Validation of the Dysphonia Severity Index in the Dr. Speech Program

The combination of accent method and phonemic contrast: an innovative strategy to improve speech production on post-stroke dysarthria

Introduction

Speech production includes segmental and suprasegmental features, which interact and cooperate with each other. Impaired speech production is common in individuals with post-stroke dysarthria. The commonly used phonemic contrast therapy and Accent Method in clinical practice can improve the segmental and suprasegmental aspects, respectively. This study aimed to explore the feasibility and immediate effectiveness of the combination of specific rhythm patterns of the Accent Method and phonemic contrast on speech production.

Methods

Fifteen poststroke dysarthria patients (12 males and three females) first received accentuation task of three rhythm patterns (Largo-slow, Andante-medium, Allegro-fast) and later received speech task in appropriate rhythm patterns combined with phonemic contrast materials and non-phonemic contrast materials. Speech parameters were analyzed by considering speech clarity and prosody.

Results

The results showed that the number of correct target syllables, sentence clarity, and standard deviation of intensity increased significantly, and the average length of pauses and abnormal pause times decreased significantly in Andante (medium) compared to other rhythms. The number of correct target syllables, sentence clarity, and standard deviation of intensity increased significantly compared with those in the non-phonemic contrast in Andante (medium).

Conclusion

The combination of phonemic contrast and Accent Method was verified to have an immediate effect on speech production in Mandarin speakers with post-stroke dysarthria and could be further validated in other diseases with impaired speech production in the clinic in the future.

Global Acoustic Speech Temporal Characteristics for Mandarin Speakers With Parkinson's Disease During Syllable Repetition and Passage Reading

PURPOSE

Previous research has revealed considerable variation in speech rates among English speakers with Parkinson's disease (PD) with slower, faster, or similar rates than controls. The purpose of this study was to characterize speech rates of Mandarin speakers with PD and the corresponding articulation and pause characteristics explaining the speech rates to enhance rate control therapies.

METHOD

Eighteen Mandarin speakers with PD and 18 controls produced syllable repetitions and passage reading using their typical speech style. Speech rates, articulation rates, mean pause durations (≥ 10 ms), and the number of pauses with duration between 10 ms and 300 ms and greater than 300 ms were measured and compared between groups and tasks as well as across the initial, middle, and final periods of the passage. Two-way, mixed-model analyses of variance were employed for data analysis.

RESULTS

Compared to controls, individuals with PD spoke with similar speech rates and faster articulation rates during passage reading, whereas during syllable repetitions, they produced slower speech rates and comparable articulation rates. The slower syllable repetitions produced by speakers with PD may be explained by longer pauses and more perceptual pauses, whereas faster articulation rates may explain the trend of faster speech rates during reading. Speech and articulation rates accelerated for both groups during passage reading.

CONCLUSIONS

Speech rates of Mandarin speakers with PD were characterized by faster articulation, longer pauses, and more perceptual pauses for passage reading. A descriptive model of speech rate suggested that speakers with PD and dysarthria in this study would benefit from rate reduction therapy decreasing articulation rate.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23982282.

Videokymographic index of glottic function: an analysis of diagnostic accuracy

ABSTRACT Purpose To develop the Videokymographic Index of Glottic Function (VIGF), a composite indicator from digital videokymography parameters, captured by high-speed videolaryngoscopy exams of women with and without laryngeal alterations of behavioral etiology. Methods The sample consisted of 92 women aged between 18 and 45 years. Fifty-five (55) women with behavioral dysphonia, presenting with laryngeal and voice alterations, and thirty-seven (37) women without any laryngeal and voice alterations. Voice evaluation was performed by consensus via an auditory-perceptual analysis of the sustained vowel /a/ at a habitual pitch and loudness. Voice classification was obtained by means of a general degree of dysphonia, where G0 indicated neutral voice quality and G1 to G3 indicated altered voice quality. Laryngeal images were captured via digital videokymography analysis of a sustained vowel /i/ at a habitual pitch and loudness. The VIGF was based on the midpoint of the glottal region for analysis. Logistic regression was performed using the MINITAB 19 program. Results Logistic regression was composed of two stages: Stage 1 consisted of the analysis of all variables, where the maximum opening and closed quotient variables showed statistical significance (p-value <0.05) and the model was well adjusted according to the Hosmer-Lemeshow test (p-value=0.794). Stage 2 consisted of the re-analysis of the selected variables, also showing a well-adjusted model (p-value=0.198). The VIGF was defined as follows: VIGF=e^(8.1318-0.2941AbMax-0.0703FechGlo)/1+e^(8.1318-0.2941AbMax-0.0703FechGlo). Conclusion The VIGF demonstrated a cut-off value equal to 0.71. The probability of success was 81.5%, sensitivity 76.4%, and specificity 89.2%.

Videokymographic index of glottic function: an analysis of diagnostic accuracy

PURPOSE

To develop the Videokymographic Index of Glottic Function (VIGF), a composite indicator from digital videokymography parameters, captured by high-speed videolaryngoscopy exams of women with and without laryngeal alterations of behavioral etiology.

METHODS

The sample consisted of 92 women aged between 18 and 45 years. Fifty-five (55) women with behavioral dysphonia, presenting with laryngeal and voice alterations, and thirty-seven (37) women without any laryngeal and voice alterations. Voice evaluation was performed by consensus via an auditory-perceptual analysis of the sustained vowel /a/ at a habitual pitch and loudness. Voice classification was obtained by means of a general degree of dysphonia, where G0 indicated neutral voice quality and G1 to G3 indicated altered voice quality. Laryngeal images were captured via digital videokymography analysis of a sustained vowel /i/ at a habitual pitch and loudness. The VIGF was based on the midpoint of the glottal region for analysis. Logistic regression was performed using the MINITAB 19 program.

RESULTS

Logistic regression was composed of two stages: Stage 1 consisted of the analysis of all variables, where the maximum opening and closed quotient variables showed statistical significance (p-value <0.05) and the model was well adjusted according to the Hosmer-Lemeshow test (p-value=0.794). Stage 2 consisted of the re-analysis of the selected variables, also showing a well-adjusted model (p-value=0.198). The VIGF was defined as follows: VIGF=e^(8.1318-0.2941AbMax-0.0703FechGlo)/1+e^(8.1318-0.2941AbMax-0.0703FechGlo).

CONCLUSION

The VIGF demonstrated a cut-off value equal to 0.71. The probability of success was 81.5%, sensitivity 76.4%, and specificity 89.2%.

Quantitative acoustic metrics of vowel production in mandarin-speakers with post-stroke spastic dysarthria

Impairment of vowel production in dysarthria has been highly valued. This study aimed to explore the vowel production of Mandarin-speakers with post-stroke spastic dysarthria in connected speech and to explore the influence of gender and tone on the vowel production. Multiple vowel acoustic metrics, including F1 range, F2 range, vowel space area (VSA), vowel articulation index (VAI) and formant centralization ratio (FCR), were analyzed from vowel tokens embedded in connected speech produced. The participants included 25 clients with spastic dysarthria secondary to stroke (15 males, 10 females) and 25 speakers with no history of neurological disease (15 males, 10 females). Variance analyses were conducted and the results showed that the main effects of population, gender, and tone on F2 range, VSA, VAI, and FCR were all significant. Vowel production became centralized in the clients with post-stroke spastic dysarthria. Vowel production was found to be more centralized in males compared to females. Vowels in neutral tone (T0) were the most centralized among the other tones. The quantitative acoustic metrics of F2 range, VSA, VAI, and FCR were effective in predicting vowel production in Mandarin-speaking clients with post-stroke spastic dysarthria, and hence may be used as powerful tools to assess the speech performance for this population.

Pathology-Related Influences on the VEM: Three Years' Experience since Implementation of a New Parameter in Phoniatric Voice Diagnostics

The vocal extent measure (VEM) represents a new diagnostic tool to express vocal capacity by quantifying the dynamic performance and frequency range of voice range profiles (VRPs). For VEM calculation, the VRP area is multiplied by the quotient of the theoretical perimeter of a circle with equal VRP area and the actual VRP perimeter. Since different diseases affect voice function to varying degrees, pathology-related influences on the VEM should be investigated more detailed in this retrospective study, three years after VEM implementation. Data was obtained in a standardized voice assessment comprising videolaryngostroboscopy, voice handicap index (VHI-9i), and acoustic-aerodynamic analysis with automatic calculation of VEM and dysphonia severity index (DSI). The complete dataset comprised 1030 subjects, from which 994 adults (376 male, 618 female; 18-86 years) were analyzed more detailed. The VEM differed significantly between pathology subgroups (p < 0.001) and correlated with the corresponding DSI values. Regarding VHI-9i, the VEM reflected the subjective impairment better than the DSI. We conclude that the VEM proved to be a comprehensible and easy-to-use interval-scaled parameter for objective VRP evaluation in all pathology subgroups. As expected, exclusive consideration of the measured pathology-related influences on the VEM does not allow conclusions regarding the specific underlying diagnosis.

Does the Combination of Glottal and Supraglottic Acoustic Measures Improve Discrimination Between Women With and Without Voice Disorders?

AIM

To analyze the accuracy of traditional acoustic measurements (F0, perturbation, and noise) and formant measurements in discriminating between women with and without voice disorders, and with different laryngeal disorders.

STUDY DESIGN

A descriptive, cross-sectional, and retrospective.

METHOD

Two hundred and sixty women participated. All participants recorded the spoken vowel /Ɛ/ and underwent laryngeal visual examination. Acoustic measures of the mean and standard deviation of the fundamental frequency (F0), jitter, shimmer, glottal-to-noise excitation ratio, and the values of the first three formants (F1, F2, and F3) were obtained.

RESULTS

Individual acoustic measurements did not demonstrate adequate (<70%) performance when discriminating between women with and without voice disorders. The combination of the standard deviation of the F0, shimmer, glottal-to-noise excitation ratio, F1, F2, and F3 showed acceptable (>70%) performance in classifying women with and without voice disorders. Individual measures of jitter as well as F1 and F3 demonstrated acceptable (>70%) performance when distinguishing women with different laryngeal diagnoses, including without voice disorders (healthy larynges), Reinke's edema, unilateral vocal fold paralysis, and sulcus vocalis. The combination of acoustic measurements showed excellent (>80%) performance when discriminating women without voice disorder from those with Reinke's edema (mean of F0, F1, and F3) and with sulcus vocalis (mean of F0, F1, and F2).

CONCLUSIONS

Individual formant and traditional acoustic measurements do not demonstrate adequate performance when discriminating between women with and without voice disorders. However, the combination of traditional and formant measurements improves the discrimination between the presence and absence of voice disorders and differentiates several laryngeal diagnoses.