Elandary S, Flom P, Chitnis S. The Effect of SPEAK OUT! and The LOUD Crowd on Dysarthria Due to Parkinson's Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1448-1465. [PMID: 32421347 PMCID: PMC7893519 DOI: 10.1044/2020_ajslp-19-00024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/09/2019] [Accepted: 02/12/2020] [Indexed: 05/31/2023]
Abstract
Purpose SPEAK OUT! and The LOUD Crowd is a standardized speech therapy program of 12 individual treatments combined with ongoing weekly group sessions for individuals with dysarthria due to Parkinson's disease (PD). The premise of this program is that individuals with PD must rely on goal-directed basal ganglia-cortical circuits to compensate for deficits in habitual, automatic control. The purpose of this study was to assess the outcome of this therapy program. Method Forty individuals with idiopathic PD received SPEAK OUT! in 12 individual 40-min sessions 3 times per week for 4 consecutive weeks and also participated in The LOUD Crowd. Assessments were conducted 3 times at baseline and then within 1 and 6 weeks after completion of the individual SPEAK OUT! sessions. Twenty-five adults without communication disorders were assessed on the same schedule. Acoustic outcome measures were mean intensity from reading and monologue, the prosody measures of standard deviation of intensity and frequency from reading and monologue, and the voice quality measure of cepstral peak prominence from reading. Patient perception of voice was also assessed with the Voice-Related Quality of Life. Results Posttherapy, mean intensity was greater and variation of frequency was larger in reading and monologue, while variation in intensity was larger in monologue but unchanged in reading. Cepstral peak prominence and Voice-Related Quality of Life scores were significantly higher (improved) after therapy. Conclusion These data contribute to evidence of the effectiveness of this program for hypokinetic dysarthria secondary to idiopathic PD and thus inform clinical practice in the selection among treatment options.
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Affiliation(s)
| | | | | | - Peter Flom
- Research Foundation, City University of New York, NY
- Peter Flom Consulting, New York, NY
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Narasimhan SV, Rashmi R. Multiparameter Voice Assessment in Dysphonics: Correlation Between Objective and Perceptual Parameters. J Voice 2020; 36:335-343. [PMID: 32651100 DOI: 10.1016/j.jvoice.2020.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/31/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Perceptual assessment and objective measures of voice provide a quantifiable tool for determining the degree of glottal closure, thus helping to distinguish dysphonic voices from normal voices. The correlation between the perceptual and objective parameters of voice in dysphonic can enable the voice pathologist to be more effective in differentiating the normal voices from dysphonic voices. However, only a few studies have investigated the correlation between these measures. OBJECTIVE To document the differences in the perceptual and objective parameters of voice in participants with dysphonia and normal controls and to investigate the correlation between the perceptual and objective parameters of voice among participants with dysphonia. STUDY DESIGN This investigation deployed standard group comparison and a retrospective study. METHODS Two groups of participants were included in the study. Participants in group 1 were diagnosed as having a voice disorder secondary to organic pathologies and group 2 participants had a clinically normal voice. Phonation samples of all the participants were collected and perceptual analysis was carried out using the GRBAS rating scale. As part of the objective measures, acoustic and cepstral measures were extracted from the phonation samples. RESULTS The analysis of the results revealed significant differences in perceptual ratings between the normal (control) and dysphonic groups. The mean values of all the objective measures of voice presented significant differences between participants of both groups. The perceptual ratings of grade, breathiness, and roughness showed better correlations with the cepstral measures than with the time-based acoustic measures. CONCLUSIONS Further foraging research on the correlation between perceptual and objective measures of voice in various degrees of dysphonia will improve reliability while discriminating and quantifying hoarse, harsh and breathy voices from modal voices.
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Affiliation(s)
- S V Narasimhan
- Department of Speech & Language Pathology, JSS Institute of Speech & Hearing, Mysore, Karnataka, India
| | - Rajesh Rashmi
- II MASLP, Samvaad Institute of Speech & Hearing, Bangalore, Karnataka, India.
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Kitayama I, Hosokawa K, Iwahashi T, Iwahashi M, Iwaki S, Kato C, Yoshida M, Umatani M, Matsushiro N, Ogawa M, Inohara H. Intertext Variability of Smoothed Cepstral Peak Prominence, Methods to Control It, and Its Diagnostic Properties. J Voice 2020; 34:305-319. [DOI: 10.1016/j.jvoice.2018.09.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 11/30/2022]
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Novotný M, Dušek P, Daly I, Růžička E, Rusz J. Glottal Source Analysis of Voice Deficits in Newly Diagnosed Drug-naïve Patients with Parkinson’s Disease: Correlation Between Acoustic Speech Characteristics and Non-Speech Motor Performance. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2019.101818] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Quantitative Assessment of Speech in Cerebellar Ataxia Using Magnitude and Phase Based Cepstrum. Ann Biomed Eng 2020; 48:1322-1336. [PMID: 31965359 DOI: 10.1007/s10439-020-02455-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
The clinical assessment of speech abnormalities in Cerebellar Ataxia (CA) is time-consuming and inconsistent. We have developed an automated objective system to quantify CA severity and thereby facilitate remote monitoring and optimisation of therapeutic interventions. A quantitative acoustic assessment could prove to be a viable biomarker for this purpose. Our study explores the use of phase-based cepstral features extracted from the modified group delay function as a complement to the features obtained from the magnitude cepstrum. We selected a combination of 15 acoustic measurements using RELIEF feature selection algorithm during the feature optimisation process. These features were used to segregate ataxic speakers from normal speakers (controls) and objectively assess them based on their severity. The effectiveness of our study has been experimentally evaluated through a clinical study involving 42 patients diagnosed with CA and 23 age-matched controls. A radial basis function kernel based support vector machine (SVM) classifier achieved a classification accuracy of 84.6% in CA-Control discrimination [area under the ROC curve (AUC) of 0.97] and 74% in the modified 3-level CA severity estimation (AUC of 0.90) deduced from the clinical ratings. The strong classification ability of selected features and the SVM model supports this scheme's suitability for monitoring CA related speech motor abnormalities.
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A Two-Stage Cepstral Analysis Procedure for the Classification of Rough Voices. J Voice 2020; 34:9-19. [DOI: 10.1016/j.jvoice.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/25/2018] [Accepted: 07/02/2018] [Indexed: 11/23/2022]
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Gaballah A, Parsa V, Andreetta M, Adams S. Objective and Subjective Speech Quality Assessment of Amplification Devices for Patients With Parkinson’s Disease. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1226-1235. [DOI: 10.1109/tnsre.2019.2915172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hosokawa K, Barsties v Latoszek B, Iwahashi T, Iwahashi M, Iwaki S, Kato C, Yoshida M, Sasai H, Miyauchi A, Matsushiro N, Inohara H, Ogawa M, Maryn Y. The Acoustic Voice Quality Index Version 03.01 for the Japanese-speaking Population. J Voice 2019; 33:125.e1-125.e12. [DOI: 10.1016/j.jvoice.2017.10.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 11/16/2022]
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26
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Effect of vowel context in cepstral and entropy analysis of pathological voices. Biomed Signal Process Control 2019. [DOI: 10.1016/j.bspc.2018.08.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Lee SJ, Pyo HY, Choi HS. Normative Data of Cepstral and Spectral Measures in Korean Adults Using Vowel Phonation and Passage Reading Tasks. ACTA ACUST UNITED AC 2018. [DOI: 10.12963/csd.18474] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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28
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Lee SJ, Lim SE, Choi HS. A Comparison of Cepstral and Spectral Measures according to Measurement Position in a Reading Passage. COMMUNICATION SCIENCES AND DISORDERS-CSD 2017. [DOI: 10.12963/csd.17433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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29
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Godino-Llorente JI, Shattuck-Hufnagel S, Choi JY, Moro-Velázquez L, Gómez-García JA. Towards the identification of Idiopathic Parkinson's Disease from the speech. New articulatory kinetic biomarkers. PLoS One 2017; 12:e0189583. [PMID: 29240814 PMCID: PMC5730127 DOI: 10.1371/journal.pone.0189583] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 11/29/2017] [Indexed: 11/22/2022] Open
Abstract
Although a large amount of acoustic indicators have already been proposed in the literature to evaluate the hypokinetic dysarthria of people with Parkinson's Disease, the goal of this work is to identify and interpret new reliable and complementary articulatory biomarkers that could be applied to predict/evaluate Parkinson's Disease from a diadochokinetic test, contributing to the possibility of a further multidimensional analysis of the speech of parkinsonian patients. The new biomarkers proposed are based on the kinetic behaviour of the envelope trace, which is directly linked with the articulatory dysfunctions introduced by the disease since the early stages. The interest of these new articulatory indicators stands on their easiness of identification and interpretation, and their potential to be translated into computer based automatic methods to screen the disease from the speech. Throughout this paper, the accuracy provided by these acoustic kinetic biomarkers is compared with the one obtained with a baseline system based on speaker identification techniques. Results show accuracies around 85% that are in line with those obtained with the complex state of the art speaker recognition techniques, but with an easier physical interpretation, which open the possibility to be transferred to a clinical setting.
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Affiliation(s)
- J. I. Godino-Llorente
- Speech Communication Group, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - S. Shattuck-Hufnagel
- Speech Communication Group, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - J. Y. Choi
- Speech Communication Group, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - L. Moro-Velázquez
- Centre for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
| | - J. A. Gómez-García
- Centre for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
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Borsky M, Mehta DD, Van Stan JH, Gudnason J. Modal and non-modal voice quality classification using acoustic and electroglottographic features. IEEE/ACM TRANSACTIONS ON AUDIO, SPEECH, AND LANGUAGE PROCESSING 2017; 25:2281-2291. [PMID: 33748320 PMCID: PMC7971071 DOI: 10.1109/taslp.2017.2759002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The goal of this study was to investigate the performance of different feature types for voice quality classification using multiple classifiers. The study compared the COVAREP feature set; which included glottal source features, frequency warped cepstrum and harmonic model features; against the mel-frequency cepstral coefficients (MFCCs) computed from the acoustic voice signal, acoustic-based glottal inverse filtered (GIF) waveform, and electroglottographic (EGG) waveform. Our hypothesis was that MFCCs can capture the perceived voice quality from either of these three voice signals. Experiments were carried out on recordings from 28 participants with normal vocal status who were prompted to sustain vowels with modal and non-modal voice qualities. Recordings were rated by an expert listener using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and the ratings were transformed into a dichotomous label (presence or absence) for the prompted voice qualities of modal voice, breathiness, strain, and roughness. The classification was done using support vector machines, random forests, deep neural networks and Gaussian mixture model classifiers, which were built as speaker independent using a leave-one-speaker-out strategy. The best classification accuracy of 79.97% was achieved for the full COVAREP set. The harmonic model features were the best performing subset, with 78.47% accuracy, and the static+dynamic MFCCs scored at 74.52%. A closer analysis showed that MFCC and dynamic MFCC features were able to classify modal, breathy, and strained voice quality dimensions from the acoustic and GIF waveforms. Reduced classification performance was exhibited by the EGG waveform.
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Effects of dopaminergic replacement therapy on motor speech disorders in Parkinson’s disease: longitudinal follow-up study on previously untreated patients. J Neural Transm (Vienna) 2016; 123:379-87. [DOI: 10.1007/s00702-016-1515-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
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Modulation Spectra Morphological Parameters: A New Method to Assess Voice Pathologies according to the GRBAS Scale. BIOMED RESEARCH INTERNATIONAL 2015; 2015:259239. [PMID: 26557656 PMCID: PMC4628766 DOI: 10.1155/2015/259239] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/04/2015] [Accepted: 05/04/2015] [Indexed: 11/17/2022]
Abstract
Disordered voices are frequently assessed by speech pathologists using perceptual evaluations. This might lead to problems caused by the subjective nature of the process and due to the influence of external factors which compromise the quality of the assessment. In order to increase the reliability of the evaluations, the design of automatic evaluation systems is desirable. With that in mind, this paper presents an automatic system which assesses the Grade and Roughness level of the speech according to the GRBAS perceptual scale. Two parameterization methods are used: one based on the classic Mel-Frequency Cepstral Coefficients, which has already been used successfully in previous works, and other derived from modulation spectra. For the latter, a new group of parameters has been proposed, named Modulation Spectra Morphological Parameters: MSC, DRB, LMR, MSH, MSW, CIL, PALA, and RALA. In methodology, PCA and LDA are employed to reduce the dimensionality of feature space, and GMM classifiers to evaluate the ability of the proposed features on distinguishing the different levels. Efficiencies of 81.6% and 84.7% are obtained for Grade and Roughness, respectively, using modulation spectra parameters, while MFCCs performed 80.5% and 77.7%. The obtained results suggest the usefulness of the proposed Modulation Spectra Morphological Parameters for automatic evaluation of Grade and Roughness in the speech.
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