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Vogel AP, Sobanska A, Gupta A, Vasco G, Grobe-Einsler M, Summa S, Borel S. Quantitative Speech Assessment in Ataxia-Consensus Recommendations by the Ataxia Global Initiative Working Group on Digital-Motor Markers. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1128-1134. [PMID: 37897626 PMCID: PMC11102369 DOI: 10.1007/s12311-023-01623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
Dysarthria is a common and debilitating symptom of many neurodegenerative diseases, including those resulting in ataxia. Changes to speech lead to significant reductions in quality of life, impacting the speaker in most daily activities. Recognition of its importance as an objective outcome measure in clinical trials for ataxia is growing. Its viability as an endpoint across the disease spectrum (i.e. pre-symptomatic onwards) means that trials can recruit ambulant individuals and later-stage individuals who are often excluded because of difficulty completing lower limb tasks. Here we discuss the key considerations for speech testing in clinical trials including hardware selection, suitability of tasks and their role in protocols for trials and propose a core set of tasks for speech testing in clinical trials. Test batteries could include forms suitable for remote short, sensitive and easy to use, with norms available in several languages. The use of artificial intelligence also could improve accuracy and automaticity of analytical pipelines in clinic and trials.
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Affiliation(s)
- Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia.
- Division of Translational Genomics of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Tübingen, Germany.
- Redenlab Inc., Melbourne, Australia.
| | - Anna Sobanska
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Anoopum Gupta
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gessica Vasco
- Bambino Gesù Children's Hospital, IRCCS, 00050, Rome, Italy
| | - Marcus Grobe-Einsler
- German Center for Neurodegenerative Diseases, Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Susanna Summa
- Bambino Gesù Children's Hospital, IRCCS, 00050, Rome, Italy
| | - Stephanie Borel
- Sorbonne Université, Paris Brain Institute (ICM Institut du Cerveau), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, F-75013, Paris, France
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2
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Isaev DY, Vlasova RM, Di Martino JM, Stephen CD, Schmahmann JD, Sapiro G, Gupta AS. Uncertainty of Vowel Predictions as a Digital Biomarker for Ataxic Dysarthria. CEREBELLUM (LONDON, ENGLAND) 2024; 23:459-470. [PMID: 37039956 PMCID: PMC10826261 DOI: 10.1007/s12311-023-01539-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/12/2023]
Abstract
Dysarthria is a common manifestation across cerebellar ataxias leading to impairments in communication, reduced social connections, and decreased quality of life. While dysarthria symptoms may be present in other neurological conditions, ataxic dysarthria is a perceptually distinct motor speech disorder, with the most prominent characteristics being articulation and prosody abnormalities along with distorted vowels. We hypothesized that uncertainty of vowel predictions by an automatic speech recognition system can capture speech changes present in cerebellar ataxia. Speech of participants with ataxia (N=61) and healthy controls (N=25) was recorded during the "picture description" task. Additionally, participants' dysarthric speech and ataxia severity were assessed on a Brief Ataxia Rating Scale (BARS). Eight participants with ataxia had speech and BARS data at two timepoints. A neural network trained for phoneme prediction was applied to speech recordings. Average entropy of vowel tokens predictions (AVE) was computed for each participant's recording, together with mean pitch and intensity standard deviations (MPSD and MISD) in the vowel segments. AVE and MISD demonstrated associations with BARS speech score (Spearman's rho=0.45 and 0.51), and AVE demonstrated associations with BARS total (rho=0.39). In the longitudinal cohort, Wilcoxon pairwise signed rank test demonstrated an increase in BARS total and AVE, while BARS speech and acoustic measures did not significantly increase. Relationship of AVE to both BARS speech and BARS total, as well as the ability to capture disease progression even in absence of measured speech decline, indicates the potential of AVE as a digital biomarker for cerebellar ataxia.
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Affiliation(s)
- Dmitry Yu Isaev
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
| | - Roza M Vlasova
- Department of Psychiatry, UNC School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - J Matias Di Martino
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Christopher D Stephen
- Ataxia Center & Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeremy D Schmahmann
- Ataxia Center & Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Guillermo Sapiro
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
- Departments of Mathematics & Computer Science, Duke University, Durham, NC, USA
| | - Anoopum S Gupta
- Ataxia Center & Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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3
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Vogel AP, Spencer C, Burke K, de Bruyn D, Gibilisco P, Blackman S, Vojtech JM, Kathiresan T. Optimizing Communication in Ataxia: A Multifaceted Approach to Alternative and Augmentative Communication (AAC). CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01675-0. [PMID: 38448793 DOI: 10.1007/s12311-024-01675-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
The progression of multisystem neurodegenerative diseases such as ataxia significantly impacts speech and communication, necessitating adaptive clinical care strategies. With the deterioration of speech, Alternative and Augmentative Communication (AAC) can play an ever increasing role in daily life for individuals with ataxia. This review describes the spectrum of AAC resources available, ranging from unaided gestures and sign language to high-tech solutions like speech-generating devices (SGDs) and eye-tracking technology. Despite the availability of various AAC tools, their efficacy is often compromised by the physical limitations inherent in ataxia, including upper limb ataxia and visual disturbances. Traditional speech-to-text algorithms and eye gaze technology face challenges in accuracy and efficiency due to the atypical speech and movement patterns associated with the disease.In addressing these challenges, maintaining existing speech abilities through rehabilitation is prioritized, complemented by advances in digital therapeutics to provide home-based treatments. Simultaneously, projects incorporating AI driven solutions aim to enhance the intelligibility of dysarthric speech through improved speech-to-text accuracy.This review discusses the complex needs assessment for AAC in ataxia, emphasizing the dynamic nature of the disease and the importance of regular reassessment to tailor communication strategies to the changing abilities of the individual. It also highlights the necessity of multidisciplinary involvement for effective AAC assessment and intervention. The future of AAC looks promising with developments in brain-computer interfaces and the potential of voice banking, although their application in ataxia requires further exploration.
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Affiliation(s)
- Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Melbourne, VIC Australia, 3010, Australia.
- Redenlab Inc, Melbourne, Australia.
- Department of Neurodegenerative Diseases, & Center for Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, University Hospital Tübingen, Tübingen, Germany.
| | - Caroline Spencer
- Department of Speech, Language, and Hearing Sciences, Indiana University, Bloomington, USA
| | - Katie Burke
- Department of Speech and Language Therapy, Tallaght University Hospital, Dublin, Ireland
| | - Daniella de Bruyn
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Melbourne, VIC Australia, 3010, Australia
| | - Peter Gibilisco
- Social and Political Sciences, The University of Melbourne, Melbourne, Australia
| | - Scott Blackman
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Melbourne, VIC Australia, 3010, Australia
| | - Jennifer M Vojtech
- Delsys, Inc, Natick, MA, 01760, USA
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, 02215, USA
| | - Thayabaran Kathiresan
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Melbourne, VIC Australia, 3010, Australia
- Redenlab Inc, Melbourne, Australia
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van Prooije T, Knuijt S, Oostveen J, Kapteijns K, Vogel AP, van de Warrenburg B. Perceptual and Acoustic Analysis of Speech in Spinocerebellar ataxia Type 1. CEREBELLUM (LONDON, ENGLAND) 2024; 23:112-120. [PMID: 36633828 PMCID: PMC10864471 DOI: 10.1007/s12311-023-01513-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/13/2023]
Abstract
This study characterizes the speech phenotype of spinocerebellar ataxia type 1 (SCA1) using both perceptual and objective acoustic analysis of speech in a cohort of SCA1 patients. Twenty-seven symptomatic SCA1 patients in various disease stages (SARA score range: 3-32 points) and 18 sex and age matched healthy controls underwent a clinical assessment addressing ataxia severity, non-ataxia signs, cognitive functioning, and speech. Speech samples were perceptually rated by trained speech therapists, and acoustic metrics representing speech timing, vocal control, and voice quality were extracted. Perceptual analysis revealed reduced intelligibility and naturalness in speech samples of SCA1 patients. Acoustically, SCA1 patients presented with slower speech rate and diadochokinetic rate as well as longer syllable duration compared to healthy controls. No distinct abnormalities in voice quality in the acoustic analysis were detected at group level. Both the affected perceptual and acoustic variables correlated with ataxia severity. Longitudinal assessment of speech is needed to place changes in speech in the context of disease progression and potential response to treatment.
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Affiliation(s)
- Teije van Prooije
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Simone Knuijt
- Department of Rehabilitation, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Judith Oostveen
- Department of Rehabilitation, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kirsten Kapteijns
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia
- Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tubingen, Germany
- Redenlab Inc., Melbourne, Australia
| | - Bart van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.
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Schultz BG, Rojas S, St John M, Kefalianos E, Vogel AP. A Cross-sectional Study of Perceptual and Acoustic Voice Characteristics in Healthy Aging. J Voice 2023; 37:969.e23-969.e41. [PMID: 34272139 DOI: 10.1016/j.jvoice.2021.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/02/2021] [Accepted: 06/10/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The human voice qualitatively changes across the lifespan. Although some of these vocal changes may be pathologic, other changes likely reflect natural physiological aging. Normative data for voice characteristics in healthy aging is limited and disparate studies have used a range of different acoustic features, some of which are implicated in pathologic voice changes. We examined the perceptual and acoustic features that predict healthy aging. METHOD Participants (N = 150) aged between 50 and 92 years performed a sustained vowel task. Acoustic features were measured using the Multi-Dimensional Voice Program and the Analysis of Dysphonia in Speech and Voice. We used forward and backward variable elimination techniques based on the Bayesian information criterion and linear regression to assess which of these acoustic features predict age and perceptual features. Hearing thresholds were determined using pure-tone audiometry tests at frequencies 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. We further explored potential relationships between these acoustic features and clinical assessments of voice quality using the Consensus Auditory-Perceptual Evaluation of Voice. RESULTS Chronological age was significantly predicted by greater voice turbulence, variability of cepstral fundamental frequency, low relative to high spectral energy, and cepstral intensity. When controlling for hearing loss, age was significantly predicted by amplitude perturbations and cepstral intensity. Clinical assessments of voice indicated perceptual characteristics of speech were predicted by different acoustic features. For example, breathiness was predicted by the soft phonation index, mean cepstral peak prominence, mean low-high spectral ratio, and mean cepstral intensity. CONCLUSIONS Findings suggest that acoustic features that predict healthy aging are different than those previously reported for the pathologic voice. We propose a model of healthy and pathologic voice development in which voice characteristics are mediated by the inability to monitor vocal productions associated with age-related hearing loss. This normative data of healthy vocal aging may assist in separating voice pathologies from healthy aging.
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Affiliation(s)
- Benjamin G Schultz
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia; Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - Sandra Rojas
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia; Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - Miya St John
- Speech and Language, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Elaina Kefalianos
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia; Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia; Redenlab, Australia.
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Schultz BG, Joukhadar Z, Nattala U, Quiroga MDM, Noffs G, Rojas S, Reece H, Van Der Walt A, Vogel AP. Disease Delineation for Multiple Sclerosis, Friedreich Ataxia, and Healthy Controls Using Supervised Machine Learning on Speech Acoustics. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4278-4285. [PMID: 37792655 DOI: 10.1109/tnsre.2023.3321874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Neurodegenerative disease often affects speech. Speech acoustics can be used as objective clinical markers of pathology. Previous investigations of pathological speech have primarily compared controls with one specific condition and excluded comorbidities. We broaden the utility of speech markers by examining how multiple acoustic features can delineate diseases. We used supervised machine learning with gradient boosting (CatBoost) to delineate healthy speech from speech of people with multiple sclerosis or Friedreich ataxia. Participants performed a diadochokinetic task where they repeated alternating syllables. We subjected 74 spectral and temporal prosodic features from the speech recordings to machine learning. Results showed that Friedreich ataxia, multiple sclerosis and healthy controls were all identified with high accuracy (over 82%). Twenty-one acoustic features were strong markers of neurodegenerative diseases, falling under the categories of spectral qualia, spectral power, and speech rate. We demonstrated that speech markers can delineate neurodegenerative diseases and distinguish healthy speech from pathological speech with high accuracy. Findings emphasize the importance of examining speech outcomes when assessing indicators of neurodegenerative disease. We propose large-scale initiatives to broaden the scope for differentiating other neurological diseases and affective disorders.
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7
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Lowit A, Cox J, Loucas M, Grassly J, Egan A, van Brenk F, Hadjivassiliou M. ClearSpeechTogether: a Rater Blinded, Single, Controlled Feasibility Study of Speech Intervention for People with Progressive Ataxia. CEREBELLUM (LONDON, ENGLAND) 2023; 22:865-876. [PMID: 36001243 PMCID: PMC9399979 DOI: 10.1007/s12311-022-01462-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Progressive ataxias frequently lead to speech disorders and consequently impact on communication participation and psychosocial wellbeing. Whilst recent studies demonstrate the potential for improvements in these areas, these treatments generally require intensive input which can reduce acceptability of the approach. A new model of care-ClearSpeechTogether-is proposed which maximises treatment intensity whilst minimising demands on clinician. This study aimed to establish feasibility and accessibility of this approach and at the same time determine the potential benefits and adverse effects on people with progressive ataxias. METHOD This feasibility study targeted people with progressive ataxia and mild-moderate speech and gross motor impairment. ClearSpeechTogether consisted of four individual sessions over 2 weeks followed by 20 patient-led group sessions over 4 weeks. All sessions were provided online. Quantitative and qualitative data were collected for evaluation. RESULTS Nine participants completed treatment. Feasibility and acceptability were high and no adverse effects were reported. Statistical tests found significantly reduced vocal strain, improved reading intelligibility and increased participation and confidence. Participant interviews highlighted the value of group support internalisation of speech strategies and psycho-social wellbeing. DISCUSSION ClearSpeechTogether presented a feasible, acceptable intervention for a small cohort of people with progressive ataxia. It matched or exceeded the outcomes previously reported following individual therapy. Particularly notable was the fact that this could be achieved through patient led practice without the presence of a clinician. Pending confirmation of our results by larger, controlled trials, ClearSpeechTogether could represent an effective approach to manage speech problems in ataxia.
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Affiliation(s)
- Anja Lowit
- School of Psychological Sciences and Health, Strathclyde University, 40 George St, Glasgow, G1 1QE, Scotland.
| | - Jessica Cox
- School of Psychological Sciences and Health, Strathclyde University, 40 George St, Glasgow, G1 1QE, Scotland
| | - Melissa Loucas
- School of Psychology and Clinical Language Sciences, Earley Gate, University of Reading, RG6 6AL, Reading, England
| | - Jennifer Grassly
- University College London, Chandler House, 2 Wakefield Street, London, WC1N 1PF, England
| | - Aisling Egan
- School of Psychological Sciences and Health, Strathclyde University, 40 George St, Glasgow, G1 1QE, Scotland
| | - Frits van Brenk
- Department of Languages, Literature and Communication, Utrecht University, Trans 10, 3512 JK, Utrecht, Netherlands
| | - Marios Hadjivassiliou
- Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Glossop Rd, Sheffield, S10 2JF, England
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Grobe-Einsler M, Faber J, Taheri A, Kybelka J, Raue J, Volkening J, Helmhold F, Synofzik M, Klockgether T. SARA speech-Feasibility of automated assessment of ataxic speech disturbance. NPJ Digit Med 2023; 6:43. [PMID: 36927996 PMCID: PMC10020430 DOI: 10.1038/s41746-023-00787-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
Ataxias are a group of movement disorders that are characterized by progressive loss of balance, impaired coordination and speech disturbance, which together lead to markedly reduced quality of life. Speech disturbance is clinically diagnosed, but methods for objective assessment of severity are lacking. Using 71 sets of speech recordings from ataxia patients, we developed an automated classification system. With a tolerance of ±1 point, this classification system correctly predicted experts' ratings of speech disturbance according to item 4 of the Scale for Assessment and rating of ataxia (SARA) in 80% of cases. We thereby demonstrate feasibility of computer-assisted voice analysis for automated assessment of severity of speech disturbance.
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Affiliation(s)
- M Grobe-Einsler
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany. .,Department of Neurology, University Hospital Bonn, Bonn, Germany.
| | - J Faber
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - A Taheri
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | | | - J Raue
- PeakProfiling GmbH, Berlin, Germany
| | | | | | - M Synofzik
- Division of Translational Genomics for Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - T Klockgether
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
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Schultz BG, Vogel AP. A Tutorial Review on Clinical Acoustic Markers in Speech Science. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3239-3263. [PMID: 36044888 DOI: 10.1044/2022_jslhr-21-00647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The human voice changes with the progression of neurological disease and the onset of diseases that affect articulators, often decreasing the effectiveness of communication. These changes can be objectively measured using signal processing techniques that extract acoustic features. When measuring acoustic features, there are often several steps and assumptions that might be known to experts in acoustics and phonetics, but are less transparent for other disciplines (e.g., clinical medicine, speech pathology, engineering, and data science). This tutorial describes these signal processing techniques, explicitly outlines the underlying steps for accurate measurement, and discusses the implications of clinical acoustic markers. CONCLUSIONS We establish a vocabulary using straightforward terms, provide visualizations to achieve common ground, and guide understanding for those outside the domains of acoustics and auditory signal processing. Where possible, we highlight the best practices for measuring clinical acoustic markers and suggest resources for obtaining and further understanding these measures.
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Affiliation(s)
- Benjamin Glenn Schultz
- Centre for Neuroscience of Speech, The University of Melbourne, Victoria, Australia
- Department of Audiology and Speech Pathology, The University of Melbourne, Victoria, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Victoria, Australia
- Department of Audiology and Speech Pathology, The University of Melbourne, Victoria, Australia
- Redenlab, Melbourne, Victoria, Australia
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Lotta S, Lisa B. Congenital or Early Developing Neuromuscular Diseases Affecting Feeding, Swallowing and Speech – A Review of the Literature from January 1998 to August 2021. J Neuromuscul Dis 2022; 9:581-596. [PMID: 35848032 PMCID: PMC9535595 DOI: 10.3233/jnd-210772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The knowledge about the impact of oral motor impairment in neuromuscular diseases (NMDs) is limited but increasing. Objective: The aim of this review was to collect and compile knowledge on how muscle weakness in congenital or early developing NMDs directly or indirectly affects feeding, swallowing, speech and saliva control. Methods: A literature search was performed in PubMed from January 1, 1998, to August 31, 2021. The keywords “feeding”, “dysphagia”, “swallowing”, “dysarthria”, “speech”, “drooling” and “sialorrhea” were used in combination with “paediatric neuromuscular disease” or specific diagnoses. Results: Sixty-five studies were selected for the review, 33 focused on feeding and swallowing, 11 on speech, four on a combination of feeding, swallowing, saliva control or speech and 17 general descriptions. Most of the studies reported on patients with a disorder affecting muscles. These studies show that muscle weakness and impaired motility affecting the muscles innervated by the cranial nerves may influence feeding, swallowing, and speech, and that respiratory function, general health and neurodevelopmental delay also influence these functions. Feeding impairment and breathing difficulties are common in NMDs. Lifesaving interventions such as tube feeding and ventilatory support are common in severe cases. Conclusions: Feeding impairment, dysphagia and dysarthria are prevalent in NMDs with congenital or early age of onset. Feeding and swallowing has been studied more than speech and saliva control. More children with NMD survive thanks to new treatment options and it is therefore urgent to follow up how these therapies may impact the development of feeding, swallowing, and speech.
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Affiliation(s)
- Sjögreen Lotta
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Medicinaregatan, Gothenburg, Sweden
| | - Bengtsson Lisa
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Medicinaregatan, Gothenburg, Sweden
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11
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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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12
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Mueller A, Paterson E, McIntosh A, Praestgaard J, Bylo M, Hoefling H, Wells M, Lynch DR, Rummey C, Krishnan ML, Schultz M, Malanga CJ. Digital endpoints for self-administered home-based functional assessment in pediatric Friedreich's ataxia. Ann Clin Transl Neurol 2021; 8:1845-1856. [PMID: 34355532 PMCID: PMC8419399 DOI: 10.1002/acn3.51438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 01/18/2023] Open
Abstract
Background Friedreich’s ataxia is an inherited, progressive, neurodegenerative disease that typically begins in childhood. Disease severity is commonly assessed with rating scales, such as the modified Friedreich’s Ataxia Rating Scale, which are usually administered in the clinic by a neurology specialist. Objective This study evaluated the utility of home‐based, self‐administered digital endpoints in children with Friedreich’s ataxia and unaffected controls and their relationship to standard clinical rating scales. Methods In a cross‐sectional study with 25 participants (13 with Friedreich’s ataxia and 12 unaffected controls, aged 6–15 years), home‐based digital endpoints that reflect activities of daily living were recorded over 1 week. Domains analyzed were hand motor function with a digitized drawing, automated analysis of speech with a recorded oral diadochokinesis test, and gait and balance with wearable sensors. Results Hand‐drawing and speech tests were easy to conduct and generated high‐quality data. The sensor‐based gait and balance tests suffered from technical limitations in this study setup. Several parameters discriminated between groups or correlated strongly with modified Friedreich’s Ataxia Rating Scale total score and activities of daily living total score in the Friedreich’s ataxia group. Hand‐drawing parameters also strongly correlated with standard 9‐hole peg test scores. Interpretation Deploying digital endpoints in home settings is feasible in this population, results in meaningful and robust data collection, and may allow for frequent sampling over longer periods of time to track disease progression. Care must be taken when training participants, and investigators should consider the complexity of the tasks and equipment used.
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Affiliation(s)
- Arne Mueller
- Translational Medicine, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Elaine Paterson
- Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | | | | | - Mary Bylo
- Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | - Holger Hoefling
- NIBR Informatics, Novartis Institute of Biomedical Research, Basel, Switzerland
| | - McKenzie Wells
- Division of Neurology, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - David R Lynch
- Division of Neurology, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Michelle L Krishnan
- Translational Medicine, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Meredith Schultz
- Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | - C J Malanga
- Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
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Noffs G, Boonstra FMC, Perera T, Kolbe SC, Stankovich J, Butzkueven H, Evans A, Vogel AP, van der Walt A. Acoustic Speech Analytics Are Predictive of Cerebellar Dysfunction in Multiple Sclerosis. THE CEREBELLUM 2021; 19:691-700. [PMID: 32556973 DOI: 10.1007/s12311-020-01151-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Speech production relies on motor control and cognitive processing and is linked to cerebellar function. In diseases where the cerebellum is impaired, such as multiple sclerosis (MS), speech abnormalities are common and can be detected by instrumental assessments. However, the potential of speech assessments to be used to monitor cerebellar impairment in MS remains unexplored. The aim of this study is to build an objectively measured speech score that reflects cerebellar function, pathology and quality of life in MS. Eighty-five people with MS and 21 controls participated in the study. Speech was independently assessed through objective acoustic analysis and blind expert listener ratings. Cerebellar function and overall disease disability were measured through validated clinical scores; cerebellar pathology was assessed via magnetic resonance imaging, and validated questionnaires informed quality of life. Selected speech variables were entered in a regression model to predict cerebellar function. The resulting model was condensed into one composite speech score and tested for prediction of abnormal 9-hole peg test (9HPT), and for correlations with the remaining cerebellar scores, imaging measurements and self-assessed quality of life. Slow rate of syllable repetition and increased free speech pause percentage were the strongest predictors of cerebellar impairment, complemented by phonatory instability. Those variables formed the acoustic composite score that accounted for 54% of variation in cerebellar function, correlated with cerebellar white matter volume (r = 0.3, p = 0.017), quality of life (r = 0.5, p < 0.001) and predicted an abnormal 9HPT with 85% accuracy. An objective multi-feature speech metric was highly representative of motor cerebellar impairment in MS.
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Affiliation(s)
- Gustavo Noffs
- Centre for Neuroscience of Speech, University of Melbourne, Melbourne, Australia. .,Department of Neurology, Royal Melbourne Hospital, Parkville, Australia.
| | - Frederique M C Boonstra
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Thushara Perera
- The Bionics Institute, East Melbourne, Australia.,Department of Medical Bionics, University of Melbourne, Melbourne, Australia
| | - Scott C Kolbe
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Jim Stankovich
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Andrew Evans
- Department of Neurology, Royal Melbourne Hospital, Parkville, Australia.,The Bionics Institute, East Melbourne, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, University of Melbourne, Melbourne, Australia.,The Bionics Institute, East Melbourne, Australia.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Redenlab Inc, Melbourne, Australia
| | - Anneke van der Walt
- Department of Neurology, Royal Melbourne Hospital, Parkville, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,The Bionics Institute, East Melbourne, Australia
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Lowit A, Egan A, Hadjivassiliou M. Feasibility and Acceptability of Lee Silverman Voice Treatment in Progressive Ataxias. THE CEREBELLUM 2021; 19:701-714. [PMID: 32588316 PMCID: PMC7471180 DOI: 10.1007/s12311-020-01153-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Communication difficulties have considerable impact on people with progressive ataxia, yet there are currently no evidence-based treatments. LSVT LOUD® focuses on the production of healthy vocal loudness whilst also improving breath support, vocal quality, loudness and articulation in participating patients. This study aimed to investigate whether Lee Silverman Voice Treatment (LSVT LOUD®) can improve communication effectiveness in these patients. We performed a rater-blinded, single-arm study investigating LSVT LOUD® treatment in a population of patients with progressive ataxia including Friedreich's ataxia (n = 18), spinocerebellar ataxia type 6 (n = 1), idiopathic cerebellar ataxia (n = 1), and spastic paraplegia 7 (n = 1). Twenty-one patients were recruited to the study, with 19 completing treatment. Sessions were administered via Skype in the LSVT-X format, meaning two sessions per week over a period of 8 weeks. Assessments included two baseline and two post-treatment measures and focused on outcome measures covering aspects ranging from physiological function to impact and participation. Results indicate improvements in patient-perceived outcomes for 14 of the 19 participants, in both speech and psychosocial domains. Speech data furthermore demonstrate significant improvements in prolonged vowel duration, and voice quality measures. Intelligibility and naturalness evaluations showed no change post-treatment. Patients reported high acceptability of the treatment itself, as well as administration by Skype. This is the largest treatment study for people with progressive ataxia published to date. It provides an indication that LSVT LOUD® can have a positive impact on communication in this patient group and could form the basis for larger-scale trials.
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Affiliation(s)
- Anja Lowit
- Speech and Language Therapy, School of Psychological Sciences and Health, Strathclyde University, 40 George St, Glasgow, G1 1QE, UK.
| | - Aisling Egan
- Speech and Language Therapy, School of Psychological Sciences and Health, Strathclyde University, 40 George St, Glasgow, G1 1QE, UK
| | - Marios Hadjivassiliou
- Sheffield Teaching Hospitals NHS Trust, University of Sheffield, Sheffield, S10 2TG, UK
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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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Vogel AP, Magee M, Torres-Vega R, Medrano-Montero J, Cyngler MP, Kruse M, Rojas S, Cubillos SC, Canento T, Maldonado F, Vazquez-Mojena Y, Ilg W, Rodríguez-Labrada R, Velázquez-Pérez L, Synofzik M. Features of speech and swallowing dysfunction in pre-ataxic spinocerebellar ataxia type 2. Neurology 2020; 95:e194-e205. [PMID: 32527970 DOI: 10.1212/wnl.0000000000009776] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/17/2019] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To determine whether objective and quantitative assessment of dysarthria and dysphagia in spinocerebellar ataxia type 2 (SCA2), specifically at pre-ataxic and early disease phases, can act as sensitive disease markers. METHODS Forty-six individuals (16 with pre-ataxic SCA2, 14 with early-stage ataxic SCA2, and 16 healthy controls) were recruited in Holguin, Cuba. All participants underwent a comprehensive battery of assessments including objective acoustic analysis, clinician-derived ratings of speech function and swallowing, and quality of life assessments of swallowing. RESULTS Reduced speech agility manifest at the pre-ataxic stage was observed during diadochokinetic tasks, with the magnitude of speech deficit augmented in the early ataxic stage. Speech rate was slower in early-stage ataxic SCA2 compared with pre-ataxic SCA2 and healthy controls. Reduced speech agility and speech rate correlated with disease severity and time to ataxia onset, verifying that speech deficits occur prior to ataxia onset and increase in severity as the disease progresses. Whereas dysphagia was observed in both pre-ataxic and ataxic SCA2, it was not associated with swallowing-related quality of life, disease severity, or time to ataxia onset. CONCLUSIONS Speech and swallowing deficits appear sensitive to disease progression in early-stage SCA2, with syllabic rate a viable marker. Findings provide insight into mechanisms of disease progression in early-stage SCA2, signaling an opportunity for stratifying early-stage SCA2 and identifying salient markers of disease onset as well as outcome measures in future early-stage therapeutic studies.
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Affiliation(s)
- Adam P Vogel
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany.
| | - Michelle Magee
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Reidenis Torres-Vega
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Jacqueline Medrano-Montero
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Melissa P Cyngler
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Megan Kruse
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Sandra Rojas
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Sebastian Contreras Cubillos
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Tamara Canento
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Fernanda Maldonado
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Yaimee Vazquez-Mojena
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Winfried Ilg
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Roberto Rodríguez-Labrada
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Luis Velázquez-Pérez
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Matthis Synofzik
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
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Pandolfo M. Neurologic outcomes in Friedreich ataxia: Study of a single-site cohort. NEUROLOGY-GENETICS 2020; 6:e415. [PMID: 32337342 PMCID: PMC7164967 DOI: 10.1212/nxg.0000000000000415] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/05/2020] [Indexed: 11/24/2022]
Abstract
Objective To investigate the pattern of progression of neurologic impairment in Friedreich ataxia (FRDA) and identify patients with fast disease progression as detected by clinical rating scales. Methods Clinical, demographic, and genetic data were analyzed from 54 patients with FRDA included at the Brussels site of the European Friedreich's Ataxia Consortium for Translational Studies, with an average prospective follow-up of 4 years. Results Afferent ataxia predated other features of FRDA, followed by cerebellar ataxia and pyramidal weakness. The Scale for the Assessment and Rating of Ataxia (SARA) best detected progression in ambulatory patients and in the first 20 years of disease duration but did not effectively capture progression in advanced disease. Dysarthria, sitting, and upper limb coordination items kept worsening after loss of ambulation. Eighty percent of patients needing support to walk lost ambulation within 2 years. Age at onset had a strong influence on progression of neurologic and functional deficits, which was maximal in patients with symptom onset before age 8 years. All these patients became unable to walk by 15 years after onset, significantly earlier than patients with later onset. Progression in the previous 1 or 2 years was not predictive of progression in the subsequent year. Conclusions The SARA is a sensitive outcome measure in ambulatory patients with FRDA and has an excellent correlation with functional capabilities. Ambulatory patients with onset before age 8 years showed the fastest measurable worsening. Loss of ambulation in high-risk patients is a disease milestone that should be considered as an end point in clinical trials.
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Affiliation(s)
- Massimo Pandolfo
- Service of Neurology, Hôpital Erasme, and Laboratory of Experimental Neurology, Université Libre de Bruxelles (ULB), Brussels, Belgium
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18
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Speech and Language Disorders in Friedreich Ataxia: Highlights on Phenomenology, Assessment, and Therapy. THE CEREBELLUM 2019; 19:126-130. [DOI: 10.1007/s12311-019-01084-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The current state of biomarker research for Friedreich's ataxia: a report from the 2018 FARA biomarker meeting. Future Sci OA 2019; 5:FSO398. [PMID: 31285843 PMCID: PMC6609901 DOI: 10.2144/fsoa-2019-0026] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The 2018 FARA Biomarker Meeting highlighted the current state of development of biomarkers for Friedreich’s ataxia. A mass spectroscopy assay to sensitively measure mature frataxin (reduction of which is the root cause of disease) is being developed. Biomarkers to monitor neurological disease progression include imaging, electrophysiological measures and measures of nerve function, which may be measured either in serum and/or through imaging-based technologies. Potential pharmacodynamic biomarkers include metabolic and protein biomarkers and markers of nerve damage. Cardiac imaging and serum biomarkers may reflect cardiac disease progression. Considerable progress has been made in the development of biomarkers for various contexts of use, but further work is needed in terms of larger longitudinal multisite studies, and identification of novel biomarkers for additional use cases Biomarkers are characteristics that can be objectively measured, evaluated and used as indicators of disease progression or the effect of a therapy. Friedreich’s ataxia is a progressive multisystem neuromuscular disease with no treatment. Current clinical measures cannot robustly detect disease progression in less than a year, meaning that clinical trials are long and drug development is slow. The Friedreich’s Ataxia Research Alliance and the scientific community are looking for biomarkers that show change in shorter time frames that can accelerate drug development. The 2018 FARA Biomarker Meeting summarized the exciting findings that represent the current state of the field.
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Alharbi GG, Cannito MP, Buder EH, Awan SN. Spectral/Cepstral Analyses of Phonation in Parkinson's Disease before and after Voice Treatment: A Preliminary Study. Folia Phoniatr Logop 2019; 71:275-285. [PMID: 31117110 DOI: 10.1159/000495837] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/27/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE This article examines cepstral/spectral analyses of sustained /α/ vowels produced by speakers with hypokinetic dysarthria secondary to idiopathic Parkinson's disease (PD) before and after Lee Silverman Voice Treatment (LSVT®LOUD) and the relationship of these measures with overall voice intensity. METHODOLOGY Nine speakers with PD were examined in a pre-/post-treatment design, with multiple daily audio recordings before and after treatment. Sustained vowels were analyzed for cepstral peak prominence (CPP), CPP standard deviation (CPP SD), low/high spectral ratio (L/H SR), and Cepstral/Spectral Index of Dysphonia (CSID) using the KAYPENTAX computer software. RESULTS CPP and CPP SD increased significantly and CSID decreased significantly from pre- to post-treatment recordings, with strong effect sizes. Increased CPP indicates increased dominance of harmonics in the spectrum following LSVT. After restricting the frequency cutoff to the region just above the first formant and second formant and below the third formant, L/H SR was observed to decrease significantly following treatment. Correlation analyses demonstrated that CPP was more strongly associated with CSID before treatment than after. CONCLUSION In addition to increased vocal intensity following LSVT, speakers with PD exhibited both improved harmonic structure and voice quality as reflected by cepstral/spectral analysis, indicating that there was improved harmonic structure and reduced dysphonia following treatment.
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Affiliation(s)
- Ghadah G Alharbi
- Department of Special Education, College of Education, University of Jeddah, Jeddah, Saudi Arabia,
| | - Michael P Cannito
- Department of Communicative Disorders, University of Louisiana, Lafayette, Louisiana, USA
| | - Eugene H Buder
- School of Communication Sciences and Disorders, University of Memphis, Memphis, Tennessee, USA
| | - Shaheen N Awan
- Department of Communication Sciences and Disorders, Bloomsburg University of Pennsylvania, Bloomsburg, Pennsylvania, USA
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Vogel AP, Rommel N, Oettinger A, Stoll LH, Kraus EM, Gagnon C, Horger M, Krumm P, Timmann D, Storey E, Schöls L, Synofzik M. Coordination and timing deficits in speech and swallowing in autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). J Neurol 2018; 265:2060-2070. [PMID: 29968200 DOI: 10.1007/s00415-018-8950-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a rare early onset neurodegenerative disease that typically results in ataxia, upper motor neuron dysfunction and sensorimotor peripheral neuropathy. Dysarthria and dysphagia are anecdotally described as key features of ARSACS but the nature, severity and impact of these deficits in ARSACS are not known. A comprehensive quantitative and qualitative characterization of speech and swallowing function will support diagnostics, provide insights into the underlying pathology, and guide day-to-day clinical management. METHODS 11 consecutive non-Quebec ARSACS patients were recruited, and compared to healthy participants from several published and unpublished cohorts. A comprehensive behavioural assessment including objective acoustic analysis and expert perceptual ratings of motor speech, the Clinical Assessment of Dysphagia in Neurodegeneration (CADN), videofluoroscopy and standardized tests of dysarthria and swallowing related quality of life was conducted. RESULTS Speech in this ARSACS cohort is characterized by pitch breaks, prosodic deficits including reduced rate and prolonged intervals, and articulatory deficits. The swallowing profile was characterized by delayed initiation of the swallowing reflex and late epiglottic closure. Four out of ten patients were observed aspirating thin liquids on videofluoroscopy. Patients report that they regularly cough or choke on thin liquids and solids during mealtimes. Swallowing and speech-related quality of life was worse than healthy controls on all domains except sleep. CONCLUSIONS The dysphagia and dysarthria profile of this ARSACS cohort reflects impaired coordination and timing. Dysphagia contributes to a significant impairment in functional quality of life in ARSACS, and appears to manifest distinctly from other ARSACS dysfunctions such as ataxia or spasticity.
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Affiliation(s)
- Adam P Vogel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany. .,Center for Neurology, University Hospital Tübingen, Tübingen, Germany. .,Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Parkville, Melbourne, VIC, 3010, Australia. .,Redenlab, Melbourne, Australia.
| | - Natalie Rommel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Center for Neurology, University Hospital Tübingen, Tübingen, Germany.,Therapiezentrum, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Oettinger
- Neurology and Rehabilitation, Kliniken Schmieder, Gailingen am Hochrhein, Germany
| | - Lisa H Stoll
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Center for Neurology, University Hospital Tübingen, Tübingen, Germany.,Therapiezentrum, University Hospital Tübingen, Tübingen, Germany
| | - Eva-Maria Kraus
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Center for Neurology, University Hospital Tübingen, Tübingen, Germany
| | - Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Jonquière, QC, Canada.,Clinique des maladies neuromusculaires, Centre de réadaptation en déficience physique Le Parcours du Centre de santé et de services sociaux de Jonquière, Jonquière, QC, Canada.,Centre hospitalier affilié universitaire régional (CAUR) de Chicoutimi, Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Patrick Krumm
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Dagmar Timmann
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Elsdon Storey
- Department of Medicine, Monash University, Melbourne, Australia
| | - Ludger Schöls
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Center for Neurology, University Hospital Tübingen, Tübingen, Germany.,Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Center for Neurology, University Hospital Tübingen, Tübingen, Germany.,Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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Consensus Paper: Neurophysiological Assessments of Ataxias in Daily Practice. THE CEREBELLUM 2018; 17:628-653. [DOI: 10.1007/s12311-018-0937-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Vogel AP, Rommel N, Oettinger A, Horger M, Krumm P, Kraus EM, Schöls L, Synofzik M. Speech and swallowing abnormalities in adults with POLG associated ataxia (POLG-A). Mitochondrion 2017. [PMID: 28634151 DOI: 10.1016/j.mito.2017.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mutations in the nuclear-encoded mitochondrial DNA polymerase gamma (POLG) can result in a wide spectrum of neurological deficits. A common presentation is progressive ataxia (POLG-A) which includes impaired speech and swallowing. The nature, severity and impact of these deficits in POLG-A is not known. A comprehensive quantitative and qualitative characterization of dysarthria and dysphagia in this recurrent ataxia disorder will assist in diagnostics, provide insights into the underlying pathology, and establish the foundation for future therapy trials. METHODS 14 consecutive patients with POLG (9 females, mean age=50.1y, SD=11.2) and 34 healthy controls were enrolled. Comprehensive assessments of motor speech and swallowing function, acoustic analysis of speech, videofluoroscopy and measures of quality of life were conducted. RESULTS The speech profile of individuals with POLG-A was characterized by poor control of pitch and strain-strangled voice quality, reduced rate of speech and longer variable silences between words, and articulatory breakdown including imprecise consonants and vowel distortions. Swallowing deficits included slower initiation of the swallow reflex, poor control of bolus and late epiglottic closure. Speech and swallowing related quality of life was worse than healthy controls. CONCLUSIONS The dysarthria and dysphagia profiles in POLG-A are largely symptomatic of impaired timing, indicating a mainly spinocerebellar deficit. Dysarthria and dysphagia contribute to a significant impairment in functional quality of life, and progress distinctly from other POLG-A dysfunctions like ataxia or cognitive impairment. Our assessments establish meaningful patient focused outcome measures that will be suitable for use in natural history studies and clinical trials.
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Affiliation(s)
- Adam P Vogel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany; Centre for Neuroscience of Speech, The University of Melbourne, Victoria, Australia; Redenlab, Melbourne, Australia.
| | - Natalie Rommel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany; Therapiezentrum, University Hospital Tübingen, Germany
| | - Andreas Oettinger
- Neurology and Rehabilitation, Kliniken Schmieder, Gailingen am Hochrhein, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Germany
| | - Patrick Krumm
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Germany
| | - Eva-Maria Kraus
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany
| | - Ludger Schöls
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany; Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany; Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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