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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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Ferreira GZ, Bressmann T, de Cássia Rillo Dutka J, Whitaker ME, de Boer G, de Castro Marino VC, Pegoraro-Krook MI. Analysis of oral-nasal balance after intensive speech therapy combined with speech bulb in speakers with cleft palate and hypernasality. JOURNAL OF COMMUNICATION DISORDERS 2020; 85:105945. [PMID: 31607437 DOI: 10.1016/j.jcomdis.2019.105945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 09/06/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the efficacy of the combination of a speech bulb with an intensive speech therapy program in hypernasal participants with cleft palate. METHODS Twenty hypernasal speakers with cleft palate (12 females and 8 males, median age 28.45 years), who were wearing speech bulbs underwent an intensive speech therapy program of 45 sessions over 3 weeks. Three experienced speech-language pathologists rated the participants' speech recordings before and after intensive speech therapy, with and without the speech bulb. Nasometric recordings and long-term averaged spectra were also analyzed using repeated-measures ANOVAs. RESULTS The ANOVA of the hypernasality ratings showed significant effects of therapy [F (1,19) = 15.97; p < .001], speech bulb [F(1,190 = 28.54, p < .001] and a therapy -speech bulb interaction effect [F(1.19) = 22.30, p < 0.001]. The most favorable listener ratings of hypernasality were obtained post-therapy when participants were wearing their speech bulbs. Without the speech bulb, intensive speech therapy by itself did not result in a significant improvement. With speech bulb, nasalance scores for high [F (1,19) = 14.07, p < .001] and low pressure [F (1,19) = 14.84, p < .001] sentences were significantly lower post-therapy, providing preliminary evidence that an intensive speech therapy program may enhance the effect of a speech bulb. Before and after comparisons of individual nasalance profiles demonstrated variable improvement in 15 participants, no progress in 2 participants and more severe hypernasality after therapy in 3 participants. Long-term averaged spectra corroborated the findings of the perceptual analysis. Based on a frequency bin from 201 to 300 Hz, there was a significant within-subject effect for with and without speech bulb [F(1, 18) = 4.54, p = .047] as well as for before vs. after session [F (1,18) = 7.14, p = .015]. CONCLUSION The speech bulb in combination with intensive speech therapy resulted in improved oral-nasal balance for the majority of participants. More research is needed to investigate long-term outcomes as well as individual factors contributing to therapy success.
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Affiliation(s)
- Gabriela Zuin Ferreira
- Speech-Language and Audiology Department, Faculdade de Odontologia de Bauru and Graduate Programs at the Universidade de São Paulo (USP), 9-75 Alameda Octávio Pinheiro Brisolla, Bauru, SP, CEP 17012-901, Brazil.
| | - Tim Bressmann
- Department of Speech-Language Pathology, University of Toronto (UofT), University Ave, 500, Toronto, ON, M5G 1V7, Canada.
| | - Jennifer de Cássia Rillo Dutka
- Speech-Language and Audiology Department, Faculdade de Odontologia de Bauru and Graduate Programs at the Universidade de São Paulo (USP), 9-75 Alameda Octávio Pinheiro Brisolla, Bauru, SP, CEP 17012-901, Brazil; Palatal Prosthesis Services, Hospital for the Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Rua Sílvio Marchione, 3-20, Vila Universitária, Bauru, SP, CEP 17012-900, Brazil.
| | - Melina Evangelista Whitaker
- Palatal Prosthesis Services, Hospital for the Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Rua Sílvio Marchione, 3-20, Vila Universitária, Bauru, SP, CEP 17012-900, Brazil.
| | - Gillian de Boer
- Department of Speech-Language Pathology, University of Toronto (UofT), University Ave, 500, Toronto, ON, M5G 1V7, Canada.
| | - Viviane Cristina de Castro Marino
- Department of Speech-Language Pathology and Audiology, São Paulo State University (UNESP), Faculdade de Filosofia e Ciências, Campus de Marília, Av. Higino Muzzi Filho, 737, Marília, SP, CEP 17525-900, Brazil.
| | - Maria Inês Pegoraro-Krook
- Speech-Language and Audiology Department, Faculdade de Odontologia de Bauru and Graduate Programs at the Universidade de São Paulo (USP), 9-75 Alameda Octávio Pinheiro Brisolla, Bauru, SP, CEP 17012-901, Brazil; Palatal Prosthesis Services, Hospital for the Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Rua Sílvio Marchione, 3-20, Vila Universitária, Bauru, SP, CEP 17012-900, Brazil.
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Acoustic analysis of voice in children with cleft lip and palate following vocal rehabilitation. Preliminary report. Int J Pediatr Otorhinolaryngol 2019; 126:109618. [PMID: 31394406 DOI: 10.1016/j.ijporl.2019.109618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/09/2019] [Accepted: 07/30/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cleft lip and palate (CLP) is the most common craniofacial anomaly. CLP affects resonance, voice and speech. Besides the most frequently reported resonance and speech disorders, several reports have addressed acoustic abnormalities in the voice of patients with CLP. However, there are just a few reports focusing on vocal treatment in this population. OBJECTIVE To study whether a Speech and Language Pathology (SLP) intervention including vocal rehabilitation for children with CLP and velopharyngeal insufficiency (VPI) provides significant improvement of abnormal acoustic parameters of voice. MATERIAL AND METHODS Fifteen children with cleft lip and palate (CLP) and velopharyngeal insufficiency (VPI) were studied. Age ranged 4-5 years. A matched control group of children without craniofacial anomalies and adequate speech, resonance and voice was assembled. All children underwent acoustic analysis of voice at the onset and at the end of SLP intervention including vocal rehabilitation. RESULTS Hypernasality persisted unchanged following SLP intervention. Mean Fundamental Frequency (F0) did not demonstrate a significant difference between the control and the active groups. At the onset of the intervention mean shimmer and jitter were significantly higher in all patients with CLP as compared to controls. At the end of the intervention shimmer and jitter significantly decreased in patients with CLP showing no differences as compared to controls. CONCLUSION SLP intervention including vocal rehabilitation improves abnormal acoustic parameters of voice. Besides surgical treatment for VPI the SLP intervention in children with CLP should also address vocal rehabilitation.
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